( ) Overlook violence against children from husbands, families, mistresses

( ) Ignoring, ( ) Loud scolding, ( ) Scaring, ( )Swear

( ) Familiar with terrible words, ( ) Forcing, ( ) Forcibly dragged, ( ) Leave infants in the car

( ) Sometimes an infant is left alone so you could go shopping.

( ) Leave him/her alone and go to work

( ) There is repeated domestic violence from the husband in the presence of children.

( ) Sexual assault on children

6) Do you know that the above actions are acts of abuse? Please enter ◯ in any of the following items.

( ) I know, ( ) I did not know

7) I would like to ask about your first child. Please enter ◯ in Yes or No.

a) My child has a delay in child development/physical growth.

Yes, No

b) My child is a premature baby.

Yes, No

c) My child is a twin, triplet, etc.

Yes, No

( children)

d) There was a time when parents and children are separated.

Yes, No

Ask the person who answered yes.

At that time, how old was your child? ( )

How long was the parent away? ( )

e) My child has a disability.

Yes, No

Ask the person who answered Yes. What kind of disability? (Content: 　　　)

f) My child is aggressive to other children or siblings.

Yes, No

g) My child has a chronic illness (long-term illness).

Yes, No

h) My child often lies down.

Yes, No

i) My child has a regression to infantile behavior.

Yes, No

j) My child overeats.

Yes, No

k) My child has gaps in developmental expectations.

Yes, No

l) My child’s height or weight doesn’t follow the development curve of the mother-child handbook.

Yes, No

m) My child has hyperactivity (restlessness).

Yes, No

n) My child is rough and violent to his/her friends.

Yes, No

o) My child is cling on everyone.

Yes, No

p) My child is attached to my husband or the man I’m dating.

Yes, No

q) My child is crying terribly at night.

Yes, No

r) My child gets in trouble in kindergarten or preschool.

Yes, No

s) My child bullies his/her younger brothers or sisters.

Yes, No

t) My child is having trouble going to a cram school or lesson that I want him/her to attend.

Yes, No

u) My child sometimes eats alone while watching TV.

Yes, No

v) My child has close friends.

Yes, No