Note: Mother Supplement questions were moved into the NLSY79 main youth instrument beginning in 2006. The Mother Supplement section of the main youth questionnaire, represented as a child-based instrument, is shown here. The question names in this Mother Supplement correspond to the Mother Supplement items in the NLSY79 Child database. The Mother Supplement can also be seen in the context of the full main NLSY79 instrument on the NLSY79 questionnaire pages.
MS-STARTSCREEN [] | Section: MS-Preliminaries |
NATIONAL LONGITUDINAL SURVEY OF YOUTH
MOTHER SUPPLEMENT
ENGLISH
VERSION: [MS VERSION STAMP]
MS-CONFIRM-CASE [] | Section: MS-Preliminaries |
INTERVIEWER: THIS INSTRUMENT IS DATE SENSITIVE -- PLEASE DO NOT PROCEED BEYOND THIS POINT UNLESS YOU ARE READY TO CONDUCT THE INTERVIEW.
YOU HAVE OPENED THE CASE SHOWN BELOW. IF THIS IS THE DESIRED CASE, AND YOU ARE READY TO COMPLETE THE INSTRUMENT, CLICK ON THE APPROPRIATE BUTTON TO PROCEED.
CASE ID: [MSCASEIDTXT]
NAME: [Child Full Name]
DATE OF BIRTH: [CHILDBDAY~X]
UPDATES TO DATE OF BIRTH MAY BE MADE LATER IN THE INSTRUMENT IF NECESSARY.
MS-CONF-SYSDATE [] | Section: MS-Preliminaries |
INTERVIEWER: THE COMPUTER SYSTEM DATE IS SET TO:
DATE: [MSDATENOW~X]
TIME: [SYSTEM TIME STAMP]
ARE THE DATE AND TIME SHOWN CORRECT?
MS-SYSDATE-RESET [] | Section: MS-Preliminaries |
INTERVIEWER: YOU INDICATED THE COMPUTER DATE INFORMATION IS INCORRECT.
PLEASE EXIT THE INSTRUMENT, RESET THE SYSTEM DATE AND TIME, AND RESTART THE CASE. ON RESTART, BE SURE TO BACKUP TO THE BEGINNING SCREEN.
MS-PRELIM-TITLE [] | Section: MS-Preliminaries |
**** PRELIMINARIES ****
MS-CKNAME [C35451.00] | Section: MS-Preliminaries |
ISVAREMPTY([Child First Name])
COMMENT: Check if first name is empty on spawned infosheet. If so, prompt for name entry.
If Answer = 1 Then Go To MS-ENTERNAME
MS-ENTERNAME [] | Section: MS-Preliminaries |
INTERVIEWER: ENTER CHILD'S FIRST NAME:
MS-CKFULLNAME [C35452.00] | Section: MS-Preliminaries |
ISVAREMPTY([Child Full Name])
COMMENT: Check if first name is empty on spawned infosheet. If so, prompt for name entry.
If Answer = 1 Then Go To MS-ENTERFULLNAME
MS-ENTERFULLNAME [] | Section: MS-Preliminaries |
INTERVIEWER: ENTER CHILD'S FULL NAME:
MS-INT-MODE [] | Section: MS-Preliminaries |
INTERVIEWER: SELECT INTERVIEW MODE.
MS-INTRO-1A [] | Section: MS-Preliminaries |
In the past years, NLS has gathered information about the work, education, and family life of your generation. Since you have children of your own, and because they are your children, they are important people to us. The purpose of this study is to better understand how children learn and develop.
The U.S. Department of Labor and the National Institute of Child Health and Human Development sponsor this study of the children of the NLS respondents. For each child who participates, you will receive [MSRESPFEE] in appreciation for the time spent answering the questionnaire.
MS-INTRO-1B [] | Section: MS-Preliminaries |
We would like to ask you some questions about [Child Full Name].
MS-QUEXSTAT [] | Section: MS-Preliminaries |
INTERVIEWER: VERIFY - WILL THE MOTHER SUPPLEMENT BE COMPLETED?
| 1 MOTHER WILL COMPLETE MOTHER SUPPLEMENT INTERVIEW |
| 2 MOTHER REFUSES THE MOTHER SUPPLEMENT QUESTIONNAIRE ...(Go To MSIR-TITLE) |
MS-CKFULLDOB1 [C35459.00] | Section: MS-Preliminaries |
[FLAG-COMPLETE DATE VALUE FOR DOB]==1
COMMENT: Verify that there are no missing elements (don't know or refusal) in Child DOB.
If Answer = 1 Then Go To MS-AGE-VRFY1
MS-AGE-VRFY1 [] | Section: MS-Preliminaries |
(VERIFY CHILD'S AGE WITH MOTHER:) [Child First Name] is [CHILD AGE (YEARS)] years and [MONTHS] months old. Is that correct?
MS-ENTR-DOB [] | Section: MS-Preliminaries |
INTERVIEWER: ENTER CORRECT BIRTH DATE FOR [Child First Name].
MS-FULLDOBCK2A [] | Section: MS-Preliminaries |
ISCOMPLETE ([CHILD DATE OF BIRTH])
COMMENT: Verify that there are no missing elements (don't know or refusal) in Child DOB.
If Answer = 1 Then Go To MS-DOB-VRFY2A
MS-DOB-VRFY2A [] | Section: MS-Preliminaries |
INTERVIEWER: VERIFY CHILD'S D.O.B. ENTRY -
YOU ENTERED [ms_childdob~x].
IF CHILD'S DATE OF BIRTH IS INCORRECT, PRESS THE BACK/LEFT ARROW ICON TO RETURN TO THE PREVIOUS QUESTION AND ENTER THE CORRECT BIRTH DATE. OTHERWISE, CLICK " Submit and Continue" TO PROCEED....
MS-DOB-VRFY2B [] | Section: MS-Preliminaries |
INTERVIEWER:
THE DATE YOU ENTERED IS AN [ms_childdob~x].
CONFIRM: REFUSAL AND DON'T KNOW ENTRIES WILL SHOW IN THE DATE FIELDS BELOW....
IF THIS IS THE TRUE RESPONSE, THEN CLICK "Submit and Continue" TO PROCEED.
OTHERWISE, ENTER THE CORRECT BIRTH DATE THEN CLICK "Submit and Continue" TO PROCEED.
MS-FULLDOBCK2B [] | Section: MS-Preliminaries |
ISCOMPLETE ([CHILD DATE OF BIRTH])
COMMENT: Verify that there are no missing elements (don't know or refusal) in Child DOB. If so, get age numerically.
If Answer = 1 Then Go To MS-AGE-VRFY2
MS-AGE-VRFY2 [] | Section: MS-Preliminaries |
(VERIFY CHILD'S AGE WITH MOTHER:)
[Child First Name] is [CHILD AGE (YEARS)] year(s) and [MONTHS] month(s) old. Is that correct?
INTERVIEWER: IF CHILD'S AGE IS INCORRECT, PRESS THE BACK/LEFT ARROW ICON TO BACK UP AND ENTER THE CORRECT BIRTH DATE.
OTHERWISE, CLICK "Submit and Continue" TO PROCEED....
MS-FILLYRS [] | Section: MS-Preliminaries |
How old was [Child First Name] on [his/her] last birthday?
INTERVIEWER: ENTER AGE IN YEARS. CODE 00 IF LESS THAN 1 YEAR OLD.
MONTHS APPEAR ON NEXT SCREEN....
If Answer >= -2 AND Answer <= -1 Then Go To MS-FILLEXIT
MS-FILLMOS [] | Section: MS-Preliminaries |
(How many months has it been since [Child First Name] was born/since [Child First Name]'s birthday?)
INTERVIEWER: ENTER MONTHS PORTION OF AGE (IN YEARS AND MONTHS)
If Answer = -2 Then Go To MS-OVERAGE-CK
If Answer = -1 Then Go To MS-FILLEXIT
MS-FILLEXIT [] | Section: MS-Preliminaries |
INTERVIEWER: NO ACCURATE AGE OR BIRTH DATE COULD BE DETERMINED FOR [Child First Name] . THE CASE WILL BE TERMINATED AS A REFUSAL.
USE THE SURVEY SCREEN BACK ARROW ICON TO RETURN TO EITHER THE BIRTH DATE OR AGE ENTRY QUESTIONS IF A BIRTH DATE OR AGE HAS BEEN INCORRECTLY ENTERED.
MS-OVERAGE-CK [C35461.00] | Section: MS-Preliminaries |
([CHILD AGE IN MONTHS] >= 180) || ([FLAG-COMPLETE DATE VALUE FOR DOB]==1 && ([MS_CHILDDOB~Y] < [MSDOBFLOOR~Y]))
COMMENT: additional age check
If Answer = 1 Then Go To MS-OVERAGE-NOTE
MS-OVERAGE-NOTE [] | Section: MS-Preliminaries |
STOP!
INTERVIEWER: THIS CHILD, [Child First Name], IS 15 YEARS OR OLDER AS OF 12/31/2006 AND THE MOTHER SUPPLEMENT SHOULD NOT BE ADMINISTERED.
PLEASE VERIFY DOB AND AGE OF THIS CHILD WITH MOTHER. IF CHILD IS STILL FOUND TO BE 15 OR OLDER BY 12/31/2006, PREPARE TO TERMINATE CASE. NOTIFY YOUR FM FOR REASSIGNMENT OF THIS CASE.
MS-OVERAGE-EXIT [] | Section: MS-Preliminaries |
INTERVIEWER: PLEASE RECORD ANY ADDITIONAL COMMENTS REGARDING THIS CASE.
RECORD PROJECT ID ON NEXT SCREEN AND TERMINATE CASE.
MS-BKGN-TITLE [] | Section: MS-CHILD BACKGROUND |
**** BEGIN SECTION: CHILD BACKGROUND *****
MS-BKGN-1 [C33871.00] | Section: MS-CHILD BACKGROUND |
Please think about the [2005-2006] regular school year. [is/was] [Child First Name] attending or enrolled in regular school or preschool?
(If [Child First Name] is between the spring and fall school sessions, please tell us about the LAST school year.)
MS-BKGN-2 [C33872.00] | Section: MS-CHILD BACKGROUND |
Has [he/she] ever attended regular school, nursery school, or preschool?
MS-BKGN-3 [C33873.00] | Section: MS-CHILD BACKGROUND |
What grade [is currently attending/did last attend]?
(IF R SAYS 'PRE-FIRST GRADE', CODE KINDERGARTEN.)
| 90 Nursery/preschool |
0 Kindergarten |
| 1 1st grade |
2 2nd grade |
| 3 3rd grade |
4 4th grade |
| 5 5th grade |
6 6th grade |
| 7 7th grade |
8 8th grade |
| 9 9th grade |
10 10th grade |
| 11 11th grade |
12 12th grade |
| 13 1st year in college |
14 2nd year in college |
| 15 3rd year in college |
16 4th year in college |
| 17 5th year in college |
18 6th year in college |
| 19 7th year in college |
20 8th year in college |
| 95 Ungraded ...(Go To MS-BKGN-4) |
If Answer = -2 Then Go To MS-BKGN-4
MS-BKGN-4 [C33874.00] | Section: MS-CHILD BACKGROUND |
If [Child First Name] were in a graded class, what grade would [he/she] be enrolled in?
(IF R SAYS 'PRE-FIRST GRADE', CODE KINDERGARTEN.)
| 90 Nursery/preschool |
| 0 Kindergarten |
| 1 1st grade |
| 2 2nd grade |
| 3 3rd grade |
| 4 4th grade |
| 5 5th grade |
| 6 6th grade |
| 7 7th grade |
| 8 8th grade |
| 9 9th grade |
| 10 10th grade |
| 11 11th grade |
| 12 12th grade |
| 95 Other (SPECIFY) |
MS-BKGN-5-DATECHK [C35482.00] | Section: MS-CHILD BACKGROUND |
([SUMMER TERM FLAG])
COMMENT: Is interview date near or after the end of the school year?
If Answer = 1 Then Go To MS-BKGN-5A
MS-BKGN-5A [C35483.00] | Section: MS-CHILD BACKGROUND |
Is/Was [Child First Name] (currently) attending or enrolled in summer school?
MS-BKGN-5B [C35484.00] | Section: MS-CHILD BACKGROUND |
Has [he/she] ever attended summer school?
MS-BKGN-6-DATECHK [C35485.00] | Section: MS-CHILD BACKGROUND |
([FALL TERM FLAG])
COMMENT: Is interview date after or near the beginning of the new school year?
If Answer = 1 Then Go To MS-BKGN-6A
MS-BKGN-6A [C35486.00] | Section: MS-CHILD BACKGROUND |
Now please think about the [2005-2006] regular school year.
Has [Child First Name] been attending regular school or preschool for at least four weeks (of the [2005-2006] school year)?
MS-BKGN-6B [C35487.00] | Section: MS-CHILD BACKGROUND |
What grade is [Child First Name] currently attending?
(IF R SAYS 'PRE-FIRST GRADE', CODE KINDERGARTEN.)
| 90 Nursery/preschool |
0 Kindergarten |
| 1 1st grade |
2 2nd grade |
| 3 3rd grade |
4 4th grade |
| 5 5th grade |
6 6th grade |
| 7 7th grade |
8 8th grade |
| 9 9th grade |
10 10th grade |
| 11 11th grade |
12 12th grade |
| 13 1st year in college |
14 2nd year in college |
| 15 3rd year in college |
16 4th year in college |
| 17 5th year in college |
18 6th year in college |
| 19 7th year in college |
20 8th year in college |
| 95 Ungraded |
MS-BKGN-6C [C35488.00] | Section: MS-CHILD BACKGROUND |
If [Child First Name] were in a graded class, what grade would [he/she] be enrolled in?
(IF R SAYS 'PRE-FIRST GRADE', CODE KINDERGARTEN.)
| 90 Nursery/preschool |
| 0 Kindergarten |
| 1 1st grade |
| 2 2nd grade |
| 3 3rd grade |
| 4 4th grade |
| 5 5th grade |
| 6 6th grade |
| 7 7th grade |
| 8 8th grade |
| 9 9th grade |
| 10 10th grade |
| 11 11th grade |
| 12 12th grade |
| 95 Other (SPECIFY) |
MS-BKGN-AGECK-PRESCHL [C35490.00] | Section: MS-CHILD BACKGROUND |
([CHILD AGE (YEARS)] < 8)
If Answer = 1 Then Go To MS-BKGN-GRDCHK-PRESCHL
MS-BKGN-GRDCHK-PRESCHL [C35491.00] | Section: MS-CHILD BACKGROUND |
([CHILD GRADE (OR EQUIVALENT)])
COMMENT: Is CHILD currently attending nursery or preschool (i.e., Child's GRADE coded 90)?
If Answer = 90 Then Go To MS-BKGN-8
MS-BKGN-7 [C35492.00] | Section: MS-CHILD BACKGROUND |
Has [Child First Name] ever been enrolled in a preschool program (not including kindergarten)?
MS-BKGN-8 [C35493.00] | Section: MS-CHILD BACKGROUND |
Has [Child First Name] ever been enrolled in day care?
MS-BKGN-11 [C35495.00] | Section: MS-CHILD BACKGROUND |
([BYPASS HEADSTART FLAG - INFO EXISTS] == 1)
COMMENT: Does complete information on Head Start participation already exist for child ?
If Answer = 1 Then Go To MS-BKGN-17
MS-BKGN-12 [C35496.00] | Section: MS-CHILD BACKGROUND |
Has [Child First Name] ever been enrolled in the Head Start Program?
MS-BKGN-13 [C35497.00] | Section: MS-CHILD BACKGROUND |
How old was [Child First Name] when [he/she] first attended Head Start?
(INTERVIEWER: ENTER AGE IN YEARS. CODE 00 = LESS THAN 1 YEAR OLD.)
