Please answer the 10 questions below by selecting either “No” or “Yes”. The questions are in English and designed for adults ages 18 and older. Questions 1-3 refer to emotional, physical and sexual abuse. Questions 4 and 5 assess emotional and physical neglect, and questions 6-10 refer to household dysfunction.
These questions may cause distress for some individuals and ask directly about experiences of child abuse. Check that you have a support person or helpline number available before starting this questionaire.