Parent-Child Relationship Questionnaire

myParentQuest.com

Background:

Help give parents a second chance before they need it. We all start with the best of intentions, but during the course of life, we tend to get sidetracked. At myParentQuest.com, we are in the business of recognizing problems and trying to prevent them before they happen. Our desire is for your input to have a meaningful impact on the lives of others.

This Questionnaire is designed to gather information about parent-child relationships and the factors that influence their development. Since the research is at an early stage, many of the questions are open ended (similar to an interview format). The qualitative information gathered through this process should provide direction for future research in this area.

The information you provide is anonymous (unless you want to provide contact information), and no IP addresses will be saved with the data. By completing this survey, you are giving permission for us to code and analyze your information as part of the research process. Results from this survey may be obtained at a later date from this website.


General Instructions:

Please Note: This is an extensive (long) survey. This survey may only be submitted once (there is no update capability), so make sure you have enough time to be thorough before beginning. While you don't need to complete every answer, the results will be much more meaningful if you are as thorough as possible.

REMEMBER to hit the "Submit" button at the end of the survey so your input will be received.

Again, please complete as much of this survey as you are able (especially the personal data at the end of the survey). Some questions may not be applicable to you and may be skipped or answered accordingly. Every attempt has been made to allow for every life situation. If you have any suggestions to improve this survey to allow for more complete reporting, please email them to surveyideas@myParentQuest.com .
 

Cultural Influences

1.1.  Birthplace
 
Country:
State/Province:
 
1.2.  Nationality
 
 
1.3.  Race
 
 
1.4.  Current Residence
 
Country:
State/Province:
How many years have you lived in this country?:
 
1.5.  Language
 
What was your first language?:
What other languages were spoken in the home where you were raised?:
What languages are you conversant or fluent in now?:
Do you plan to (or did you) teach your children another language?: Yes No
If so, which one?:
 
1.6.  Religion
 
As a child, did you receive religious training or attend church regularly?: Yes No
If so, do you still participate?: Actively
Occassionally
Rarely (or not at all)
Did you change or adopt your religious affiliation as you grew older?: Yes No
What aspects of your religion/spirituality do you value most today?:
What was your first religion?:
What religion or belief system do you currently follow?:
 
1.7.  Please indicate the extent to which you agree with the following statement:
 
 Agree. . . .. . . .. . . .Disagree
I hope to impart my religious beliefs and values to my children.
My religious beliefs greatly influence the rest of my values.
 
1.8.  What are your most cherished family, ethnic or national traditions?
 
 
1.9.  Please indicate the extent to which you agree with the following statements:
 
 Agree. . .. . .. . .Disagree
I believe it is important to pass along these traditions to my offspring.
I believe in assimilation as I try to fit in with my surroundings.
I celebrate the diversity in life's many cultures.
 

Your Childhood

2.1.  Please indicate the number of your siblings by gender:
 
Female:
Male:
 
2.2.  Your birth order:
 
 
2.3.  Did you have step brothers and/or sisters?
 
YesNo
 
2.4.  Were you a twin (or triplet)?
 
YesNo
 
2.5.  Were you adopted?
 
YesNo
 
2.6.  Were you a foster child?
 
YesNo
 
2.7.  What was your family's primary economic condition while you were growing up?
 
Upper classUpper-middle classMiddle classLower-middle classLower-class
 
2.8.  What were your parent's occupations?
 
Father:
Mother:
 
2.9.  Who was the most important caregiver or major parental influence in your life?
 

 
2.10.  If other, please indicate who:
 
 
2.11.  What other caregivers had a significant influence (positive or negative) on your life?
 
 Positive InfluenceNegative Influence
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Older Sibling
Foster parent
A friend's parent
Other
 
2.12.  If your parents divorced or separated when you were a minor (under age 18), how often did you visit the non-custodial parent (or the parent you lived with the least) after the divorce?
 

 
2.13.  Did you grow up in a non-traditional family?
 
YesNo
 
2.14.  If yes, please explain:
 
 
2.15.  How did your parents express their love and concern for you?
 
 
2.16.  How did your parents discipline you?
 
 
2.17.  How much value did your parents place on you receiving a good education? (please explain):
 
 
2.18.  What values did your parents try to instill in you?
 
 
2.19.  Did your parents change their parenting style or behavior as you grew older? (e.g. they became more strict, they became less involved in my life, etc.)
 
 

Childhood Memories

3.1.  What are your happiest memories of childhood?
 
 
3.2.  What are some of the more troubling aspects about your childhood?
 
 
3.3.  While you were growing up, were there any major traumatic events in your life? (Examples: parent's divorce, sibling's death, violence, war, etc.) Please indicate your age for each event.
 
