PARENT DESIGNED REPORT FORM AND PARENT SPECIFICS DOCUMENTATION LETTER FOR METHYL-B12 THERAPY Score Each Response Separately By The Following Rating Scale: 1-Mild; 2-Mild-to-Moderate; 3-Moderate; 4-Moderate-to-Significant; 5-Significant; NEVER ENTER A ZERO. JUST LEAVE IT BLANK ! The scoring should be from the MB12 injections began . MN12 PDRFs build the previous one for each follow-up appt DATE---- 单独对每种反应打分：1：轻度； 2：轻度至中度； 3：中度； 4：中度至高度； 5：高度。不要填写0分，没有反应则空白；所有打分和开始MB12时进行对比。 1 Abstract thinking: can do better or for the first time: Be specific. Give examples to support your conclusion.抽象思维能力 2 Activity level now the appropriate amount for age (this does not mean “hyperactivity”): What was it like before and how is it better now? 与年龄相当的活跃程度？ 3 Affectionate, more than before taking methyl- B12 shots, even if s/he was already affectionate: Describe the changes you have seen and what time period after starting the shots. 情感表达？ 4 Age appropriate, more than prior methyl- B12 shots: Explain your answer. 表现符合年龄？ 5 Aggression decreased: Describe - Be specific. 攻击性/侵犯性行为减少 6 Aggression increased: Describe - Be specific. Be sure to indicate what other factors may be contributing, e.g. allergy “season”; change in routine, teachers, therapists, classmates that may be bothering your child, etc.攻击性/侵犯性行为增加。要排除其他因素。 7 Alert, more: Describe. In what circumstances has this become obvious? 警觉性增加 8 Allergies, fewer symptoms: How can you tell? What is/was it usually like? 过敏现象减少 9 Amicable, pleasant: More than before: Describe. 友好、友善比以前改善 10 Appetite has increased and/or is trying new foods, more varied; gaining weight: Describe what it was like before the shots. What it is like now. Indicate the time period within which this change began to occur, and indicate if the changes are subtle, mild, moderate, or significant.食欲增加，食物种类增加，能够尝试新的食物，重量增加。 11 Assertive, more self-knowledge and self-protection; “defending one’s own space” but and doing it in an appropriate manner (Example: s/he is not rude but just expresses what s/he does or does not want or wish to do; no longer lets siblings or playmates take advantage of him/her; defines his/her “equal right-to-be” in the world)自信心增加、自我意识增强、自我保护意识增强，用恰当的方式“保护自己的地盘” 12 Attempts to use words or to use more new words or harder words: Be very specific with this section. Give as many examples as possible. Tell what your child was like before the shots began and what your child is like now. Let us know how quickly you saw the effects and how obvious they were to you or others. Let us know whether the changes are mild, moderate, or significant. Let us know within what period of time after starting the shots that the changes started to occur.词汇增加，使用新词语或更复杂/高级的词语。尽可能详细举例描述，并让我们知道针剂开始之后多长时间有变化。 13 Attentive: Be specific: Describe in detail what it was like before and what it is like now and within what period of time you noted the changes and how strong the changes were.对人的关注度，有礼貌。 14 Attitude or disposition: Improved, overall or in general: Describe. We are looking for the general trend as compared to an occasional good day here or there. Be specific in your description if this is present in your child. 总体印象/综合气质改善 15 Attitude or disposition: Worsening in general: Describe. We are looking for the general trend as compared to an occasional bad day or secondary to a triggering event. 总体印象/综合气质 下降。记录触发事件。 16 Awareness is increased. This is awareness “in general” and/or self-awareness, awareness of who s/he is and where s/he belongs in the greater scheme of things. Increased awareness of changing situations and life events. Explain with as many examples as possible from before and after the shots and the degree of change. 警觉性/自我意识增加，对我是谁，我属于。。对环境、位置的改变、生活事件的警觉性增加。尽可能详细举例描述 17 Behavior: Better, all types of better behaviors including fewer tantrums and outbursts: Describe before the methyl- B12 shots and now. Indicate within what period of time the changes began to be noticed once you started the shots. Be specific as to how much these improved behaviors affect your child, the family, the school, and the therapists.行为改善，包括减少发脾气的次数等 18 Behavior: Worse, all types of better behaviors including more tantrums, aggression, screaming, kicking, biting, hitting, crying, and/or other outbursts: Describe in detail everything you are seeing. Be sure to describe the baseline behaviour before the methyl- B12 shots and how they are different now. Indicate within what period of time the changes began to be noticed once you started the shots. Be specific as to how much these worsened behaviors affect the child, the family, the school, and the therapists.行为恶化 19 Biting objects has returned or increased: Describe. 