MIT-AILab:AIM-986 · 2019. 4. 11. · Title: MIT-AILab:AIM-986 Created Date: 5/3/2002 7:56:17 PM
986 · 2021. 6. 4. · THIS IS CASE Introduction for Child OF YOUTH SURVEY ROUND 986 En los ultimos...
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THIS IS CASE Introduction for Child OF YOUTH SURVEY ROUND 986 En los ultimos afios NLS ha estado interesado en reunir educacion, y las esto. Pero ahora nifios, ellos de su on y, naturalmente, a tener sus para nosotros. El Instituto Nacional de Salud y Desarollo ha sobre el desarrollo de los nifios de las personas entrevistadas la mad Para que las respuestas de su n1no a ) sean las necesitamos llevar a cabo la entrevista en un ambiente distracciones como sea estudio, pero son voluntarias. de 974. Los resultados del estudio seran estadistica para que las personas entrevis nifios y porque son este estudio el NLS. Por cada nino de a con tan poco ruido y Privacia
Transcript of 986 · 2021. 6. 4. · THIS IS CASE Introduction for Child OF YOUTH SURVEY ROUND 986 En los ultimos...
THIS IS
CASE
Introduction for Child
OF
YOUTH SURVEY ROUND 986
En los ultimos afios NLS ha estado interesado en reunir
educacion, y las
esto. Pero ahora
nifios, ellos
de su on y, naturalmente,
a tener sus
para nosotros.
El Instituto Nacional de Salud y Desarollo ha
sobre el desarrollo de los nifios de las personas entrevistadas
la mad
Para que las respuestas de su n1no a ) sean las
necesitamos llevar a cabo la entrevista en un ambiente
distracciones como sea
estudio, pero son voluntarias.
de 974. Los resultados del estudio seran
estadistica para que las personas entrevis
nifios y porque son
este estudio
el NLS. Por cada nino
de
a
con tan poco ruido y
Privacia
CS-1 DECK 06
TIME BEGAN: ,-1-1 ,-,-, !� --12-15-/
- --SECTION 1 : CHILD BACKGROUND
MOTHER/GUARDIAN OF EACH CHILD
READ TO MOTHER/GUARDIAN:
Quiero empezar verificando el nombre de (CHILD) su fecha de nacimiento y su grado de escolaridad.
1. RECORD CHILD'S FULL NAME AND ID FROM CHILDREN'S RECORD FORM, PART A.
l_l_l CHILD'S NAME CHILD ID
A. RECORD CHILD'S NAME AND CHILD ID IN MOTHER SUPPLEMENT, MS-1, Q.1.
16-17/
2. RECORD MONTH AND DAY OF CHILD INTERVIEW:
3. RECORD CHILD'S DATE OF BIRTH FROM CHILDREN'S RECORD FORM, PART A.
4. CALCULATE CHILD'S AGE: (SUBTRACT Q.3 FROM Q.2)
A. RECORD AGE IN MOTHER SUPPLEMENT, MS-1, Q. 3.
1_8_1_6_1 l_l_l l_l_l YEAR MONTH DAY
18-23/
l_l_l l_l_l l_l_l YEAR MONTH DAY
24-29/
l_l_l l_l_l l_l_l YEARS MONTHS DAYS
30-35/
5. (CHILD) tiene (YEARS AND MONTHS FROM Q.4) lCorrecto?
Yes • • • • (GO TO B) No • • • • • (GO TO A)
A. RECALCULATE CHILD'S AGE. CHECK CHILD'S DOB ON CHILDREN'S RECORD FORM, PART A. WHEN RECALCULATION IS VERIFIED, GO TO B.
B. RECORD CHILD'S AGE (YEARS AND MONTHS FROM Q.4) ON FLAP (BOX A) AND IN MOTHER SUPPLEMENT, MS-1, Q.3.
CS-2
6. CHECK FLAP (BOX A). IS CHILD 2 YRS, 11 MOS OR OLDER?
YES • • • • • (GO TO A) • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • • (SKIP TO Q.ll AND CODE 00) • • • • • • • • • 0
A. CALCULATE PPVT AGE:
IF# DAYS IN Q. 4 IS 16 OR GREATER, ADD '1' TO MOS AND RECORD HERE
(IF# PPVT MOS = 12 ADD '1' TO PPVT YRS AND ZERO FILL If PPVT MOS. )
B. RECORD If YRS FROM Q.4 HERE---------� .,,_,_,
(IF NEEDED, SEE Q X Q. )
C. RECORD PPVT AGE ON FLAP (BOX B).
7. CHECK FLAP (BOX A). IS CHILD AGE 4 YRS OR OLDER?
YES. • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • (SKIP TO Q.ll
AND CODE 00) • • • • • 0
If PPVT YRS 36-37/
,_,_, If PPVT MOS
38 -39/
8. iActualmente (CHILD) asiste o esta matriculado/a en una escuela regular?
s i. . . . . . . . . . . . . . . . . . 1 No • • • • (ASK A) • • • • • • • 0
A. iAlguna vez (el/ella) ha asistido a una escuela regular?
s i. . . . . . . . . . . . . . . . . . 1 No • • • (SKIP TO Q. ll
AND CODE 00) • • 0
9. lA que grado de escuela regular [esta (CHILD) asistiendo/asisti6 (CHILD) de ultimo? ] (CODE ONE. )
Kindergarten • • • • • • • 00 9th grade • • • • • • • . • • • 09 1st grade . . . . . . . . . • 01 lOth grade • . • • . . • . • • 10 2nd grade • . • . • . • . • • 02 11th gradeoeeooeeoeo 11 3rd grade . • . . . . . . • . 03 12th grade • • • • . . • • • • 12 4th grade • . . . . • • . • • 04 1st year in college. 13 5th grade . . . . • . • . . • OS 2nd year in college. 14 6th grade • . . • . . . . • . 06 3rd year in college. 15 7th grade • • • • . . • . • • 07 4th year in college. 16 8th grade • . . . . . • . . . 08 Ungraded • • • • • • • • • • • • 95
DECK 06
40/
41/
42-43/
CS-3
10. INTERVIEWER: IS Q.9 CODED 95, UNGRADED?
YES ••••• (ASK A) ••••• 1 NO. • • • • • • • • • • • • • • • • • 0
A. Si su nino(a) estuviera en una clase que tuviera un grado, len que g_ado estarfa matriculado(a)? (CODE ONE.)
Kindergarten ••••••• 00 9th grade ••••.•••••• 09 1st grade •.•••.•••• 01 lOth grade •..•..•••• 10 2nd grade •..••.•... 02 11th grade •••••••••• 11 3rd grade ..•..•.... 03 12th grade •••••••••• 12 4th grade ...••....• 04 1st year in college. 13 5th grade .......... OS 2nd year in college. 14 6th grade•••••e•••• 06 3rd year in college. 15 7th grade .......... 07 4th year in college. 16 8th grade ••..•••••• 08
11. INTERVIEWER: CODE CHILD'S GRADE LEVEL FROM Q.9 OR Q.lOA.
Kindergarten or less. 00 9th grade .•••••••••• 09 1st grade •••••••••••• 01 lOth grade •••••••••• 10 2nd grade .....•..•..• 02 11th grade •••••.... . 11 3rd grade •••••••..•.. 03 12th grade •••••••••• 12 4th grade •••••••••.•• 04 1st year in college •• 13 5th grade •••••••••••• OS 2nd year in college •• 14 6th grade •••.•.•••••• 06 3rd year in college •• 15 7th grade •••••••••••• 07 4th year in college •• 16 8th grade ...........• 08
RECORD GRADE IN Q.11 ON FLAP (BOX C).
DECK 06
II 44/
45-46/
47-48/
CS-4
THIS PAGE INTENTIONALLY BLANK
CS-5 DECK 06
SECTION 2: CHILD HEALTH
MOTHER/GUARDIAN OF EACH CHILD
READ TO MOTHER/GUARDIAN:
Ahora quisiera hacerle algunas preguntas sobre el estado general de salud y caracteristicas fisicas de (CHILD).
1. z,Cual es el color natural del (CODE ONE. )
2. z,Cual es el color de los ojos
( CODE ONE . )
pelo de (CHILD)?
Rubio claro • • • • • • 01 Rubio • • • • • • • • • • . • 02 Pardo claro • • • • • • 03 Pardo • • • • • • • • • • • • 04 Negro • • • • • • • • • • • • OS Ro jo • • • • • • • • • • • • • 06 Otro (SPECIFY)
07
de (CHILD)?
Azul claro • • • • • • • • 01 Azul • • • • • • • • • • • • • • 02 Pardo claro • • • • • • • 03 Pardo • • • • • • • • • • • • • 04 Negro • • • • • • • • • • • • • 05 Verde • • • • • • • • • • • • • 06 Avellana • • • • • • • • • • 07 Gris • • • • • • • • • • • • • • 08 Otro (SPECIFY)
09 -----------------Todavia no se sabe. 10
3. INTERVIEWER: CHECK FLAP (BOX A). IS CHILD AGE 4 YRS OR OLDER?
YES. • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • (ASK ONLY Q.4C) • • • • 0
49-50/
51-52/
CS-6 DECK 06
4. iTiene (CHILD) algun problema fisico, emocional o mental que limita o reduce su habilidad para. • •
A. ir regularmente a la escuela?
Sf. • • • • • • • • • • • • • • • • • . • • • 1 No. • • • • • • • • • • • • • • • . • . • • • 0 No asiste a la escuela •• 2
B. hacer el trabajo de la escuela?
Sf. e e o o e o e o o o e o o o e o o o o o o 1 No. • • • . • • • • • • • • • • • • • • . • • 0 No asiste a la escuela •• 2
C. hacer actividades habituales de la ninez , como jugar, o participar en juegos o deportes?
s i. . . . . . . . . . . . . . . . . . . . . . 1 No. • • • • • • • • . . • • • • • • • • • • • 0
53/
54/
55/
5. iTiene (CHILD) algun probema fisico, emocional, o mental que requiere • • •
6.
