ISPCAN Questionnaire for CHILDREN V3.

0 (c) 2015 by ISPCAN

Administration Date: _________________

Subject No:_____/_____/_______
Country Area Number

ICAST-C: Survey of Children's experiences with Discipline

Children all over the world are exposed to different types of discipline. Many children
are exposed to violence in the home, school, or other locations. Often, violence is used
to discipline children. This survey is about children's experiences with discipline and
with violence.
Background: Please tell us about yourself.
B1. Are you a male or a female? (put X in one box only)
 Male  Female

B2. Your date of birth: ____/_____(please, write only the month and year)

B3. What position were you born into the family?

 First (Oldest)  Middle  Last (Youngest)  Only child
B4. How many brother or sister do you have? ( _ _ _ _ _ _ )

B5. What year in school are you? (circle one number only)

Hasn’t 1st grade 2 3 4 5 6 7 8 9 10 11 12

go to school

B6. Where do you live? (put X in one box only)

 On a farm, or in a small village  A town or small city
 A big city  Other (please specify: __________________)

B7. Which best describes your living situation? (check all that apply)
 Both parents are at home  I live with my mother
 I live with my father  I live with other relatives
 I live with my foster parents
 I live away from my family with other children and adults
 Group home  Boarding school  Juvenile detention center
 Work camp  Orphanage  Other institution
 Some other place (please specify: _______________________)

B8. Do you belong to any religion or religious group? If yes, which religious groups do you belong
to? (List choices for country) (put X in one box only)
 Yes ( XXXXX  XXXXX  XXXXX  XXXXX)
 No (If NO, go to question B9)

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

B9. What is your ethnicity? (List choices for country)

 XXXXX  XXXXX
 XXXXX  XXXXX

B10. Your parents’ educational level is/was:

Mother Father
 Hasn’t gone to school  Hasn’t gone to school
 Primary School  Primary School
 Middle School  Middle School
 High School/ Lyceum  High School/ Lyceum
 Vocational/ Technical School  Vocational/ Technical School
 University  University
 Post-graduate studies (Masters, Doctorate)  Post-graduate studies (Masters, Doctorate)
 I don’t know  I don’t know

B11. Do you feel safe in your family? (put X in one box only)
 Always  Usually  Few times  Never

B12. Has anyone in your home used alcohol and/or drugs and then behaved in a way that frightened
you?
 Yes  No

B13. Have you seen adults in your home shouting and screaming in a way that frightened you?
 Yes  No

B14. Have you seen adults in your home hurt each other physically (e.g. hitting, slapping, and kicking)?
 Yes  No

B15. Have you seen adults in your home use knives, guns, stick, rocks or other things to hurt or scare
someone else inside home?
 Yes  No

B16. Have you been mistreated or bullied by your brother(s) or sister(s) at home?
 Yes  No

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

Children's Experiences with discipline

Using this questionnaire, we want to find out about experiences that have happened to children at
home (inside their families) or, for some children, have experienced disciplines in another place like
school, or foster care. This questionnaire is being used with children in many parts of the world. We
want to know what things children experience in order to keep children safe.

The questions below ask you about things that have happened to you in the past year. These
questions may seem strange or hard to answer. Please try to answer them as best you can. This is not
a test. There are no right or wrong answers. If at any point you feel too uncomfortable to continue
you can stop. Some questions may not apply because of who you live with or where you live. You
may skip over questions that don’t apply to you.

If you want to get help about any of the things we asked about, talk to the person who gave this
questionnaire to you. Unless you tell us you want to talk, no one will ever know that the answers that
you give are about you. For each question please check all that apply for perpetrator options (adult
male, adult female, child/adolescent male, child/adolescent female).

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often
D1a. Shouted, yelled, or
screamed at you very
loudly?
D1b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D2a. Insulted you by calling
you dumb, lazy or other
names like that?
D2b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D3a. Cursed you?

D3b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D4a. Ignored you?

D4b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often

D5a. Blamed you for his/her

misfortune?

D5b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D6a. Told you to start or

stop doing something?

D6b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D7a. Explained to you why
something you did was
wrong?
D7b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D8a. Gave you a reward for

behaving well?

D8b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D9a. Gave you something
else to do (in order to stop or
change behavior)?
D9b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D10a. Took away privileges

or money?

D10b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D11a. Forbade you from

going out?

D11b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D12a. Embarrassed you

publicly?
D12b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often
D13a. Said they wished you
were dead or never been
born?
D13b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D14a. Threatened to leave or

abandon you?

D14b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D15a. Locked you out of the

home?

D15b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D16a. Threatened to invoke
harmful people, ghosts or
evil spirits against you?
D16b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D17a. Threatened to hurt or

kill you?

D17b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D18a. Kicked you?

D18b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D19a. Shook you

aggressively?

D19b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D20a. Slapped you on the

face or on back of head?

D20b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often

D21a. Hit you on the head

with knuckles?

D21b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D22a. Spanked you on the

bottom with bare hand?