咬东西的现象重新出现或次数增加 20 Biting objects has been eliminated or decreased: Describe. 咬东西的现象消失或次数减少 21 Body control, more (any type): Be specific. Why do you say this? Give enough examples so that any reader could tell the difference.身体控制，请具体描述，详细举例 22 Calmer, less anxious, content, more relaxed: Describe what your child was like before and what s/he is like now. Indicate whether this finding is subtle, mild, moderate, or significant. Indicate how long after starting the shots it took before you started to notice this finding. Describe a typical day or scene before and after starting the methyl- B12 shots. 焦虑减轻、平和、满足、放松 23 Cause and effect – your child now understands this concept: This is an important finding when present. Therefore it is very important that you explain why you believe your child has improved in this area. Be specific. Give examples and the degree to which the changes have occurred and the amount of time it took after starting the shots before you saw improvement.明白因果关系。需要详细描述并举例为什么你判断你的孩子具备这个能力。 24 Changes in routine no longer upset child or upset the child less: Describe this in detail with as many examples as possible. 常规的变化不再使孩子不安或不安的程度减轻。 25 Clumsy, less: Explain what your child was like before the methyl- B12 shots and what your child is like now. Describe in detail the effects you are observing. 没有之前那么笨拙 26 Cognition, active mind, thought processes higher, more intelligent: This is an extremely important finding. Give as many specific examples as possible. Take as much time as is needed to think about your child’s “mind” in detail. By your description of the before and after changes, allow us to get a snapshot of your child’s thought processing abilities and how they have improved. Indicate the degree to which you are seeing these changes: mild, moderate, or significant. Indicate how much time it took after starting the shots before you began to notice this effect. Describe how these changes are affecting the child at home and at school and how they are affecting the family and teachers in general. 认知能力和理解能力提升，思维的层次提升。详细说明何时开始，尽量详细举例，并记录开始MB12之后多长时间开始观察到变化，并描述在家和学校的变化以及家庭成员、老师的反应。 27 Compliance has improved: Describe what his/her compliance was before the shots and how his/her compliance is now. 遵从性提高 28 Comprehension: Explain your answer in detail. (See Cognition above. If applicable, combine the discussions. However, be sure to indicate the two separate response numbers as shown in the example.) 理解能力提升 29 Compulsive behaviors are less: Explain your observations and describe the behaviors both before and after the shots.自我沉迷和强迫行为减少 30 Compulsive behaviors are more: Explain your observations and describe the behaviors both before and after the shots. 自我沉迷和强迫行为增加 31 Concentration: higher level, better, held for longer periods of time, stronger: This is an important finding when present. Be sure to give as many examples as possible to support your observations. 注意力/专注：更高层次、注意力更好、持续更长时间、更强 32 Conversational language increased; appropriate and unprompted “back-and-forth” conversations; conversing in a more normal and appropriate fashion regarding time, place, and content: Be very specific here: Give all the specific examples you can think of before the shots and now: Give the time period that you noted the changes begin to occur. How has this change affected you and/or your family or his teachers at school?交互性语言增加，语言运用更恰当，自发/主动性语言，来回交互对话，以更自然的方式交谈，交谈内容涉及时间、地点、事物。 33 Cooperative: to a greater degree: Why do you say this? Support your response.协作性增强 34 Dark circles under the eyes are less: Describe why you believe this to be true. Indicate whether or not your child "usually had dark circles" regardless of the season. Tell me if your child is allergic to foods and/or airborne (environmental) agents. If sensitive to pollens and other airborne( environmental) allergens, which season(s) affect your child: spring, summer, fall, winter? Also indicate which season(s) is/are the worst season(s).黑眼圈减轻 35 Directives/directions/commands: Follows these better and/or for the first time: Explain your answer in detail. Be specific. Give examples of what it was like before the shots and what it is like now. 对指令的执行度提高或开始执行指令 36 Discriminates better or more wisely between available choices: This is important for a child to do. Give examples why you feel your child has improved and quantify your answer: mild, moderate, or significant.能够更明智地作出选择/分辨能力提升 37 Distracted, less: Why do you say this? Give examples of how easily your child was distracted before as compared to now.