MS-BKGN-14 [C35498.00] | Section: MS-CHILD BACKGROUND |
In total, how long (has [Child First Name] attended/did [Child First Name] attend) Head Start?
| 1 Less than 3 months |
| 2 3 - 11 months |
| 3 1 year - 23 months |
| 4 2 years or more |
| 5 Still enrolled |
MS-BKGN-15 [C35499.00] | Section: MS-CHILD BACKGROUND |
How satisfied are you with what Head Start has done for [Child First Name]?
| 1 Very satisfied |
| 2 Somewhat satisfied |
| 3 Somewhat dissatisfied |
| 4 Very dissatisfied |
MS-BKGN-16 [C35500.00] | Section: MS-CHILD BACKGROUND |
How satisfied are you with what [Child First Name]'s Head Start program has done for you?
| 1 Very satisfied |
| 2 Somewhat satisfied |
| 3 Somewhat dissatisfied |
| 4 Very dissatisfied |
MS-BKGN-17 [C35501.00] | Section: MS-CHILD BACKGROUND |
([CHILD AGE (YEARS)] < 5 )
COMMENT: If child age is less than 5 YRS , jump to BKGN-END
If Answer = 1 Then Go To MS-HLTH-HW-TITLE
MS-BKGN-18 [C35502.00] | Section: MS-CHILD BACKGROUND |
([IN SCHOOL] == 1)
If Answer = 1 Then Go To MS-BKGN-20
MS-BKGN-19 [C35503.00] | Section: MS-CHILD BACKGROUND |
If [Child First Name] does not attend school at all, what is the reason?
| 1 Unable to attend due to physical, emotional, or mental condition |
| 2 Expelled or suspended |
| 3 School closed because of strike, physical damage, etc. |
| 4 Child's father, stepfather, father-figure won't let child attend |
| 7 Home schooled |
| 5 Other reasons (SPECIFY) |
MS-BKGN-20 [C33875.00] | Section: MS-CHILD BACKGROUND |
Which of the following describes the school [Child First Name] attends:
| 1 Public school ...(Go To MS-BKGN-23) |
| 2 Charter school |
| 3 Catholic school |
| 4 Other religious or church-sponsored school |
| 5 Non-religious private school ...(Go To MS-BKGN-23) |
| 6 Indian reservation school |
| 7 Military academy |
| 8 Home-schooled ...(Go To MS-BKGN-23) |
| 9 Other (SPECIFY) |
MS-BKGN-21 [C33876.00] | Section: MS-CHILD BACKGROUND |
Is the school [he/she] attends public or private?
| 1 Public |
| 2 Private |
| 3 Other (SPECIFY) |
| 4 Does not attend school at all |
MS-BKGN-23 [C35504.00] | Section: MS-CHILD BACKGROUND |
([EVER IN SCHOOL] == 0) && ([IN SCHOOL] == 0)
If Answer = 1 Then Go To MS-BKGN-32
MS-BKGN-24 [C35505.00] | Section: MS-CHILD BACKGROUND |
How many different schools has your child ever attended? Please include the school [he/she] is currently attending.
If Answer >= -2 AND Answer <= -1 Then Go To MS-BKGN-FIRSTLANG
MS-BKGN-25 [C35506.00] | Section: MS-CHILD BACKGROUND |
How many of these were elementary schools?
MS-BKGN-FIRSTLANG [C35507.00] | Section: MS-CHILD BACKGROUND |
What language did [Child First Name] speak when [he/she] first started regular school?
| 1 ENGLISH (OR MOSTLY ENGLISH) |
| 2 SPANISH (OR MOSTLY SPANISH) |
| 3 ENGLISH AND SPANISH EQUALLY |
| 4 ENGLISH AND ANOTHER LANGUAGE EQUALLY (SPECIFY) |
| 5 CHILD DOES NOT SPEAK |
| 6 ANOTHER LANGUAGE (SPECIFY) |
MS-BKGN-CURRLANG [C35508.00] | Section: MS-CHILD BACKGROUND |
What language does [Child First Name] speak most now?
COMMENT:
| 1 ENGLISH (OR MOSTLY ENGLISH) |
| 2 SPANISH (OR MOSTLY SPANISH) |
| 3 ENGLISH AND SPANISH EQUALLY |
| 4 ENGLISH AND ANOTHER LANGUAGE EQUALLY (SPECIFY) |
| 5 CHILD DOES NOT SPEAK |
| 6 ANOTHER LANGUAGE (SPECIFY) |
MS-BKGN-26 [C35509.00] | Section: MS-CHILD BACKGROUND |
In a typical school week, how much time does [Child First Name] usually spend after school working on math problems or math homework?
ENTER HOURS PER WEEK. ROUND TO NEAREST 1/2 HR.
MS-BKGN-27 [C35510.00] | Section: MS-CHILD BACKGROUND |
In a typical school week, how much time does [Child First Name] usually spend after school writing up reports, papers, book-reports, or stories?
ENTER HOURS PER WEEK. ROUND TO NEAREST 1/2 HR.
MS-BKGN-28 [C35511.00] | Section: MS-CHILD BACKGROUND |
([EVER IN SCHOOL] == 0) && ([IN SCHOOL] == 0)
If Answer = 1 Then Go To MS-BKGN-32
MS-BKGN-29A [C35512.00] | Section: MS-CHILD BACKGROUND |
[During the [SCHOOL YEAR REFERENT] school year], did/has [Child First Name] participate(d) in a remedial math program?
MS-BKGN-29B [C35513.00] | Section: MS-CHILD BACKGROUND |
[During the [SCHOOL YEAR REFERENT] school year], did/has [he/she] participate(d) in a remedial reading, remedial English, or remedial language arts program?
MS-BKGN-29C [C35514.00] | Section: MS-CHILD BACKGROUND |
[During the [SCHOOL YEAR REFERENT] school year], did/has [he/she] participate(d) in a gifted and talented program, or a special class for advanced work?
MS-BKGN-29D [C35515.00] | Section: MS-CHILD BACKGROUND |
[During the [SCHOOL YEAR REFERENT] school year], did/has [he/she] participate(d) in special education or a program for handicapped children?
MS-BKGN-29E [C35516.00] | Section: MS-CHILD BACKGROUND |
[During the [SCHOOL YEAR REFERENT] school year], did/has [he/she] participate(d) in a program that teaches English as a second language (ESL)?
MS-BKGN-30 [C35517.00] | Section: MS-CHILD BACKGROUND |
([IN SCHOOL] == 1)
If Answer = 1 Then Go To MS-BKGN-31A
MS-BKGN-31A [C35518.00] | Section: MS-CHILD BACKGROUND |
Do you or your (spouse/partner) participate in a parent-teacher organization at [Child First Name]'s school?
MS-BKGN-31B [C35519.00] | Section: MS-CHILD BACKGROUND |
Do you or your (spouse/partner) volunteer in the classroom at [his/her] school?
MS-BKGN-31C [C35520.00] | Section: MS-CHILD BACKGROUND |
Do you or your (spouse/partner) do volunteer work such as supervising lunch, or chaperoning a field trip at [Child First Name]'s school?
MS-BKGN-31D [C35521.00] | Section: MS-CHILD BACKGROUND |
Do you or your (spouse/partner) attend parent-teacher conferences at [his/her] school?
MS-BKGN-32 [C35522.00] | Section: MS-CHILD BACKGROUND |
How many of [Child First Name]'s close friends do you know by sight and by first and last name?
Do you know . . .
| 1 All of them |
| 2 Most of them |
| 3 About half |
| 4 Only a few |
| 5 None of them |
| 6 CHILD HAS NO CLOSE FRIENDS |
MS-BKGN-33 [C35523.00] | Section: MS-CHILD BACKGROUND |
About how often do you know who [Child First Name] is with when [he/she] is not at home?
Would you say you know who [he/she] is with . . .
| 1 All of the time |
| 2 Most of the time |
| 3 Some of the time, or |
| 4 Rarely? |
MS-BKGN-34 [C35524.00] | Section: MS-CHILD BACKGROUND |
In the past year, how often has [Child First Name] attended religious services (including Sunday School, or other religious classes)?
| 1 About once a week |
| 2 At least once a month |
| 3 A few times a year |
| 4 Never |
MS-BKGN-35 [C35525.00] | Section: MS-CHILD BACKGROUND |
Aside from attending religious services, how important is it to you to provide religious training for [him/her]?
| 1 Very important |
| 2 Fairly important |
| 3 Not at all important |
MS-HLTH-HW-TITLE [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
**** BEGIN SECTION: CHILD HEALTH - HEIGHT & WEIGHT ****
MS-HLTH-HW-MODECHK [C35528.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[INTERVIEW MODE]==1 && [PERMISSION TO INTERVIEW CHILD OBTAINED?]==1 && ([HOW CHILD SUPPLEMENT WILL BE ADMINISTERED] == 1 || [HOW CHILD SUPPLEMENT WILL BE ADMINISTERED] == 2)
COMMENT: Internal Function - If telephone interview or mother permission refusal, go directly to height & weight questions. Otherwise continue.
If Answer = 1 Then Go To MS-HLTH-21A
MS-HLTH-21A [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER: DOES CHILD HAVE ANY SERIOUS HEALTH LIMITATIONS THAT WOULD AFFECT MEASUREMENT OR TESTING?
.
MS-HLTH-21B [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER: IF CHILD HAS A SERIOUS PHYSICAL OR MENTAL CONDITION THAT MAY INFLUENCE MEASUREMENT, TACTFULLY TELL MOTHER THAT SOME MEASUREMENTS MAY BE INAPPROPRIATE FOR THE CHILD BUT YOU WILL ADMINISTER THE ONES YOU CAN.
RECORD CONDITION BELOW.
MS-HLTH-HW-INTRO-IP [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER: (IF CHILD IS NOT ALREADY PRESENT) READ TO MOTHER:
Could you please bring [Child First Name] into the room and help make [him/her] feel comfortable?
MS-HLTH-HW-INTRO-AGECK [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[PPVT AGE IN MONTHS] >=60 && [HOW CHILD SUPPLEMENT WILL BE ADMINISTERED]==1
COMMENT: Internal Function - If Child age eligible for assessment, read Intro B. Otherwise, read Intro A.
If Answer = 1 Then Go To MS-HLTH-HW-INTRO-IPB
MS-HLTH-HW-INTRO-AGECK-A [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[PPVT AGE IN MONTHS] < 60 || ([CHILD AGE (YEARS)] < 8 && [HOW CHILD SUPPLEMENT WILL BE ADMINISTERED]==2)
If Answer = 1 Then Go To MS-HLTH-HW-INTRO-IPA
MS-HLTH-HW-INTRO-IPA [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
What did your mother tell you about my visit?
(WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:)
(That's right or I see.) Your mother has been helping us by answering some questions. Now it's your turn.
MS-HLTH-HW-INTRO-AGECK-B [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[CHILD AGE (YEARS)] < 8
COMMENT: Internal Function - If Child age eligible for assessment, read Intro B. Otherwise, read Intro A.
If Answer = 1 Then Go To MS-HLTH-HW-INTRO-IPB
MS-HLTH-HW-INTRO-IPB [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
What did your mother tell you about my visit?
(WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:)
(That's right or I see.) Your mother has been helping us by answering questions for many years now. This makes her a very important person to us. Now we have some questions for you. Some are about language, some are about arithmetic or math. Some questions have right or wrong answers, others don't. I want you to concentrate on the questions and give me your best answer for each one.
MS-HLTH-HW-INTRO-IPC [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
What did your mother tell you about my visit?
(WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:)
(That's right or I see.) Your mother has been helping us by answering questions for many years now. This makes her a very important person to us. Now we have some questions for you. Some are about language, some are about arithmetic or math, and some are about school. Some questions have right or wrong answers, others don't. I want you to concentrate on the questions and give me your best answer for each one.
MS-HLTH-HGT-SELECT [C35529.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER:) I'd like to find out how tall [Child First Name] is. [Would you prefer to measure yourself or shall I do it?/]
INTERVIEWER: SELECT HOW YOU WISH TO ENTER HEIGHT -
IN FEET AND INCHES - OR - TOTAL INCHES
.
| 1 FEET AND INCHES ENTRY |
| 2 TOTAL INCHES ENTRY (ESP INFANTS) |
MS-HLTH-HGT-MTHDCK [C35530.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[HEIGHT INPUT METHOD SELECTION]
COMMENT: Internal Function
If Answer = 1 Then Go To MS-HLTH-HGT-FEET
If Answer = 2 Then Go To MS-HLTH-HGT-TOTALINCHES
MS-HLTH-HGT-FEET [C35531.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER: I'd like to find out how tall [Child First Name] is. [Would you prefer to measure yourself or shall I do it?/])
INTERVIEWER: RECORD FEET AND INCHES BELOW.
.
MS-HLTH-HGT-INCHES [C35532.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
MS-HLTH-HGT-TOTALINCHES [C35533.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER: I'd like to find out how tall [Child First Name] is. [Would you prefer to measure yourself or shall I do it?/])
INTERVIEWER: RECORD HEIGHT IN TOTAL INCHES.
.
MS-HLTH-HGTCOMP [C35535.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
([HEIGHT INPUT] < [CALCULATED MIN HEIGHT VALUE]) || ([HEIGHT INPUT] > [CALCULATED MAX HEIGHT VALUE])
COMMENT: Internal Function - Is total child height in inches outside of calculated min - max range?
If Answer = 1 Then Go To MS-HLTH-HGT-MTHDCK2
MS-HLTH-HGT-MTHDCK2 [C35536.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[HEIGHT INPUT METHOD SELECTION]
COMMENT: Internal Function
If Answer = 1 Then Go To MS-HLTH-HGTCONF1
If Answer = 2 Then Go To MS-HLTH-HGTCONF2
MS-HLTH-HGTCONF1 [C35537.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER:
CAUTION...
THE HEIGHT ENTERED FOR [Child First Name] IS OUTSIDE THE USUAL RANGE OF HEIGHT FOR A CHILD THIS AGE. PLEASE CHECK -- ARE THESE VALUES CORRECT?
[NUMBER OF FEET] FEET AND [NUMBER OF INCHES] INCHES
BACK UP TO CORRECT ANY ERROR, OR SELECT "YES" TO CONFIRM THE VALUES AND CONTINUE.
.
| 1 YES - VALUES ARE ENTERED CORRECTLY |
| 0 NOT CORRECT |
MS-HLTH-HGTCONF2 [C35538.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER:
CAUTION...
THE HEIGHT ENTERED FOR [Child First Name] IS OUTSIDE THE USUAL RANGE OF HEIGHT FOR A CHILD THIS AGE. PLEASE CHECK -- IS THIS VALUE CORRECT?
[TOTAL NUMBER OF INCHES] TOTAL INCHES
BACK UP TO CORRECT ANY ERROR, OR SELECT "YES" TO CONFIRM THE VALUE AND CONTINUE.
MS-HLTH-HGT-REPT [C35539.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER: HOW WAS HEIGHT REPORTED?
| 1 TAPE MEASUREMENT |
| 2 MOTHER RECALL |
| 3 CHILD RECALL |
| 4 Other; DK |
MS-HLTH-WGT-SELECT [C35540.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER:) I'd like to find out [Child First Name]'s weight. [Would you prefer to weigh yourself or shall I do it?/]
INTERVIEWER: CLICK SUBMIT AND CONTINUE, UNLESS CHILD IS LESS THAN 20 LBS.
.
| 1 ENTER POUNDS ONLY |
| 2 ENTER POUNDS AND OUNCES (ESP INFANTS) |
MS-HLTH-WGT-MTHDCK [C35541.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[SELECTION OF ENTRY METHOD]
COMMENT: Internal Function
If Answer = 1 Then Go To MS-HLTH-WGT-LBSONLY
If Answer = 2 Then Go To MS-HLTH-WGT-LBS
MS-HLTH-WGT-LBSONLY [C35542.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER: I'd like to find out [Child First Name]'s weight. [Would you prefer to weigh yourself or shall I do it?/])
INTERVIEWER: RECORD WEIGHT IN POUNDS. BE SURE CHILD IS NOT WEARING SHOES OR HEAVY OUTER GARMENTS.
.
MS-HLTH-WGT-LBS [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
(TO MOTHER: I'd like to find out [Child First Name]'s weight. [Would you prefer to weigh yourself or shall I do it?/])
INTERVIEWER: RECORD POUNDS AND OUNCES. BE SURE CHILD IS NOT WEARING SHOES OR HEAVY OUTER GARMENTS.