A. frecuente atenci6n o tratamiento de un medico u otro profesional de la salud?
Sf. • • • • • . . • . • • . . . . • . • . . . 1 No. • • • • • • • • • • • • • • • • • • • • • 0
B. uso regular de alguna medicina o droga (aparte de vitaminas)?
s1. . . . . . . . . . . . . . . . . . . . . . 1 No. • • • • • • . • • • • • • • • • • • • • • 0
56/
57/
C. iuso de cualquier equipamiento especial, como tirantes, muletas, silla de ruedas, z apatos especiales, casco, cama especial, mascara para respirar, filtro de aire, un cateter, etc. ?
s {. . . . . . . . . . . . . . . . . . . . . . 1 No. • • • • • • • • • • • • • • • • • • • . • 0
INTERVIEWER: IS ANY PART OF Q. 4 (A-C) OR Q.5 (A-C) CODED YES?
YES•••••••••••••••••••••••• 1 NO ••••• (SKIP TO Q.8 ) ••••••• 0
58/
59/
CS-7 DECKS 06-07
7. 6Cual es el problema de salud o limitaci6n de (CHILD) ? (PROBE IF NECESSARY: 6C6mo se llama? )
---R:EG0R:D-VE-RB-A-T-lM- A:ND-C0DE-A:U:;-THAT -A:PFtY-:-
Problema de aprendizaje • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 01
Una minima disfunci6n cerebral, deficit en la
capacidad de prestar atenci6n • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 02
Hipercinesis, hiperactividad • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 03
Asma • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 04
Desordenes respiratorios • • • • • • • · ·� • • • • • • • • • • • • • • • • • • • • • • • • • OS
Impedimenta del habla • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 06
Seria dificultad para oir o sordera • • • • • • • • • • • • • • • • • • • • • • • • • 07
Seria dificultad para ver o ceguera • • • • • • • • • • • • • • • • • • • • • • • • • 08
Serios problemas emocionales • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 09
Alergias . . • • • • • • . . . • • • • • . . . . • . • . • . • • • • . . . • • • • . . • • • • • . • • • • . . 10
60-61/
62-63/
64-65/
66-67/
68-69/
70-71 I
72-73/
74-75/
Lisiado, impedimenta ortopedico • • • • • • • • • • • • • • • • • • • • • • • • • • • • 11 76-77/ BEGIN DECK 07
Retardo mental • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 12 Probemas cardiacos • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 13 Des6rdenes nerviosos Otro (SPECIFY)
cr6nicos • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 14
78-79/ 12-13/ 14-15/
15 20-21/
8 . 6Durante los ultimos 1 2 meses ha sufrido (CHILD) algun accidente 0 tenido lesiones que hayan requerido atenci6n medica?
Si • • • • • • (ASK A) • • • • • • • 1 No. • • • • • • • • • • • • • • . • • • • 0
A. 6Cuantos accidentes o lesiones ha tenido (CHILD) en los ultimos 12 meses? (RECORD NUMBER. )
,_,_, NUMBER OF ACCIDENTS
OR INJURIES
22/
9. 6Durante los ultimos 12 meses ha tenido (CHILD) alguna enfermedad que haya requerido atenci6n 0 tratamiento medico?
Yes • • • • • (ASK A) • • • • • • • 1 No. • • • • • • • • • • • • • • • • • • • 0
A. 6Cuantas de estas enfermedades ha tenido (CHILD) en los ultimos 12 meses? (RECORD NUMBER. )
,_,_, NUMBER OF ILLNESSES
26 -27/
23-24/
CS-8
10. lCuando fue la ultima vez que (CHILD) fue al medico para un examen de rutina?
Race menos de un mes • • • • • 01
Race 1 - 3 meses • • • • • • • • • 02
Race 4 - 6 meses • • • • • • • • • 03
Race 7 - 11 meses • • • • • • • • 04
Race 1 afio - 23 meses • • • • 05
Race 2 o mas anos • • • • • • • • 06
Nunc a. • • • • . . • • • • • • . • • • • • • 0 7
11. INTERVIEWER:
A. WHAT SEX IS CHILD?
MALE • • • • (GO TO Q.ll C). • • • 1 FEMALE. • • • • • • • • • • • • • • • • • • • 2
B. CHECK FLAP (BOX A). IS CHILD AGE 8 YRS OR OLDER?
YES • • • • (GO TO Q.12) • • • • • • 1 NO. • • • • • • • • • • • • • • • • • • • • • • 0
C. CHECK FLAP (BOX A). IS CHILD AGE 2 YRS OR OLDER?
YES • • • • (SKIP TO Q.13) • • • • 1 NO • • • • • (SKIP TO Q.14) • • • • 0
12. INTERVIEWER: SKIP TO CS-70 AND ADMINISTER QUESTION 12 TO MOTHER.
13. lCuando fue la ultima vez que (CHILD) fue al dentista para un examen o para recibir algun tratamiento dental?
Race menos de un mes • • • • • • 01
Race 1 - 3 meses • • • • • • • • • • 02
Race 4 - 6 meses • • • • • • • • • • 03
Race 7 - 11 meses • • • • • • • • • 04
Hace 1 ano - 23 meses • • • • • 05
Race 2 o mas anos • • • • • • • • • 06
Nunca • • • e • • • • • • • • • • • • • • • • • 07
DECK 07
28 -29/
30/
31-32/
CS-9 DECK 07
14. lTiene (CHILD) actualmente un seguro de salud provisto por un patron o por un plan individual que paga parte o todas las facturas de hospital, del medico 0 del cirujan?
Yes. • • • • • • • • • • • • • • • • • • 1 No. • • • • • • • • • • • • • • • • • • • 0
15. Hay un programa nacional llamado Medicaid que paga los gastos medicos de todas las personas necesitadas. lCubre Medicaid actualmente la atenci6n medica de (CHILD)?
Yes. • • • • • • • • • • • • • • • • • • 1 No. • • • • • • • • • • • • • • • • • • • 0
16. INTERVIEWER: CHECK FLAP (BOX A). IS CHILD'S AGE 3 YEARS OR OLDET:':
YES. • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • • (SKIP TO Q.18 ) • • • • • 0
17. lEn los ultimos 12 meses ha (CHILD) ido algun psiquiatra, psic6logo consejero, o terapista por algun problema emocional, mental o de conducta?
Si • • • • (ASK A). • • • • • • 1 No. • • • • • • • • • • • • • • • • • 0
A. lCual era el problema? (RECORD VERBATIM)
B. lEstaba el costo cubierto, al menos parcialmente, por cualquier tipo o de programa de seguro o de beneficios?
Si • • (SKIP TO Q.19) • • • • • • • • 1 No • • • • • (SKIP TO Q.19) • • • • • 0
18. lEn los ultimos 12 meses sinti6 usted o alguien le sug1r1o que (CHILD) necesita ayuda en relaci6n a cualquier problema emocional, mental o de conducta?
s i. . . . . . . . . . . . . . . . . . . . . . . . 1 No. • • • • • • • • • • • • • • • • • • • • • • • 0
35/
36/
37/
CS-10
19. lToma (CHILD) regularmente algun medicina o droga que ayuda a controlar su nivel de actividad o su conducta?
Si • • • . • • • . . • • • • 1 No • • • • • • • • • • • • • o
20. INTERVIEWER: ARE ANY CONDITIONS CODED IN Q.7, CS, 7?
YES • • • • • • (GO TO A). • • • • • • • 1 NO • • • • • • • (GO TO Q.21) • • • • • 0
INTERVIEWER: IF CHILD HAS SERIOUS PHYSICAL OR MENTAL CONDITION THAT MAY INFLUENCE MEASUREMENTS, TACTFULLY TELL MOTHER THAT SOME MEASUREMENTS MAY BE INAPPROPRIATE FOR CHILD BUT THAT YOU WILL ADMINISTER THE ONES YOU CAN.
21. lPor favor, puede Ud. traer a (CHILD) al cuarto y ayudarme a hacer que se sienta c6modo(a)?
A. CHECK FLAP (BOX A): IS CHILD AGE 4 YRS OR OLDER?
YES. • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • (SKIP TO Q.23) • • • • • • 0
22. INTERVIEWER: CHILDREN 4 YRS AND OLDER NEED A GENERAL INTRODUCTION.
IF CHILD IS •
4 YRS - 4 YRS, 11 MOS • • • • (READ A) 5 YRS OR OLDER • • • • • • • • • • • (READ B)
A. lQue te dijo tu madre acerca de mi visita?
WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:
(Muy bien. Ya veo). Tu madre nos ha estado ayudando respondiendo algunas preguntas. Ahora te toea a ti. Primero vamos a ver lo grande que eres y luego te hare algunas preguntas. Quisiera que las respondieras mejor que puedas. GO TO Q.23
B. lQue te dijo tu madre acerca de mi visita?
WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:
(Muy bien. 0 Ya veo). Tu madre nos ha estado ayudando respondiendo preguntas desde hace muchos afios. Esto hace que ella sea una persona muy importante para nosotros. Ahora tenemos algunas preguntas para ti. Algunas son sobre lenguaje, algunas sobre (aritmetica/matematicas), y algunas son sobre como tu te sientes. Algunas preguntas tienen respuestas correctas o incorrectas, otras no. Quiero que pienses bien en las preguntas y me des tu mejor respuesta para cada una de ellas.
CS-11 DECK 07
INTERVIEWER NOTE: FOR Q.23 AND Q.24 BE SURE CHILD IS NOT WEARING SHOES OR HEAVY OUTER GARMENTS.