烦躁、慌乱的情况减少 38 Distracted, more: Why do you say this? Are there any concurrent things happening, e.g. changes in routine at school or home, changes in therapists or teachers, changes in medications or treatments (any type), problems at home, illness, allergies, especially in an "allergy season", etc. (It is very important to think about each of these in detail.) 烦躁、慌乱的情况增加 39 Eczema, less: How severe was it before and how much better is it now?湿疹减少 40 Eczema, more: How severe was it before and how much worse is it now? Did your child start eating any new foods during this period of time? What other changes may have occurred during this period, e.g changes in medication, stress levels, worsening allergies or asthma, etc.湿疹增多 41 Energy: more energy (not ‘hyperactivity”) and/or more appropriate amounts of energy and activity for your child’s age and sex: Explain.更有活力 42 Engaged or engaging: Explain your answer. How is your child becoming engaged with others (and specifically who) and/or how is child attempting to engage others or is actually engaging others for the first time or to a greater degree? (Be specific with your examples of person and place.)能被别人吸引或更有吸引力 43 Eye contact has improve: what was it like before and how much has it improved: mild, moderate, or significant? 目光接触改善 44 Fears: Now the appropriate balance – more appropriate fears to protect himself/herself when needed but less fearful otherwise because of an awareness that “things aren’t as bad as s/he used to believe them to be”; more trusting: What was your child like before the shots and how has s/he improved in this area? 恐惧：取得比较恰当的平衡，在有自我保护需要的时候/场景下能更恰当的表现出自我保护性质的害怕/担心，但其他时候的恐惧减少，其原因在于认识到以前害怕的事物其实并没有那么可怕。更容易信赖他人。 45 Feelings: able to express better, more completely, and more appropriatately: Give as many examples as to what it was like before the shots and what it is like now.情感表达能力增强，表达更充分、更恰当 46 Fine motor skills are better: Describe why you believe this to be true. Be specific in your examples describing in detail the changes you see from what it was like before. 精细动作提升 47 Flexible, less rigid, can be redirected: Describe why you feel this to be a true statement. Be specific and give as many examples as you can think of.灵活度增加，没那么固执，能够被引导和改变 48 Focused, more so: Give examples from before the shots and examples after starting the shots. How has this additional focus affected your child, you, your family, and his school? 更容易聚焦 49 Follows commands, directions, or directives: what has changed, how much has it changed, and to what degree? (Combine your discussion of this response with #35)遵从指令 和#35雷同 50 Frustrated less easily: Explain. 挫败感减轻 51 Gaining weight, for the first time or faster or unexpected amount: How long has weight been a problem? Why do you believe the methyl-B12 has helped your child gain weight?体重开始增加/或体重增长比以往更快/或体重增长出乎意料 52 Generalizes what is learned: Support your answer by giving specific examples as to how s/he takes something learned and applies it to something else. 学习应用能力增强。给出孩子学以致用的实际例子。 53 Gestures are more appropriate, e.g. if non-verbal then waves, etc, or if partially verbal more attempts are made to gesture appropriately and at the right times: Explain how your child now uses non-verbal ways to gesture and/or communicate to make his/her wants and needs known. 肢体语言更恰当。 54 Good days, more, especially around time of shot: Explain. Is there a “drop-off” in effectiveness so many days after or so many days before the next shot? 在注射的前后情况好的天数，在注射前或注射后数天是否有效果下滑？ 55 Gross motor skills better: Describe why you believe this to be true. Be specific in your examples describing in detail the changes you see from what it was like before.大动作提升 56 Hair or skin tone better or “healthier looking”: What was it like before? How do you support your conclusion? How strongly do you feel about your conclusion? 肤色或发色看起来更健康 57 Happier, more cheerful, more "full of life", "more sparkly or more bouncy", etc.: This seems to be a common answer so therefore I want you to support your before and now conclusion. How happy was your child before and how can you support that an “already happy child” has had an even greater improvement in this area? 更开心、更有活力。如果你的孩子之前已经是个“快乐的孩子”，你需要说明他现在如何更加开心。 58 Healthier looking or general "well being" is improved: Why do you say this? How strongly do you feel about your conclusion?看起来更健康 59 Hierarchy of his/her place in the family, school, society is better understood: Explain your answer. This is a more difficult concept so think about the best way to tell us why you are saying what you are. Give examples to help us understand what you mean.能够更好地理解他在家庭、学校、社会的位置。这是个比较难以理解的概念，因此你需要思考一个比较好的方式来表达你的意思。 