ELECTRONIC USAGE SURVEY ...ENTER A DRAWING FOR A CHANCE TO WIN A FREE BOOK

THIS SURVEY IS ABOUT USAGE OF ELECTONICS AND GAMING. RESULTS MAY BE USED BY DR. BERK IN HIS PRESENTIONS, BOOKS, OR ARTICLES, BUT NO PERSONAL IDENTIFYING DATA WILL BE DISCLOSED. BY PROVIDING ANSWERS YOU AGREE TO THESE TERMS. YOU WILL ALSO ENTERED IN A DRAWING FOR AN OPPORTUNITY TO WIN A FREE BOOK FROM DR. BERK ENTITLED "A PARENTS QUICK GUIDE TO ELECTRONIC ADDICTION".

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* 1. HOW OLD IS THE CHILD/ADOLESCENT/ADULT I AM ASWERING THESE QUESTIONS ABOUT

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* 2. HOW LONG DOES YOUR SON/DAUGHTER (OR YOU IF ADULT) SPEND ON ELECTRONIC DEVICES PER WEEK (NOT INCLUDING SCHOOL OR WORK PURPOSES)

5-10 HOURS

11-15 HOURS

16-20 HOURS

21-25 HOURS

26-30 HOURS

MORE THAN 30 HOURS

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* 3. CHECK ALL MEDIA THAT THEY USE ON A REGULAR BASIS

FACEBOOK

YOUTUBE

GAMING CONSOLE

INSTAGRAM

SNAPCHAT

CHATROOMS

WEBSITES

PHONE (NOT INCLUDING PHONE CALLS

VIDEO GAMES IN GENERAL

DISCORD

SWITCH

Other (please specify)

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* 4. AGE THE INDIVIDUAL STARTED USING THESE ELECTRONICS

UDDER 10

10-13

14-17

18-25

26-35

35- 50

OVER 50

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* 5. IF A "gamer" what age did they (you) begin playing video games

under 5

6-10

11-13

14-17

is an adult

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* 6. THE BIGGEST ISSUES: (CHECK ALL THAT APPLY)

RAGE WHEN ASKED TO STOP

LOSS OF OTHER ACTIVITIES

LOSS OF FACE TO FACE FRIENDS

INAPPROPRIATE CONTENT

INAPPROPRIATE CONTACT WITH OTHERS

BEEN BULLIED

USED WHEN ASKED NOT TO

STOLE MONEY OR USED CREDIT CARD WITHOUT PERMISSION

USE AT NIGHT AND SLEEP ISSUES

SCHOOL GRADE ISSUES

ANGER ISSUES

DISTRACTED WHILE DOING SCHOOLWORK

SNEAKING USAGE

THEY SAY "ALL THE OTHER KID'S PARENTS LET THEM PLAY THAT GAME"

THEY ARE PLAYING GAMES I DON'T WANT THEM PLAYING AT OHTERS HOUSES

Other issue(s) that are a problem (please specify)

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* 7. IF A GAMER WHAT GAMES ARE THE TOP 3 PLAYED

GRAND THEFT AUTO

RED DEAD REDEMTION

MADDEN

MINDCRAFT

ROADBLOX

FORTNITE

POKEMON

OVERWATCH

LEAGUE OF LEGENDS

CALL OF DUTY

COUNTER-STRIKE

LEGEND OF ZELDA

SUPER SMASH BROS

FIFA

ASSASSIN'S CREED

STAR WARS BATTLEFRONT

DESTINY 2

WORLD OF WARCRAFT

Other game (please specify)

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* 8. WHEN RATING THE INDIVIDUAL, I FEEL THEY HAVE A ISSUE WITH ELECTRONIIC USEAGE

Yes

UNSURE

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* 9. AS A PARENT, I HAVE EXPERIENCED THE FOLLOWING (CHECK ALL THAT APPLY)

CHILD SAYS "ALL THE OTHER KIDS HAVE THIS GAME"

IF YOU ARE THE PARENT, THE CHILD IS BETTER AT TECHNOLOGY THEN YOU

CANNOT GET THEM TO DO ACTIVITIES

GRADES DROPPED

SNEAKS AT NIGHT

I DON'T HVE THEI PHONE CODE;;

I DON'T KNOW HOW TO CHECK THEIR HISTORY

I AM NOT SURE HOW TO LIMIT THIER USE

MY SIGNIFICANT OTHER AND I DISAGREE ABOUT THE RULES

THEY TURNED OFF LOCATION SERVICES

BOUGHT SOMETHING WITH MY CREDIT CARD WITHOUT PERMISSION

RAGE

DESTRUCTION OF PROPERTY

OTHER ISSUES (please specify) OR QUESTIONS FOR DR. BERK

ELECTRONIC USAGE SURVEY ...ENTER A DRAWING FOR A CHANCE TO WIN A FREE BOOK

Question Title

* 1. HOW OLD IS THE CHILD/ADOLESCENT/ADULT I AM ASWERING THESE QUESTIONS ABOUT

Question Title

* 2. HOW LONG DOES YOUR SON/DAUGHTER (OR YOU IF ADULT) SPEND ON ELECTRONIC DEVICES PER WEEK (NOT INCLUDING SCHOOL OR WORK PURPOSES)

Question Title

* 3. CHECK ALL MEDIA THAT THEY USE ON A REGULAR BASIS

Question Title

* 4. AGE THE INDIVIDUAL STARTED USING THESE ELECTRONICS

Question Title

* 5. IF A "gamer" what age did they (you) begin playing video games

Question Title

* 6. THE BIGGEST ISSUES: (CHECK ALL THAT APPLY)

Question Title

* 7. IF A GAMER WHAT GAMES ARE THE TOP 3 PLAYED

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* 8. WHEN RATING THE INDIVIDUAL, I FEEL THEY HAVE A ISSUE WITH ELECTRONIIC USEAGE

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* 9. AS A PARENT, I HAVE EXPERIENCED THE FOLLOWING (CHECK ALL THAT APPLY)

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* 10. EMAIL ADDRESS ...IF YOU WISH TO BE IN DRAWING FOR FREE BOOK