Responses for each item take the form of 1=always false‚ 2=mostly false‚ 3=partly false and partly true‚ 4=mostly true‚ and 5= always true.
1. I like the way I look.
2. I have a happy family.
3. I don't sleep well.
4. It's hard for me to do what's right.
5. I know as much as the other children in my class.
6. I'm happy with who I am.
7. I don't feel well as I should.
8. It's hard for me to be around other people.
9. I don't do well in school‚ even I try.
10. I really care about my family.
11. I'm as nice as I should be .
12. I don't feel happy when I'm smart.
13. It's hard for someone to be my friend.
14. My family doesn't trust me.
15. My teacher thinks I am smart.
16. I get along well with other people.
17. I hate myself.
18. I'm not the person I would like to be.
19. H am an honest person.
20. I feel good most of time.
21. My body is healthy.
22. I am a decent sort of person.
23. I'm a cheerful person.
24. I'm not important at all.
25. My family will always help me.
26. I am a friend person.
27. Boys like me.
28. I don't always tell the truth.
29. I get angry sometimes.
30. I have lots of aches and paints.
31. I am a sick person.
32. Math is hard.
33. I have a lot of self-control.
34. I'm not a nice person.
35. I am not loved by my family.
36. Girls like me.
37. I'm mad at the whole world.
38. Once in a while I think of things too bad to talk about.
39. Sometimes when I am not feeling well‚ I get cranky.
40. I don't want to change the way I look.
41. I'd like to change some part of my body.
42. I think I do the right things most of the time.
43. I understand what I read.
44. I wish I could be more trustworthy.
45. I know my family as well as I should.
46. I'm as friendly as I want to be.
47. I do not like everyone I know.
48. Sometimes I laugh at a dirty joke.
49. I shouldn't tell so many lies.
50. I'm as smart as I want to be.
51. I should love my family more.
52. I'm not as smart as the other children in my class.
53. It's easy for me to do a good job on my homework.
54. I am a bad person.
55. I should get along better with other people.
56. Sometimes h feel like swearing.
57. I take good care of my body.
58. I often clumsy.
59. I some times do very bad things.
60. I do things without thinking about them first.
61. I try to be fair with my friends and family.
62. I do what my parents want me to do‚ even when I don't agree with them.
63. I don't forgive other people easily.
64. I'm not good at sports and games.
65. I sometimes cheat.
66. I solve my problems very easily.
67. I fight with my family.
68. I don't act the way my family think I shoud.
69. Most people are good.
70. I find it hard to talk with people I don't know.
71. Sometimes I put off until tomorrow what I ought to do to day.
72. I know the answers to questions the teacher asks.
73. I do what's right most of times.
74. I'm happy with the way I treat other people.
75. I'll never be as smart as other people.
76. I like to do math.
W.H.Fitts‚ ph.D. and W.L.warren‚ ph.D.
Kramschuster. Jenny. Lynn : A Research Paper‚ Submitted in Partial Fulfillment of the Requirements for the master of Science Degree With a Major in Guidance and Counseling The Graduate College . University of Wisconsin-Stout. August‚ 2001