60 Humor, jokes around and/or laughs at appropriate times: This is a very important finding in many children. Therefore be very specific in your examples of how you are seeing this manifested in your child. Tell us the joke your child made up. Tell us how your child “twisted something s/he said or you said around” and then hysterically laughed. Tell us what your child is now doing that is funny or to amuse himself/herself or others. Be specific as to what the child’s level of understanding something funny was before the shots and now. If your child now laughs at the appropriate times from TV or something you say or do, tell us about it in detail.幽默/开玩笑/在恰当时候笑。 61 Hyperactivity, less: To what degree has it lessened? Give examples of how bad it was before and how much better it is now. Be very specific here. 多动减轻 62 Hyperactivity, more. How much more has it increased and would you consider it to be mild, moderate, severe, or almost incapacitating to the child, school, therapists, or family? How soon after the shots started did it begin. Were there any other change in the child’s life that may explain some or part of the problem? 多动加重 63 Imaginative play, pretend play, fantasy: Increased or beginning. Describe in detail. Show us the mind of your child when your child is in this mental state and how it has improved from before to now after starting the shots.假想/假扮游戏增加或开始出现 64 Imitating other children or adults: Explain what you are observing with examples of the imitations taking place. 模仿其他小朋友或成人。 65 Immune system better, sick less often: Support your conclusion. How often was your child sick before and how much less sick is your child since the shots? 免疫系统增强，生病的频度减少 66 Inappropriate behavior, less: Describe what types of inappropriate behaviors your child demonstrated before the shots and what it is like now. 不恰当的行为减少 67 Independence, gaining in an appropriate manner and degree: Why do you say this? Give before and now examples. Be very specific. 独立能力增强， 68 Initiation of social interaction or play: Be specific with before and now examples. Give as many examples as possible. (Often this response may be combined with response #42)开始参与社会性活动或游戏，通常与#42一同评估 69 Inquisitive: physical or verbal, e.g. exploring new places the s/he would never explore before, or asking lots of inquisitive questions never really asked before: Be specific with examples and give as many as you can think of.好奇心增强（行动或语言），探索新的事物或问一些以前没问过的问题 70 Interaction with children, adults, groups, peers now to a greater or more appropriate degree: Give before and after examples necessary to document your observations.和儿童、成人、集体的互动改善。目光对视更长或更自然/恰当 71 Interests have increased: general or specific interest(s): Be specific as to how your child was before and how your child is now. Indicate the degree of change and over what period of time it began to happen.兴趣增加 72 Irritability, less or absent: What was it like with your child before the methyl-B12 shots and now? 易怒、兴奋的现象消失或减少 73 Irritability, more: Describe: Be very specific what your child was like before and now and whether or not any other changes occurred during the same time period, e.g. new school, allergy season, new medication(s), a sickness, etc. Discuss how soon after starting the shots this occurred. 易怒、兴奋的现象增多 74 Itchy, less: Also state whether or not your child has known food and/or airborne (environmental) allergies.皮肤瘙痒减少 75 Itchy, more: Also state whether or not your child has known food and/or airborne (environmental) allergies. 皮肤瘙痒增多 76 Laughter, more normal amounts and more normal types of laughter: Why are you saying this? Support your observations as to what it was before and now? 笑得更自然，次数正常 77 Laughter, uncontrollable, unusual, not normal type or amount: Describe what you mean. Had this ever been seen before at any time in the child’s life or is this the very first time it has been noticed? How often does it happen and to what degree of “bother” is it to you, your family, the school, etc.? Be specific. 笑得不自然/失控/次数异常 78 Language and communication: Receptive, expressive, number of words, sentence length, sentence structure, etc. It is very important for you to describe this section in as much detail as possible for us to see what your child was like before the shots and how things have changed now that your child is taking the shots. I need to have you document your observations with before and now examples. It is extremely important that you indicate the time period in which this occurred, e.g. within 5 days after starting the shots, etc. Be very specific and complete with this section with as much detail as possible whenever it applies! Take as much time as needed to do this with as much detail as possible. It is important. (You may combine all the speech and language questions together if you would like. If you do, just indicate the numbers of the questions you are including in your discussion.) 