| LP116800-6 | Does your child have difficulty falling asleep at night | COMPONENT | 1 |
| LP116801-4 | How long does it take your child to fall asleep at night | COMPONENT | 1 |
| LP116802-2 | At bedtime does your child usually have difficult routines or rituals, argue a lot, or otherwise behave badly | COMPONENT | 1 |
| LP116803-0 | Does your child bang his or her head or rock his or her body when going to sleep | COMPONENT | 1 |
| LP116804-8 | Does your child wake up more than twice a night on average | COMPONENT | 1 |
| LP116805-5 | Does your child have trouble falling back asleep if he or she wakes up at night | COMPONENT | 1 |
| LP116806-3 | Does your child wake up early in the morning and have difficulty going back to sleep | COMPONENT | 1 |
| LP116807-1 | Does the time at which your child goes to bed change a lot from day to day | COMPONENT | 1 |
| LP116808-9 | Does the time at which your child gets up from bed change a lot from day to day | COMPONENT | 1 |
| LP116809-7 | What time does your child usually go to bed during the week | COMPONENT | 1 |
| LP116810-5 | What time does your child usually go to bed on the weekend or vacation | COMPONENT | 1 |
| LP116811-3 | What time does your child usually get out of bed on weekday mornings | COMPONENT | 1 |
| LP116812-1 | What time does your child usually get out of bed on weekend or vacation mornings | COMPONENT | 1 |
| LP116813-9 | Does your child wake up feeling unrefreshed in the morning | COMPONENT | 1 |
| LP116814-7 | Does your child have a problem with sleepiness during the day | COMPONENT | 1 |
| LP116815-4 | Does your child complain that he or she feels sleepy during the day | COMPONENT | 1 |
| LP116816-2 | Has a teacher or other supervisor commented that your child appears sleepy during the day | COMPONENT | 1 |
| LP116817-0 | Does your child usually take a nap during the day | COMPONENT | 1 |
| LP116818-8 | Is it hard to wake your child up in the morning | COMPONENT | 1 |
| LP116819-6 | Does your child wake up with headaches in the morning | COMPONENT | 1 |
| LP116820-4 | Does your child get a headache at least once a Mo, on average | COMPONENT | 1 |
| LP116821-2 | Did your child stop growing at a normal rate at any time since birth | COMPONENT | 1 |
| LP116822-0 | Does your child still have tonsils | COMPONENT | 1 |
| LP116823-8 | When were your childs tonsils removed | COMPONENT | 1 |
| LP116824-6 | Why were your childs tonsils removed | COMPONENT | 1 |
| LP116825-3 | Has your child ever had a condition causing difficulty with breathing | COMPONENT | 1 |
| LP116826-1 | Has your child ever had surgery | COMPONENT | 1 |
| LP116827-9 | Did any difficulties with breathing occur before, during, or after surgery | COMPONENT | 1 |
| LP116828-7 | Has your child ever become suddenly weak in the legs, or anywhere else, after laughing or being surprised by something | COMPONENT | 1 |
| LP116829-5 | Has your child ever felt unable to move for a short period, in bed, though awake and able to look around | COMPONENT | 1 |
| LP116830-3 | Has your child felt an irresistible urge to take a nap at times, forcing him or her to stop what he or she is doing in order to sleep | COMPONENT | 1 |
| LP116831-1 | Has your child ever sensed that he or she was dreaming, seeing images or hearing sounds, while still awake | COMPONENT | 1 |
| LP116832-9 | Does your child drink caffeinated beverages on a typical day - cola, tea, coffee | COMPONENT | 1 |
| LP116833-7 | How many cups or cans of caffeinated beverages per day | COMPONENT | 1 |
| LP116834-5 | Does your child use any recreational drugs | COMPONENT | 1 |
| LP116835-2 | Which recreational drugs does your child use | COMPONENT | 1 |
| LP116836-0 | Does your child use cigarettes, smokeless tobacco, snuff, or other tobacco products | COMPONENT | 1 |
| LP116837-8 | Which tobacco products does your child use | COMPONENT | 1 |
| LP116838-6 | How often does your child use cigarettes, smokeless tobacco, snuff, or other tobacco products | COMPONENT | 1 |
| LP116839-4 | Is your child overweight | COMPONENT | 1 |
| LP116840-2 | At what age did this first develop | COMPONENT | 1 |
| LP116841-0 | Has a doctor ever told you that your child has a high-arched palate, roof of the mouth | COMPONENT | 1 |
| LP116842-8 | Has your child ever taken Ritalin, methylphenidate, for behavioral problems | COMPONENT | 1 |
| LP116843-6 | Has a health professional ever said that your child has attention-deficit disorder, ADD, or attention-deficit-hyperactivity disorder, ADHD | COMPONENT | 1 |
| LP116844-4 | If you are currently at a clinic with your child to see a physician, what is the problem that brought you | COMPONENT | 1 |
| LP116845-1 | If your child has long-term medical problems, please list the three you think are most significant | COMPONENT | 1 |
| LP116847-7 | Please list the size, mg, or amount per dose of medication your child currently takes | COMPONENT | 1 |
| LP116848-5 | How often does your child take this medication | COMPONENT | 1 |
| LP116849-3 | Date your child has taken this medication | COMPONENT | 1 |
| LP116850-1 | Effect this medication has on your child | COMPONENT | 1 |