1.During the 2 years before your child was born, were you bothered by recurrent vaginitis, menstrual irregularities, premenstrual tension, fatigue, headache, depression, digestive disorders or "feeling bad all over? (30 points)

2. Was your child bothered by Thrush (white coating on tongue or lips)? (Score 10 if mild, score 20 if severe)

3. Was your chld bothered by frequent diaper rashes in infancy? (Score 10 if mild, score 20 if severe or persistent)

4. During infancy, was your child bothered by colic and irritability lasting over 3 months? (Score 10 if mild, score 20 if moderate to severe)

5. Are his/her symptoms worse on damp days or in damp or moldy places? (20 points)

6. Has your child been bothered by recurrent or persisten "athlete's foot" or chronic fungus infections on his/her skin or nails? (30 points)

7. Has your child been bothered by recurrent hives, eczema or other skin problems? (10 points)

8. Has your child received:

a. 4 or more courses of antibiotic drugs during the past year? Or has he/she received continuous "prophylactic? courses of antibiotic drugs? (60 points)

b. 8 or more courses of "broad spectrum? antibiotics (such as amoxicillin, Keflex, Septr, Bactrim or Ceclor) during the past three years? (40 points)

9. Has your child experienced recurrent ear problems? (20 points)

10. Has your child had tubes inserted in his/her ears? (10 points)

11. Has your child been labeled "hyperactive? (Score 10 if mild, score 20 if moderate to severe)

12. Is your child bothered by learning problems (even though his/her early development history was normal)? (10 points)

13. Does your child have a short attention span? (10 points)

14. Is your child persistently irritable, unhappy and hard to please? (10 points)

15. Has your child been bothered by persistent or recurrent digestive problems, including constipation, diarrhea, bloating or excessive gas? (Score 10 if mild; score 20 if moderate; score 30 if severe)

16. Has your child been bothered by persistent nasal congestion, cough and /or wheezing? (10 points)

17. Is your child unusually tired or unhappy or depressed? (Score 10 if mild, score 20 if severe)

18. Has your child been bothered by recurrent headaches, abdominal pain, or muscle aches? (Score 10 if mild, score 20 if severe)

19. Does your child crave sweets? (10 points)

20. Does exposure to perfume, insecticides, gas or other chemicals provoke moderate to severe symptoms? (30 points)

21. Does tobacco smoke really bother him/her? (20 points)

22. Do you feel that your child isn't well, yet diagnostic tests and studies haven't revealed the cause? (10 points)