语言和交际：接受能力、表达能力、词汇量、句子长度、句子结构等 79 Learning better in general: I need to know why you are telling me this. Support your answers. Let us know what his/her teachers and therapists are saying. 学习能力提升 80 Learning easier or without a teacher's help or prompting or with less help or prompting in general: Tell us what it was like before the shots and now. You may want to include examples of what your child’s teacher(s) or therapist(s) are telling you. 更容易学习或可以脱离或减少老师的帮助或提示 81 Listens better and longer and/or more attentively: Support your answer by specific details of what a typical day or scene was like before and now. 听别人说话时间增加，注意力提升 82 Loving, cuddly, more so now than prior to the shots even though your child may always have been loving: Describe the difference that have occurred and how quickly you noticed the change. Indicate the degree of positive change that has occurred even though your child may have already been loving and affectionate prior to the shots.比用MB12之前更可爱 83 Memory has improved: Support your answer. What can your child remember better now that s/he could not remember/do before? 记忆力提升 84 Mood swings, fewer: Describe.情绪波动减少 85 Mood swings, more: Describe. Be sure to indicate whether these moods swings are a general trend or whether they are just sporadic and/or intermittent. What is their frequency? What else may be going on in your child’s life, e.g. a divorce, a death, a change in school or routine, another child in the classroom bothering your child, etc. It is important to recognize when methyl-B12 may be causing the problem so it is important to make sure that some other factor is not the real cause. 情绪波动加剧 86 New things never done before s/he is now willing to attempt or try and/or actually do: Describe this in detail. Be specific. Give as many examples as possible or describe why s/he wouldn’t do something before that now s/he is is suddenly doing. 开始做一些以前没做过的事情 87 Night waking, less: Explain what your child’s sleep pattern was like before the shots and what it is like now.夜里醒来的次数减少 88 Night waking, more: Be very specific as you describe your child’s sleep pattern before and after starting the shots. It is important to know what time the child goes to sleep and awakens and whether or not the child returns to sleep, and if so, how long it takes to get back to sleep. Note that there is a difference between “night waking” and if a child “awakens early” because s/he needs less sleep to fill up his/her “sleep cup”. (Compare with the responses about “sleep” below.) 夜里醒来次数增多 89 Obsessions: Less: Be specific as to what the obsessions were like before, what they are like now, the degree to which they have changed, and the period of time from starting the shots within which this change began to occur.强迫行为减少 90 Obsessions: More: Be specific as to what the obsessions were like before, what they are like now, the degree to which they have changed, and the period of time from starting the shots within which this change began to occur. 强迫行为增加 91 “On”, becoming “more normal like other children”: Describe what you mean and why you say this. How was your child different from more normal children before? What have you noticed the changes to be and within what period of time did you begin to see these changes? 更接近正常小孩 92 Opinions, has his/her own and expresses them, e.g. s/he expresses more freely and/or appropriately his/her likes or dislikes, e.g. “the I don't want to's because I'm happy doing what I'm doing”, etc.: Describe in detail with as many specific examples as possible. 有自己的见解并能够表达出来，例如能更加自如、恰当地表达他/她喜欢或不喜欢的东西。 93 Participation has increased in specific situations or in general: Give examples. Let us see a day or a week in the life of your child as it relates to this change. 总体来说，在特定场环境的参与度/分享 增加。 94 Pays attention to family, peers, adults, groups, etc.: Be specific. Show us what it was like before and now. 关注家庭成员、同龄小朋友、成人、集体。描述之前和现在的情况。 95 Peers, now has more appropriate interactions with them: Give specific examples from before the shots and what it is like now. Indicate how long after starting the shots this began to occur. 能更恰当地和同龄人交互 96 PICA (chewing on things) has decreased: How bad was it before and how much better is it now? ？？ 97 PICA (chewing on things) has increased. How bad was it before and how much worse is it now? ？？ 98 Play is appropriate; initiates play; play is not parallel; there are more play skills and they are being better implemented: Give specific examples to document your conclusions. 