WEISS Functional Impairment (WFIRS)

1.Having problems with brothers & sisters *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

2.Causing problems between parents *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

3.Takes time away from family members’ work or activities *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

4.Causing fighting in the family *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

5.Isolating the family from friends and social activities *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

6.Makes it hard for the family to have fun together *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

7.Makes parenting difficult *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

8.Makes it hard to give fair attention to all family members *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

9.Provokes others to hit or scream at him/her *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

10.Costs the family more money *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

11.Makes it difficult to keep up with schoolwork *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

12.Needs extra help at school *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

13.Needs tutoring *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

14.Receives grades that are not as good as his/her ability *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

15.Causes problems for the teacher in the classroom *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

16.Receives ”time-out” or removal from the classroom *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

17.Having problems in the school yard *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

18.Receives detentions (during or after school) *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

19.Suspended or expelled from school *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

20.Misses classes or is late for school *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

21.Excessive use of TV, computer, or video games *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

22.Keeping clean, brushing teeth, brushing hair, bathing, etc. *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

23.Problems getting ready for school *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

24.Problems getting ready for bed *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

25.Problems with eating (picky eater, junk food) *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

26.Problems with sleeping *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

27.Gets hurt or injured *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

28.Avoids exercise *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

29.Needs more medical care *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

30.Has trouble taking medication, getting needles *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

31.My child feels bad about himself/herself *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

32.My child does not have enough fun *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

33.My child is not happy with his/her life *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

34.Being teased or bullied by other children *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

35.Teases or bullies other children *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

36.Problems getting along with other children *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

37.Problems participating in after-school activities (sports, music, clubs) *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

38.Problems making new friends *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

39.Problems keeping friends *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

40.Difficulty with parties (not invited, avoids them, misbehaves) *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

41.Easily led by other children (peer pressure) *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

42.Breaking or damaging things *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

43.Doing things that are illegal *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

44.Being involved with the police *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

45.Smoking cigarettes *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

46.Taking illegal drugs *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

47.Doing dangerous things *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

48.Causes injury to others *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

49.Says mean or inappropriate things *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A

50.Sexually inappropriate behaviour *

Never or Not at All

Sometimes or Somewhat

Very Often or Very Much

Often or Much

N/A