Laserfiche WebLink
J13. When you were a child, did any parent or caretaker treat you in a way that made you feel <br /> bad about yourself(insulted, verbally abused,or demeaned)? <br /> a. No <br /> b. Yes <br /> J14. When you look back on your childhood, do you feel that you were abused (physically, <br /> sexually, or emotionally)or neglected? <br /> a. No <br /> b. Yes <br /> J15. When you were in grammar school or high school,were you ever held back(made to <br /> repeat a grade)? <br /> a. No <br /> b. Yes <br /> J16. Did you graduate from high school? (Do NOT COUNT GED DEGREE,OR HIGH SCHOOL <br /> EQUIVALENCY.) <br /> a. Yes, I did graduate from high school <br /> b. No, I did not graduate from high school <br /> • J17. Were you ever suspended or expelled from high school for any reason(disciplinary or <br /> academic)? <br /> a. No <br /> b. Yes, 1 time <br /> c. Yes,2 times <br /> • <br /> d. Yes, 3 or more times <br /> J18. As a child,were you ever told you had dyslexia? <br /> a. No <br /> b. Yes <br /> J19. As a child,were you ever treated for dyslexia? <br /> a. No <br /> b. .Yes <br /> J20. As a child,were you ever treated for learning disabilities or Attention Deficit Disorder <br /> (ADD)? <br /> a. No <br /> b. Yes <br /> J21. As a child,were you ever treated with medication (e.g. Ritalin)for hyperactivity or other <br /> behavior control problems? <br /> a. No <br /> • <br /> b. Yes <br /> J22. During childhood or adolescence did you experience any traumatic events or injuries?That <br /> is, did anything happen to you that left you with recurring thoughts of the event, "flashbacks" <br /> to the event, unusual fears, terror dreams, or distortions of time during the event? <br /> a. No, I did not experience any traumatic events during childhood or adolescence <br /> b. Yes <br /> PSS/LEPS PLLC 91 <br />