23. Yo qu1s1era averiguar la altura de (CHILD). ]Prefiere medirlo/a usted o lo hago yo?
RECORD HEIGHT. l_l_l FEET
l_l_l INCHES
40-41/ 42-43/
24. Yo quisiera averiguar el peso de (CHILD). �Prefiere pesarlo/a usted o lo hago yo?
RECORD WEIGHT. l_l_l_l l_l_l POUNDS OUNCES
44-46/ 47-48/
25. INTERVIEWER: HOW SHY OR ANXIOUS WAS CHILD WHEN YOU FIRST MET (HIM/HER)?
NOT AT ALL SHY & ANXIOUS/ SOCIABLE & FRIENDLY
EXTREMELY SHY/QUIET/ WITHDRAWN
1 2 3 4 5
26. INTERVIEWER: WAS ANYONE ELSE PRESENT, EXCLUDING YOUNG CHILDREN, WHEN YOU ASKED THE QUESTIONS IN THIS SECTION?
YES. • • • • • • • • • • • • • • • • 1 NO. • • • • • • • • • • • • • • • • • 0
27. INTERVIEWER: CHECK FLAP (BOX A). IS CHILD'S AGE • • •
0 MOS - 7 MOS • • • • • • • • • • • • • • • • (SKIP TO SECTION 12, CS-65) • • • • • 01
8 MOS - 11 MOS • • • • • • • • • • • • • • • • (SKIP TO SECTION 4, CS-17) • • • • • • 02
12 MOS - 2 YRS, 11 MOS • • • • • • • • (GO TO SECTION 3, CS-13) • • • • • • • • 03
3 YRS - 3 YRS, 11 MOS • • • • • • • • (SKIP TO SECTION 4, C S-17) • • • • • • 04
4 YRS - 6 YRS, 11 MOS • • • • • • • • (SKIP TO SECTION 5, CS-25) • • • • • • OS
7 YRS - 7 YRS, 11 MOS • • • • • • • • (SKIP TO SECTION 7, cs-37) • • • • • • 06
8 YRS OR OLDER? • • • • • • • • • • • • • • • (SKIP TO SECTION 6, CS-33) • • • • • • 07
49/
50/
CS- 1 2
THI S PAGE INTENTIONALLY BLANK
STEP ONE:
[STEP TWO:
CS-13
SECTION 3: PARTS OF THE BODY
AGES: 12 MONTHS - 2 YEARS, 11 MONTHS
CHECK FLAP (BOX A). IS CHILD'S AGE 12 MOS - 2 YRS, 11 MOS?
YES. • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • • (CHECK FLAP, BOX E) • • • • • 0
IF NEEDED, READ TO MOTHER/GUARDIAN.
Queremos saber cuantas partes del cuerpo (CHILD) sabe identificar por sus nombres comunes en ingles. Le pedire a (el/ella) que senale varias partes del cuerpo. Por favor trate de no aydarlo/a. ]
[STEP THREE: IF NEEDED SEE Q x Q.]
STEP FOUR: INSTRUCT THE CHILD.
Vamos a jugar un juego. Quiero que me ensenes algunas cosas.
CS-14 DECK 07
STEP FIVE: ADMINISTER EACH QUESTION, SAYING:
Ensefiame tu • • • /Sefiala tu • • • /D6nde esta tu • • • /Toea tu • • • / (ONLY IF NECESSARY HAND SHOWCARD A) Ensefiame el/la • • • del bebe • • •
ATTEMPT ONE ATTEMPT TWO ATTEMPT THREE CODE BOX CODE BOX CODE BOX
NO KO KO BODY PART CORRECT WRON; ANSWER ffiRRECT WRCN:.i ANSWER ffiRRECT WRCN:.i ANSWER
1. nariz 1 2 3 51/ l 2 3 61/ 1
2. ojo 1 2 3 52/ 1 2 3 62/ l
3. oreja l 2 3 53/ l 2 3 63/ l
4. boca 1 2 3 54/ 1 2 3 64/ l
5. pelo 1 2 3 55/ 1 2 3 65/ 1
6. ment6n 1 2 3 56/ 1 2 3 66/ 1
dedo de 7. la mano 1 2 3 57/ 1 2 3 67/ 1
de do 8. del pie 1 2 3 58/ 1 2 3 68/ 1
9. ceja 1 2 3 59/ 1 2 3 69/ 1
10. co do 1 2 3 60/ 1 2 3 70/ l
INTERVIEWER NOTE: IF CHILD FAILS TO ANSWER ALL 10 QUESTIONS • • •
(1) BY SKIPPING AN OCCASIONAL WORD • • •
CONTINUE TO ASK WORDS THROUGH Q. lO. RETURN IMMEDIATELY AND RE-ASK EACH UNANSWERED WORD
ONE MORE TIME ONLY. RECORD CHILD'S ANSWER IN SAME ATTEMPT CODE BOX •
• MAKE NO FURTHER ATTEMPTS. GO TO Q.ll.
(2) BY REFUSING TO ANSWER (Q.l - Q.5 CODED 'NO ANSWER')
ASSUME CHILD WILL WARM UP LATER.
2
2
2
2
2
2
2
2
2
2
TURN TO FLAP (BOX D), RECORD NEED FOR ATTEMPT 2 OR 3 RETURN TO SECTION 3 LATER TO COMPLETE.
(3) WHEN YOU COMPLETE AN ATTEMPT, GO TO Q.ll.
3
3
3
3
3
3
3
3
3
3
71/
72/
73/
74/
75/
76/
77/
78/
79/
8 0/
SI!OWC;\RD i\ 4440-l OS,\
CS- 1 5 BEGIN D ECK 0 8
INTERVIEWER REMARKS :
1 1 . HOW MANY PEOPLE W ERE PRESENT DURING ADMINI S TRATION OF THIS S ECTION AND WHAT EFFECT , I F ANY , DID THEI R PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD ' S P ERFORMANCE SEEMED TO NONE
IF PRESEN T , CODE # PERSONS BE HARMFUL OBSERVABLE -,_, MOTHER 1 2/
FATHER ,_ I 1 4/
GUARDIAN ,_, 1 6/
ADULTS - RELATIVE I_LI 1 8- 1 9 /
FAMILY
FRIEND I_LI 2 1 - 2 2/
OTHER ( SPECIFY)
I_LI 2 4- 2 5 /
-=-S I BL ING I_LI 2 7 - 28/
FRIEND I_LI 3 0- 3 1 /
CHILDREN- OTHER ( S PECIFY)
I_LI 3 3- 3 4/ -1 2 . CODE CHILD ' S ENERGY
L EVEL DURING S ECTION . low ( tired)
1
1
1
1
1
1
1
1
1
1 3 . WAS THIS S ECTION TERMINATED PREMATURELY?
YES • • • • • ( ASK A) • • • • • •
NO . • • • • • • • • • • • • • • • • • • 0
2
2
2
2
2
2
2
2
2
medium
2
S EEMED TO IMPROVE
3
3
3
3
3
3
3
3
3
high
3
1
1
1
2
2
2
2
3
3
3/
5/
7 /
0/
3/
6/
9/
2/
5/
3 6 /
3 7 /
A . REASON FOR PREMATURE TERMINATION OF T H I S S ECTION . ( CODE ALL THAT APPLY . )
PARENT/GUARDIAN TERMINATED/REFUSED • • • • • • 0 1 3 8 - 39 /
CHILD WOULD N OT RESPOND • • • • • • • • • • • • • • • • • 0 2 4 0 -4 1 /
MAJOR INTERRUPTION CAUSED TERMINATION • • • 0 3 4 2 - 4 3 /
CHILD COULD NOT UNDERSTAND TASK ••••••••• 0 4 4 4 - 4 5 /
CHILD HAD LANGUAGE PROBLEM• • • •••• • • • • • • • 0 5 4 6 - 4 7 /
CHILD ' S EMOTIONAL CONDITION • •••••••••• • • 0 6 4 8 - 4 9 /
CHILD ' S PHYS ICAL CONDITION • • • • • • • • • • • • • • 0 7 5 0 - 5 1 /
OTHER ( SPECIFY)
0 8 5 2- 5 3/
IF THIS IS SECOND OR THIRD ATTEMPT, SKIP TO SECTION 1 1 , CS-61 .
-i=:= ;.:;;;;;;; ,_.
CS- 1 6
THIS PAGE INTENTIONALLY BLANK
STEP ONE:
[STEP TWO:
CS-17
SECTION 4: MEMORY FOR LOCATIONS
AGES: 8 MONTHS - 3 YEARS, 11 MONTHS
CHECK FLAP (BOX A). IS CHILD 8 MOS - 3 YRS, 11 MOS?
YES. • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • (CHECK FLAP, BOX E) • • • • • 0
IF NEEDED, READ TO MOTHER/GUARDIAN.
Nifios de distintas edades recuerdan la ubicaci6n de objetos por distintos periodos de tiempo. Nosotros quisi{ramos averiguar por cuanto tiempo puede (CHILD) recordar la ubicaci6n de ese mufieco (SHOW DOLL). Para averiguarlo, pondre el mufieco debajo de una de estas copas. Luego escondere las copas para que no las pueda ver por un rato. Despues de eso, le pedire que me ensefie d6nde esta el mufieco. ]
[STEP THREE: IF NEEDED, SEE Q X Q.]
STEP FOUR: INSTRUCT THE CHILD.
Vamos a jugar a un juego. Voy a esconder el mufieco bajo una de estas copas. Luego voy a esconder las copas. Dejame ver si puedes recordar d6nde esta el mufieco. lDe acuerdo?
CS-18
STEP FIVE: ADMINISTER PRACTICE QUESTIONS
PRACTICE A (ALL CHILDREN)
(CIRCLE CHILD'S ANSWER)
USE 2 CUPS -> 0 2
* 1 3 4 5 6
SCREENING TIME = NONE
CORRECT • • (SKIP TO STEP SIX) • • • 1 WRONG • • • (GO TO P RACTICE B) • • • • 2
PRACTICE B (CHILDREN CODED WRONG ON PRACTICE A)
(CIRCLE CHILD'S ANSWER)
USE 2 CUPS-) * 1 2 3 4
0 5 6
SCREENING TIME = NONE
CORRECT. • • • • • • • • • • • • • • • • • • • • • • • • • 1 WRONG • • • • (DO FURTHER PRACTICE
THEN GO TO STEP SIX) • • • • 2
INTERVIEWER NOTE:
STEP SIX:
IF CHILD REFUSES TO RESPOND, RECORD NEED FOR ADDITIONAL ATTEMPT ON FLAP (BOX D). MAKE UP TO TWO ADDITIONAL ATTEMPTS TO GAIN COOPERATION. AFTER FINAL ATTEMPT -- WHETHER COMPLETED OR NOT -- SKIP TO Q.11, CS-23.