 
3.4.  How was affection displayed within your family?
 
 

Your Children

4.1.  Please identify the number of children in your family.
 
 Male Female
Total number of children
Number of adopted children
Number of stepchildren
Number of foster children
 
4.2.  Please identify the gender and year of birth for each of your children (oldest first).
 
 Indicate your child's gender  Year of birth
MaleFemale
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10
 
4.3.  Do any of your children have disabilities?
 
YesNo
 
4.4.  If yes, please elaborate
 
 
4.5.  Did any of your children ever have any serious disciplinary problems? (Example: expelled from school, police records, etc.)
 
YesNo
 
4.6.  If yes, please describe
 
 
4.7.  Describe any of your children's successes (education, career, service, etc.)
 
 
4.8.  How close is your relationship with your children?
 
 Close. . . .. . . .. . . .Distant
Oldest child
Youngest child
Middle children
 
4.9.  What has given you the most satisfaction and joy in your role as a parent?
 
 
4.10.  How involved are (were) you with raising your children? (give examples)
 
 
4.11.  What are (were) the more effective means of disciplining your children?
 
 
4.12.  Who helped you the first few days with your first new baby at home?
 
 
4.13.  If your children are parents, describe their parenting style (including positive and negative aspects)
 
 
4.14.  What do you wish you would have done differently as a parent?
 
 

Values & Personal Characteristics

5.1.  What values and personal characteristics do/did you want your children to develop?
 
 
5.2.  How do/did you teach and reinforce these values and characteristics?
 
 
5.3.  What experiences did you have with your parents that helped shape who you are today?
 
 
5.4.  What influences had the most profound impact on your personality and outlook on life?
 
 
5.5.  In order of importance, what things bring you the most happiness?
 
 
5.6.  What is your attitude about marriage?
 
 

Relationships & Role of the Parent

6.1.  What are (were) the most important goals you have (had) as a parent while raising your children?
 
 
6.2.  Why have you adopted these goals as a parent?
 
 
6.3.  How do you define the role and responsibilities of a parent?
 
 
6.4.  What type of relationship did/do you have with your parents/primary caregiver...
 
 During your Childhood  During your Teen Years
Very closeLovingGenial, cordialSomewhat distantEstrangedVery closeLovingGenial, cordialSomewhat distantEstranged
Father
Mother
Other
 
6.5.  What type of relationship did/do you have with your parents/primary caregiver...
 
 During your Young Adult Years  As you were an Older Adult
Very closeLovingGenial, cordialSomewhat distantEstrangedVery closeLovingGenial, cordialSomewhat distantEstranged
Father
Mother
Other
 
6.6.  How would you describe your relationship as a child with your siblings (those with the greatest impact on your life)? Please indicate relationship (eg. older sister).
 
 Very closeLovingGenial / CordialSomewhat distantEstranged
Specify relationship
Specify relationship
Specify relationship
 
6.7.  I believe my relationships evolved as they did because...
 
 
6.8.  Please add any other information you feel is important about parenting and developing strong relationships with one's children
 
 

Personal Data

7.1.  Sex
 
MaleFemale
 
7.2.  Year of birth
 
 
7.3.  Marital status
 

 
7.4.  Number of previous marriages
 
 
7.5.  Age at first marriage
 
 
7.6.  Employment status
 

 
7.7.  Occupation
 
 
7.8.  Highest level of education attained
 

 
7.9.  Home ownership
 

 
7.10.  I have a formal retirement savings program.
 
YesNo
 
7.11.  General health condition
 
 
7.12.  I have experienced serious health problems during my life.
 
YesNo
 

Contact Information

8.1.  If you would like to be notified regarding the results of this survey or related research, please provide your contact information (this information will not be shared with any other organization).
 
Email:
Name:
Address:
City/Town:
State/Province:
Country:
Zip/Post Code:
Phone:
 

SUPPLEMENTAL INFORMATION (remember to click on the SUBMIT button at the end of the survey when you have finished)

9.1.  Would you be interested in participating in additional research related to this survey?
 
YesNo
 

Personality and Parenting Style Profile - Yourself

10.1.  Please indicate the extent to which the following words describe you and your parenting style:
 
 Extent that this word describes YOURSELF
Agree. . . .. . . .. . . .Disagree
Loving toward spouse
Loving toward your children
Enthusiastic
Sociable
Talkative
Serious
Outgoing
Cautious
Good natured
Cooperative
Trusting
Helpful
Easy going
Organized
Careful
Self-disciplined
Responsible
Poised
Calm
Composed
Healthy
Imaginative
Interesting
Formal
Simple
Diverse interests
Peacemaker
Kind
Thoughtful
Strict
Merciful
Open minded
Devoted
Attentive
 