恰当地进行游戏活动，能发起游戏，不是平行进行的模式，能够运用更多的游戏技巧 99 Questions, asks more questions and/or asks questions more frequently: Give several examples what it was like before, what it is like now, and how soon after starting the shots you began to notice the changes. 更多的提问或提问更频繁 100 Reading is now at higher levels: Tell me what documentation or statements from teachers and therapists you have to support your conclusion. Tell me your own observations as you read with your child. 能够进行更高层次的阅读。 101 Redirection: Needs less redirection and more quickly understands what is expected of him/her in specific situations and therefore follows the directions given more easily and appropriately: Describe in detail examplesof what it was like before the shots and what it is like now. How quickly did the change occur? 能更快地理解别人对他/她的期望，更容易执行指令或执行得更恰当。 102 Requests: makes them known to family, friends, playmates, etc.: Give examples. 能向家庭成员、朋友、玩伴表达自己的需求 103 Resilience is increased; less frustrated by change and things around him/her; tolerance level has improved: Give specific examples to support your conclusion. 适应能力增加，因周围事物发生变化而产生的挫折感减少，忍耐力增强 104 Responses to various stimuli/questions/requests demonstrate a higher degree of accuracy: Document why you believe this to be true. Indicate the inaccuracies that occurred before and the more appropriate responses that are now occurring. How soon after the shots began did you begin to see these changes? 对不同场景/问题/请求的反应，反应的精准度更高。 105 Responses to various stimuli are more appropriate (in general), e.g. doesn’t get scared (or “wildly scared”) at the dentist or barber or when being examined by the doctor; doesn’t scream or cry for excessive periods of time when something unexpected or undesirable happens, etc.: Give as many examples as possible. Tell me why, to what degree, and within what time period this happened after starting the shots. What was it like before the shots compared to now? 对不同场景的反应更恰当，例如看牙医/理发/医生检查时不再尖叫，当意料之外的事情或不希望发生的事情发生时，不再尖叫、哭泣或尖叫、哭泣的时间减少。 106 Response time is quicker or more normal (physical, mental, or verbal responses): Describe why you say this. Support your answer from before and now. 反应时间更快 107 Responsiveness to people has increased: Be specific with your examples. What was it like before? What people are you talking about. How much better is it? 对人的反应增加 108 Retains what he/she learns and builds on previous knowledge: This is an important observation so you will need to validate with examples why you have arrived at your conclusion. Take no shortcuts with this answer. 所学的东西能够保持，能够在过往的知识基础上学习。 109 School reports your child has more "better days": Describe how the school has communicated this information to you. Also, describe whether or not these "better days" are closer to the day of the shot, e.g. for the first two days after the shot the teacher’s report say he was excellent and then the day before the shot they often say, “S/he just wasn’t as sharp today.” 学校报告(反映)你的孩子更多的“表现好的日子”：请描述学校如何给你提供这些信息，并记录这些“表现好的日子”是否在打MB12针剂的附近。 例如在打完针剂1－2天后老师反映他表现优秀而打针前一天则通常说“今天没有特别优秀的表现” 110 Self confidence is greater; seems proud of himself/herself and his/her accomplishments: If so, why do say this? Help us to understand why you have come to this conclusion. 自信心增加，为自己和自己的成就感到骄傲 111 Sentences are longer and/or more complete and/or better structured and/or include articles: You need to document this section in great detail! It is extremely important for you to let us know what your child was like in this area before the shots and now with the shots. Without your specific examples, we will be unable to follow the degree of improvement over the next 6 to 12 to 24 weeks. Therefore no number of examples are too many. You are creating a set of records that will be crucial to following the progress. We need to have you make a statement as to the degree of improvement, whether subtle, mild, moderate, significant, or incredible. You also need to state within what period of time this occurred after beginning the methyl-B12 shots. (You should combine all the speech and language questions into one “discussion set” – just indicate the question numbers for us on the Specifics Documentation Letter you are writing.) 句子长度/复杂度增加，或结构更合理，或使用冠词。 112 Silliness: Less: What was it like before and why do you say this is an improvement? 犯迷糊的情况减少 113 Silliness: More: Is this increased silliness a positive or a negative finding and is it an appropriate type of silliness or and inappropriate finding? Is your child just happier and suddenly just "playing with life", possibly for the first time as s/he becomes more aware or his/her surroundings and is just overjoyed but doesn’t know how to appropriately show it in a socially acceptable manner, or is the child’s silliness truly inappropriate? Be as objective as possible because we need to determine which of these two types of inappropriate silliness we are encountering. 