CHECK FLAP (BOX A). IS CHILD'S AGE • • •
8 MOS - 23 MOS • • • • • • • • • • • • (GO TO Q.1) • • • • • • • • • • • • • • 1
2 YRS - 2 YRS, 11 MOS • • • • • (SKIP TO Q.4, CS-20) • • • • • 2
3 YRS - 3 YRS, 11 MOS • • • • • (SKIP TO Q.7, CS-21) • • • • • 3
1 •
2 .
3 .
CS- 1 9 DECK 08
(CIRCLE ANSWER THEN CODE)
--------"----------- 1 USE 2 CUPS-> , � 3 4 � 6 I CORRECT •••• a • • • • • • • • • • • • • 1
WRONG •••• ( ASK A ) ••••••••• 2
--·------------"------· _I
SCREEN ING TIME = 1 SECOND
A . r---·-----------·--------1
USE 2 CUPS-> \ 0 *
I CORRECT . , • • • • • • • • • • • • 1 1 2 3 4 5 6
I�----·-·--·-------------� WRONG ••• ( SKIP TO Q.11,
CS-23 ) •••••• 2
USE 2
A .
SCREENING TIME = 1 SECOND
1----------·---· I CUPS-> 0 *
I 2 3 -�-----�----�--!
SCREENING TP.1E 5 SECONDS
�-·----------------
USE 2 CUPS-> * 0 5 2 3 4
SCREENING TIME = 5 SECONDS
6
CORRECT••••••••••••••••••
WR0NG. , •• ( ASX �) ••••••••• 2
CORRECT . • • • • • • • • • • • • • 1 WRONG. ( SKIP TO Q.4) •• 2
54/
55/
56/
57/
-------·-·---- ---·----- - - - - - - - -- - - ----·----- -··-----·---- - -- . - - - - - ---- - - - - - .
USE 2 CUPS->
A .
I --------------·--·---·----1
; 3 4 � 6 I ------ - - -- - --------·-- _________ I
SCREENING TIME = 10 SECONDS
COR<<.�<�r"::'l', , , , WRONG •••• ( .�SK
�-- - - - - -- - - - - -- - ----- -- ----·--- 1
A ) •• " •••••• 2
USE 2 CUPS-> � 3 4 ; 6 I CORRECT •••••• ••••••• WRONG ••• (G0 T0 Q.4) •• �
___________ . ____ I
SCREENING TIME ·1 0 sgcuN:):)
58/
59/
II
4 .
5 .
6 .
(C IRCLE ANSWER THEN CODE)
USE 4 CUPS-> 0 2
0 3
*
4
CS-2 0
0 5 6
SCREENING T IME = 1 SECOND
A .
USE 4 CUPS->
USE 4 CUPS->
0 2
*
3
SCREENING TIME
0 2
0 3
0 4
0 4
0 5
SECOND
*
5 6
SCREENING TIME 1 0 SECONDS
A .
USE 4 CUPS-> 0 2
*
3
SCREEN ING TIME
0 4
0 5
1 0 SECONDS
6
6
DECK 08
CORRECT . • • • • • • • • • • • • • • • • • 1 WRONG • • • • ( ASK A ) • • • • • • • • • 2
CORRECT . • • • • • • • • • • • • • 1 WRONG • • • ( SKIP TO 9 . 1 1 ,
CS-2 3 ) • • • • • 2
CORRECT . • • • • • • • • • • • • • • • • • 1 WRONG • • • • • ( ASK A ) • • • • • • • • 2
CORRECT . • • • • • • • • • • • • • 1 WRONG • • ( GO TO Q . 7 ) • • • 2
60/
6 1 /
64/
65/
7 .
8 .
9 .
CS-2 1
( C IRCLE ANSWER THEN CODE)
,------------------ , USE 6 CUPS-> 0 * 0
2 3
SCREENI NG TIME
A .
US E 6 CUPS-> ,---·-
0 0 2
0 3
0 4 � __ :_I
S ECOND
0 4
*
5
SCREENING TIME 1 S ECOND
USE 6 CUPS-> 0 0 2
*
3 0 4
0 5
0 7
SCREENING 'l'IME 5 SECONDS
A,
USE 6 CUPS->
US E 6 CUPS-> 0
0 0 2
0 3
*
4 0 5
---------------------
SCREENING TIME
0 2
0 3
0 4
5 S ECONDS
*
5 0 6
SCREENI NG TIME 1 0 S ECONDS
A .
US E 6 CUPS-> 0 0 2
*
3
SCREENI NG TIME
0 4
0 5
1 0 S ECONDS
0 6
0 6
0 6
DECK 08
CORRECT,,,,,,,,,,,,,,,,, . WRONG, • • • • ( ASK A ) . ,,,,,,, 2
CORRECT,,,,,,,,,,,,,, 1 WRONG • • , ( SKIP TO Q . 1 1 ,
CS-23 ) . , • • • • 2
CORRECT,,,,,,,, • • • • • • • • • • WRONG,,,,, ( ASK A ) • • • • • • • • 2
CORRECT • • • • • • • • • • • • • • 1 WRONG • • • ( SKIP TO Q . 1 1 ,
CS-2 3 ) , • • • • • 2
CORRECT . • • • • • • • • • • • • • • • • • 1 WRONG • • • • • ( ASK A ) ,,,,,,,, 2
CORRECT . • • • • • • • • • • • • • 1 WRONG,,, ( SKIP TO Q . 1 1 ,
CS-2 3 ) • • • • • • 2
6 6 /
6 7 /
68/
69/
7 0 /
7 1 /
1 0 .
C S- 2 2 DECK 0 8
------------
U S E 6 CUPS-> 0 0 0 * 0 0 CORREC T • • • • • • • • • • • • • • • • • • 7 2/ 1 2 3 4 5 6 WRONG • • • • • ( ASK A ) • • • • • • • • 2
! ___________ _
SCREENING TIME = 15 S ECONDS
A .
U S E 6 CUPS-> 0 * 0 3
0 4
0 5 2
SCREENING TIME 15 S ECONDS
0 6
CORRECT • • • • • • • • • • • • • • WRONG . • • • • • • • • • • • • • • • 2
7 3/
CS-2 3 DECKS 08-09
INTERVIEWER REMARKS :
1 1 . HOW MANY PEOPLE WERE PRES ENT DURING ADMIN ISTRATION OF THIS SECTION AND WHAT EFFECT , IF AN Y, D I D THEIR PRES ENCE HAVE ON THE CHILD?
EFFECT ON CHILD'S PERFORMANCE SEEMED TO NONE SEEMED 'I'O
I F PRESEN T , CODE # PERSONS BE HARMFUL OBSERVABLE I MP ROVE
r-- I I MOTHER 74/ 1 2 3
FATHER I I 7 6/ 1 2 3
GUARDIAN I I 7 8 / 1 2 3
7 5 /
7 7 I
79/
II
ADULTS - RELATIVE I_ I_ I 1 2-1 3/ 1 2 3
BEGIN DECK 09 1 4/
FAMILY
FRIEND l_l_l 1 5- 1 6/
OTHER
( SPECI FY )
I_ I_ I 1 8- 1 9/ -,..--S I BL ING I_ I_ I 2 1 -2 2/
FRIEND I_ I_ I 24-25/
CHILDREN- OTHER ( SPECI FY )
I_ I __ I 2 7-28/ '--
1 2 . CODE CHILD'S ENERGY LEVEL DURING S ECTION .
low (tired)
1 3 . WAS THIS SECTION TERMINATED P REMATURELY?
YES ••••• ( ASK A) •••••
NO e o e • e e o e e e o e e e e e e o Q
1 2
1 2
1 2
1 2
1 2
medium
2
3
3
3
3
3
high
3
1 7 /
2 0 /
2 3/
26/
29/
3 0 /
3 1 /
A . REASON FOR PREMATURE TERMINATION OF THI S SECTION . ( CODE ALL THAT APPLY . )
PARENT/GUARDIAN TERMINATED/REFUS ED••••••••••••• 0 1
CHILD WOULD NOT RESPOND/REFUSED•••••••••••••••• 0 2
MAJOR INTERRUPTION CAUSED TERMINATION •••••••••• 0 3
CHILD COULD NOT UNDERSTAND TASK•••••••••••••••• 04
CHILD HAD LANGUAGE PROBLEM••••••••••••••••••••• 0 5
CHILD'S EMOTIONAL CONDITION•••••••••••••••••••• 0 6
CHILD'S PHYSICAL CONDITION••••••••••••••••••••• 0 7
OTHER ( SPEC I FY )
08
3 2- 3 3/
34-35/
36- 3 7 I
38- 39/
4 0-4 1 /
4 2-43 /
4 4-4 5/
46-47 /
C S - 2 4
INTERVIEWER NOTE : IF YOU HAVE NOT DONE SO , GIVE MOTHER/GARDIAN MOTHER SUPPLEMENT. IF THIS IS LAST SECTION ADMINISTERED TO CHILD , THANK CHILD FOR HELP ING YOU.
1 4 . CHECK FLAP ( BOX A ) . IS CHILD' S AGE • • •
8 MOS - 2 YRS, 1 1 MOS •• ( SK I P TO SECT I ON 1 1 , CS- 6 1 ) •••• •
3 YRS - 3 YRS, 1 1 MOS •• ( GO TO S ECTION 5) ••• • • • • • • • • • • •• 2
I F THIS IS S ECOND OR THIRD ATTEMPT, SKIP TO SECTION 1 1 , CS-6 1 .
STEP ONE:
[STEP TWO:
STEP THREE:
STEP FOUR:
CS-25
SECTION 5: VERBAL MEMORY
AGES: 3 YEARS - 6 YEARS, 11 MONTHS
CHECK FLAP (BOX A) . IS CHILD'S AGE 3 YRS - 6 YRS, 11 MOS?
