SURVEY QUESTIONNAIRE

These are questions that aim to pinpoint to analyze the level of interaction
between parents and child; rate the following parental behaviors as 4 is the highest and
1 is the lowest.

Respondent Details
Name of the Parent/Guardian:
Age of the Child:

Directions: Please answer these following questions, put a check (√) for your
corresponding answer.

SUB-DOMAIN: EMOTIONAL (EMOTIONAL EXPRESSION)

1 2 3 4

1. Are you generally in good spirits and encouraging when

interacting with the child?
2. Do you smile often at the child?

3. Do you hug the child, pat the child on the back or hold the child’s
hand?

4. Do you comfort the child?

5. Do your repeat the child’s words, comment on what the child says
or tries to say and answer the child’s questions?

6.Do you encourage the child to talk or communicate by asking

questions that the child can answer easily, such as “yes” or “no”
questions, or asking about a family member or toy?

7. Do you talk in other ways, such as praising or encouraging;

teaching by having the child repeat phrases or naming shapes;
singing songs; and telling stories?
Standards 1.1: The child expresses different basic emotions.
Based on your experience, are these indicators generally observed on and/or
performed by a child on the specified age?

Months Description Data Presented

Cries in different ways to

express different needs
(e.g., hungry, sleepy, wet)
Shows excitement or
pleasure by moving arms,.
Kicking, moving the entire
body and the face lighting
up.
Smiles or laughs in
response to a pleasant
0-6 experience (e.g., caregiver
sing to him/her)
Amuses self by simple
repetitive muscle
movements without objects
(e.g., rolling back and forth)
Amuses self by simple
repetitive muscle
movements with objects
(e.g., shaking, rattle)

Likes playing with water.

Enjoys going to the park.

Shows fear and hesitation

towards unfamiliar persons.
A. Emotional Expression

Months Description Data Presented

Has a favorite toy.
7-12
Smiles/ laughs when happy
or amused.
Cries when sad, angry or
13-18 scared.
 Shows varying degrees or
intensities of various
emotions.

Standards 1.2: The child demonstrates ability to self-regulate feelings/emotions

and follows schedules as well as rules and regulations.

Months Description Data Presented

Stops crying almost
0-6 immediately when need is
met.
Eventually gets used to an
irritating experience.(e.g.,
honking horn) and calms
down.
Able to stop an undesirable
behaviour or activity when
instructed to do so (e.g.,
13-18 going out to street)
Can calm down or stop
tantruming with from adults.
Can follow simple rules.

Can wait his/her turn

Shows ability to contain

his/her expression of anger
19-24 or frustration when source
is removed.

Shows ability to contain

one’s expression of anger
or frustration in a public
place when asked by
parent/ caregiver.
Tries to control his tears
when in pain or scared.
 Standards 1.3: The child comprehends and displays self-appraisal emotions
(shame, pride, and guilt)

Months Description Data Presented

Smiles or claps his hands
7-12 when he/she displays a
learned behaviour (e.g.,
close-open)
Recognizes and is able to
label self appraisal
13-18 emotions such as shame,
pride, guilt, envy, jealousy.

Will do something that gets

him/her praised (e.g., doing
a task properly, singing,
etc.)

Shows interest in doing

things that are his/her own
19-24 creation.

Says “sorry” when he/she

has made a mistake or has
hurt someone.

SUB-DOMAIN: EMOTIONAL (RECEPTIVITY TO OTHER’S EMOTIONS)

Standards 1: The child is receptive to the different emotions of other people and
shows empathy.
Based on your experience, are these indicators generally observed on and/or
performed by a child on the specified age?

Months Description Data Presented

 Can mimic people’s facial
7-12 expression.

Demonstrates
appropriate/acceptable
13-18 responses to other people’s
emotions )e.g., does not
laugh at someone who is
crying)

Identifies feelings in others.

19-24
Shoes respect for rights
and properties of
others )e.g., asks
permission, does not
deliberately destroy other
things)

B. RECEPTIVITY TO OTHER’S EMOTIONS

SUB-DOMAIN: SOCIAL (EMERGING SENSE OF SELF)

Standards 1: The child expresses knowledge of self and basic roles of people in
his/her immediate environment.
Based on your experience, are these indicators generally observed on and/or
performed by a child on the specified age?

Months Description Data Presented

Explores own body (e.g,

observes hands and toes),
often smiles and vocalizes.
0-6 months
Looks at self in the mirror

Respond ton own name by

turning to look or reaching
 to be picked up when
called.
Identifies self in the mirror
7-12 months or photograph via patting
or pointing to his/her
image.
Identifies what part of
his/her body part hurts by
pointing to this.

