My Struggling Kids
We invite you to complete this quick assessment to help us better understand how your child experiences daily life. Each question is scaled 1-10. Part of our care process is sending parents a weekly version of this assessment as a regular check-in to evaluate progress within the program.
Child's Full Name
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First Name
Last Name
Parent's Full Name
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First Name
Last Name
Phone Number
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Format: (000) 000-0000.
Email Address
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How does your child typically handle emotional challenges and frustration?
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No regulation - Constant escalation; completely unable to recover from any upset without major intervention (1-2)
Needs full support - Cannot recover from upsets without significant support; escalates quickly when challenged (3-4)
Needs some support - Needs moderate support to regulate; some recovery possible with help (5-6)
Mostly regulated - Manages most challenges with light support; generally settles; occasional difficulty (7-8)
Fully regulated - Handles frustrations calmly; recovers quickly with minimal or no support (9-10)
How many significant meltdowns or shutdowns does your child tend to experience in a week?
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6+ daily - Multiple episodes every day; unpredictable; extremely hard to de-escalate (1-2)
6+ weekly - Frequent significant episodes throughout the week; little predictability; hard to de-escalate (3-4)
3-5 weekly - Several episodes; some predictability; able to de-escalate eventually (5-6)
1-2 weekly - Rare episodes; short duration; easy to redirect (7-8)
Zero - No significant meltdowns or shutdowns (9-10)
How much does your child get stuck on fears, worries, or rigid refusals—refusing to leave the house, go to school, or try anything new?
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Full lockdown - Refuses to leave the house or engage with anything outside; completely stuck in refusal mode (1-2)
Leaves but frozen - Can leave the house but in paralysis once there; physically present, emotionally locked (3-4)
Limited participation - Participates minimally; avoidant in most situations; occasional moments of engagement (5-6)
Some participation - Participates in familiar activities; cautious in new situations (7-8)
Open and flexible - High comfort in multiple environments; initiates new things; bad days are the exception (9-10)
How well is your child able to tune into what is happening around them—listening, following conversations, and staying present in the room?
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Fully in own world - Does not register what people are doing or saying; cannot process external input at all; entirely in their own reality (1-2)
Mostly unreachable - Rare and very brief moments of external connection; cannot sustain attention outside themselves (3-4)
Sporadic connection - Can connect to what's happening around them briefly and inconsistently; drifts back to own world regularly (5-6)
Tracking but tires - Able to follow conversations and stay on task, but fades out relatively quickly; not consistent (7-8)
Engaged and tracking - Engaged with the external world consistently; tracks conversations for long stretches; genuinely present (9-10)
How does your child tend to engage in communication and social connection?
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No communication - No eye contact; no spontaneous communication of any kind; socially completely absent (1-2)
Minimal and prompted - Minimal eye contact; responds only when directly prompted; no spontaneous initiation (3-4)
Limited but present - Some prompted responses; occasional brief spontaneous moments; inconsistent connection (5-6)
Socially present - Responds well to others; occasional spontaneous initiation; socially present most of the time (7-8)
Connected - Initiates interaction independently; responds well; genuinely present and engaged (9-10)
As an ongoing weekly assessment, we average responses to all five questions—with higher scores indicating better outcomes—and aim for a steady trajectory toward 8+ by session 40.
Submit Assessment
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