YES • • • • • • • • • • • • • • • • • • • • • • • • • • • • • NO • • • • • • (CHECK FLAP, BOX E) • • • • • 0
IF NEEDED, READ TO MOTHER/GUARDIAN.
Children at different ages remember the order of words for different lengths of time. These questions give us an idea of (CHILD) 's verbal memory - that is (his/her) ability to remember
and repeat sequences of words.]
INSTRUCTIONS FOR PART A (WORDS) .
ADMINISTER WORDS:
(1) READ AT EVEN RATE: ONE WORD/SECOND.
(2) READ EACH QUESTION ONLY ONCE.
( 3 ) IF NEEDED, ENCOURAGE CHILD WITH: Now it's your turn. Say the words back to me.
SCORE WORDS:
(1) AS CHILD REPEATS WORDS, WRITE ORDER NUMBER ABOVE EACH WORD. IF CHILD DOES NOT REPEAT WORD, WRITE NOTHING ABOVE IT.
(2) COUNT EACH WORD WITH A NUMBER ABOVE IT. ENTER TOTAL NUMBER IN BOX A.
( 3 ) IF CHILD MADE ANY CHANGE IN WORD ORDER, ENTER A SCORE OF '1' IN BOX B.
IF NO REVERSALS OCCURRED, ENTER A SCORE OF 'O' DO NOT DEDUCT POINTS FOR BABY WORDS OR SLANG.
( 4 ) CALCULATE BOX C SCORE FOR EACH QUESTION.
[IF NEEDED, SEE Q X Q.]
INSTRUCT CHILD FOR PART A.
Now I am going to say some words and I want to see how many of them you can say after me. Wait until I have finished saying all the words before you start to answer.
BEFORE READING EACH QUESTION, MAKE SURE CHILD IS PAYING ATTENTION. SAY: Listen/Ready!
Reproduced by permission from McCARTHY SCALES FOR CHILDREN'S ABILITIES. Copyright © 1979, 1972 by The Psychological Corporation. All rights reserved.
CS-26
PART A: WORDS.
(WRITE ORDER NUMB ER ABOVE EACH WORD ) BOX A minus BOX
1 • toy chair light minus
2. doll dark coat minus
3. after color funny today minus
4. around because under never minus
STEP FIVE: INSTRUCTIONS FOR PART 8 (SENTENCES) .
ADMINISTER SENTENCES:
(1) READ EACH SENTENCE ONLY ONCE, SLOWLY AND CLEARLY. DO NOT EMPHASIZE UNDERLINED WORDS.
SCORE SENTENCES:
DECK 09
B BOX C
48-50/
51-53/
54-56/
57-59/
(1) CIRCLE ONLY UNDERLINED WORDS AS CHILD REPEATS THEM.
--DO NOT DEDUCT POINTS FOR REVERSE WORD ORDER, BABY WORDS OR SLANG.
(2) COUNT CIRCLED WORDS, ENTER TOTAL IN BOX C FOR EACH SENTENCE.
STEP SIX: INSTRUCT CHILD FOR PART B.
Now I am going to say some sentences. I want you to repeat them back to me. Ready?
PART B: SENTENCES.
5. The boy said goodbye to his dog every
morning before he went to school.
6. The girl tied a pretty pink ribbon on
her doll before she went out.
7. TOTAL ALL BOX C SCORES FROM Q.1-Qe6e ENTER TOTAL IN BOX D --->
8. DOES BOX D TOTAL E QUAL 8 OR MORE?
YES •••• (GO TO PART C) e•••••••••••••••
NO ••••• (SKIP TO Qe21, CS-30) ••••••••• 0
BOX C
1 1 60-61/
l_o_l_l
I o I I 62-63/
BOX D
III 64-65/
CS-27
PART C: STORY.
[STEP SEVEN: IF NEEDED, SEE Q X Q.]
STEP EIGHT: INSTRUCT THE CHILD FOR PART C (Story) .
STEP NINE:
STEP TEN:
Now I am going to read you a little story. Listen carefully, and we will see how well you can tell it back to me. You don't have to tell it back to me word-for -word. Just tell me the story as well as you can.
READ THE STORY SLOV�LY, CLEARLY, AND WITHOUT EMPHASIZING ANY SIGNIFICANT WORDS OR PHRASES.
One day after school Bob was walking to the store. On the way he saw a woman carrying some letters to a mailbox. Suddenly, the wind blew the woman's letters into the street. Bob shouted, 11 I'll get them for you! 11 He looked both ways and saw that there were no cars coming. He ran into the street and picked up all of the letters. The woman was very happy to get her letters back. She thanked Bob for being such a kind and helpful boy.
RECORD CHILD 1 S ANS�vER ON IDEA SHEET, NEXT PAGE.
Q.9
BOB
SAW
CS-28
CIRCLE EXACT WORD/PHRASE IF CHILD USED IT. WRITE ALTERNATE WORDS CHILD USED ABOVE PRINTED WORD. IF CONCEPT OMITTED BY CHILD, RECORD NOTHING.
IDEA SHEET
WALKING TO STORE
WOMAN
BLEW
SHOUTED "I' LL GET THEM FOR YOU! "
DECK 09
LETTERS
WAS CAREFUL PICKED UP/RETURNED
WAS HAPPY THANKED BOB
INTERVIEWER: COUNT NUMBER OF CORRECT ANSWERS AND RECORD HERE: 1 __ 1 __ 1 SKIP TO Q.21, CS-30.
66-67/
INTERVIEWER NOTE:
1 0. Bob
1 1 • The Woman
1 2. Letters
13. (Bob) Walking To Store
1 4. (Bob) Saw Woman
1 5. (Wind) Blew Letters
1 6. (Bob Shouted,) "I'll Get Them For You!"
1 7. (Bob) was Careful
18. (Bob) Picked Up Letters
1 9. (Woman) was happy
20. (Woman) Thanked Bob
CS-29
CODERS WILL CODE THESE QUESTIONS.
Correct • • • • • • • • • • • • 1 Wrong. • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong • • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • Wrong • • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong. • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • Wrong. • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong • • • • • • • • • • • • • • 2
DECK-09
68/
69/
70/
71/
72/
73/
Correct............ 74/ Wrong • • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong. • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong • • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • 1 Wrong • • • • • • • • • • • • • • 2
Correct • • • • • • • • • • • • Wrong • • • • • • • • • • • • • • 2
75/
76/
77/
78/
CS-30 BEGIN DECK 10
INTERVIEWER REMARKS:
21. HOW MANY PEOPLE WERE PRESENT DURING ADMINISTRATION OF THIS SECTION AND WHAT EFFECT, IF ANY, DID THEIR PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD'S PERFORMANCE SEEMED TO
IF PRESENT, CODE # PERSONS )3E
r- 1_1 MOTHER 12/
FATHER 1_1 1 4/
GUARDIAN 1_1 16/
ADULTS - RELATIVE I_LI 18-19/
FAMILY FRIEND I_LI 21-22/
OTHER (SPECIFY)
l_l_l 24-25/
"r=- I_LI SIBLING 27-28/
FRIEND I_LI 30-31/
CHILDREN- OTHER (SPECIFY)
I_!_ I 33-34/ '--
22. CODE CHILD'S ENERGY LEVEL DURING SECTION.
low (tired)
HARMFUL
1
1
1
1
1
1
1
1
1
23. WAS THIS SECTION TERMINATED PREMATURELY?
YES •••• (ASK A) •••••
No ••••••••••••••••• o
NONE SEEMED TO OBSERVABLE IMPROVE
2 3
2 3
2 3
2 3
2 3
2 3
2 3
2 3
2 3
medium high
2 3
1
1
1
2
2
2
2
3
3
3/
5/
7/
0/
3/
6/
9/
2/
5/
36/
37/
A. REASON FOR PREMATURE TERMINATION OF THIS SECTION. (CODE ALL THAT APPLY.)
PARENT/GUARDIAN TERMINATED/REFUSED••••••• 01 38-39/
CHILD WOULD NOT RESPOND/REFUSED•••••••••• 02 40-41/
MAJOR INTERRUPTION CAUSED TERMINATION•••• 03 42-43/
CHILD COULD NOT UNDERSTAND TASKeoo••••••• 04 44-45/
CHILD HAD LANGUAGE PROBLEM••••••••••••••• 05 46-47/
CHILD'S EMOTIONAL CONDITIONe••••••••••••• 06 48-49/
CHILD'S PHYSICAL CONDITIONe•••••••••••••• 07 50-51/
OTHER (SPECIFY)
08 52-53/
CS-31
24. INTERVIEWER: CHECK FLAP (BOX A) . IS CHILD'S AGE
3 YRS - 4 YRS, 11 MOS • • • • (SKIP TO SECTION 10, CS-53) • • • • •
5 YRS AND OLDER • • • • • • • • • • (SKIP TO SECTION 8, CS-41) • • • • • • 2
CS-32
THIS PAGE INTENTIONALLY BLANK
STEP ONE:
[STEP TWO:
CS-33
SECTION 6 : WHAT I AM LIKE
AGES: 8 YEARS AND OLDER
CHECK FLAP (BOX A): IS CHILD'S AGE 8 YRS OR OLDER?
YES • • • • • • • • • • • • • • • • • • • • • • " • • • • 1 NO • • • • (CHECK FLAP, BOX E) • • • • • 0
IF NEEDED, READ TO MOTHER/GUARDIAN.
El prop6sito de esta secci6n es darnos una idea de como (CHILD) se ve a si mismo/a.]
[STEP THREE: IF NEEDED, SEE Q X Q.]
STEP FOUR: INSTRUCT THE CHILD.
A. Gada nino piensa y siente de diferente manera. Nos interesa saber c6mo crees que eres y c6mo piensas y sientes. Esto no es un examen. No hay respuestas correctas o incorrectas. Recuerda que cada nino es diferente.
