1. How would your caregiver describe you as a child?
Happy
A bit distant
Anxious
Depressed or Passive
2. As a child, how did you react when you were separated from your caregiver and left with other adults and children?
I was upset at first but soon started playing with the other kids.
I was upset at first but found a way to soothe myself without needing to be calmed by the caregiver.
I was very upset and angry at my caregiver for leaving.
I was afraid, but other adults who were around helped me.
3. As a child, how did you respond to adults you had just met?
I was more social if my caregiver was present.
I was more comfortable with them, whether my caregiver was there or not.
I was nervous around adults i had just met, even if my caregiver was there.
I was more comfortable around adults i had just met than my caregiver.
4. In early childhood, how likely were you to explore a room with your caregiver present?
I was curious and explored a lot.
I explored just as much whether they were present or not.
I was able to explore but was still timid.
I didn't explore at all.
5. Thinking back as far as you can, how would you describe your relationship with your caregiver?
I felt understood, comfortable, valued, and loved.
I didn't feel close to my caregiver.
We were close sometimes, but other times my caregiver felt distant.
My caregiver and I weren't very connected, or my caregiver was abusive.
6. How did your caregiver react when you were upset as a child?
My caregiver was patient and understanding.
My caregiver wasn't interested, so i had to soothe myself.
My caregiver was overly involved in soothing my stress but sometimes wasn't available.
My caregiver reacted in a manner that sometimes scared me.
7. As a child, how did you perceive your caregiver’s feelings for you?
I was confident that they loved and supported me no matter what.
My needs weren't met by my caregiver.
My caregiver loved me most when i excelled at a task.
To avoid disappointment or conflict, I didn't rely on confirmation of love from my caregiver
8. As a child, how did you communicate your needs to your caregiver?
I was always able to ask for reassurance or validation.
I didn't look for reassurance but instead looked for validation on my own.
When i needed reassurance from my caregiver, I'd sometimes fuss, cry, and have a breakdown to get it.
I had trouble soothing myself but was uncomfortable asking for reassurance from my caregiver.
9. How was your behavior in the classroom when you were a child?
I was confident and outspoken.
I tended not to engage in classroom discussions.
I was always afraid I'd give the wrong answer, so I was mostly quiet.
Sometimes I participated and other times I was disruptive.
10. What was your experience making friends when you were a child?
I had no problem making new friends.
I didn't look for new friends, nor did I feel the need to.
I really wanted to make friends, but I worried all the time whether they liked me.
I liked making new friends but wasn't great at it. We'd often have conflicts.
11. How do you react when you enter a new relationship or friendship?
It's easy for me to get to know a person.
It takes a long time to open up to a new person.
I immediately focus on that person's happiness to validate my own.
I tend to find myself in intimate but volatile relationships
12. How confident do you feel in romantic and friendship relationships?
I'm confident that others love me.
I know others love me. but I don't think much of it because I don't need anyone else.
I love deeply but question whether I'm worthy of love.
I can't depend on others to love me, so to avoid getting hurt, I'd rather not rely on them.
13. How do you feel about closeness and intimacy in relationships?
I'm comfortable and encourage closeness and intimacy.
I avoid closeness. Some may say that I put up walls.
I want to be close but often question whether my partner feels the same. I need reassurance often.
I haven't been able to be very close to others. I'm either too clingy or too angry.
14. How often do you rely on your partner or friends for assistance in everyday situations?
I'm comfortable asking for assistance from those closest to me.
I don't ask for assistance because I usually can't count on others to help me.
Asking for assistance makes me feel uncomfortable, I'd rather be the one helping others.
I don't ask for assistance because people don;t help me.
15. How do you and your partner or friends deal with conflict?
I'm able to resolve conflicts.
In the event of a conflict, I pause communication until they can figure it out.
If conflicts aren't resolved immediately, I can't function.
When a conflict arises, I'm likely to end the relationship rather than address it.