D22b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D23a. Hit you on the
buttocks with an object (such
as a stick, broom, cane, or belt)?
D23b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D24a. Hit you elsewhere (not
buttocks) with an object (such
as a stick, broom, cane, or belt)?
D24b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D25a. Hit you over and over
again with object or fist
(“beat-up”)?
D25b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D26a. Choked you to prevent

you from breathing?

D26b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D27a. Burned or scalded or

branded you?

D27b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D28a. Put hot pepper, soap
or spicy food in your mouth
to cause you pain?
D28b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often

D29a. Locked you up or tied

you to restrict movement?

D29b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D30a. Twisted your ear?

D30b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D31a. Pulled your hair?

D31b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D32a. Pinched you to cause

pain?
D32b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D33a. Forced you to stand,
sit or kneel in a position that
caused pain?
D33b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D34a. Put you in time-out?

D34b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D35a. Withhold a meal as a

punishment?
D35b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D36a. Give you drugs or

alcohol?
D36b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often
D37a. Referred to you skin
color/gender/ religious or
culture in a hurtful way
D37b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D38a. Tried to embarrass
you because you were an
orphan or without a parent?
D38b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D39a. Stopped you from
being with other children to
make you feel bad or lonely?
D39b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

D40a. Stole or broke or

ruined your belonging?

D40b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
D41a. Threatened you with
bad marks that you didn’t
deserve?
D41b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

Please turn page over for more questions

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

Sometimes, when children are growing up, people who are responsible for caring for them
(for example parents/stepparents/adoptive parents/other carers/aunts and uncles) do not
know how to care for children properly, and the children do not get what they need to grow
up healthy. Have any of these things happened to you in the past year?

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often
N1a. You did not get enough
to eat (went hungry) and/or
drink (were thirsty)?
N1b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
N2a. You had to wear
clothes that were dirty,
torn, or inappropriate for
the season?
N2b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
N3a. You were not taken
care of when you were sick
or injured?
N3b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
N4a. You were hurt or
injured because no adult
was supervising?
N4b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

N5a. You did not feel cared

for?

N5b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

N6a. You were made to feel

unimportant?

N6b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

Other scary things may also happen near your home.

O1. Has anyone close to you (a family member, friend or neighbor) been murdered in the last year?
 Yes  Not in the past year, but it has happened before
 No  Unsure
O2a. Have you lived somewhere where you have seen people being shot, bombs going off, people fighting, or
rioting in the last year? If No, skip to O3.
 Yes  Not in the past year, but it has happened before
 No  Unsure

O2b. If Yes, was this because you were living where there was a war?
 Yes  No
Would you like to say more? __________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

O3. Has anyone come into your home and stolen something?
 Yes  Not in the past year, but it has happened before
 No  Unsure

In addition to these three questions you have answered, would you like to say anything more about what has
been happening near your home in the past year?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Sometimes adults or other people make children do sexual things that make them feel
uncomfortable. Did any of the following happen to you in the past year?

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often

O4a. Made you watch a sex

video or look at sexual
pictures?

O4b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

≥ 50 13-50 6-12 3-5 1-2

Not in the
times times times times times
past year, Never
No
Once a but it has in my
Several About Several Once or answer
week or happened life
times once times twice
more before
a month a month a year a year
often

O5a. Made you look at their

private parts or wanted to
look at yours?

O5b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

O6a. Touched your private

parts in a sexual way, or
made you touch theirs?

O6b. If this happened, was it by (Please check all that apply)

□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
O7a. Made a sex video or
took photographs of you
alone, or with other people,
doing sexual things?
O7b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female
O8a. Forced you to have
sex or tried to have sex with
you when you did not want
them to?
O8b. If this happened, was it by (Please check all that apply)
□ Adult male □ Adult female □ Child/Adolescent male □ Child/adolescent female

These questions refer to your opinion on this questionnaire

Q1. Do you have any other experiences with being hurt at home that we have not already asked you
about?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________ _______________________

Q2. Do you have any suggestions for preventing violence against children?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________ _______________________

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 ISPCAN Questionnaire for CHILDREN V3.0 (c) 2015 by ISPCAN

Q3a. Was this a hard questionnaire to answer?

 Yes  No (If No, please go to Q4a)
Q3b. If yes, what was it that you find difficult to answer?
_________________________________________________________________________________________
_________________________________________________________________________________________
______________________________________________________________________________ ___________

Q4a. Is there anything that you didn’t understand?

 Yes  No (If No, please go to Q5a)
Q4b. If yes, what was that?
_________________________________________________________________________________________
_________________________________________________________________________________________
______________________________________________________________________________ ___________

Q5a. Was it difficult to be completely open about what happened to you?

 Yes  No (If No, please go to Q6)
Q5b. If yes, why?
_________________________________________________________________________________________
_________________________________________________________________________________________
______________________________________________________________________________ ___________

Q6. Is there anything else you would like to say about what happened to you or about filling in the
questionnaire?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Thank you very much for helping with this research. If this questionnaire raised difficult or
upsetting issues, we encourage you to call ____________________(local resource) for information or
help. If you have questions about this survey, please feel free to contact the
investigator___________________________ by calling____________________ or ask the person who
gave you this questionnaire for help. Thank you so much for your help.

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