[HAND SHOWCARD SET B.] Esta secci6n se llama "C6mo soy." Te voy a dar un ejemplo de c6mo funcionan las preguntas. Te leere la pregunta en voz alta y mientras la escuchas piensa bien antes de responderla. Esta pregunta es acerca de dos tipos de ninos y quisieramos saber cual de ellos se parece mas a ti.
B. READ BOTH PARTS OF PRACTICE SENTENCE. EMPHASIZE THE ITALICIZED WORDS.
Algunos ninos prefieren jugar afuera en su tiempo libre
PERO Otros ninos prefieren ver televisi6n.
C. Lo que tienes que hacer es lo siguiente: Primero? decide cuales ninos son mas como tu--los ninos del lado "X" de la tarjeta (POINT TO "X" SIDE OF SHOWCARD) o los ninos del lado "Y" de la tarjeta (POINT TO "Y" SIDE OF SHOWCARD).
IF NECESSARY, PROBE: lCual tipo de nino es mas como tu? El nino del lado "X" o del lado "Y" de la tarjeta?
D. POINTING TO ANSWER CATEGORIES ON SHOWCARD, SAY:
Ahora, piensa acerca de la respuesta que me diste y decide si es muy cierta en tu caso o solamente mas o menos cierta.
IF NECESSARY, PROBE: Bueno, lque piensas? lEn tu caso, es muy cierta o es mas o menos cierta?
E. Bien, esto era s6lo para practicar. Ahora vamos a hacer unas preguntas mas. Pasa a la pr6xima tarjeta.
SIIOWO\RD B 1
. PRACTICA
X Algunos �l�os prefleren
jugar rtfuer� en su tiempo ttbr�
PSRO
y
1tros n iHos prefieren v�r televisHin.
SllOWCNW B 2
X y 1.
Algunos ni�os piensan Otros ni�os se ereocuean MUY MAS 0 que son muy buenos PERO acerca de si pueden hacer MASO t'IUY
CIERTO MENOS CIERTO haciendo la tarea de la tatea que les dan en la MENOS CIERTO CIERTO PARA MI PARA MI la escuela escuela. PARA MI PARA MI
2. Algunos ni�os con Otros ni�os se sienten
MUY MAS 0 frecuencia se PERO bastante satisfechos MASO l�UY CIERTO MENOS CIERTO sienten descontentos consigo mismos. MENOS CIERTO CIERTO PARA MI PARA MI consigo mismos PARA HI PARA MI
3. Algunos ni�os Otros ni�os no est!n tan piensan que son PERO seguros y se preguntan
MUY MAS 0 igual de inteli- si son igual de MASO MUY CIERTO MENOS CIERTO gentes que otros inteligentes. HENOS CIERTO CIERTO PARA MI PARA MI ni�os de su edad PARA HI PARA MI
4. MUY MAS 0 A algunos ni�os � A otros niftos sl les MASO MUY
CIERTO MENOS CIERTO les gusta la vida PERO gusta la vida que MENOS CIERTO CIERTO PARA HI PARA HI que llevan llevan. PARA MI PARA MI
s. Algunos ni�os son Otros ni�os pueden
MUY MAS 0 bastante lentos PERO hacer la tarea de la MASO MUY CIERTO HENOS CIERTO para terminar la escuela rAeldamente. MENOS CIERTO CIERTO PARA HI PARA MI tarea de la escuela PARA MI PARA MI
6. MUY MAS 0 Algunos niftos Otros niftos
CIERTO MENOS CIERTO est4n contentos PERO frecuentemente � MASO MUY consigo mismos est4n contentos consigo MENOS CIERTO CIERTO PARA MI PARA MI como personas mismos. PARA MI PARA MI
SIIOWCAIW B 3
X y
7. MUY MASO Algunos nlnos Otros ninos pueden MASO MUY
CIERTO MEMOS CIERTO olvldan con PERO recordar con facllldad MENOS CIERTO CIERTO PARA MI PARA MI frecuencia lo lo que aprenden. PARA MI PARA MI
que aprenden
MUY MASO a. MASO MUY CIERTO MEMOS CIERTO A algunos nii\os les Otros nii\os desearian MENOS CIERTO CIERTO PARA MI PARA MI gusta el tipo de--- PERO con frecuencla ser PARA Ml PARA MI
persona que son otra persona.
MUY MASO 9. MASO MUY
CIERTO MEMOS CIERTO A algunos ninos les A otros nlftos no MENOS CIERTO CIERTO
PARA MI PARA MI va muy bien en su PERO les va bien en-siu PARA MI trabajo en cl�se trabajo en clase. PARA Ml
MUY MASO 10. MASO MUY CIERTO MEMOS CIERTO Algunos ninos Otros nii\os desearian MENOS CIERTO CIERTO PARA MI PARA MI estAn contentos PERO ser diferentes.
PARA Ml PARA MI siendo como son
1 1. MUY MAS 0 Algunos ninos tienen Otros ninos casi siempre MASO MUY
CIERTO MEMOS CIERTO dificultad para PERO pueden pensar las MENOS CIERTO CIERTO
PARA MI PARA MI pensar las respues- respuestas. PARA MI PARA MI
tas en la escuela
12. Algunas nii\os Otros nii\os piensan que
MUY MAS 0 no estAn muy PERO la forma en que hacen MASO MUY CIERTO MEMOS CIERTO contentos con la las cosas estA bien. MENOS CIERTO CIERTO PARA MI PARA MI forma en que hacen PARA MI PARA MI
muchas cosas
MUY CIERTO PARA MI
4
1
4
1
1
4
CS-34 DECK 10
MAS 0 MAS 0 MENOS CIERTO MENOS CIERTO
PARA MI _X_ Y __ PARA MI
3
2
3
2
2
3
------------------------------------------------------
1 • Algunos nifios piensan que son muy buenos PERO hacienda la tarea de la escuela
2.
Otros ni5os se preocupan acerca de si pueden hacer 2 la tarea que les dan en la escuela.
Algunos nifios con frecuencia se sienten descontentos consigo mismos
Otros nifios se sienten PERO bastante satisfechos
consigo mismos. 3
Algunos nifios piensan que son igual de inteligentes que otros nifios de su edad
A algunos nifios no
3.
PERO
4.
les gusta la vida PERO que llevan
Algunos nifios son bastante lentos para terminar la tarea de la escuela
Algunos nifios estan contentos consigo mismos como personas
5.
PERO
6.
PERO
Otros nifios no estan tan seguros y se preguntan si son igual de inteligentes.
A otros nifios si les gusta la vida que llevan.
Otros nifios pueden hacer la tarea de la escuela rapidamente.
Otros nifios frecuentemente no estan contentos�onsigo mismos.
2
3
3
2
MUY CIERTO PARA MI
54/ 1
55/ 4
56/ 1
57 I 4
58/ 4
59/ 1
INTERVIEWER: INSTRUCT CHILD.
Hay unas cuantas mas de estas preguntas. Pasa a la pr6xima tarjeta.
CS-35 DECK 10
REALMENTE MAS 0 MAS 0 CIERTO MENOS CIERTO MENOS CIERTO PARA MI PARA MI X Y PARA MI
1
4
4
4
1
1
-----.-----------------------------------------------------------r----
2
3
3
3
2
2
Algunos nifios olvidan con frecuencia lo que aprenden
A algunos nifios les
7.
PERO
8.
gusta el tipo de--- PERO persona que son
9. A algunos nifios les va muy bien en su PERO trabajo en clase
Algunos nifios estan contentos siendo como son
Algunos nifios tienen
10.
PERO
11.
dificultad para PERO pensar las respues-tas en la escuela
Algunas nifios no estan muy contentos con la forma en que hacen muchas cosas
12.
PERO
Otros nifios pueden recordar con facilidad lo que aprenden.
Otros nifios desearfan con frecuencia ser otra persona.
A otros nifios no les va bien en!3u trabajo en clase.
Otros nifios desearfan ser diferentes.
Otros nifios casi siempre pueden pensar las respuestas.
Otros nifios piensan que la forma en que hacen las cosas esta bien.
3
2
2
2
3
3
REALMENTE CIERTO PARA MI
60/ 4
1
62/ 1
63/ 1
64/ 4
65/ 4
CS-36 DECKS 10-11
INTERVIEWER REMARKS:
13. HOw MANY PEOPLE WERE PRESENT DURING ADMINISTRATION OF THIS SECTION AND WHA'r EFFECT, IF ANY, DID THEIR PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD'S PERFORMANCE SEEMED TO
IF PRESENT, CODE # PERSONS BE
r-- I_ I MOTHER 66/
FATHER 1_1 68/
GUARDIAN 1_1 70/
ADULTS- RELATIVE I_LI 72-7 3/
f'AMILY FRIEND I_LI 75-76/
OTHER (SPECIFY)
I_LI 78-79/ 1--
r--SIBLING I_LI 12-13/
FRIEND I_LI 15-16/
CHILDREN- OTHER (SPECIFY)
I_LI 18-19/ ....._
14. CODE CHILD' S ENERGY LEVEL DURING SECTION.
low (tired)
HARt1FUL
1
1
1
1
1
1
1
1
1
15. WAS THIS SECTION TERMINATED PREMATURELY?
YES ••••• (ASK A) ••••••
NO••••••••••••••••••• 0
NONE SEEMED TO OBSERVABLE IMPROVE
2 3 67/
2 3 69/
2 3 71/
2 3 74/
2 3 77/
2 3 80/ BEGIN DECK
2 3 14/
2 3 17/
2 3 20/
medium high
21/
2 3
22/
1 1
A. REASON FOR PREMATURE TERMINATION OF THIS SECTION. (CODE ALL THAT APPLY.)
PARENT/GUARDIAN TERMINATED/REFUSED••••••••••• 01
CHILD WOULD NOT RESPOND/REFUSED•••••••••••••• 02
MAJOR INTERRUPTION CAUSED TERMINATION•••••••• 03
CHILD COULD NOT UNDERSTAND TASK•••••••••••••• 04
CHILD HAD LANGUAGE PROBLEM••••••••••••••••••• 05
CHILD' S EMOTIONAL CONDITION•••••••••••••••••• 06
CHILD' S PHYSICAL CONDITION••••••••••••••••••• 07
OTHER (SPECIFY)
23-24/
25 -26/
27-28/
29 -30/
31 -32/
33-34/
35-36/
08 37 -38/
STEP ONE:
[STEP TWO:
[STEP THREE:
I STEP FOUR:
CS-37
SECTION 7: MEMORY FOR DIGIT SPAN
AGES: 7 YEARS AND OLDER
CHECK FLAP (BOX A): IS CHILD'S AGE 7 YRS OR OLDER?