犯迷糊的情况增多：要区分是属于积极的还是消极的情况，是否真正的犯迷糊，抑或是你的孩子只是更开心了、突然想开玩笑？可能是他第一次对周围的环境的意识增强，只是开玩笑开过头了而不知道如何用社会所接纳的方式来正确表达？还是他在真正地犯迷糊？ 114 Singing: Your child has reached a new level of singing if s/he sang before; s/he could not do it before or did it poorly and now it is improving; your child has gained a new or increased interest in singing and/or is making up his/her own songs and/or inserting his/her own words (being funny or humorous?), is spontaneously singing more songs that were learned at school and/or is surprising you with the songs s/he knows: Describe in detail the before and now. 唱歌：能够唱得更好（如果以前就会唱歌）；或以前不会唱/唱得很糟糕而现在进步了。对唱歌有新的兴趣或兴趣增加/自己编歌词/在歌词里面加入自己的词语（有趣或幽默），是否唱出更多在学校学的歌曲而令你觉得惊奇？ 115 Sitting: Your child now has the ability to stay in place for the task at hand or for a longer period of time: This is an important observation so give the necessary details before the shots and and after starting the shots. Give the time frame within which this occurred and give the necessary examples to support your claim. 能静坐下来完成任务或能够安坐更长时间 116 Sleep patterns: Better: Describe how they are better. Does your child sleep more soundly, get to sleep more quickly, have fewer nigh awakenings, or need less sleep than before but seems rested and alert? Indicate how long after starting the shots this observation occurred and indicate to what degree you feel the sleep patterns have improved. 睡眠模式/质量改善：睡得更沉、入睡更快、夜里醒来次数减少、需要比以前更少的睡眠但显得休息得很好、更清醒？ 117 Sleep patterns: Worse: This is a very important observation if it is present but not quite so simple to answer. Please describe how long after starting the shots the sleep problem began to be seen. Describe what the sleep pattern was with your child before the sleep pattern changed. Describe in detail the changes. Note that a child needing less sleep and just awakening earlier in the morning "ready to go" is not necessarily bad whereas night awakenings, the inability to return to sleep, etc. is undesirable. Please be sure to differentiate between these two "sleep disturbance patterns” and any others that are specific for your child. 睡眠质量下降：要区分睡眠时间少、早上醒的早但是已经休息充分和夜里经常醒来而再次入睡困难这两种不同的睡眠模式，或者是你孩子的其他特定模式。 118 Sociability and/or social awareness has increased or is present for the first time: describe what it was like before and now. Be specific and complete as to with whom the sociability has increased, e.g. siblings, parents, grandparents, classmates, teachers, therapists, “familiar others” like the crossing guard, bus driver, etc. 社会性增加或首次表现出社会性：要详细描述和谁的社会性增加，如同伴、父母、祖父母、同学、老师、治疗师、“熟悉的陌生人”如保安、司机等 119 Speech is clearer; “clarity of speech” has improved; your child’s words are better understood and/or they are pronounced in a more normal fashion; the words are physically “formed better or more correctly”: Be specific by giving examples of how your child used to say or pronounce a word or phrase and how s/he is doing it now.发音更清晰 120 Spontaneous speech. Be sure to give the degree of improvement as well as the timing of the improvement once you began the shots. Give as many specific examples as you can think of that are meaninful to you. (You may combine this response with all the other appropriate speech and language questions. Just be sure to indicate on your letter the number of each response that you are discussing in the “combined set”.) 说话更自然 121 Stimming, increased: Give examples: Be specific. Indicate the timing of when this increased stimming began. 自我刺激增加 122 Stimming, reduced: What was it like before? To what degree and within what time period after starting the shots has this observation occurred? 自我刺激减少 123 Tasks: Can focus better and complete more tasks and/or more difficult tasks: Give examples with detailed specifics. 能更专注地完成任务或能完成更多/难度更大的任务 124 Tasks: Can now multi-task and think about and/or perform more than one task at time: Give examples and describe how this is obviously an improvement since starting the shots. 能一次完成或考虑多项任务 125 Tasks: New things never done before or never attempted before: Give the before and now examples necessary to explain you observation and document it well. 能完成以往不能完成或从未尝试过的事情 126 Teeth grinding: To what degree? Within what period of time after starting the shots? Was teeth grinding present at all before the shots and just to a lesser degree or was it never present? Were any concurrent illness going on? Did this happen in any of the "allergy seasons?" Does your child have any known allergies? 磨牙：到什么程度。在开始MB12之前就已经出现还是MB12之后出现的，目前有没什么疾病？