Refers to self by first or

13-18 months nickname

Calls family member by

their name/role (mama,
papa, ate, kuya)

Asks for what she needs

without hesitation

Expresses dislike or
disagreement (e.g,. no,
ayaw)
Identifies self by first and
last name
19-24 months
Identifies what part of
his/her body hurts by
naming this.

SUB- DOMAIN: SOCIAL (FORMING ATTACHMENTS)

Standards 1: The child forms healthy attachments to primary caregivers and
other significant adults and children in his/her life.
Based on your experience, are these indicators generally observed on and/or performed
by a child on the specified age?

Months Description Data Gathered

Looks for caregivers during

times of distress or
 0-6 months discomfort.

Shows distress (e.g.,

inability to eat or sleep,
crying) if primary caregiver
is absent.
Is affectionate toward
primary caregivers and
other family members

Goes to primary caregivers

for help

13- 18 months Is comfortable in the

company of strangers if
primary caregiver is
present

May play alone but likes to

be near families, adults or
siblings

Hugs or cuddles toys

Enjoys playing regularly

with significant adults and
children
Eventually moves away
from primary caregiver
19-24 months when playing with
unfamiliar children or
adults ,but may look
occasionally in his/her
direction
SUB-DOMAIN: SOCIAL (INTERACTING WITH OTHER CHILDREN)
Standards 1: The child plays and positive interactions with other children. Based on
your experience, are these indicators generally observed on and/or by the child of the
specifies age?

Months Description Data Presented

 Plays with toys by himself
(e.g., mouths, examines,
swipe toys)

Smiles in response to the

0-6 months facial expressions of other
children

Looks at other children

with interests; watches
them play

Displays amusement
interacting with other
children (e.g., cooing,
flailing arms and legs)
Engages in play alongside
but not necessarily with
7-12 months other children (i.e., parallel
play)

Plays with other children

(i.e., interactive play)

Plays cooperatively with

other children

May hug/kiss or hold

hands with other children
13-18 months
Shows or shares food,
books and toys with other
children

Asks to play with other

children or invites him to
play with her/him
Talks to other children, ask
them questions
19-24 months Shows preferences for
some children and
interacts more with them

SUB DOMAIN: SOCIAL (INTERACTION WITH ADULTS)

Standards 1: The child has positive relations and interactions with adults.
Based on your experience, are these indicators generally observed on and/or performed
by a child on the specified age?
Months Description Data Presented

0-6 months Will look at adult’s faces

and make eye-to-eye
contact

Listens to verbalizations
by adult

Coos or smiles when

talked to by a familiar
adult

Plays peek-a-boo
interactively with others
7-12 months Hugs pats, kisses
“familiar” persons

13-18 months Friendly with strangers but

initially may show slight
anxiety or shyness

Asks adults (other than

primary caregiver or adult
family members) for help
or to indicate what he/she
wants or needs

Willingly does what

familiar adults ask him/her
to do
Appropriately uses cultural
gestures of greeting
without prompting (e.g.,
mano/bless, kiss)

SUB DOMAIN: SOCIAL (PAKIKIRAMDAM- SENSITIVITY)

Standards 1: The child takes social cues from the environment and adjust his/her
behavior accordingly.
Based on your experience, are these indicators generally observed on and/or performed
by the child on specified age?
Months Description Data Presented

0-6 months Is shy or more quiet with

strangers

Refers to caregiver for

cues about novel
situations, people or
objects

13-18 months Usually quiets down or

stops when caregiver
shushes him/her

Takes notice when there is

a sudden change in mood
of caregiver or people
around him/her
19-24 months If he/she needs something,
can wait quietly, as told,
until the caregiver is able
to attend to him

SUM-DOMAIN: SOCIAL (APPRECIATING DIVERSITY)

Standards 1: The child recognizes and respects similarities and differences in people,
language, culture.
19-24 months
Able to differentiate between boys and girls Sub domain: Social (Pakikiramdam-
Sensitivity
Standards 1: The child takes social cues from the environment and adjusts his/her
behavior accordingly.
Based on your experience, are these indicators generally observed on and/or performed
by a child on the specific age?

SUB DOMAIN: SOCIAL (APPRECIATING DIVERSITY)

Standards 1: The child recognizes and respects similarities and differences in people,
language and culture.
Based on your experience, are these indicators generally observed on and/or performed
by the child?
Months Description Data presented
19-24 months Treats house help or those
less fortunate people with
respect (e.g., talking to
them in polite manner)

Months Description Data presented

0-6 months Is shy or more quiet with

strangers

Refers to caregivers for

cues about novel
situations, people, or
objects
13-18 months Usually quiets down or
stops when caregiver
shushes him/her

Takes notice when there is

a sudden change in mood
of caregiver or people
around him/her
12-24 months If he/she needs something,
can wait quietly, as told,
until the caregiver is able to
attend to him