NOTE: THIS SCREEN IS FOR CHILDREN WEIGHING LESS THAN 20 LBS. IF CHILD WEIGHS 20 LBS OR MORE, BACKUP TO "HLTH-WGT-SELECT" AND SELECT "ENTER POUNDS".
.
.
MS-HLTH-WGT-OZS [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
MS-HLTH-WGTCOMP [C35544.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
([WEIGHT INPUT VALUE] < [CALCULATED MIN WEIGHT VALUE]) || ([WEIGHT INPUT VALUE] > [CALCULATED MAX WEIGHT VALUE])
COMMENT: Internal Function - Is total child height in inches outside of calculated min - max range?
If Answer = 1 Then Go To MS-HLTH-WGT-MTHDCK2
MS-HLTH-WGT-MTHDCK2 [C35545.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
[SELECTION OF ENTRY METHOD]
COMMENT: Internal Function
If Answer = 1 Then Go To MS-HLTH-WGTCONF1
If Answer = 2 Then Go To MS-HLTH-WGTCONF2
MS-HLTH-WGTCONF1 [C35546.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER:
CAUTION...
THE WEIGHT ENTERED FOR [Child First Name] IS OUTSIDE THE USUAL RANGE OF WEIGHT FOR A CHILD THIS AGE. PLEASE CHECK -- IS THE VALUE SHOWN CORRECT?
[NUMBER OF POUNDS] POUNDS
BACK UP TO CORRECT ANY ERROR, OR SELECT "YES" TO CONFIRM THE VALUE AND CONTINUE.
MS-HLTH-WGTCONF2 [] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER:
CAUTION...
THE WEIGHT ENTERED FOR [Child First Name] IS OUTSIDE THE USUAL RANGE OF WEIGHT FOR A CHILD THIS AGE. PLEASE CHECK -- ARE THE VALUES SHOWN CORRECT?
[NUMBER OF POUNDS] POUNDS AND [NUMBER OF OUNCES] OUNCES
BACK UP TO CORRECT ANY ERROR, OR SELECT "YES" TO CONFIRM THE VALUE(S) AND CONTINUE.
MS-HLTH-WGT-REPT [C35547.00] | Section: MS-HEALTH - HEIGHT & WEIGHT |
INTERVIEWER: HOW WAS WEIGHT REPORTED?
| 1 SCALE MEASUREMENT |
| 2 MOTHER RECALL |
| 3 CHILD RECALL |
| 4 Other; DK |
| 5 Other; out of range |
MS-HLTH-TITLE [] | Section: MS-HEALTH |
**** BEGIN SECTION: CHILD HEALTH *****
MS-HLTH-INTRO [] | Section: MS-HEALTH |
(READ TO MOTHER/GUARDIAN)
Now I'd like to ask you some questions about [Child First Name]'s general state of health and [his/her] physical characteristics.
MS-HLTH-1A [C35550.00] | Section: MS-HEALTH |
[RESN-NOSCHL] == 1
COMMENT: If reason for not attending school is health related, skip directly to HEALTH-5 LOOP begin
If Answer = 1 Then Go To MS-HLTH-5-LOOP-BEGIN
MS-HLTH-1B [C35551.00] | Section: MS-HEALTH |
([CHILD AGE (YEARS)] >= 4) || ([IN SCHOOL] == 1) || ([EVER IN SCHOOL] == 1)
If Answer = 1 Then Go To MS-HLTH-2A
MS-HLTH-2A [C35552.00] | Section: MS-HEALTH |
Does [Child First Name] have any physical, emotional, or mental condition that limits or prevents [his/her] ability to...
...attend school regularly?
MS-HLTH-2B [C35553.00] | Section: MS-HEALTH |
Does [he/she] have any physical, emotional, or mental condition that limits or prevents [his/her] ability to...
...do regular school work?
MS-HLTH-2C [C35554.00] | Section: MS-HEALTH |
Does [Child First Name] have any physical, emotional, or mental condition that limits or prevents [his/her] ability to...
...do usual childhood activities such as play, or participate in games or sports?
MS-HLTH-3A [C35555.00] | Section: MS-HEALTH |
Does [he/she] have any physical, emotional, or mental condition that requires...
...frequent attention or treatment from a doctor or other health professional?
MS-HLTH-3B [C35556.00] | Section: MS-HEALTH |
Does [Child First Name] have any physical, emotional, or mental condition that requires...
...regular use of any medicine or drug (other than vitamins)?
MS-HLTH-3C [C35557.00] | Section: MS-HEALTH |
Does [he/she] have any physical, emotional, or mental condition that requires...
... use of any special equipment, such as a brace, crutches, a wheelchair, special shoes, a helmet, a special bed, a breathing mask, an air filter, or a catheter and so on?
MS-HLTH-5-LOOP-BEGIN [] | Section: MS-HEALTH |
REPEAT
COMMENT: Begin loop about limiting conditions
MS-HLTH-5A_VERBATIM [C35568.00] | Section: MS-HEALTH |
What is [Child First Name]'s (next) health condition or limitation?
INTERVIEWER: PROBE AS NECESSARY: (What is it called?)
MS-HLTH-5A [C35577.00] | Section: MS-HEALTH |
CODE ONLY ONE
| 1 Learning disability |
| 2 Minimal brain dysfunction, minimal cerebral dysfunction, attention deficit disorder |
| 3 Hyperkinesis, hyperactivity |
| 4 Asthma |
| 5 Respiratory disorder or sinus infection |
| 6 Speech impairment |
| 7 Serious hearing difficulty or deafness |
| 8 Serious difficulty in seeing or blindness |
| 9 Serious emotional disturbance |
| 10 Allergic condition(s) |
| 11 Orthopedic handicap |
| 12 Mental retardation |
| 13 Heart trouble |
| 14 Chronic nervous disorder |
| 16 Chronic ear problems or infections |
| 17 Blood disorder or immune deficiency (e.g. sickle cell anemia) |
| 18 Epilepsy/Seizures |
| 95 Health condition not listed (SPECIFY) |
MS-HLTH-5C-AGECK [C35586.00] | Section: MS-HEALTH |
[CHILD AGE IN MONTHS]<=11
COMMENT: Don't ask how long had condition if less than 1 yr old
If Answer = 1 Then Go To MS-HLTH-5-CNT
MS-HLTH-5C [C35595.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
How old was [Child First Name] when [he/she] first developed this condition?
INTERVIEWER: ENTER AGE IN YEARS (SINCE BIRTH=0)
MS-HLTH-5-CNT [C35604.00] | Section: MS-HEALTH |
[LOOP COUNTER - HLTH 5]
COMMENT: IF loop=1 goto HLTH-5-1STQ2A, else skip to HLTH-5-SCHLCHK
If Answer = 1 Then Go To MS-HLTH-5-1STQ2A
MS-HLTH-5-1STQ2A [C35613.00] | Section: MS-HEALTH |
([LIMITS TO ATTENDING SCHL?] == 1) || ([RESN-NOSCHL] == 1)
COMMENT: jump to NEXT appropriate effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5E
MS-HLTH-5-1STQ2B [C35614.00] | Section: MS-HEALTH |
[LIMITS AFFECT SCHOOLWORK?] == 1
COMMENT: jump to NEXT appropriate effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5F
MS-HLTH-5-1STQ2C [C35615.00] | Section: MS-HEALTH |
[LIMITS AFFECT PLAY?] == 1
COMMENT: jump to NEXT appropriate effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5G
MS-HLTH-5-1STQ3A [C35616.00] | Section: MS-HEALTH |
[LIMITS REQUIRE SEEING DR OFTEN?] ==1
COMMENT: jump to NEXT appropriate effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5H
MS-HLTH-5-1STQ3B [C35617.00] | Section: MS-HEALTH |
[LIMITS REQUIRE MEDS?] == 1
COMMENT: jump to NEXT appropriate effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5I
MS-HLTH-5-1STQ3C [C35618.00] | Section: MS-HEALTH |
[LIMITS REQUIRE EQUIPMENT?] == 1
COMMENT: jump to NEXT effect of limit to ask about
If Answer = 1 Then Go To MS-HLTH-5J
MS-HLTH-5-SCHLCK [C35619.00] | Section: MS-HEALTH |
([CHILD AGE (YEARS)] >=4) || ([IN SCHOOL] == 1) || ([EVER IN SCHOOL] == 1)
If Answer = 1 Then Go To MS-HLTH-5D
MS-HLTH-5D [C35627.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition limit or prevent [his/her] ability to...
...attend school regularly?
MS-HLTH-5E [C35635.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition limit or prevent [his/her] ability to...
...do regular schoolwork?
MS-HLTH-5F [C35644.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition limit or prevent [his/her] ability to...
...do usual childhood activities such as play, or participate in games or sports?
MS-HLTH-5G [C35653.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition require...
...frequent attention or treatment from a doctor or other health professional?
MS-HLTH-5H [C35662.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition require...
...regular use of any medicine or drug (other than vitamins)?
MS-HLTH-5I [C35671.00] | Section: MS-HEALTH |
IN REFERENCE TO VERBATIM: [HEALTH CONDITION]
Does this condition require...
... use of any special equipment, such as a brace, crutches, a wheelchair, special shoes, a helmet, a special bed, a breathing mask, an air filter, or a catheter and so on?
MS-HLTH-5J [C35680.00] | Section: MS-HEALTH |
Does [Child First Name] have any other health conditions (that we haven't talked about)?
MS-HLTH-5-LOOP-END [] | Section: MS-HEALTH |
UNTIL([ANYMORECONDITIONS]==0)
COMMENT: loop until there are no more conditions to ask about
MS-HLTH-6 [C35698.00] | Section: MS-HEALTH |
[Since was born/During the past 12 months], has [Child First Name] had any accidents or injuries that required medical attention?
MS-HLTH-6-LOOP-BEGIN [] | Section: MS-HEALTH |
REPEAT
COMMENT: Begin loop about accidents requiring medical attention
MS-HLTH-6B [C35704.00] | Section: MS-HEALTH |
Thinking of the [most recent accident or injury/accident or injury that occurred before the one you just described], in what month and year did it occur?
MS-HLTH-6C_VERBATIM [C35708.00] | Section: MS-HEALTH |
What was the cause of that accident or injury?
MS-HLTH-6C [C35712.00] | Section: MS-HEALTH |
CODE ONLY ONE
| 1 Motor vehicle accident as occupant |
2 Motor vehicle accident as pedestrian |
| 3 Cycling |
4 Fall/contact unrelated to athletics or sports activity |
| 5 Fall/contact related to athletics/sports activity |
6 Fire or smoke |
| 7 Hot liquid |
8 Toy or item intended for child use |
| 9 Equipment or device not intended for a child |
10 Poisoning |
| 11 Smashed body part: car/door/window bruise/contusion |
12 Adult injured child accidentally (pull/lift injury) |
| 13 Intentional violent injury |
14 "Rough housing", impact injury: wrestling, etc. |
| 16 Fighting: broke bone/nose, hit in face, shot, stabbed, etc. |
17 Struck by object from other person (intent unknown) |
| 18 Insect sting or bite |
19 Stepped on sharp object, i.e. glass/nails/metal |
| 20 Ran into stationary object (not in home environment) |
22 Ran into stationary object (home environment) |
| 21 Animal bite |
23 Cut by sharp object, i.e. knife/glass/tool |
| 24 Burn, i.e. from heater/cigarette/oven/stove |
25 Jump/fall accident, i.e. off furniture/other object |
| 26 "Temper" injuries, i.e. fell, kicked furniture, etc. |
15 Other (SPECIFY) |
MS-HLTH-6D [C35716.00] | Section: MS-HEALTH |
What specific injury or conditions resulted from the accident just mentioned?
(CODE ALL THAT APPLY)
| 1 Broken or dislocated bones |
| 2 Sprain, strain, or pulled muscle |
| 3 Wound: cuts, scrapes, puncture |
| 4 Head injury, concussion |
| 5 Bruise, contusion, or internal bleeding |
| 6 Burn, scald |
| 7 Illness or effect from poisons, medicines (drugs), etc |
| 15 Other (SPECIFY) |
MS-HLTH-6E [C35720.00] | Section: MS-HEALTH |
Where did the accident or injury happen?
| 1 At home (any, not necessarily the child's) |
| 2 School (including grounds and athletic areas) |
| 3 Day care location (preschool/nursery) |
| 4 Street or highway |
| 5 Public building or space (other than streets or schools) |
| 6 Place of recreation and sports, except school |
| 7 Farm or agricultural area, except farm house |
| 8 Other (SPECIFY) |
MS-HLTH-6G [C35724.00] | Section: MS-HEALTH |
Has [Child First Name] had any other accidents or injuries requiring medical attention [since was born/during the past 12 months]?
MS-HLTH-6-LOOP-END [] | Section: MS-HEALTH |
UNTIL([ANY MORE HURTS?]==0)
COMMENT: loop until there are no more accidents or injuries
MS-HLTH-7 [C35732.00] | Section: MS-HEALTH |
Now we're going to talk about any time [Child First Name] may have been hospitalized since [ was born/we last interviewed you on ]. (This may include an injury that you have already mentioned here.)
Has [Child First Name] had any accidents or injuries that required hospitalization since [ was born/we last interviewed you on ]?
MS-HLTH-7-LOOP-BEGIN [] | Section: MS-HEALTH |
REPEAT
MS-HLTH-7B [C35735.00] | Section: MS-HEALTH |
Thinking of the [most recent accident or injury that/accident or injury that occurred before the one you just described that also] required hospitalization, in what month and year did it occur?
MS-HLTH-7C_VERBATIM [C35736.00] | Section: MS-HEALTH |
What was the cause of this accident or injury?
MS-HLTH-7C [C35737.00] | Section: MS-HEALTH |
CODE ONLY ONE
| 1 Motor vehicle accident as occupant |
2 Motor vehicle accident as pedestrian |
| 3 Cycling |
4 Fall/contact unrelated to athletics or sports activity |
| 5 Fall/contact related to athletics/sports activity |
6 Fire or smoke |
| 7 Hot liquid |
8 Toy or item intended for child use |
| 9 Equipment or device not intended for a child |
10 Poisoning |
| 11 Smashed body part: car/door/window bruise/contusion |
12 Adult injured child accidentally (pull/lift injury) |
| 13 Intentional violent injury |
14 "Rough housing", impact injury: wrestling, etc. |
| 16 Fighting: broke bone/nose, hit in face, shot, stabbed, etc. |
17 Struck by object from other person (intent unknown) |
| 18 Insect sting or bite |
19 Stepped on sharp object, i.e. glass/nails/metal |
| 20 Ran into stationary object (not in home environment) |
22 Ran into stationary object (home environment) |
| 21 Animal bite |
23 Cut by sharp object, i.e. knife/glass/tool |
| 24 Burn, i.e. from heater/cigarette/oven/stove |
25 Jump/fall accident, i.e. off furniture/other object |
| 26 "Temper" injuries, i.e. fell, kicked furniture, etc. |
15 Other (SPECIFY) |
MS-HLTH-7D [C35738.00] | Section: MS-HEALTH |
What specific injury or conditions resulted from the accident just mentioned?
(CODE ALL THAT APPLY)
| 1 Broken or dislocated bones |
| 2 Sprain, strain, or pulled muscle |
| 3 Wound: cuts, scrapes, puncture |
| 4 Head injury, concussion |
| 5 Bruise, contusion, or internal bleeding |
| 6 Burn, scald |
| 7 Illness or effect from poisons, medicines (drugs), etc |
| 15 Other (SPECIFY) |
MS-HLTH-7E [C35739.00] | Section: MS-HEALTH |
Where did the accident or injury happen?
| 1 At home (any, not necessarily the child's) |
| 2 School (including grounds and athletic areas) |
| 3 Day care location (preschool/nursery) |
| 4 Street or highway |
| 5 Public building or space (other than streets or schools) |
| 6 Place of recreation and sports, except school |
| 7 Farm or agricultural area, except farm house |
| 8 Other (SPECIFY) |
MS-HLTH-7G [C35740.00] | Section: MS-HEALTH |
Has [Child First Name] had any other accidents or injuries requiring hospitalization since [ was born/we last interviewed you on ]?
