Gender: _____________

1. Direction: To assess the level of addiction, answer the following questions by checking ( / ) the
box provided corresponding to any number written above each item using the scale:

0 = Not Applicable
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Often
5 = Always

Question 5 4 3 2 1 0

1. How often do you find your child stay online longer than
he/she intended to do?
2. How often do you find your child neglect household
chores to spend more time online?
3. How often do your child prefer the excitement of the
internet to any of those close friendships he/she have?
(Or intimacy with his/her parents)
4. How often do your child form new relationships with
fellow users online?
5. How often do others complain to the amount of time
your child spend online?
6. How often do your child’s grade/schoolwork suffer
because of the amount your child spend online?
7. How often do your child check his/her email before
something else that he/she need to do?
8. How often does your child’s job performance/productivity
suffer because of the internet?
9. How often do your child become defensive or secretive
when you ask about what he/she do online?
10. How often do your child block out disturbing thoughts
about his/her life with soothing thoughts of internet?
11. How often do you find your child anticipating when will
he/she go online?
12. How often do your child fear that life without internet
would be boring, empty, and joyless?
13. How often do your child snap, yell, or act annoyed if
someone bothers him/her while online?
14. How often do your child lose sleep due to late night log
ins?
15. How often do your child feel pre occupied with the
internet when offline or fantasize about being online?
16. How often do you find your child saying “Just a few more
minutes” when online?
17. How often do you find your child try ti cut down the
amount of time he/she spend online and fail?
18. How often do your child try to hide how long he/she have
been online?
19. How often do your child choose to spend more time
online over going out with others?
20. How often do your child feel depressed, moody, or
nervous when he/she is offline which goes away once
he/she is back online?