Personality and Parenting Style Profile - Your Mother

11.1.  Please indicate the extent to which the following words describe your mother and her parenting style:
 
 Extent that this word describes YOUR MOTHER
Agree. . . .. . . .. . . .Disagree
Loving toward spouse
Loving toward your children
Enthusiastic
Sociable
Talkative
Serious
Outgoing
Cautious
Good natured
Cooperative
Trusting
Helpful
Easy going
Organized
Careful
Self-disciplined
Responsible
Poised
Calm
Composed
Healthy
Imaginative
Interesting
Formal
Simple
Diverse interests
Peacemaker
Kind
Thoughtful
Strict
Merciful
Open minded
Devoted
Attentive
 

Personality and Parenting Style Profile - Your Father

12.1.  Please indicate the extent to which the following words describe your father and his parenting style:
 
 Extent that this word describes YOUR FATHER
Agree. . . .. . . .. . . .Disagree
Loving toward spouse
Loving toward your children
Enthusiastic
Sociable
Talkative
Serious
Outgoing
Cautious
Good natured
Cooperative
Trusting
Helpful
Easy going
Organized
Careful
Self-disciplined
Responsible
Poised
Calm
Composed
Healthy
Imaginative
Interesting
Formal
Simple
Diverse interests
Peacemaker
Kind
Thoughtful
Strict
Merciful
Open minded
Devoted
Attentive
 

Personality and Parenting Style Profile - Your Spouse

13.1.  Please indicate the extent to which the following words describe your spouse and his/her parenting style:
 
 Extent that this word describes YOUR SPOUSE
Agree. . . .. . . .. . . .Disagree
Loving toward spouse
Loving toward your children
Enthusiastic
Sociable
Talkative
Serious
Outgoing
Cautious
Good natured
Cooperative
Trusting
Helpful
Easy going
Organized
Careful
Self-disciplined
Responsible
Poised
Calm
Composed
Healthy
Imaginative
Interesting
Formal
Simple
Diverse interests
Peacemaker
Kind
Thoughtful
Strict
Merciful
Open minded
Devoted
Attentive
 

Personal Data About Your Spouse

14.1.  Sex
 
MaleFemale
 
14.2.  Year of birth
 
 
14.3.  Marital status
 

 
14.4.  Number of previous marriages
 
 
14.5.  Age at first marriage
 
 
14.6.  Employment status
 

 
14.7.  Occupation
 
 
14.8.  Highest level of education attained
 

 
14.9.  General health condition
 
 
14.10.  My spouse has experienced serious health problems during his/her life.
 
YesNo
 
14.11.  Birthplace
 
Country:
State/Province:
 
14.12.  Nationality (if different)
 
 
14.13.  Race
 
 
14.14.  Current Residence
 
Country:
State/Province:
How many years living in this country?:
 
14.15.  Language
 
What was his/her first language?:
What other languages were spoken in the home where he/she was raised?:
What languages is he/she conversant or fluent in now?:
Did he/she teach your children another language?: Yes No
If so, which one?:
 
14.16.  Religion
 
As a child, did he/she receive religious training or attend church regularly?: Yes No
If so, does he/she still participate?: Actively
Occassionally
Rarely (or not at all)
Did he/she change or adopt their current religious affiliation as he/she grew older?: Yes No
What was his/her first religion?:
What religion or belief system does he/she currently follow?:
 
14.17.  Please indicate the extent to which you agree with the following statement:
 
 Agree. . .. . .. . .Disagree
My spouse seeks to impart his/her religious beliefs and values to our children.
My spouse's religious beliefs greatly influence the rest of his/her values.
 
14.18.  What are some of your spouse's most important family, ethnic or national traditions?
 
 
14.19.  Please indicate the extent to which you believe with the following statements describe your spouse:
 
 Agree. . .. . .. . .Disagree
My spouse believes it is important to pass along his/her traditions to our offspring.
My spouse enjoys the diversity in this world's many cultures.
 
14.20.  Please indicate the number of your spouse's siblings by gender:
 
Female:
Male:
 
14.21.  Your spouse's birth order:
 
 
14.22.  Was your spouse a twin? adopted? a foster child?
 
 
14.23.  What was your spouse's family's primary economic condition while he/she was growing up?
 
Upper classUpper-middle classMiddle classLower-middle classLower-class
 
14.24.  What were your spouse's parent's occupations?
 
Father:
Mother:
 
14.25.  Did your spouse grow up in a non-traditional family?
 
YesNo
 
14.26.  If yes, please explain:
 
 
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