MS-HLTH-7-LOOP-END [] | Section: MS-HEALTH |
UNTIL([ANYMORE HOSPITALIZATIONS?]==0)
MS-HLTH-8 [C35742.00] | Section: MS-HEALTH |
[Since was born has /During the past 12 months has ] had any illnesses that required medical attention or treatment?
MS-HLTH-8A [C35743.00] | Section: MS-HEALTH |
How many such illnesses has [Child First Name] had [since was born/during the past 12 months]?
MS-HLTH-9 [C35744.00] | Section: MS-HEALTH |
When did [Child First Name] last see a doctor for a routine health checkup?
| 1 Less than 1 month ago |
| 2 1 - 3 months ago |
| 3 4 - 6 months ago |
| 4 7 - 11 months ago |
| 5 1 year - 23 months ago |
| 6 2 or more years ago |
| 7 Never |
MS-HLTH-11-AGECK [C35747.00] | Section: MS-HEALTH |
[CHILD SEX] == 2 && [CHILD AGE (YEARS)] >= 8 && [MENSES FLAG]==0
If Answer = 1 Then Go To MS-HLTH-11A
MS-HLTH-11A [C35748.00] | Section: MS-HEALTH |
Has [Child First Name] ever had a menstrual period?
MS-HLTH-11B [C35749.00] | Section: MS-HEALTH |
How old was [Child First Name] when she had her first menstrual period?
(INTERVIEWER: ENTER AGE IN YEARS.)
MS-HLTH-11C [C35750.00] | Section: MS-HEALTH |
In what month and year did she have her first period?
MS-HLTH-12-AGECHK [C35751.00] | Section: MS-HEALTH |
([CHILD AGE (YEARS)]>=2)
COMMENT: Is child age 2 yrs or older?
If Answer = 1 Then Go To MS-HLTH-12A
MS-HLTH-12A [C35752.00] | Section: MS-HEALTH |
Which hand does [Child First Name] use for writing?
IF R VOLUNTEERS "AMBIDEXTROUS","EITHER", OR "BOTH", ENTER EITHER/BOTH AND RECORD EXPLANATION IN COMMENT SCREEN.
IF R SAYS CHILD DOESN'T WRITE YET, ASK WHICH HAND HE/SHE USES MOST OFTEN.
| 1 Left |
| 2 Right |
| 3 Either/both |
MS-HLTH-12B [C35753.00] | Section: MS-HEALTH |
Please think about the hand [Child First Name] uses for activities such as throwing a ball. When [he/she] throws a ball, does [he/she] use [his/her]...
| 1 right hand nearly all of the time? |
| 2 right hand more than half of the time? |
| 3 right and left hands about equally? |
| 4 left hand more than half of the time? |
| 5 left hand nearly all of the time? |
MS-HLTH-12C [C35754.00] | Section: MS-HEALTH |
When [he/she] brushes [his/her] teeth, does [he/she] use [his/her]...
| 1 right hand nearly all of the time? |
| 2 right hand more than half of the time? |
| 3 right and left hands about equally? |
| 4 left hand more than half of the time? |
| 5 left hand nearly all of the time? |
MS-HLTH-13 [C35755.00] | Section: MS-HEALTH |
When did [Child First Name] last see a dentist for a checkup or to have some dental work done?
| 1 Less than 1 month ago |
| 2 1 - 3 months ago |
| 3 4 - 6 months ago |
| 4 7 - 11 months ago |
| 5 1 year - 23 months ago |
| 6 2 or more years ago |
| 7 Never |
MS-HLTH-14 [C35756.00] | Section: MS-HEALTH |
Is [Child First Name]'s health care now covered by health insurance provided either by an employer or by an individual plan that pays part or all of a hospital, doctor's, or surgeon's bill?
(THIS DOES NOT INCLUDE PUBLIC ASSISTANCE HEALTH CARE PROGRAMS.)
MS-HLTH-15 [C35757.00] | Section: MS-HEALTH |
There is a national program called Medicaid that pays for health care for persons in need.
Is [Child First Name]'s health care now covered by Medicaid?
(INTERVIEWER: IF NEEDED, HAND R SHOW CARD "STATE MEDICAID PROGRAMS". IF TELEPHONE INTERVIEW, SHOWCARD MAY BE READ)
MS-HOME-AGECK1 [C33878.00] | Section: The HOME |
([CHILD AGE IN MONTHS]>=0)
COMMENT: IF child meets AGE and YOB/BORNSR19 constraints, then continue. Otherwise skip to HOME-END
If Answer = 1 Then Go To MS-HOME-TITLE
MS-HOME-TITLE [] | Section: The HOME |
**** BEGIN SECTION: The HOME *****
MS-HOME-INTRO [] | Section: The HOME |
INTERVIEWER: THE FOLLOWING SECTION IS A CHILD ASSESSMENT. IT IS VITAL THAT YOU COMPLETE ALL QUESTIONS IN THIS SECTION.
READ TO MOTHER
We are interested in your family's lifestyle and rules.
MS-HOME-AGECK2 [C33879.00] | Section: The HOME |
([CHILD AGE IN MONTHS])
COMMENT: Jump to appropriate HOME section based on months of age.
If Answer >= 0 AND Answer <= 35 Then Go To MS-HOME-A01
If Answer >= 36 AND Answer <= 71 Then Go To MS-HOME-B01
If Answer >= 72 AND Answer <= 119 Then Go To MS-HOME-C01
If Answer >= 120 AND Answer <= 179 Then Go To MS-HOME-D01
MS-HOME-A01 [C33880.00] | Section: The HOME |
About how often does [Child First Name] have a chance to get out of the house?
| 5 Every day |
| 4 4 or more times a week |
| 3 A few times a week |
| 2 About once a week |
| 1 A few times a month or less |
MS-HOME-A02 [C33881.00] | Section: The HOME |
About how many children's books does [Child First Name] have?
| 4 10 or more books |
| 3 3 to 9 books |
| 2 1 or 2 books |
| 1 None |
MS-HOME-A03 [C33882.00] | Section: The HOME |
How often do you get a chance to read stories to [Child First Name]?
| 1 Never |
| 2 Several times a year |
| 3 Several times a month |
| 4 Once a week |
| 5 About 3 times a week |
| 6 Everyday |
MS-HOME-A04 [C33883.00] | Section: The HOME |
About how often do you take [Child First Name] to the grocery store?
| 1 Twice a week or more |
| 2 Once a week |
| 3 Once a month |
| 4 Hardly ever |
MS-HOME-A05 [C33884.00] | Section: The HOME |
About how many, if any, cuddly, soft or role-playing toys (like a doll) does [Child First Name] have? (May be shared with sister or brother.)
ENTER NUMBER OF SOFT TOYS.
MS-HOME-A06 [C33885.00] | Section: The HOME |
About how many, if any, push or pull toys does [Child First Name] have? (May be shared with sister or brother.)
ENTER NUMBER OF PUSH/PULL TOYS.
MS-HOME-A07 [C33886.00] | Section: The HOME |
Some parents spend time teaching their children new skills while other parents believe children learn best on their own. Which of the following most closely describes your attitude?
| 1 Parents should always spend time teaching their children |
| 2 Parents should usually spend time teaching their children |
| 3 Parents should usually allow their children to learn on their own |
| 4 Parents should always allow their children to learn on their own |
MS-HOME-A08 [C33887.00] | Section: The HOME |
Think for a moment about a typical weekday for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekday?
INTERVIEWER: ENTER HOURS PER WEEKDAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekday?)
MS-HOME-A09 [C33888.00] | Section: The HOME |
Now, think about a typical weekend day (Saturday or Sunday) for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekend day?
INTERVIEWER: ENTER HOURS PER WEEKEND DAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekend day?)
MS-HOME-A10A [C33889.00] | Section: The HOME |
About how many hours is the TV on in your home each day?
INTERVIEWER: ENTER HOURS PER DAY, ROUND TO NEAREST 1/2 HR.
NOTE: LESS THAN 1 HOUR PER DAY = 0. IF R DOES NOT HAVE A TV, ENTER ZERO AND CHANGE CHECK ITEM BELOW.
MS-HOME-A10B [C33890.00] | Section: The HOME |
MARK AS APPROPRIATE
| 1 R HAS A TV |
| 0 R DOES NOT HAVE A TV |
MS-HOME-A-DADCHK1 [C33891.00] | Section: The HOME |
([FATHER IN HOUSEHOLD PRELOAD FLAG] == 1)
COMMENT: IF FATHER PRESENT IN MOTHER HOUSEHOLD SKIP TO HOME-A-TXTSUB1
If Answer = 1 Then Go To MS-HOME-A14
MS-HOME-A11 [C33892.00] | Section: The HOME |
Does [Child First Name] ever see [his/her] father, or someone [he/she] considers a father-figure?
MS-HOME-A12 [C33893.00] | Section: The HOME |
Is this person [his/her] biological father, stepfather, or a father-figure?
| 1 BIOLOGICAL FATHER |
| 2 STEPFATHER |
| 3 FATHER-FIGURE |
MS-HOME-A13 [C33894.00] | Section: The HOME |
What is his relationship to you? (Is he your spouse, your partner, your friend, a relative, or someone else?)
| 1 SPOUSE |
| 2 EX-SPOUSE |
| 3 PARTNER |
| 4 EX-PARTNER |
| 5 BOYFRIEND |
| 6 EX-BOYFRIEND |
| 7 FIANCE |
| 8 FRIEND |
| 9 FATHER |
| 10 GRANDFATHER |
| 11 BROTHER |
| 12 UNCLE |
| 13 SOMEONE ELSE (SPECIFY) |
MS-HOME-A14 [C33895.00] | Section: The HOME |
Does [Child First Name] see [his/her] [father/stepfather/father-figure] on a daily basis?
MS-HOME-A15 [C33896.00] | Section: The HOME |
How often does [Child First Name] eat a meal with both you and [his/her] [father/stepfather/father-figure]?
| 1 More than once a day |
| 2 Once a day |
| 3 Several times a week |
| 4 About once a week |
| 5 About once a month |
| 6 Never |
MS-HOME-A16 [C33897.00] | Section: The HOME |
Children seem to demand attention when their parents are busy around the house. How often do you talk to [Child First Name] while you are working?
| 1 Always (talk to your child when working) |
| 2 Often (talk to your child when working) |
| 3 Sometimes (talk to your child when working) |
| 4 Rarely (talk to your child when working) |
| 5 Never (talk to your child when working) |
MS-HOME-A17A [C33898.00] | Section: The HOME |
How close does [Child First Name] feel toward you? Does [he/she] feel...
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-A-DADCHK2 [C33899.00] | Section: The HOME |
([WHODAD])
COMMENT: WHODAD=0 (NO FATHER-FIGURE), SKIP TO HOME-A18;
WHODAD>=1 SKIP TO HOME-A17B.
If Answer = 0 Then Go To MS-HOME-A18
If Answer >= 1 AND Answer <= 3 Then Go To MS-HOME-A17B
MS-HOME-A17B [C33900.00] | Section: The HOME |
How close does [he/she] feel toward [his/her] (biological) father?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
| 5 Does not have this parent |
MS-HOME-A-DADCHK3 [C33901.00] | Section: The HOME |
([WHODAD])
COMMENT: IF father is in HH, don't ask about closeness to stepfather
(WHODAD=1 skip to HOME-A18).
If Answer = 1 Then Go To MS-HOME-A18
MS-HOME-A17D [] | Section: The HOME |
How close does [he/she] feel toward [his/her] [father/stepfather/father-figure]?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-A18 [C33902.00] | Section: The HOME |
Sometimes kids mind pretty well and sometimes they don't.
About how many times, if any, have you had to spank [Child First Name] in the past week?
MS-HOME-B01 [C33903.00] | Section: The HOME |
About how often do you read stories to [Child First Name]?
| 1 Never |
| 2 Several times a year |
| 3 Several times a month |
| 4 Once a week |
| 5 At least 3 times a week |
| 6 Everyday |
MS-HOME-B02 [C33904.00] | Section: The HOME |
About how many children's books does [Child First Name] have?
| 4 10 or more books |
| 3 3 to 9 books |
| 2 1 or 2 books |
| 1 None |
MS-HOME-B03 [C33905.00] | Section: The HOME |
About how many magazines does your family get regularly?
| 1 None |
| 2 One |
| 3 Two |
| 4 Three |
| 5 Four or more |
MS-HOME-B04 [C33906.00] | Section: The HOME |
Does [Child First Name] have the use of a CD player, tape deck, or tape recorder, or record player at home and at least 5 children's records or tapes? (May be shared with sister or brother.)
MS-HOME-B05A [C33907.00] | Section: The HOME |
Please tell me which of the following you (or someone else) have helped [Child First Name] learn at home.
Do you or have you helped with...numbers?
MS-HOME-B05B [C33908.00] | Section: The HOME |
Do you (or someone else) help with...the alphabet?
MS-HOME-B05C [C33909.00] | Section: The HOME |
Do you (or someone else) help with...colors?
MS-HOME-B05D [C33910.00] | Section: The HOME |
Do you (or someone else) help with...shapes and sizes?
MS-HOME-B06 [C33911.00] | Section: The HOME |
How much choice is [Child First Name] allowed in deciding what foods [he/she] eats at breakfast and lunch?
| 1 A great deal of choice |
| 2 Some choice |
| 3 Little choice |
| 4 No choice |
MS-HOME-B07A [C33912.00] | Section: The HOME |
About how many hours is the TV on in your home each day?
INTERVIEWER: ENTER HOURS PER DAY, ROUND TO NEAREST 1/2 HR.
NOTE: LESS THAN 1 HOUR PER DAY = 0. IF R DOES NOT HAVE A TV, ENTER ZERO AND CHANGE CHECK ITEM BELOW.
MS-HOME-B07B [C33913.00] | Section: The HOME |
| 1 R HAS A TV |
| 0 R DOES NOT HAVE A TV |
MS-HOME-B08A [C35759.00] | Section: The HOME |
Most children get angry at their parents from time to time. If [Child First Name] got so angry that [he/she] hit you, what would you do?
INTERVIEWER: ENTER VERBATIM AND MARK ALL THAT APPLY
MS-HOME-B08B [C33915.00] | Section: The HOME |
| 1 Hit him/her back |
| 2 Send him/her to his/her room |
| 3 Spank him/her |
| 4 Talk to him/her |
| 5 Ignore it |
| 6 Give him/her household chore |
| 7 Take away his/her allowance |
| 8 Hold child's hands until he/she was calm |
| 10 Put child in a short 'time out' |
| 9 Other (SPECIFY) |
MS-HOME-B09 [C33916.00] | Section: The HOME |
How often does a family member get a chance to take [Child First Name] on any kind of outing (like shopping, to the park, a picnic, drive-in, and so on)?
| 1 A few times a year or less |
| 2 About once a month |
| 3 About two or three times a month |
| 4 Several times a week |
| 5 About once a day |
MS-HOME-B10 [C33917.00] | Section: The HOME |
How often has a family member taken or arranged to take [Child First Name] to any type of museum (children's, scientific, art, historical, etc.) within the past year?
| 1 Never |
| 2 Once or twice |
| 3 Several times |
| 4 About once a month |
| 5 About once a week or more often |
MS-HOME-B11 [C33918.00] | Section: The HOME |
Think for a moment about a typical weekday for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekday?
INTERVIEWER: ENTER HOURS PER WEEKDAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekday?)
MS-HOME-B12 [C33919.00] | Section: The HOME |
Now, think about a typical weekend day (Saturday or Sunday) for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekend day?
INTERVIEWER: ENTER HOURS PER WEEKEND DAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekend day?)
MS-HOME-B-DADCHK1 [C33920.00] | Section: The HOME |
([FATHER IN HOUSEHOLD PRELOAD FLAG] == 1)
COMMENT: IF FATHER PRESENT IN MOTHER HOUSEHOLD SKIP TO HOME-B-TXTSUB1
If Answer = 1 Then Go To MS-HOME-B16
MS-HOME-B13 [C33921.00] | Section: The HOME |
Does [Child First Name] ever see [his/her] father, or someone [he/she] considers a father-figure?
