| Almost never | Once in a while | Sometimes | Frequently | Almost always |
| 1 | 2 | 3 | 4 | 5 |
| Describe your family now (original family) | ||||
| 1) Family members ask each other for help | ||||
| 2) In solving problem, the children’s suggestion are followed | ||||
| 3) We approve of each other’s friends | ||||
| 4) Children have a say in their decision | ||||
| 5) We like to do things with just our immediate family | ||||
| 6) Different persons act as leaders in our family | ||||
| 7) Family members feel closer to others family members than to people outside the family | ||||
| 8) Our family changes its way of handling tasks | ||||
| 9) Family members like to spend free time with each other | ||||
| 10) Parent(s) and children discuss punishment together | ||||
| 11) Family members feel very close to each other | ||||
| 12) The children make the decisions in our family | ||||
| 13) When our family gets together for activities, everybody is present | ||||
| 14) Rules change in our family | ||||
| 15) We can easily think of things to do together as a family | ||||
| 16) We shift household responsibilities from person to person | ||||
| 17) Family members consult other family members on their decision | ||||
| 18) It is hard to identify the leader(s) in our family | ||||
| 19) Family togetherness is very important | ||||
| 20) It is hard to tell who does which household chores | ||||