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Lou's Questionnaire
Lou Sitting
Download the User Guide
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It is mandatory to consult the user guide prior to administering the questionnaire. The completion of the questionnaire by the child must be accompanied by a qualified person. The Lou's Questionnaire is not intended to be used as a diagnostic tool.
Hello!
          I am Lou.
          I would like to get to know you.
  
          To do this, I invite you to answer my questionnaire. There are no right or wrong answers. You can refuse to answer any questions and your answers are confidential.
  
          If you have any questions or need explanations, don't hesitate to talk to the adult accompanying you.
  
          Let's go!
Lou Sitting
Hello!
How old are you?
Do you have a brother or a sister (or a half-brother/half-sister)?
Your Chores
Sometimes, children help their family by doing certain chores or taking on responsibilities. For the next questions, think about the things you have done recently to help someone in your family. Choose the answer that best describes you.
Lou Sitting
Your Chores
For the next questions, think about things you've done recently to help someone in your family. Choose the answer that best describes you.
Your Family
Now, I'd like to know a little more about your family.
Lou Sitting
Your Family
Now, I'd like to know a little more about your family.
Is there someone at home or close to you who is often sick or needs a lot of help?
This person could be your parent, your brother, your sister, your grandparent or anyone else you know who's important to you.
Who is this person? If you can think of several people, choose one.
Do you often worry about this person?
Do you regularly help this person (with chores for example)?
What's it like to help this person?
Choose one of the following images to represent your choice.
Your Profile
Now I'd like to get to know you better.
Lou
Your Profile
Now I'd like to get to know you better.
How would you describe yourself?
Where do you come from (for example, Québec, France, Morocco, Lebanon, Haiti, China)?
What grade are you in school?
Who do you live with most of the time? Check all the people who live with you.
True or false? When you need help, you prefer to do things alone so you don't disturb your family.
True or false? You keep your problems to yourself so you don't worry your family.
Choose the one that best describes how you've been feeling lately. You can choose more than one answer.
True or false? Lately, you've had time to do what you love (for example, playing, watching TV or reading).
True or false? Lately, you've been having fun with your friends.
In general, how would you describe your health (how do you feel in body and mind)?
How do you feel now?
Choose one of the following images to show how you feel.
You're done!
Thank you for taking the time to complete my questionnaire. If you'd like to share more about what you're experiencing, feel free to use this space. You can also write any questions or comments you have before finishing.
Summary
1. Profile
Age: [value]
Self-described as: [value]
Grade: [value]
Origin: [value]
Lives most of the time with: [value]
[value]
For the following statements, the child indicated:
True or false? When you need help, you prefer to do things alone so you don't disturb your family: [value]
True or false? You keep your problems to yourself so you don't worry your family: [value]
Affirmative answers or a refusal to answer one or both of these statements may indicate that the child tends to provide discreet support to those around him or her.
For the following statements, the child indicated:
True or false? Lately, you've had some time to do what you like: [value]
True or false? Lately, you've been having fun with your friends: [value]
Negative answers or a refusal to answer one or more of these statements may indicate that the child is feeling a lack of personal or leisure time, which can be a sign of stress or overload.
2. General State
Child's feelings over the last few days: [value]
Child describes health as: [value]
At the end of the questionnaire, the child indicated feeling: [value]
3. Chore Frequency
The overall score below is calculated by adding the frequencies at which the child indicated performing the 18 to 21 chores presented.
0
No chores
1-6
Low frequency
7-10
Moderate frequency
11-13
High frequency
14+
Very high frequency
This score is for children aged 7 to 12. Please consider the child's age because his or her level of involvement may vary according to his or her stage of development. It's possible that a 12-year-old will obtain a higher score than a 7-year-old.
Question(s) the child skipped:
The child has indicated that he/she takes care of his/her brothers or sisters (or half-brothers/half-sisters), when there are no adults present. It is recommended that the responsibility of supervising young children be entrusted to a child of at least 12 years of age who is mature enough to do so.
Chore(s) the child indicated Sometimes doing:
Chore(s) the child indicated Often doing:
4. Support for a relative
Is anyone at home or close to the child often sick or in need of a lot of help [value]
This is: [value]
Does the child often worry about this person? [value]
Does the child regularly help this person? [value]
Child's Comments
[value]
To sum up
https://lapproche.uqo.ca/lous-questionnaire