MS-HOME-B14 [C33922.00] | Section: The HOME |
Is this man [Child First Name]'s biological father, stepfather, or a father-figure?
| 1 BIOLOGICAL FATHER |
| 2 STEPFATHER |
| 3 FATHER-FIGURE |
MS-HOME-B15 [C33923.00] | Section: The HOME |
What is his relationship to you? (Is he your spouse, your partner, your friend, a relative, or someone else?)
| 1 SPOUSE |
| 2 EX-SPOUSE |
| 3 PARTNER |
| 4 EX-PARTNER |
| 5 BOYFRIEND |
| 6 EX-BOYFRIEND |
| 7 FIANCE |
| 8 FRIEND |
| 9 FATHER |
| 10 GRANDFATHER |
| 11 BROTHER |
| 12 UNCLE |
| 13 SOMEONE ELSE (SPECIFY) |
MS-HOME-B16 [C33924.00] | Section: The HOME |
Does [Child First Name] see [his/her] [father/stepfather/father-figure] on a daily basis?
MS-HOME-B17 [C33925.00] | Section: The HOME |
How often does [Child First Name] eat a meal with you and [his/her] [father/stepfather/father-figure]?
| 1 More than once a day |
| 2 Once a day |
| 3 Several times a week |
| 4 About once a week |
| 5 About once a month |
| 6 Never |
MS-HOME-B18A [C33926.00] | Section: The HOME |
How close does [Child First Name] feel toward you? Does [he/she] feel...
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-B-DADCHK2 [C33927.00] | Section: The HOME |
([WHODAD])
COMMENT: WHODAD=0 (NO FATHER-FIGURE), SKIP TO HOME-B19;
WHODAD>=1 SKIP TO HOME-B18B.
If Answer = 0 Then Go To MS-HOME-B19
If Answer >= 1 AND Answer <= 3 Then Go To MS-HOME-B18B
MS-HOME-B18B [C33928.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] (biological) father?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
| 5 Does not have this parent |
MS-HOME-B-DADCHK3 [C33929.00] | Section: The HOME |
([WHODAD])
COMMENT: IF father is in HH, don't ask about closeness to stepfather (WHODAD=1 skip to HOME-B19).
If Answer = 1 Then Go To MS-HOME-B19
MS-HOME-B18D [C33930.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] [father/stepfather/father-figure]?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-B19 [C33931.00] | Section: The HOME |
Sometimes kids mind pretty well and sometimes they don't. About how many times, if any, have you had to spank [Child First Name] in the past week?
MS-HOME-C01 [C33932.00] | Section: The HOME |
About how many books does [Child First Name] have?
| 1 None |
| 2 1 or 2 books |
| 3 3 to 9 books |
| 4 10 or more books |
MS-HOME-C02 [C33933.00] | Section: The HOME |
About how often do you read aloud to [Child First Name]?
| 1 Never |
| 2 Several times a year |
| 3 Several times a month |
| 4 Once a week |
| 5 At least 3 times a week |
| 6 Everyday |
MS-HOME-C03A [C33934.00] | Section: The HOME |
How often is [Child First Name] expected to make [his/her] own bed?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-C03B [C33935.00] | Section: The HOME |
How often is [Child First Name] expected to clean [his/her] own room?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-C03C [C33936.00] | Section: The HOME |
How often is [Child First Name] expected to clean up after spills?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-C03D [C33937.00] | Section: The HOME |
How often is [Child First Name] expected to bathe [him/her]self?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-C03E [C33938.00] | Section: The HOME |
How often is [Child First Name] expected to pick up after [him/her]self?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-C04 [C33939.00] | Section: The HOME |
Is there a musical instrument (for example, piano, drum, guitar, etc.) that [Child First Name] can use here at home?
MS-HOME-C05 [C33940.00] | Section: The HOME |
Does your family get a daily newspaper?
| 1 Yes |
| 0 No |
| 2 (IF VOLUNTEERED:) READ NEWSPAPER ONLINE
|
| 3 (IF VOLUNTEERED:) SUNDAY PAPER ONLY
|
MS-HOME-C06 [C33941.00] | Section: The HOME |
About how often does [Child First Name] read for enjoyment?
| 1 Every day |
| 2 Several times a week |
| 3 Several times a month |
| 4 Several times a year |
| 5 Never |
MS-HOME-C07 [C33942.00] | Section: The HOME |
Does your family encourage [Child First Name] to start and keep doing hobbies?
MS-HOME-C08 [C33943.00] | Section: The HOME |
Does [Child First Name] get special lessons or belong to any organization that encourages activities such as sports, music, art, dance, drama, etc.?
MS-HOME-C09 [C33944.00] | Section: The HOME |
How often has a family member taken, or arranged to take [Child First Name] to any type of museum (children's, scientific, art, historical, etc.) within the past year?
| 1 Never |
| 2 Once or twice |
| 3 Several times |
| 4 About once a month |
| 5 About once a week or more often |
MS-HOME-C10 [C33945.00] | Section: The HOME |
How often has a family member taken, or arranged to take [Child First Name] to any type of musical or theatrical performance within the past year?
| 1 Never |
| 2 Once or twice |
| 3 Several times |
| 4 About once a month |
| 5 About once a week or more often |
MS-HOME-C11 [C33946.00] | Section: The HOME |
About how often does your whole family get together with relatives or friends?
| 1 Once a year or less |
| 2 A few times a year |
| 3 About once a month |
| 4 Two or three times a month |
| 5 About once a week or more |
MS-HOME-C12 [C33947.00] | Section: The HOME |
Think for a moment about a typical weekday for your family. How much time--either in your home or elsewhere--would you say your child spends watching television on a typical weekday?
INTERVIEWER: ENTER HOURS PER WEEKDAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekday?)
MS-HOME-C13 [C33948.00] | Section: The HOME |
Now, think for a moment about a typical weekend day (Saturday or Sunday) for your family. How much time--either in your home or elsewhere-- would you say [Child First Name] spends watching television on a typical weekend day?
INTERVIEWER: ENTER HOURS PER WEEKEND DAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekend day?)
MS-HOME-C-DADCHK1 [C33949.00] | Section: The HOME |
([FATHER IN HOUSEHOLD PRELOAD FLAG] == 1)
COMMENT: IF FATHER PRESENT IN MOTHER HOUSEHOLD SKIP TO HOME-C-TXTSUB1
If Answer = 1 Then Go To MS-HOME-C17
MS-HOME-C14 [C33950.00] | Section: The HOME |
Does [Child First Name] ever see [his/her] father, or someone [he/she] considers a father-figure?
MS-HOME-C15 [C33951.00] | Section: The HOME |
Is this man [his/her] biological father, step father, or a father-figure?
| 1 BIOLOGICAL FATHER |
| 2 STEPFATHER |
| 3 FATHER-FIGURE |
MS-HOME-C16 [C33952.00] | Section: The HOME |
What is his relationship to you? (Is he your spouse, your partner, your friend, a relative, or someone else?)
| 1 SPOUSE |
| 2 EX-SPOUSE |
| 3 PARTNER |
| 4 EX-PARTNER |
| 5 BOYFRIEND |
| 6 EX-BOYFRIEND |
| 7 FIANCE |
| 8 FRIEND |
| 9 FATHER |
| 10 GRANDFATHER |
| 11 BROTHER |
| 12 UNCLE |
| 13 SOMEONE ELSE (SPECIFY) |
MS-HOME-C17 [C33953.00] | Section: The HOME |
About how often does [Child First Name] spend time with [his/her] [father/stepfather/father-figure]?
| 1 Once a day or more often |
| 2 At least 4 times a week |
| 3 About once a week |
| 4 About once a month |
| 5 A few times a year or less |
| 6 Never |
| 7 No father, stepfather, or father-figure |
MS-HOME-C18 [C33954.00] | Section: The HOME |
About how often does [Child First Name] spend time with [his/her] [father/stepfather/father-figure] in outdoor activities?
| 1 Once a day or more often |
| 2 At least 4 times a week |
| 3 About once a week |
| 4 About once a month |
| 5 A few times a year or less |
| 6 Never |
| 7 No father, stepfather, or father-figure |
MS-HOME-C19 [C33955.00] | Section: The HOME |
How often does [Child First Name] eat a meal with both you and [his/her] [father/stepfather/father-figure]?
| 1 More than once a day |
| 2 Once a day |
| 3 Several times a week |
| 4 About once a week |
| 5 About once a month |
| 6 Never |
| 7 No father, stepfather, father-figure |
MS-HOME-C20 [C33956.00] | Section: The HOME |
When your family watches TV together, do you [FATHER-FIGURE PRINT TEXT] discuss TV programs with [him/her]?
| 1 Yes |
| 0 No |
| 2 Do not have a TV |
MS-HOME-C21A [C33957.00] | Section: The HOME |
How close does [Child First Name] feel toward...you? Does [he/she] feel...
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-C-DADCHK2 [C33958.00] | Section: The HOME |
([WHODAD])
COMMENT: WHODAD=0 (NO FATHER-FIGURE), SKIP TO HOME-C22A;
WHODAD>=1 SKIP TO HOME-C21B.
If Answer = 0 Then Go To MS-HOME-C22A
If Answer >= 1 AND Answer <= 3 Then Go To MS-HOME-C21B
MS-HOME-C21B [C33959.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] (biological) father?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
| 5 Does not have this parent |
MS-HOME-C-DADCHK3 [C33960.00] | Section: The HOME |
([WHODAD])
COMMENT: IF father is in HH, don't ask about closeness to stepfather/father-figure
(WHODAD=1 skip to HOME-C22A).
If Answer = 1 Then Go To MS-HOME-C22A
MS-HOME-C21D [C33961.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] [father/stepfather/father-figure]?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-C22A [C35760.00] | Section: The HOME |
Sometimes children get so angry at their parents that they say things like "I hate you" or swear in a temper tantrum.
What action(s) you would take if this happened?
INTERVIEWER: ENTER VERBATIM AND MARK ALL THAT APPLY.
MS-HOME-C22B [C33963.00] | Section: The HOME |
| 1 Grounding |
| 2 Spanking |
| 3 Talk with child |
| 4 Give him/her a household chore |
| 5 Ignore it |
| 6 Send to room for more than 1 hour |
| 7 Take away his/her allowance |
| 8 Take away TV, phone, or other privileges |
| 10 Put child in a short "time out" |
| 9 Other (SPECIFY) |
MS-HOME-C23A [C33964.00] | Section: The HOME |
If [Child First Name] brought home a report card with grades lower than expected, how likely would you be to contact [his/her] teacher or principal?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23B [C33965.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to lecture [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23C [C33966.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to keep a closer eye on [his/her] activities?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23D [C33967.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to punish [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23E [C33968.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to talk with [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23F [C33969.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to wait and see if [he/she] improves on [his/her] own?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23G [C33970.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to tell [him/her] to spend more time on schoolwork?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23H [C33971.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to spend more time helping [him/her] with schoolwork?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23I [C33972.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to limit or reduce [his/her] non-school activities (such as play, sports, clubs, etc.)?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-C23J [C33973.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...would you do anything else?
MS-HOME-C23JV [C35761.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected...would you do anything else?)
What would that be?
MS-HOME-C24A [C33975.00] | Section: The HOME |
INTERVIEWER: ENTER NUMBER OF TIMES IN PAST WEEK FOR EACH QUESTION
Sometimes kids mind pretty well and sometimes they don't. Sometimes they do things that make you feel good.
How many times in the past week have you...had to spank your child?
MS-HOME-C24B [C33976.00] | Section: The HOME |
How many times in the past week have you...grounded [him/her]?
MS-HOME-C24C [C33977.00] | Section: The HOME |
How many times in the past week have you...taken away TV or other privileges?
MS-HOME-C24D [C33978.00] | Section: The HOME |
How many times (in the past week) have you...praised [Child First Name] for doing something worthwhile?
MS-HOME-C24E [C33979.00] | Section: The HOME |
How many times (in the past week) have you...taken away [his/her] allowance?
MS-HOME-C24F [C33980.00] | Section: The HOME |
How many times (in the past week) have you...shown [him/her] physical affection (kiss, hug, stroke hair, etc.)?
MS-HOME-C24G [C33981.00] | Section: The HOME |
How many times (in the past week) have you...sent [Child First Name] to [his/her] room?
MS-HOME-C24H [C33982.00] | Section: The HOME |
How many times (in the past week) have you...told another adult (spouse, friend, co-worker, visitor, relative) something positive about [Child First Name]?
MS-HOME-D01 [C33983.00] | Section: The HOME |
About how many books does [Child First Name] have?
| 1 None |
| 2 1 to 9 |
| 3 10 to 19 |
| 4 20 or more |
MS-HOME-D02A [C33984.00] | Section: The HOME |
Please tell me how often [Child First Name] is expected to do each of the following:
How often is [Child First Name] expected to make his/her own bed?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D02B [C33985.00] | Section: The HOME |
How often is [Child First Name] expected to clean his/her own room?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D02C [C33986.00] | Section: The HOME |
How often is [he/she] expected to pick up after [him/her]self?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D02D [C33987.00] | Section: The HOME |
How often is [he/she] expected to help keep shared living areas clean and straight?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D02E [C33988.00] | Section: The HOME |
How often is [he/she] expected to do routine chores such as mow the lawn, help with dinner, wash dishes, etc.?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D02F [C33989.00] | Section: The HOME |
How often is [Child First Name] expected to help manage [his/her] own time (get up on time, be ready for school, etc.)?
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-HOME-D03 [C33990.00] | Section: The HOME |
Is there a musical instrument (for example, piano, drum, guitar, etc.) that your child can use here at home?
MS-HOME-D04 [C33991.00] | Section: The HOME |
Does your family get a daily newspaper?
MS-HOME-D05 [C33992.00] | Section: The HOME |
About how often does [Child First Name] read for enjoyment?
| 1 Every day |
| 2 Several times a week |
| 3 Several times a month |
| 4 Several times a year |
| 5 Never |
MS-HOME-D06 [C33993.00] | Section: The HOME |
Does your family encourage [Child First Name] to start and keep doing hobbies?
MS-HOME-D07 [C33994.00] | Section: The HOME |
Does [Child First Name] get special lessons or belong to any organization that encourages activities such as sports, music, art, dance, drama, etc.?
MS-HOME-D08 [C33995.00] | Section: The HOME |
How often has any family member taken or arranged to take [Child First Name] to any type of museum (children's, scientific, art, historical, etc.) within the past year?
| 1 Never |
| 2 Once or twice |
| 3 Several times |
| 4 About once a month |
| 5 About once a week or more often |
MS-HOME-D09 [C33996.00] | Section: The HOME |
How often has a family member taken or arranged to take [him/her] to any type of musical or theatrical performance within the past year?
| 1 Never |
| 2 Once or twice |
| 3 Several times |
| 4 About once a month |
| 5 About once a week or more often |
MS-HOME-D10 [C33997.00] | Section: The HOME |
About how often does your whole family get together with relatives or friends?
| 1 Once a year or less |
| 2 A few times a year |
| 3 About once a month |
| 4 Two or three times a month |
| 5 About once a week or more |
MS-HOME-D11 [C33998.00] | Section: The HOME |
Think for a moment about a typical weekday for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekday?
INTERVIEWER: ENTER HOURS PER WEEKDAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekday?)
MS-HOME-D12 [C33999.00] | Section: The HOME |
Now, think about a typical weekend day (Saturday or Sunday) for your family. How much time--either in your home or elsewhere--does [Child First Name] spend watching television on a typical weekend day?
INTERVIEWER: ENTER HOURS PER WEEKEND DAY (ROUND TO NEAREST 1/2 HR. "NO" OR "NONE"= 0)
(IF REPLY IS "Do not have a TV" THEN PROMPT: Does [Child First Name] spend any time watching TV outside of your home (for example with a babysitter) on a typical weekend day?)
MS-HOME-D-DADCHK1 [C34000.00] | Section: The HOME |
[FATHER IN HOUSEHOLD PRELOAD FLAG] == 1
COMMENT: IF FATHER PRESENT IN MOTHER HOUSEHOLD SKIP TO HOME-D-TXTSUB1
If Answer = 1 Then Go To MS-HOME-D16
MS-HOME-D13 [C34001.00] | Section: The HOME |
Does [Child First Name] ever see [his/her] father, stepfather, or father-figure?