YES • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • (CHECK FLAP, BOX E) • • • • • 0
IF NEEDED, READ TO MOTHER/GUARDIAN.
Esta secci6n nos da una idea de la memoria de (CHILD) para recordar el orden de los numeros. Cada secuencia de numeros tiene mas digitos que la anterior. Es raro que alguien pueda recordar todas las secuencias.] IF NEEDED, SEE Q X Q.]
INSTRUCTIONS FOR DIGITS FORWARD.
ADMINISTER QUESTIONS:
(1) READ EACH DIGIT SPAN ONLY ONCE AT AN EVEN RATE OF 1 DIGIT PER SECOND.
(2) READ PART A OF QUESTION; PAUSE FOR RESPONSE THEN SCORE.
(3) READ PART B OF QUESTION; PAUSE FOR RESPONSE THEN SCORE.
(4) IF CHILD DOES NOT RESPOND, DO NOT ENCOURAGE FURTHER.
(5) STOP WHEN CHILD MISSES PART A AND PART B OF ANY ONE QUESTION.
SCORE QUESTIONS:
(1) TO BE SCORED CORRECT, NO NUMBERS MAY BE OMITTED OR BE IN REVERSED ORDER.
Reproduced by permission from the WECHSLER INTELLIGENCE FOR CHILDREN-REVISED. Copyright © 1974 by the Psychological Corporation. All rights reserved.
CS-38 DECK 11
STEP FIVE: INSTRUCT THE CHILD FOR DIGITS FORWARD.
Voy a decir unos numeros. Pon (presta) atenci6n, y cuando yo acabe (termine) dilos tu inmediatamente despues. SAY: Listo. BEFORE ITEMS TO GET CHILD'S ATTENTION.
DIGITS FORWARD MEASUREMENT
CORRECT WRONG CORRECT WRONG
A. 3-8-6 1 2 B. 6-1-2 1 2 1. 39-40/
A. 3-4-1-7 1 2 B. 6-1-5-8 1 2 2. 41-42/
A. 8-4-2-3-9 1 2 B. 5-2-1-8 6 1 2 3. 43-44/
A. 3-8-9-1-7-4 1 2 B. 7-9-6-4-8-3 1 2 4. 45-46/
A. 5-1-7-4-2-3-8 1 2 B. 9-8-5-2-1-6-3 1 2 5. 47-48/
A. 1-6-4-5-9-7-6-3 1 2 B. 2-9-7-6-3-1-5-4 1 2 6. 49-50/
A. 5-3-8-7-1-2-4-6-9 1 2 B. 4-2-6-9-1-7-8-3-5 1 2 7. 51-52/
STEP SIX: INSTRUCT CHILD FOR DIGITS BACKWARD.
A. READ: Ahora voy a decir otros numeros, pero esta vez cuando yo pare quiero que tu los digas al reves, de atras para adelante. For ejemplo, si yo digo 9-2-7, iQue dirias tu (tu dirias)?
B. PAUSE FOR THE CHILD TO RESPOND. DID CHILD RESPOND CORRECTLY (7-2-9)?
YES (7-2-9) • • • • • SAY:
Eso es. Continuemos con el resto de los numeros.
NO • • • • • SAY:
No, tu dirias 7-2-9. Yo dije 9-2-7, entonces para decirlos al reves tu tendrias que decir 7-2-9. Ahora trata estos numeros. Acuerdate, tienes que decirlos al reves: 5-6-3.
C. WHETHER THE CHILD IS CORRECT OR WRONG ON THE SECOND EXAMPLE, GO TO Q.8 AND PROCEED EXACTLY AS IN DIGITS FORWARD.
CS-39 DECK 11
DIGITS BACKWARD MEASUREMENT
CORRECT WRONG CORRECT WRONG
8. A. 2-5 B. 6-3 1 2 I 1 2
(ANS = 5-2) (ANS = 3-6) 53-54/
_1··--------- --- ---li--------- --- ----,B. 9. A. 5-7-4 2-5-9
2 2 55-56/
I (ANS = 4-7-5) (ANS = 9-5-2)
I 1 0. ,A. 7-2-9-6 B. 8-4-9-3
1 2 1 2 57-58/
I (ANS = 6-9-2-7) (ANS = 3-9-4-8)
fl A. 4-1-3-5-7 B. 9-7-8-5-2 I I I
2 I 2 59-60/
I (ANS 2-5-8-7-9)
--- 1 -I 12. ,A. 1-6-5-2-9-8
2 I B. 3-6-7-1-9-4 2 61-62/
(ANS = 8-9-2-5-6-1) I (ANS = 4-9-1-7-6-3) ---------- ---1---1----------------,B. 4-5-7-9-2-8-1 13. lA. 8-5-9-2-3-4-2 1 2 1 2
(ANS = 2-4-3-2-9-5-8) (ANS = 1-8-2-9-7-5-4) I 63-64/
1 4. A. 6-9-1-6-3-2-5-8 B. 3-1-7-9-5-4-8-2 1 2 1 2 65-66/
I.(ANS = 8-5-2-3-6-1-9-6) I I I (ANS = 2-8-4-5-9-7-1-3)
I
CS-40 DECKS 11-12
INTERVIE WER REMARKS:
15. HOW MANY PEOPLE WE RE PRESENT DURING THE ADMINISTRATION OF THIS SECTION AND WHAT EFFECT, IF ANY, DID THEIR PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD'S PE RFORMANCE SEEMED TO NONE
IF PRESENT, CODE # PERSONS BE HARMFUL OBSE RVABLE
r- I_ I 67/ MOTHER 1 2
FATHER 1_1 69/ 1 2
GUARDIAN 1_1 71/ 1 2
ADULTS - RELA TIVE I_LI 73-74/ 1 2
FAMILY FRIEND I_LI 76-77 I 1 2
OTHER (SPECIFY)
I_LI 12-13/ 1 2 -
,.-- I_LI SIBLING 15-16/ 1 2
FRIEND I_LI 18-19/ 1 2
CHILDREN OTHER (SPECIFY)
I_LI 21-22/ 1 2 ._
16. CODE CHILD'S ENERGY LEVEL DURING SECTION.
low (tired) medium
2
17. WAS THIS SECTION TERMINATED P REMATURELY?
YES ••••••• (ASK A) •••••••••
NO. • • •. • • • • •••• • • ••• • • • •. • 0
SEE MED TO IMPROVE
3
3
3
3
3 BEGIN
3
3
3
3
high
3
6
7
7
7
7
1
1
2
2
8/
0/
2/
5/
8/ DECK 12
4/
7/
0/
3/
24/
25/
A G REASON FOR PREMATURE TERMINATION OF THIS SECTION. (CODE ALL THAT APPLY.)
PARENT/GUA RDIAN TERMINATED/REFUSED•• ••••• 01 26-27/
CHILD WOULD NOT RESPOND/REFUSED•••••••••• 02 28-29/
MAJOR INTERRUPTION CAUSED TE RMINATION •••• 03 30-31/
CHILD COULD NOT UNDERSTAND TASK•••••••••• 04 32-33/
CHILD HAD LANGUAGE P ROBLEM••••••••••••••• 05 34-35/
CHILD'S EMO TIONAL CONDITION•••••••••••••• 06 36 -37/
CHILD'S PHYSICAL CONDITION••••••••••••••• 07 38-39/
OTHER (SPECIFY)
08 40-41/
STEP ONE:
[ST EP TWO:
CS-41
SECTION 8 : PIAT MATH TEST
AGES: 5 Y EARS AND OLDER
CHECK FLAP (BOX A) : IS CHIL D ' S AGE 5 YRS OR OLDER?
Y ES • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • (CH ECK FLAP, BOX E) • • • • • 0
IF N EEDED 1 R EA D TO MOTHER/GUARDIAN.
This section measures (CHILD) 's mathematical skills. The questions begin at a very basic skill level and go to a very high skill level. No one is expected to answer all the questions.]
[ST EP THR EE: IF N EEDED, S EE Q X Q.]
STEP FOUR: PRACTIC E EXERCISES (INCLUDES INSTR UCTIONS TO CHILD) .
CHECK FLAP ( BOX C): IS CHILD IN 1ST GRADE OR HIGHER?
Y ES • • • • • (SKIP TO B) • • • • • NO • • • • • • (GO TO A) • • • • • • • 0
A. PRACTIC E EXERCISES FOR CHILDRF.N NOT Y ET IN 1ST GRADE.
(1) T URN TO "INTRODUCTION TO THE MATHEMATICS SUBTEST " (IN PIAT VOLUME I). R EAD:
Let's start with some math problems. First, we ' ll do some just for practice to show you what the y are like.
( 2) FOLLOW T EXT IN EA SEL FOR PRACTIC E EXERCISES A - E THEN GO TO ST EP FIVE.
B. CHILDR EN IN 1ST GRA DE OR HIGHF.R N EED NO PRACTIC E EXERCISES. R EAD:
STEP FIVE:
We are qoing to start with some mathematics probl ems. Some of the first ones vmuld he too easy for you, so let's start with this one .
CODE CHILD'S STARTING Q#, T URN TO APPROPRIATE EASEL PAG E AND PROC EED.
