Dear Parents,

The Connections Child and Adolescent Group Program is conducting this survey to learn about children's social activities, the obstacles children encounter in engaging with their peers, and strategies parents employ to support children's friendships. We invite you to share your observations about your child's social experience. Your responses are completely anonymous. We will summarize the results and make our findings available to help children improve their level of social satisfaction.

Please answer the following questions about one specific child. If you would like to respond about another child in the family, you can sign in again and fill out an additional questionnaire. Please note that some of the wordings in the questions sound age-specific, but you should interpret them in accordance with the age of your child; for example, if you are responding about a teenager, you might replace the word "playdate" with "hanging out" as you think about your answer.

We thank you for your time and participation. If you would like to receive a summary of the results, you will have an opportunity after you exit the survey to leave an e-mail address.

* 4. Ages of other children in household (beginning with the youngest)

* 5. Does your child have any of the following diagnosed special needs/psychological challenges? (Please check all that apply.)

* 6. Which of the following best describes your child’s educational setting?

* 8. During the past year, how many new friendships (defined as regular social contact outside of the organized activity setting) has your child formed with children he/she met during the organized activities listed above?

* 10. As a parent, which of the following roles do you play in facilitating your child’s playdates? (Please check all that apply.)

* 11. Which of the following strengths does your child regularly exhibit, which help him/her have successful social activities with peers? (Please check all that apply.)

* 12. Does your child experience any of the following difficulties in having social activities with peers? (Please check all that apply.)

* 13. How many playdates has your child had during the past month (your house, another child's house, a movie, skating, etc.)?

* 14. How many playdates has your child been invited to, during the past month?

* 15. How would you describe your child's social experience during the school day? (Please check all that apply.)

* 16. How many regular social partners does your child have (not necessarily close friends, but someone your child shares social activities with on a regular basis)?

* 17. How many close friends does your child have (someone your child sees regularly and seems to have a high comfort level together)?

* 19. Which statements describe your child's social style? (You may choose more than one.)

* 20. How satisfied is your child with his/her overall social activities?

* 21. What are some of the main consequences of your child’s social activities? (Please check all that apply.)

* 22. Please describe a successful playdate activity, indicating the age range, number of children, and approximate time requirements for this activity. Also, please indicate your approval for this activity to be shared with other parents. If you have time, you may describe several activities you’ve found to be helpful in facilitating your child’s playdates.

* 23. Is it okay to share this activity with other parents?

* 24. Use this space to add any comments or additional concerns about your child’s social experience.

Thank you very much for completing this questionnaire!

James W. Caron, Ed.D.
Connections Child and Adolescent Group Program
120 School Street
Lexington, MA 02421
(781) 863-5555