MS-HOME-D14 [C34002.00] | Section: The HOME |
Is this man [his/her] biological father, stepfather, or a father-figure?
| 1 BIOLOGICAL FATHER |
| 2 STEPFATHER |
| 3 FATHER-FIGURE |
MS-HOME-D15 [C34003.00] | Section: The HOME |
What is his relationship to you? (Is he your spouse, your partner, your friend, a relative, or someone else?)
| 1 SPOUSE |
| 2 EX-SPOUSE |
| 3 PARTNER |
| 4 EX-PARTNER |
| 5 BOYFRIEND |
| 6 EX-BOYFRIEND |
| 7 FIANCE |
| 8 FRIEND |
| 9 FATHER |
| 10 GRANDFATHER |
| 11 BROTHER |
| 12 UNCLE |
| 13 SOMEONE ELSE (SPECIFY) |
MS-HOME-D16 [C34004.00] | Section: The HOME |
About how often does [Child First Name] spend time with [his/her] [father/stepfather/father-figure]?
| 1 Once a day or more often |
| 2 At least 4 times a week |
| 3 About once a week |
| 4 About once a month |
| 5 A few times a year or less |
| 6 Never |
| 7 No father, stepfather, or father-figure |
MS-HOME-D17 [C34005.00] | Section: The HOME |
About how often does [he/she] spend time with [his/her] [father/stepfather/father-figure] in outdoor activities?
| 1 Once a day or more often |
| 2 At least 4 times a week |
| 3 About once a week |
| 4 About once a month |
| 5 A few times a year or less |
| 6 Never |
| 7 No father, stepfather, or father-figure |
MS-HOME-D18 [C34006.00] | Section: The HOME |
How often does [Child First Name] eat a meal with both mother and father?
| 1 More than once a day |
| 2 Once a day |
| 3 Several times a week |
| 4 About once a week |
| 5 About once a month |
| 6 Never |
| 7 No father, stepfather, father-figure |
MS-HOME-D19 [C34007.00] | Section: The HOME |
When your family watches TV together, do you [FATHER-FIGURE PRINT TEXT] discuss TV programs with [him/her]?
| 1 Yes |
| 0 No |
| 2 Do not have a TV |
MS-HOME-D20A [C34008.00] | Section: The HOME |
How close does [Child First Name] feel toward you?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
MS-HOME-D-DADCHK2 [C34009.00] | Section: The HOME |
([WHODAD])
COMMENT: WHODAD=0 (NO FATHER-FIGURE), SKIP TO HOME-D21A;
WHODAD>=1 SKIP TO HOME-D20B.
If Answer = 0 Then Go To MS-HOME-D21A
If Answer >= 1 AND Answer <= 3 Then Go To MS-HOME-D20B
MS-HOME-D20B [C34010.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] (biological) father?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
| 5 Does not have this parent |
MS-HOME-D-DADCHK3 [C34011.00] | Section: The HOME |
([WHODAD])
COMMENT: IF father is in HH, don't ask about closeness to stepfather (WHODAD=1 skip to HOME-D21A).
If Answer = 1 Then Go To MS-HOME-D21A
MS-HOME-D20D [C34012.00] | Section: The HOME |
How close does [Child First Name] feel toward [his/her] [father/stepfather/father-figure]?
| 1 Extremely close |
| 2 Quite close |
| 3 Fairly close |
| 4 Not at all close |
| 5 Does not have this parent |
MS-HOME-D21A [C35762.00] | Section: The HOME |
Sometimes children get so angry at their parents that they say things like "I hate you" or swear in a temper tantrum.
What action(s) would you take if this happened?
INTERVIEWER: ENTER VERBATIM AND MARK ALL THAT APPLY.
MS-HOME-D21B [C34014.00] | Section: The HOME |
| 1 Grounding |
| 2 Spanking |
| 3 Talk with child |
| 4 Give him/her a household chore |
| 5 Ignore it |
| 6 Send to room for more than 1 hour |
| 7 Take away his/her allowance |
| 8 Take away TV, phone, or other privileges |
| 10 Put child in a short "time out" |
| 9 Other (SPECIFY) |
MS-HOME-D22A [C34015.00] | Section: The HOME |
If [Child First Name] brought home a report card with grades lower than expected, how likely would you be to contact [his/her] teacher or principal?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22B [C34016.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to lecture [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22C [C34017.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to keep a closer eye on [his/her] activities?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22D [C34018.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to punish [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22E [C34019.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to talk with [him/her]?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22F [C34020.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to wait and see if [he/she] improves on [his/her] own?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22G [C34021.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to tell [him/her] to spend more time on schoolwork?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22H [C34022.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to spend more time helping [him/her] with schoolwork?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22I [C34023.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...how likely would you be to limit or reduce [his/her] non-school activities (such as play, sports, clubs, etc.)?
| 5 Very Likely |
| 4 Somewhat Likely |
| 3 Not Sure How Likely |
| 2 Somewhat Unlikely |
| 1 Not At All Likely |
MS-HOME-D22J [C34024.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected),
...would you do anything else?
MS-HOME-D22JV [C35763.00] | Section: The HOME |
(If [Child First Name] brought home a report card with grades lower than expected...would you do anything else?)
What would that be?
MS-HOME-D23A [C34026.00] | Section: The HOME |
INTERVIEWER: ENTER NUMBER OF TIMES IN PAST WEEK FOR EACH QUESTION
Sometimes kids mind pretty well and sometimes they don't. Sometimes they do things that make you feel good.
How many times in the past week have you...had to spank your child?
MS-HOME-D23B [C34027.00] | Section: The HOME |
How many times in the past week have you...grounded [him/her]?
MS-HOME-D23C [C34028.00] | Section: The HOME |
How many times in the past week have you...taken away TV or other privileges?
MS-HOME-D23D [C34029.00] | Section: The HOME |
How many times (in the past week) have you...praised [Child First Name] for doing something worthwhile?
MS-HOME-D23E [C34030.00] | Section: The HOME |
How many times (in the past week) have you...taken away [his/her] allowance?
MS-HOME-D23F [C34031.00] | Section: The HOME |
How many times (in the past week) have you...shown [him/her] physical affection (kiss, hug, stroke hair, etc.)?
MS-HOME-D23G [C34032.00] | Section: The HOME |
How many times (in the past week) have you...sent [Child First Name] to [his/her] room?
MS-HOME-D23H [C34033.00] | Section: The HOME |
How many times (in the past week) have you...told another adult (spouse, friend, co-worker, visitor, relative) something positive about [Child First Name]?
MS-ACT-AGECK1 [C34036.00] | Section: TEMPERAMENT |
[CHILD AGE IN MONTHS] < 84
COMMENT: If child age is 83 months or younger and meets YOB/BORNSR19 constraints, then continue OTHERWISE goto end of section
If Answer = 1 Then Go To MS-ACT-TITLE
MS-ACT-TITLE [] | Section: TEMPERAMENT |
**** BEGIN SECTION: TEMPERAMENT *****
MS-ACT-INTRO [] | Section: TEMPERAMENT |
INTERVIEWER: THE FOLLOWING SECTION IS A CHILD ASSESSMENT.
IT IS VITAL THAT YOU COMPLETE ALL QUESTIONS IN THIS SECTION.
READ TO MOTHER:
We are interested in how your child normally acts during an average day. Please think about [Child First Name] during the last two weeks.
If [he/she] was not feeling well, think back to the last two-week time period when [he/she] was [his/her] normal self.
MS-ACT-AGECK2 [C34037.00] | Section: TEMPERAMENT |
([CHILD AGE IN MONTHS])
COMMENT: Jump to appropriate section based on months of age.
If Answer >= 0 AND Answer <= 11 Then Go To MS-ACT-A01
If Answer >= 12 AND Answer <= 23 Then Go To MS-ACT-B01
If Answer >= 24 AND Answer <= 83 Then Go To MS-ACT-C01
MS-ACT-A01 [C34038.00] | Section: TEMPERAMENT |
(The following questions ask about how often [Child First Name] acted in a certain way.)
During feeding, how often does [Child First Name] squirm and kick?
Would that be...
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A02 [C34039.00] | Section: TEMPERAMENT |
During feeding, how often does [Child First Name] wave [his/her] arms?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A03 [C34040.00] | Section: TEMPERAMENT |
During sleep, how often does [he/she] usually move around in the crib?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A04 [C34041.00] | Section: TEMPERAMENT |
Some children get sleepy about the same time each evening, give or take 15 minutes. How often does [Child First Name] do this?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A05 [C34042.00] | Section: TEMPERAMENT |
Some children get hungry at about the same time each day, give or take 15 minutes. How often does [Child First Name] do this?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A06 [C34043.00] | Section: TEMPERAMENT |
When [he/she] wakes up in the morning, how often is [he/she] in the same mood?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A07 [C34044.00] | Section: TEMPERAMENT |
When [Child First Name] sees a stranger, how often does [he/she] turn away or cry as if afraid?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A08 [C34045.00] | Section: TEMPERAMENT |
When [he/she] sees an unfamiliar dog or cat, how often does [he/she] turn away or cry as if afraid?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A09 [C34046.00] | Section: TEMPERAMENT |
When you leave the room and leave [him/her] alone, how often does [he/she] become upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A10 [C34047.00] | Section: TEMPERAMENT |
When you take [Child First Name] to the doctor, dentist or nurse, how often does [he/she] turn away or cry as if afraid?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A11 [C34048.00] | Section: TEMPERAMENT |
When you play with [Child First Name], how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A12 [C34049.00] | Section: TEMPERAMENT |
When [he/she] plays alone, how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A13 [C34050.00] | Section: TEMPERAMENT |
When [he/she] is in the bath, how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A14 [C34051.00] | Section: TEMPERAMENT |
When [Child First Name] hears an unexpected loud sound (for example, a car back-firing or a vacuum cleaner), how often does [he/she] cry or become upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A15 [C34052.00] | Section: TEMPERAMENT |
How often do you have trouble soothing or calming [him/her] when [he/she] is crying or upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-A16 [C34053.00] | Section: TEMPERAMENT |
The answer choices change a little here....
During the average day, how often does [Child First Name] get fussy and irritable?
Would you say...
| 1 Almost never |
| 2 Once or twice a day |
| 3 A couple of times a.m. & p.m. |
| 4 Several times a day |
| 5 Almost every hour |
MS-ACT-A17 [C34054.00] | Section: TEMPERAMENT |
In general, compared with most babies, how often does [Child First Name] cry and fuss?
Would that be...
| 1 Almost never |
| 2 Less than average |
| 3 About average |
| 4 More than average |
| 5 Almost always |
MS-ACT-B01 [C34055.00] | Section: TEMPERAMENT |
(The following questions ask about how often [Child First Name] acted in a certain way.)
When [Child First Name] sees a stranger, how often does [he/she] turn away or cry as if afraid?
Would that be...
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B02 [C34056.00] | Section: TEMPERAMENT |
When [Child First Name] sees an unfamiliar dog or cat, how often does [he/she] turn away or cry as if afraid?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B03 [C34057.00] | Section: TEMPERAMENT |
When you leave the room and leave [him/her] alone, how often does [he/she] become upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B04 [C34058.00] | Section: TEMPERAMENT |
When you take [Child First Name] to the doctor, dentist or nurse, how often does [he/she] turn away or cry as if afraid?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B05 [C34059.00] | Section: TEMPERAMENT |
When you play with [Child First Name], how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B06 [C34060.00] | Section: TEMPERAMENT |
When [he/she] plays alone, how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B07 [C34061.00] | Section: TEMPERAMENT |
When [he/she] is in the bath, how often does [he/she] smile or laugh?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B08 [C34062.00] | Section: TEMPERAMENT |
When [Child First Name] hears an unexpected loud sound (for example, a car back-firing or a vacuum cleaner), how often does [he/she] cry or become upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B09 [C34063.00] | Section: TEMPERAMENT |
How often do you have trouble soothing or calming [him/her] when [he/she] is crying or upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-B10 [C34064.00] | Section: TEMPERAMENT |
The answer choices change a little here....
During the average day, how often does [Child First Name] get fussy and irritable?
Would you say...
| 1 Almost never |
| 2 Once or twice a day |
| 3 A couple of times a.m. & p.m. |
| 4 Several times a day |
| 5 Almost every hour |
MS-ACT-B11 [C34065.00] | Section: TEMPERAMENT |
In general, compared with most toddlers, how often does [Child First Name] cry and fuss?
Would that be...
| 1 Almost never |
| 2 Less than average |
| 3 About average |
| 4 More than average |
| 5 Almost always |
MS-ACT-C01 [C34066.00] | Section: TEMPERAMENT |
(The following questions ask about how often [Child First Name] acted in a certain way.)
When it is mealtime, how often does [Child First Name] eat what you want [him/her] to eat?
Would that be...
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C02 [C34067.00] | Section: TEMPERAMENT |
When [Child First Name] doesn't eat what you want [him/her] to eat and you tell [him/her] to do so, how often does [he/she] obey and eat?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C03 [C34068.00] | Section: TEMPERAMENT |
When it is [Child First Name]'s bedtime, how often does [he/she] protest or resist going to bed?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C04 [C34069.00] | Section: TEMPERAMENT |
When [he/she] does protest and you tell [him/her] again to go to bed, how often does [he/she] do so?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C05 [C34070.00] | Section: TEMPERAMENT |
When you tell [Child First Name] to turn off the TV, how often does [he/she] do so without protest?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C06 [C34071.00] | Section: TEMPERAMENT |
When [he/she] does protest and you tell [him/her] again to turn off the TV, how often does [he/she] do so?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C07 [C34072.00] | Section: TEMPERAMENT |
When [Child First Name] meets a new child about the same age, how often is [he/she] shy at first?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C08 [C34073.00] | Section: TEMPERAMENT |
When [he/she] meets an adult [he/she] does not know, how often is [he/she] shy at first?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C09 [C34074.00] | Section: TEMPERAMENT |
How often does [Child First Name] cry when [he/she] hurts [him/her]self a little bit?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C10 [C34075.00] | Section: TEMPERAMENT |
How often does [he/she] laugh and smile easily (for example, when no one is touching [him/her])?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C11 [C34076.00] | Section: TEMPERAMENT |
When [Child First Name] is with other children [his/her] own age, how often does [he/she] fight, take toys, hit, and so on?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C12 [C34077.00] | Section: TEMPERAMENT |
When [he/she] is with other children [his/her] own age, how often does [he/she] willingly share toys?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C13 [C34078.00] | Section: TEMPERAMENT |
How often do you have trouble soothing or calming [Child First Name] when [he/she] is upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C14 [C34079.00] | Section: TEMPERAMENT |
When [Child First Name] is playing, how often does [he/she] stay close to you and make sure that [he/she] can still see you?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C15 [C34080.00] | Section: TEMPERAMENT |
How often does [he/she] try to copy what you do or how you act? (You may not always allow [him/her] to do this.)
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C16 [C34081.00] | Section: TEMPERAMENT |
When you leave the room and leave [Child First Name] alone, how often does [he/she] get upset?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C17 [C34082.00] | Section: TEMPERAMENT |
How often is [Child First Name] demanding and impatient even when you are busy?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C18 [C34083.00] | Section: TEMPERAMENT |
When you get upset about something, how often does [he/she] get worried, or try to help, or make you feel better?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C19 [C34084.00] | Section: TEMPERAMENT |
How often does [Child First Name] want you to help with the things [he/she] is doing?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-ACT-C20 [C34085.00] | Section: TEMPERAMENT |
During the past year, how often has [Child First Name] slept through the night?
(Would that be...)
| 1 Almost never |
| 2 Less than 1/2 of the time |
| 3 1/2 of the time |
| 4 More than 1/2 of the time |
| 5 Almost always |
MS-MSD-AGECK1 [C34088.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
[CHILD AGE IN MONTHS]<48
COMMENT: MSD A1 to H15 Dropped for R21.
If Answer = 1 Then Go To MS-MSD-TITLE
MS-MSD-TITLE [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
**** BEGIN SECTION: MOTOR AND SOCIAL DEVELOPMENT *****
MS-MSD-INTRO [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
INTERVIEWER: THE FOLLOWING SECTION IS A CHILD ASSESSMENT.