是否过敏的原因？ 127 Time, place, and space awareness, e.g. now your child can think in future tense ("next Halloween I want to be …") or s/he knows where s/he lives, etc.: Explain the changes you have seen in detail to support your observations. Give before and now examples. Indicate the period of time after starting the shots in which this specific type of abstract awareness began to be observed. 对时间、地点、空间的意识增强。例如：能使用将来时，如下星期我想。。。或知道自己住在哪里。。 128 Tone inflection is increased or more "alive, bright, vibrant, or animated” while communicating: Why do you say this? What have you observed? This will be interesting for us to hear about so please give specific examples, especially those that even surprised you (if applicable). 语音语调增加，在交谈的时候更生动、更有活力 129 Tongue tingles: Describe what you mean. Is you child able to verbalize this symptom? If so, please quote, as best as possible, what your child has said. Does your child describe any other area of the body that has a "tingly" or other strange sensation? 发音不流利。是否他还不会发这个音？详细描述他是如何说的，或是否他正在描述一个奇怪的感受？ 130 Trying new things, experimenting more, becoming more adventurous: Tell us what it was like with your child before the shots and what it is like now. Tell us within what period of time this occurred after starting the shots. 尝试新事物，有更多的经历，更大胆和富有冒险精神。 131 Understanding: Increased amount of understanding; more in touch with what is being said or done around him/her, e.g. parents frequently have stated that they "must now guard what you say": This is an important observation so be complete in your answer with examples. Inclue degree of improvement and the timing from when the shots were started to when you began to observe this finding. 理解能力提升：对周围的人所说的话或所做的事关注度提高。例如：父母经常说“现在要小心你的一言一行了。。。”（因为孩子听得明白） 132 Verbalization or vocalization increasing and/or more appropriate, "babbling" increasing; more sounds being made or attempted: Be very specific with you answer here. Be sure to quantify your observations as mild, moderate, or significant. Also indicate the time period after starting the shots that this occurred within. (This section may be included in the other language sections as long as the number of this question is included in the “combined set” discussion.) 发音增加或更准确，胡乱发音增加，能发出或尝试发出更多的声音。 133 Vocabulary increased or is used more appropriately: Once again, give as many examples as possible. Describe what your child could not do before the shots that s/he can do now. Be sure to quantify whether the findings are mild, moderate, or significant. Tell us within what period of time after starting the shots that this began. (This section may be included in the other language sections as long as the number of this question is included in the “combined set” discussion.) 词汇量增加或运用得更恰当 134 “What, Where, Who, When, and Why” questions now used and/or "Because" answers: Support your observation by giving examples. Be thorough in order for us to see what is happening and to monitor the success as we go forward. 问“什么、哪里、谁、什么时候、为什么”，能回答“因为。。” 135 “Yes and No” questions are beginning to be answered more spontaneously or with prompting and/or they are answered more frequently and more correctly: Support your observations with examples. 能够更自然地回答“是和否”的问题（或在辅助下回答），回答的频率增加/正确率提高 136 IMPORTANT -- OTHER: IN YOUR OWN WORDS, PLEASE INDICATE ANYTHING ELSE YOU SEE. Please note: this section is important to take time to consider. By now you are tired of completing this form and probably have little energy left to think about anything else you may be seeing in your child. I really need you to try to come up with anything else that may be happening with your child so I may add it to this list in the future. Some of these “other things” you may be observing in your child may also trigger another parent to say, “Oh yeah, my child does that too.” Thank you for doing this. 非常重要——其他：用自己的话描述你所观察到的任何其他问题和现象。 137 ANSWER THIS EVERY TIME: Overall Global Feeling 总体感觉/印象 138 ANSWER THIS EVERY TIME: Improvement in Quality Of Life Of Your Child 孩子的生活质量的提高 138 ANSWER THIS EVERY TIME: Improvement in Quality Of Life Of Your Family 家庭生活质量的提高 140 ANSWER THIS EVERY TIME: Improvement in Quality Of Life For School Personnel 在学校的生活质量提高 141 ANSWER THIS EVERY TIME: Improvement in Quality Of Life for Others, e..g Therapists, etc. (Indicate a title or position of the person) 其他角色的生活质量提高 注意事项： 1.在这一百三十多条里面，不是每个孩子都会有反应，没有反应的空白不填即可。 2.每个MB12的周期（5周或6周）填一列，记住第二个周期及以后的改变是要和最开始的基线相比，而不是和前一个周期比。 3.MB12第一轮效果评估后，要建立自己的分类，每个家长的分类会不一样。 4.从Y轴和X轴看孩子的变化是不同的，Y轴：纵向，和自己比较，从这个角度往往进步会比较明显；X轴：横向，和正常孩子比较，看孩子改善的程度，从这个角度的变化往往比较小。从Y轴比较容易看到MB12的效果，而X轴则展现孩子康复或脱离谱系的前进地图。 5.请尽量详细的具体说明，尽量给予细节描述。记录MB12针剂开始之前的情况和目前的情况。记录发生变化的 |
