Demographic Information Form
Demographic Information Form
4. I am able to do things
as well as most A B C D
Other
people.
Instructions: For each of the following statements circle the number of the 5-point scale (1-
strongly disagree, 5- strongly agree) that best describes how that statements applies to you
and your mother. Try to read and think about each statement as it as it applies to you and
your mother during your years of growing up at home .There are no right or wrong
answers ,so don’t spend a lot of time on any one item. We are looking for your overall
impression regarding each statement .Be sure not to omit any items.
1=strongly disagree
2=Disagree
4=Agree
5=Strongly Agree
1. While I was growing up, my mother felt that in a well-run home the children should have
their way in the family as often as the parents do.
2. Even if her children didn’t agree with her, my mother felt that it was for our own good if
we were force to confirm to what it was she thought was right.
4. As I was growing up, once family policy had been established, my mother discussed the
reasoning behind the policy with the children in the family.
5. My mother has always encouraged verbal give-and- takes whenever I have felt that
family rules and restrictions are unreasonable.
7. As I was growing up my mother did not allow me to question any decision she had
made.
8. As I was growing up my mother directed the activities and decisions of the children in
the family through reasoning and discipline.
9. My mother has always felt that more force should be used by parents in order to get their
children to behave the way they are supposed to.
10. As I was growing up my mother did not feel that I needed to obey rules and regulations
of behavior simply because someone in authority had established them.
11. My mother felt that wise parents should teach their children early just who is boss in the
family.
12. As I was growing up, my mother seldom gave me expectations and guidelines for my
behavior.
13. Most of the time as I was growing up, my mother did what the children are the family
wanted when making family decisions.
14. As I was growing up my mother would get very upset if I tried to disagree with her.
15. My mother feels that most problems in society would be solved if parents would not
restrict their children’s activities, decisions, and desires as they are growing up.
1. SDA 2.DA 3.NANDA 4.Ag 5.SA
16. As I was growing up my mother would get very upset if I tried to disagree with her.
17. As I was growing up, my mother allowed me to decide most things for myself without
18. My Mother did not view herself as responsible for directing and guiding my behavior
19. As I was growing up my mother allowed me to form my own point of view on family
matter and she generally allowed me to decide for myself what I was going to do.
20. My mother has always felt that most problems in society would be solved if we could get
parents to strictly and forcibly deal with their children when they don’t do what they are
21. As I was growing up my mother often told me exactly what she wanted me to do and
22. As I was growing up, my mother did not direct the behaviors, activities, and desires of
23. As I growing up I knew what my mother expected of me in the family and she insisted
that I have conformed to those expectations simply out of respect for her authority.