IT IS VITAL THAT YOU COMPLETE ALL QUESTIONS IN THIS SECTION.
READ TO MOTHER
This section asks you questions about things children do at different ages.
MS-MSD-AGECK2 [C34089.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
[CHILD AGE IN MONTHS]
COMMENT: AGE SKIP INFO FROM PREVIOUS ROUNDS PRESERVED - NOT ALL BRANCHES APPLY If child age is 0 to 3 mos jump to MSD A If child age is 4 to 6 mos jump to MSD B If child age is 7 to 9 mos jump to MSD C If child age is 10 to 12 mos jump to MSD D If child age is 13 to 15 mos jump to MSD E If child age is 16 to 18 mos jump to MSD F If child age is 19 to 21 mos jump to MSD G If child age is 22 to 47 mos jump to MSD H
If Answer >= 0 AND Answer <= 3 Then Go To MS-MSD-A01
If Answer >= 4 AND Answer <= 6 Then Go To MS-MSD-B01
If Answer >= 7 AND Answer <= 9 Then Go To MS-MSD-C01
If Answer >= 10 AND Answer <= 12 Then Go To MS-MSD-D01
If Answer >= 13 AND Answer <= 15 Then Go To MS-MSD-E01
If Answer >= 16 AND Answer <= 18 Then Go To MS-MSD-F01
If Answer >= 19 AND Answer <= 21 Then Go To MS-MSD-G01
If Answer >= 22 AND Answer <= 47 Then Go To MS-MSD-H01
MS-MSD-A01 [C34090.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
When lying on [his/her] stomach, has [Child First Name] ever turned [his/her] head from side to side?
MS-MSD-A02 [C34091.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Have [Child First Name]'s eyes ever followed a moving object?
MS-MSD-A03 [C34092.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
When lying on [his/her] stomach on a flat surface, has [Child First Name] ever lifted [his/her] head off the surface for a moment?
MS-MSD-A04 [C34093.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Have [Child First Name]'s eyes ever followed a moving object all the way from one side to the other?
MS-MSD-A05 [C34094.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever smiled at someone when that person talked to or smiled at (but did not touch) [him/her]?
MS-MSD-A06 [C34095.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
When lying on [his/her] stomach, has [Child First Name] ever raised [his/her] head AND chest from the surface while resting [his/her] weight on [his/her] lower arms or hands?
MS-MSD-A07 [C34096.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever turned [his/her] head around to look at something?
MS-MSD-A08 [C34097.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
While lying on [his/her] back and being pulled up to a sitting position, did [Child First Name] ever hold [his/her] head stiffly so that it DID NOT hang back as [he/she] was pulled up?
MS-MSD-A09 [C34098.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever laughed out loud without being tickled or touched?
MS-MSD-A10 [C34099.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever held in one hand a moderate size object such as a block or a rattle?
MS-MSD-A11 [C34100.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever rolled over on [his/her] own ON PURPOSE?
MS-MSD-A12 [C34101.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever seemed to enjoy looking in the mirror at [him/her]self?
MS-MSD-A13 [C34102.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever been pulled from a sitting to a standing position and supported [his/her] own weight with legs stretched out?
MS-MSD-A14 [C34103.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever looked around with [his/her] eyes for a toy which was lost or not nearby?
MS-MSD-A15 [C34104.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever sat alone with no help except for leaning forward on [his/her] hands or with just a little help from someone else?
MS-MSD-B01 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
While lying on [his/her] back and being pulled up to a sitting position, has [Child First Name] ever held [his/her] head stiffly so that it DID NOT hang back as [he/she] was pulled up?
MS-MSD-B02 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever laughed out loud without being tickled or touched?
MS-MSD-B03 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever held in one hand a moderate size object such as a block or a rattle?
MS-MSD-B04 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever rolled over on [his/her] own ON PURPOSE?
MS-MSD-B05 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever seemed to enjoy looking in the mirror at [him/her]self?
MS-MSD-B06 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever been pulled from a sitting to a standing position and supported [his/her] own weight with legs stretched out?
MS-MSD-B07 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever looked around with [his/her] eyes for a toy which was lost or not nearby?
MS-MSD-B08 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever sat alone with no help except for leaning forward on [his/her] hands or with just a little help from someone else?
MS-MSD-B09 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever sat for 10 minutes without any support at all?
MS-MSD-B10 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever pulled [him/her]self to a standing position without help from another person?
MS-MSD-B11 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever crawled when left lying on [his/her] stomach?
MS-MSD-B12 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever said any recognizable words such as "mama" or "dada"?
MS-MSD-B13 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever picked up small objects such as raisins or cookie crumbs, using only [his/her] thumb and first finger?
MS-MSD-B14 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked at least 2 steps with one hand held or holding on to something?
MS-MSD-B15 [] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever waved good-bye without help from another person?
MS-MSD-C01 [C34105.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever seemed to enjoy looking in the mirror at [him/her]self?
MS-MSD-C02 [C34106.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever been pulled from a sitting to a standing position and supported [his/her] own weight with legs stretched out?
MS-MSD-C03 [C34107.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever looked around with [his/her] eyes for a toy which was lost or not nearby?
MS-MSD-C04 [C34108.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever sat alone with no help except for leaning forward on [his/her] hands or with just a little help from someone else?
MS-MSD-C05 [C34109.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever sat for 10 minutes without any support at all?
MS-MSD-C06 [C34110.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever pulled [him/her]self to a standing position without help from another person?
MS-MSD-C07 [C34111.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever crawled when left lying on [his/her] stomach?
MS-MSD-C08 [C34112.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said any recognizable words such as "mama" or "dada"?
MS-MSD-C09 [C34113.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever picked up small objects such as raisins or cookie crumbs, using only [his/her] thumb and first finger?
MS-MSD-C10 [C34114.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked at least 2 steps with one hand held or holding on to something?
MS-MSD-C11 [C34115.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever waved good-bye without help from another person?
MS-MSD-C12 [C34116.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever shown by [his/her] behavior that [he/she] knows the names of common objects when somebody else names them out loud?
MS-MSD-C13 [C34117.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever shown that [he/she] wanted something by pointing, pulling, or making pleasant sounds rather than crying or whining?
MS-MSD-C14 [C34118.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever stood alone on [his/her] feet for 10 seconds or more without holding on to anything or another person?
MS-MSD-C15 [C34119.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked at least 2 steps without holding on to anything or another person?
MS-MSD-D01 [C34120.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever crawled when left lying on [his/her] stomach?
MS-MSD-D02 [C34121.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said any recognizable words such as "mama" or "dada"?
MS-MSD-D03 [C34122.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever picked up small objects such as raisins or cookie crumbs, using only [his/her] thumb and first finger?
MS-MSD-D04 [C34123.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked at least 2 steps with one hand held or holding on to something?
MS-MSD-D05 [C34124.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever waved good-bye without help from another person?
MS-MSD-D06 [C34125.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever shown by [his/her] behavior that [he/she] knows the names of common objects when somebody else names them out loud?
MS-MSD-D07 [C34126.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever shown that [he/she] wanted something by pointing, pulling, or making pleasant sounds rather than crying or whining?
MS-MSD-D08 [C34127.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever stood alone on [his/her] feet for 10 seconds or more without holding on to anything or another person?
MS-MSD-D09 [C34128.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked at least 2 steps without holding on to anything or another person?
MS-MSD-D10 [C34129.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever crawled up at least 2 stairs or steps?
MS-MSD-D11 [C34130.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] said 2 recognizable words besides "mama" and "dada"?
MS-MSD-D12 [C34131.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever run?
MS-MSD-D13 [C34132.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said the name of a familiar object, such as a ball?
MS-MSD-D14 [C34133.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever made a line with a crayon or pencil?
MS-MSD-D15 [C34134.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Did [he/she] ever walk up at least 2 stairs with one hand held or holding the railing?
MS-MSD-E01 [C34135.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever waved good-bye without help from another person?
MS-MSD-E02 [C34136.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever shown by [his/her] behavior that [he/she] knows the names of common objects when somebody else names them out loud?
MS-MSD-E03 [C34137.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever shown that [he/she] wanted something by pointing, pulling, or making pleasant sounds rather than crying or whining?
MS-MSD-E04 [C34138.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever stood alone on [his/her] feet for 10 seconds or more without holding on to anything or another person?
MS-MSD-E05 [C34139.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked at least 2 steps without holding on to anything or another person?
MS-MSD-E06 [C34140.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever crawled up at least 2 stairs or steps?
MS-MSD-E07 [C34141.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] said 2 recognizable words besides "mama" and "dada"?
MS-MSD-E08 [C34142.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever run?
MS-MSD-E09 [C34143.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever said the name of a familiar object such as a ball?
MS-MSD-E10 [C34144.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever made a line with a crayon or pencil?
MS-MSD-E11 [C34145.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Did [Child First Name] ever walk up at least 2 stairs with one hand held or holding the railing?
MS-MSD-E12 [C34146.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever fed [him/her]self with a spoon or fork without spilling much?
MS-MSD-E13 [C34147.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever let someone know, without crying, that wearing wet (soiled) pants or diapers bothered [him/her]?
MS-MSD-E14 [C34148.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever spoken a partial sentence of 3 words or more?
MS-MSD-E15 [C34149.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked up stairs by [him/her]self without holding on to a rail?
MS-MSD-F01 [C34150.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked at least 2 steps without holding on to anything or another person?
MS-MSD-F02 [C34151.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever crawled up at least 2 stairs or steps?
MS-MSD-F03 [C34152.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] said 2 recognizable words besides "mama" and "dada"?
MS-MSD-F04 [C34153.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever run?
MS-MSD-F05 [C34154.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said the name of a familiar object such as a ball?
MS-MSD-F06 [C34155.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever made a line with a crayon or pencil?
MS-MSD-F07 [C34156.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Did [Child First Name] ever walk up at least 2 stairs with one hand held or holding the railing?
MS-MSD-F08 [C34157.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever fed [him/her]self with a spoon or fork without spilling much?
MS-MSD-F09 [C34158.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever let someone know, without crying, that wearing wet (soiled) pants or diapers bothered [him/her]?
MS-MSD-F10 [C34159.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever spoken in a partial sentence of 3 words or more?
MS-MSD-F11 [C34160.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked upstairs by [him/her]self without holding on to a rail?
MS-MSD-F12 [C34161.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever washed and dried [his/her] hands without any help except for turning the water on and off?
MS-MSD-F13 [C34162.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever counted 3 objects correctly?
MS-MSD-F14 [C34163.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever gone to the toilet alone?
MS-MSD-F15 [C34164.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked up stairs by [him/her]self with no help, stepping on each step with only one foot?
MS-MSD-G01 [C34165.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever run?
MS-MSD-G02 [C34166.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said the name of a familiar object such as a ball?
MS-MSD-G03 [C34167.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever made a line with a crayon or pencil?
MS-MSD-G04 [C34168.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Did [Child First Name] ever walk up at least 2 stairs with one hand held or holding the railing?
MS-MSD-G05 [C34169.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever fed [him/her]self with a spoon or fork without spilling much?
MS-MSD-G06 [C34170.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever let someone know, without crying, that wearing wet (soiled) pants or diapers bothered [him/her]?
MS-MSD-G07 [C34171.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever spoken in a partial sentence of 3 words or more?
MS-MSD-G08 [C34172.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked up stairs by [him/her]self without holding on to a rail?
MS-MSD-G09 [C34173.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever washed and dried [his/her] hands without any help except for turning the water on and off?
MS-MSD-G10 [C34174.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever counted 3 objects correctly?
MS-MSD-G11 [C34175.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever gone to the toilet alone?
MS-MSD-G12 [C34176.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked up stairs by [him/her]self with no help, stepping on each step with only one foot?
MS-MSD-G13 [C34177.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Does [Child First Name] know [his/her] own age AND sex?
MS-MSD-G14 [C34178.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said the names of at least 4 colors?
MS-MSD-G15 [C34179.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever pedaled a tricycle at least 10 feet?
MS-MSD-H01 [C34180.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever let someone know, without crying, that wearing wet (soiled) pants or diapers bothered [him/her]?
MS-MSD-H02 [C34181.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever spoken a partial sentence of 3 words or more?
MS-MSD-H03 [C34182.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever walked up stairs by [him/her]self without holding on to a rail?
MS-MSD-H04 [C34183.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever washed and dried [his/her] hands without any help except for turning the water on and off?
MS-MSD-H05 [C34184.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever counted 3 objects correctly?
MS-MSD-H06 [C34185.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever gone to the toilet alone?
MS-MSD-H07 [C34186.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever walked up stairs by [him/her]self with no help, stepping on each step with only one foot?
MS-MSD-H08 [C34187.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Does [Child First Name] know [his/her] own age AND sex?
MS-MSD-H09 [C34188.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever said the names of at least 4 colors?
MS-MSD-H10 [C34189.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever pedaled a tricycle at least 10 feet?
MS-MSD-H11 [C34190.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever done a somersault without help from anybody?
MS-MSD-H12 [C34191.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever dressed [him/her]self without any help except for [tying shoes/tying shoes and buttoning the backs of dresses]?
MS-MSD-H13 [C34192.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever said [his/her] first and last name together without someone's help? (Nickname may be used for first name.)
MS-MSD-H14 [C34193.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [Child First Name] ever counted out loud up to 10?
MS-MSD-H15 [C34194.00] | Section: MOTOR AND SOCIAL DEVELOPMENT |
Has [he/she] ever drawn a picture of a man or woman with at least 2 parts of the body besides a head?
MS-BPI-INTRO [] | Section: BEHAVIOR PROBLEMS INDEX |
The following statements are about behavior problems many children have. For each item, think about [Child First Name]'s behavior over the last three months. Then indicate whether the statement is often true, sometimes true, or not true.
MS-BPI-01 [C34197.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...has sudden changes in mood or feeling.
Is this statement often true, sometimes true, or not true?
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-02 [C34198.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...feels or complains that no one loves [him/her].
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-03 [C34199.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is rather high strung, tense and nervous.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-04 [C34200.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...cheats or tells lies.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-05 [C34201.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is too fearful or anxious.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-06 [C34202.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name] ...argues too much.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-07 [C34203.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...has difficulty concentrating, cannot pay attention for long.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-08 [C34204.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is easily confused, seems to be in a fog.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-09 [C34205.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...bullies or is cruel or mean to others.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-10 [C34206.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is disobedient at home.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-11 [C34207.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name] ...does not seem to feel sorry after [he/she] misbehaves.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-12 [C34208.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...has trouble getting along with other children.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-13 [C34209.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is impulsive, or acts without thinking.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-14 [C34210.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...feels worthless or inferior.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-15 [C34211.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is not liked by other children.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-16 [C34212.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...has a lot of difficulty getting [his/her] mind off certain thoughts (has obsessions).
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-17 [C34213.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is restless or overly active, cannot sit still.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-18 [C34214.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is stubborn, sullen, or irritable.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-19 [C34215.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...has a very strong temper and loses it easily.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-20 [C34216.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is unhappy, sad, or depressed.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-21 [C34217.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is withdrawn, does not get involved with others.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-22 [C34218.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...breaks things on purpose or deliberately destroys [his/her] own or another's things.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-23 [C34219.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...clings to adults.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-24 [C34220.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...cries too much.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-25 [C34221.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...demands a lot of attention.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-26 [C34222.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is too dependent on others.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-27 [C34223.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...feels others are out to get [him/her].
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-28 [C34224.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...hangs around with kids who get into trouble.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-29 [C34225.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...is secretive, keeps things to [him/her]self.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-30 [C34226.00] | Section: BEHAVIOR PROBLEMS INDEX |
[Child First Name]...worries too much.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
MS-BPI-SCHLCK [C34227.00] | Section: BEHAVIOR PROBLEMS INDEX |
([IN SCHOOL] == 1) || ([EVER IN SCHOOL] == 1)
If Answer = 1 Then Go To MS-BPI-31
MS-BPI-31 [C34228.00] | Section: BEHAVIOR PROBLEMS INDEX |
Please answer even if school is not in session:
[Child First Name]...is disobedient at school.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
| 4 Never Attended School |
MS-BPI-32 [C34229.00] | Section: BEHAVIOR PROBLEMS INDEX |
(Please answer even if school is not in session:)
[Child First Name]...has trouble getting along with teachers.
| 1 Often True |
| 2 Sometimes True |
| 3 Not True |
| 4 Never Attended School |
MS-BPI-END [] | Section: BEHAVIOR PROBLEMS INDEX |
End of series. Click on the "Submit and Continue" button to proceed....
COMMENT: ------------END OF BEHAVIOR PROBLEM INDEX ASSESSMENT-------------
MS-BKGN-CASI-AGECK1 [C35765.00] | Section: MS CASI SECTION |
[CHILD AGE (YEARS)] >= 5
COMMENT: If child age is 5 years or OLDER then continue;
Otherwise, skip to BKGN-CASI-END
If Answer = 1 Then Go To MS-BKGN-37
MS-BKGN-37 [C35767.00] | Section: MS CASI SECTION |
[Has/Since we last interviewed you on (date of mom's last interview) has] [Child First Name] repeated a grade for any reason?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-BKGN-37-LOOP-BEGIN [] | Section: MS CASI SECTION |
REPEAT
MS-BKGN-37A [C35770.00] | Section: MS CASI SECTION |
What was the [most recent/next most recent] grade that [Child First Name] repeated?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 0 PRE-KINDERGARTEN/KINDERGARTEN/PRE-1ST GRADE |
| 1 1ST GRADE |
| 2 2ND GRADE |
| 3 3RD GRADE |
| 4 4TH GRADE |
| 5 5TH GRADE |
| 6 6TH GRADE |
| 7 7TH GRADE |
| 8 8TH GRADE |
| 9 9TH GRADE |
| 10 10TH GRADE |
| 11 11TH GRADE |
| 12 12TH GRADE |
MS-BKGN-37B [C35771.00] | Section: MS CASI SECTION |
What was the main reason [he/she] repeated that grade?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 1 Academic failure or lack of ability |
| 2 Immature; acts too young |
| 3 Frequently absent (excused absence) |
| 4 Truancy (unexcused absence) |
| 5 Health reasons |
| 6 Moved into a more difficult school |
| 7 Other reason (SPECIFY) |
MS-BKGN-37C [C35772.00] | Section: MS CASI SECTION |
Has [Child First Name] repeated any other grades?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-BKGN-37-LOOP-END [] | Section: MS CASI SECTION |
UNTIL([ANY MORE TO REPORT?]==0)
MS-BKGN-38 [C35774.00] | Section: MS CASI SECTION |
Has [Child First Name] ever had any behavior problems at school resulting in your receiving a note or being asked to come in and talk to the teacher or principal?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-BKGN-39 [C35775.00] | Section: MS CASI SECTION |
What grade was [Child First Name] in the first time you received a note, or were asked to come in and talk to the teacher or principal?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 90 NURSERY/PRESCHOOL |
| 0 KINDERGARTEN |
| 1 1ST GRADE |
| 2 2ND GRADE |
| 3 3RD GRADE |
| 4 4TH GRADE |
| 5 5TH GRADE |
| 6 6TH GRADE |
| 7 7TH GRADE |
| 8 8TH GRADE |
| 9 9TH GRADE |
| 10 10TH GRADE |
| 11 11TH GRADE |
| 12 12TH GRADE |
MS-BKGN-40 [C35776.00] | Section: MS CASI SECTION |
Has [Child First Name] ever been suspended or expelled from school?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-BKGN-40A [C35777.00] | Section: MS CASI SECTION |
(Has your child ever been suspended or expelled from school?)
In what grade did this first happen?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 90 NURSERY/PRESCHOOL |
| 0 KINDERGARTEN |
| 1 1ST GRADE |
| 2 2ND GRADE |
| 3 3RD GRADE |
| 4 4TH GRADE |
| 5 5TH GRADE |
| 6 6TH GRADE |
| 7 7TH GRADE |
| 8 8TH GRADE |
| 9 9TH GRADE |
| 10 10TH GRADE |
| 11 11TH GRADE |
| 12 12TH GRADE |
MS-BKGN-41 [C35778.00] | Section: MS CASI SECTION |
[IN SCHOOL] == 1
If Answer = 1 Then Go To MS-BKGN-42
MS-BKGN-42 [C35779.00] | Section: MS CASI SECTION |
Is your child one of the best students in class, above the middle, in the middle, below the middle, or near the bottom of the class?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 1 One of the best students in class |
| 2 Above the middle |
| 3 In the middle |
| 4 Below the middle |
| 5 Near the bottom of the class |
MS-BKGN-43A [C35780.00] | Section: MS CASI SECTION |
Please think about how well [Child First Name]'s school does its job.
What grade would you give the school for how much the teachers care about the students?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-BKGN-43B [C35781.00] | Section: MS CASI SECTION |
What grade would you give the school for how effective the principal is as the leader of the school?
MS-BKGN-43C [C35782.00] | Section: MS CASI SECTION |
What grade would you give the school for the skill of the teachers?
MS-BKGN-43D [C35783.00] | Section: MS CASI SECTION |
What grade would you give the school for how safe the school is for the students to attend?
MS-BKGN-43E [C35784.00] | Section: MS CASI SECTION |
What grade would you give the school for letting parents know how their children are doing?
MS-BKGN-43F [C35785.00] | Section: MS CASI SECTION |
What grade would you give the school for letting parents participate in decisions about how the school is run?
MS-BKGN-43G [C35786.00] | Section: MS CASI SECTION |
What grade would you give the school for helping students learn the difference between right and wrong?
MS-BKGN-43H [C35787.00] | Section: MS CASI SECTION |
What grade would you give for maintaining order and discipline?
MS-BKGN-44 [C35788.00] | Section: MS CASI SECTION |
Looking ahead, how far do you think [Child First Name] will go in school? Will [he/she]...
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 1 leave high school before graduation |
| 2 graduate from high school |
| 3 get some college or other training |
| 4 graduate from college |
| 5 take further training after college |
| 6 or something else? (SPECIFY) |
MS-BKGN-45 [C35789.00] | Section: MS CASI SECTION |
In general, how much trouble has [Child First Name] been to bring up?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 1 None |
| 2 Just a little |
| 3 Quite a bit |
| 4 A lot |
MS-BKGN-46A [C35790.00] | Section: MS CASI SECTION |
Think now about how things are going in general in [Child First Name]'s life. Please rate each of the following parts of [his/her] life as either excellent, good, only fair, or poor.
First, how would you rate [Child First Name]'s health?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
MS-BKGN-46B [C35791.00] | Section: MS CASI SECTION |
How would you rate [his/her] friendships?
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
MS-BKGN-46C [C35792.00] | Section: MS CASI SECTION |
(How would you rate...) [his/her] relationship with you?
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
MS-BKGN-46D [C35793.00] | Section: MS CASI SECTION |
(How would you rate...) [his/her] feelings about [him/her]self?
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
MS-BKGN-46E [C35794.00] | Section: MS CASI SECTION |
(How would you rate...) [his/her] prospects for the future?
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
MS-BKGN-46F [C35795.00] | Section: MS CASI SECTION |
(How would you rate...) [his/her] relationships with brothers, sisters, or other children [he/she] lives with?
| 4 EXCELLENT |
| 3 GOOD |
| 2 FAIR |
| 1 POOR |
| 0 NO OTHER CHILDREN IN HOUSEHOLD |
MS-HLTH-16 [C35798.00] | Section: MS CASI SECTION |
[CHILD AGE (YEARS)] < 4
COMMENT: If child's age less than 4 years skip to HLTH-19, OTHERWISE continue
If Answer = 1 Then Go To MS-HLTH-19
MS-HLTH-17 [C35799.00] | Section: MS CASI SECTION |
During the past 12 months has [Child First Name] seen a psychiatrist, psychologist, or counselor about any behavioral, emotional, or mental problem?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-HLTH-17A [C35800.00] | Section: MS CASI SECTION |
What was the problem?
[(Type in your response here) / ENTER VERBATIM AND CODE ALL THAT APPLY ON NEXT SCREEN]
MS-HLTH-17B [C35801.00] | Section: MS CASI SECTION |
You said that the problem was "[BEHAVIOR PROBLEM TEXT ENTRY]".
[Please mark all of the items in the list below that describe the problem(s)/CODE ALL THAT APPLY]
| 1 LEARNING PROBLEMS OR DISABILITY, DYSLEXIA, READING OR SPEECH PROBLEMS |
| 11 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD, ADD) |
| 2 BEHAVIOR PROBLEMS IN SCHOOL/PRESCHOOL |
| 3 FAMILY PROBLEMS: LOSS OF PARENT OR SIB, DIVORCE |
| 4 UNMANAGEABLE, TEMPER TANTRUMS, DISRUPTIVE, HYPERACTIVE |
| 5 STRESS, CRIES A LOT |
| 6 LYING |
| 7 EMOTIONAL TRAUMA: MOLESTATION, ABUSE |
| 8 AUTISM |
| 9 SHYNESS |
| 10 NIGHTMARES |
| 15 OTHER (SPECIFY) |
MS-HLTH-18 [C35802.00] | Section: MS CASI SECTION |
Was the cost of the visit to the psychiatrist, psychologist, or counselor covered, at least in part, by any form of insurance or benefit program?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-HLTH-19 [C35803.00] | Section: MS CASI SECTION |
[Since was born/During the past 12 months], have you felt, or has anyone suggested, that [Child First Name] needed help for any behavioral, emotional, or mental problem?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-HLTH-20 [C35804.00] | Section: MS CASI SECTION |
Does [Child First Name] regularly take any medicines or prescription drugs to help control [his/her] activity level or behavior?
[ / REMINDER: CLICK ON THE CIRCLE OR BOX NEXT TO YOUR ANSWER, THEN CLICK ON THE Submit and Continue BUTTON TO RECORD THE ANSWER AND GO TO THE NEXT QUESTION.] [.] [.]
MS-CASI-RESP-CHK [] | Section: MS CASI SECTION |
[ADMINISTRATION MODE OF SECTION] == 1
COMMENT: SKIP STOP SCREEN IF MOTHER IS NOT COMPLETING CONFIDENTIAL - CASI ITEMS HERSELF
If Answer = 1 Then Go To MS-CASI-THANKYOU
MS-CASI-OTHERPRES [C35806.00] | Section: MS CASI SECTION |
INTERVIEWER: WAS ANYONE ELSE PRESENT, EXCLUDING THE RESPONDENT AND YOUNG CHILDREN (AGE 3 AND YOUNGER), WHEN YOU ASKED THE QUESTIONS ABOUT [Child First Name]'S HEALTH AND BEHAVIOR?
| 1 YES |
| 0 NO |
| 2 TELEPHONE INTERVIEW |
MS-CASI-THANKYOU [] | Section: MS CASI SECTION |
Please stop here.
You are now finished with this section of the interview. Thank you!
Please turn the screen back toward the interviewer.
MSIR-TITLE [] | Section: MS INTERVIEWER REMARKS |
**** BEGIN SECTION: REMARKS*****
MSIR-CHKQXSTAT [] | Section: MS INTERVIEWER REMARKS |
[MOTHER SUPPLEMENT TO BE ADMINISTERED]==2 || [FLAG-REFUSAL VALUE FOR DOB]==1
If Answer = 1 Then Go To MSIR-REFCONFIRM
MSIR-REFCONFIRM [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: PLEASE CONFIRM -
IS THIS MOTHER SUPPLEMENT INSTRUMENT BEING REFUSED?
MSIR-NOT-REFUSAL [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER:
REFUSAL OF THE INSTRUMENT HAS NOT BEEN CONFIRMED.
PLEASE VERIFY:
-IF THE RESPONDENT IS NOW WILLING TO COMPLETE THE INSTRUMENT, PLEASE BACK UP TO THE BEGINNING OF THE INSTRUMENT AND RESUME FROM QUESTION ITEM: MS-STARTSCREEN .
ELSE
-IF THIS INSTRUMENT IS BEING REFUSED, BACK UP TO THE PREVIOUS CHECK ITEM AND CORRECT.
NOTE: NO ACCESSIBLE SCREENS FOLLOW.
MSIR-REF-REASON [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: BE SURE TO ENTER COMMENTS HERE AND IN CM-FIELD AS TO THE NATURE OF THE REFUSAL. THEN CONTACT YOUR FM ABOUT THE STATUS OF THIS INSTRUMENT.
REASON FOR REFUSAL
MSIR-REF-FMID [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER - STOP HERE.
EXIT THE CASE AND ASK YOUR FM TO REVIEW THE REFUSAL STATUS OF THIS INSTRUMENT.
DO NOT PROCEED UNTIL THE FM HAS PROVIDED FURTHER INSTRUCTION.
IF FM APPROVES THE REFUSAL:
ENTER THE FM APPROVAL CODE BELOW. THIS MOTHER SUPPLEMENT WILL BE CODED AS A REFUSAL
IF THIS IS A CONVERSION:
IF THE RESPONDENT IS NOW WILLING TO COMPLETE THE INSTRUMENT, PLEASE BACK UP TO THE BEGINNING OF THE INSTRUMENT AND RESUME FROM QUESTION ITEM: MS-STARTSCREEN .
.
FM APPROVAL CODE
MSIR-1 [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: LIST QUESTIONS WITH SKIP ERRORS, QUESTIONS THAT WERE CONFUSING TO THE RESPONDENT, OR QUESTIONS THAT OTHERWISE DIDN'T WORK.
| 1 SELECT TO ENTER QUESTION ...(Go To MSIR-1A) |
| 0 NO QUESTIONS CAUSED PROBLEMS |
MSIR-1A [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: LIST SECTION AND QUESTION NUMBER OF FIRST QUESTION THAT CAUSED RESPONDENT PROBLEMS. IF DON'T KNOW SECTION OR QUESTION NUMBER, RECORD DESCRIPTION OF QUESTION.
MSIR-1B [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: YOU SAID THE PROBLEM WAS WITH THE ITEM [PROBLEM TEXT ENTRY].
PLEASE ENTER A DESCRIPTION OF PROBLEM WITH QUESTION MENTIONED IN MSIR-1A.
MSIR-1C [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: WERE THERE ANY OTHER QUESTIONS THAT CAUSED PROBLEMS?
| 1 SELECT TO ENTER QUESTION ...(Go To MSIR-1A2) |
| 0 NO QUESTIONS CAUSED PROBLEMS |
MSIR-1A2 [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: LIST SECTION AND QUESTION NUMBER OF NEXT QUESTION THAT CAUSED RESPONDENT PROBLEMS. IF DON'T KNOW SECTION OR QUESTION NUMBER, RECORD DESCRIPTION OF QUESTION.
MSIR-1B2 [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: YOU SAID THE PROBLEM WAS WITH THE ITEM [PROBLEM2 TEXT ENTRY].
PLEASE ENTER A DESCRIPTION OF PROBLEM WITH QUESTION MENTIONED IN MSIR-1A2.
MSIR-EVALCHK [] | Section: MS INTERVIEWER REMARKS |
[INTERVIEW MODE]==1
If Answer = 1 Then Go To MSIR-EVAL
MSIR-EVAL [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: IN GENERAL, WHAT WAS THE MOTHER'S ATTITUDE ABOUT ENTERING HER OWN ANSWERS ON THE COMPUTER? PLEASE DESCRIBE BELOW.
IF NO REACTION, ENTER "NONE".
MSIR-REMINDER [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: REMINDER - MAKE SURE THAT MOTHER IS PAID. IF IN-PERSON INTERVIEW, BE SURE THAT SHE SIGNS THE RECEIPT. IF YOU HAVE NOT ALREADY THANKED MOTHER FOR HER PARTICIPATION, PLEASE DO SO NOW.
MSIR-IDNUM [] | Section: MS INTERVIEWER REMARKS |
INTERVIEWER: PLEASE ENTER YOUR PROJECT ID NUMBER.