KINDERGARTEN OR L ESS • • • • (GO TO Q o 1 1 CS-4 2) • • • • • • • • • • • 00 1ST GRADE • • • • • • • • • • • • • • • (GO TO Q o 1 5 1 CS-4 2) • • • • • • • • • • • 01 2ND GRA DE • • • • • • • • • • • • • • • (GO TO 0. • 2 5 1 CS-4 2) • • • • • • • • • • • 0 2 3R D GRA DE • • • • • • • • • • • • • • • (GO TO Q. 30, CS-4 2) • • • • • • • • • • • 03 4TH GRADE • • • • • • • • • • • • • • • (GO TO Q. 3 5, CS-4 2) • • • • • • • • • • • 04 5TH GRADE • • • • • • • • • • • • • • • (GO TO Q.40, CS-4 2) • • • • • • • • • • • 0 5 6TH GRADE • • • • • • • • • • • • • • • (GO TO Q.4 5, CS-4 2) • • • • • • • • • • • 06 7TH GRADE • • • • • • • • • • • • • • • (GO TO Q. S O, CS-42) • • • • • • • • • • • 07 8TH G RADE • • • • • • • • • • • • • • • (GO TO 9· 54, CS-4 2) • • • • • • • • • • • 08 9TH GRADE • • • • • • • • • • • • • • • (GO TO Q. 58, CS-4 2) • • • • • • • • • • • 09 10TH GRADE • • • • • • • • • • • • • • (SKIP TO Q.60, CS-43) • • • • • • • · •. 10 11TH GRADF. • • • • • • • • • • • • • • (SKIP TO Q.6 2, CS-43) • • • • • • • • • 1 1 1 2TH GRADE • • • • • • • • • • • • • • (SKIP TO Q.64, CS-43) • • • • • • • • • 1 2
4 2-43/
I BASAL = 5 OF 5 CORREcr I I
I I CEILING = 5 OF 7 WRONG I I
I I I I
CS- 4 2 DECKS
OJUNT BACK 5 TO ESTABLISH BASAL I I
ONLY IF STARTING Q# IS WRONG -- JUMP BACK I TO NEXT LOWER GRADE . I
I
1 2- 1 3
RECORD ( CODE ONE ) RECORD ( CODE ONE )
GRADE ANSWER RESPONS E CORRECT WRONG GRADE ANSWER RESPONSE
<:K:> 1 • ( 4 ) 2 4 4/ Oi9) 3 0 . ( 2 )
2 . ( 2 ) 2 4 5 / 3 1 • ( 2 )
3 . ( 3 ) 2 46/ 3 2 . ( 4 )
4 . ( 1 ) 2 4 7 / 3 3 . ( 4 )
5 . ( 4 ) 2 4 8 / 3 4 . ( 2 )
6 . ( 3 ) 2 49/ <@D 3 5 . ( 3 )
7 . ( 3 ) 2 50/ 3 6 . ( 1 )
8 . ( 1 ) 2 5 1 / 3 7 . ( 2 )
9 . ( 4 ) 2 5 2 / 3 8 . ( 3 )
1 0 . ( 4 ) 2 5 3 / 3 9 . ( 1 )
1 1 . ( 1 ) 2 5 4 / <SID 4 0 . ( 3 )
1 2 . ( 3 ) 2 5 5 / 4 1 . ( 4 )
1 3 . ( 4 ) 2 5 6 / 4 2 . ( 4 )
1 4 . ( 2 ) 2 5 7 / 4 3 . ( 1 )
� 1 5 . ( 4 ) 2 5 8 / 4 4 . ( 3 )
1 6 . ( 3 ) 2 5 9 / <:@:> 4 5 . ( 4 )
1 7 . ( 1 ) 2 6 0 / 4 6 . ( 2 )
1 8 . ( 3 ) 2 6 1 / 4 7 . ( 1 )
1 9 . ( 2 ) 2 6 2 / 4 8 . ( 1 )
2 0 . ( 3 ) 2 6 3/ 49 . ( 3 )
2 1 • ( 2 ) 2 6 4 / <1TIV 5 0 . ( 3 )
2 2 . ( 1 ) 2 6 5/ 5 1 • ( 2 )
2 3 . ( 2 ) 2 6 6 / 5 2 . ( 4 )
2 4 . ( 2 ) 2 6 7 / 5 3 . ( 4 )
� 2 5 . ( 1 ) 2 6 8 / � 5 4 . ( 4 )
2 6 . ( 4 ) 2 69/ 5 5 . ( 2 )
2 7 . ( 3 ) 2 7 0 / 5 6 . ( 3 )
28 . ( 1 ) 2 7 1 / 5 7 . ( 1 )
2 9 . ( 3 ) 2 7 2 / C@l) 5 8 . ( 2 )
� INTERVIEWER : I F YOU CODED 5 OF 7 WRONG , SKIP TO Q . 8 5 .
CORRECT WRONG
2 7 3 /
2 7 4/
2 7 5 /
2 7 6/
2 77/
2 78/
2 79/
2 8 0/ BEGIN DECK 1 3
2 1 2 /
2 1 3/
2 1 4/
2 1 5/
2 1 6/
2 1 7 /
2 1 8 /
2 1 9 /
2 20/
2 2 1 /
2 2 2 /
2 2 3 /
2 24/
2 2 5/
2 2 6 /
2 2 7 /
2 2 8 /
2 29/
2 30/
2 3 1 /
2 3 2 /
CS- 4 3 D ECK 1 3
B.�SAL = 5 OF 5 CDRRECT o::mrr Pli.CK 5 'ID ESTABLISH E'li.SAL
CEILING = 5 OF 7 WRONG ONLY IF STARriNG Q# IS WRONG -- JUMP E'li.CK 'ID NE)IT I.CWER GRADE .
RECORD ( CODE ONE) GRADE ANSWER RESPONSE CORRECT WRONG
5 9 . ( 2 ) 2 3 3 /
@E)6 o . ( 1 ) 2 3 4/
6 1 • ( 3 ) 2 3 5 /
<:!}}Ii) 6 2 • ( 1 ) 2 3 6/
6 3 . ( 4 ) 2 3 7 /
<:Uili> 6 4 . ( 3 ) 2 3 8/
6 5 . ( 2 ) 2 3 9 /
6 6 . ( 2 ) 2 40/
6 7 . ( 4 ) 2 4 1 /
68 . ( 4 ) 2 4 2/
6 9 . ( 1 ) 2 4 3 /
7 0 . ( 1 ) 2 4 4/
7 1 • ( 2 ) 2 4 5 /
8 5 . INTERVI EWER : CALCULATE RAW SCORE :
---> A . ENTER CEIL ING Q# :
( LAST ITEM WRONG ) 1_1_1
GRADE ANSWER
7 2 . ( 1 )
7 3 . ( 1 )
7 4 . ( 3 )
7 5 . ( 3 )
7 6 . ( 4 )
7 7 . ( 3 )
7 8 . ( 2 )
7 9 . ( 3 )
8 0 . ( 4 )
8 1 • ( 2 )
8 2 . ( 1 )
8 3 . ( 2 )
8 4 . ( 2 )
B . ENTER TOTAL # OF ERRORS BETWEEN
BASAL AND CEIL ING : l_l_l
C . SUBTRACT ' B ' FROM ' A ' : l_l_l
---> D . RECORD RAW SCORE FROM ' C ' ABOVE INTO
S ECTION 9 , S TEP FIVE ( BOX A ) ,
CS- 45 , THEN RETURN TO Q.86, CS-44 .
RAW S CORE
RECORD ( CODE RESPON S E CORRECT
59- 60/
6 1 - 6 2/
6 3- 6 4/
ONE ) WRONG
2
2
2
2
2
2
2
2
2
2
2
2
2
4 6/
47 /
48 /
49 /
5 0/
5 1 /
5 2 /
5 3/
5 4/
5 5 / m 5 6 /
5 7 /
5 8/
CS-44 DECKS 13-14
INTERVIEWER REMARKS:
86. HOW MANY PEOPLE WERE PRESENT DURING ADMINISTRATION OF THIS SECTION AND WHAT EFFECT, IF ANY, DID THEIR PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD'S PERFORMANCE
ADULTS -
CHILDREN -
IF PRESENT,
r-MOTHER
FATHER
GUARDIAN
RELATIVE
FAMILY FRIEND
OTHER (SPECIFY)
1-..
...... SIBLING
FRIEND
OTHER (SPECIFY)
I..-
SEEMED TO CODE # PERSONS BE HARMFUL
1_1 65/ 1
1_1 67/ 1
1_1 69/ 1
I_LI 71-7 2/ 1
I_LI 74-75/ 1
I_LI 77-7 8/ 1
I_LI 12-13 1
I__LI 15-16/ 1
I__LI 1 8-19/ 1
87. CODE CHILD'S ENERGY LEVEL DURING SECTION.
low (tired)
88. WAS THIS SEC'riON TER!'4INATED PREMATURELY?
YES • • • • • (ASK A) • • • • •
NO • • • • • • • • • • • • • • • • • • 0
NONE OBSERVABLE
2
2
2
2
2
2
2
2
2
medium
2
SEEMED TO IMPROVE
3
3
3
3
3
3
6
6
7
7
7
7
6/
8/
0/
3/
6/
9/ BEGIN D ECK 14
3
3
3
high
3
1
1
2
4/
7/
0/
21/
22/
A � REASON FOR PREMATURE TERMINATION OF THIS SECTION . (CODE ALL THAT APPLY.)
PARENT/GUARDIAN TERMINATED/REFUSED •• • • • • • 01 23-24/
CHILD WOULD NOT RESPOND/REFUSED • • • • • • • • • • 02 25-26/
MAJOR INTERRUPTION CAUSED TERMINATION • •• • 03 27-2 8/
CHILD COULD NOT UNDERSTAND TASK • • • • • • • • • • 04 29-3 0/
CHILD HAD LANGUAGE PROBLEM • •• • • • • • • • • •• •• 05 31-3 2/
CHILD'S EMOTIONAL CONDITION • • • • • • • • • • • • • • 06 33-34/
CHILD'S PHYSICAL CONDITION • • • • • • • • • • • • • • • 07 35-36/
OTHER (SPECIFY)
08 37-3 8/
CS-45
SECTION 9 : PlAT READING
AGES : 5 YEARS AND OLDER
PART A : READING RECOGNITION
STEP ONE : CHECK FLAP ( BOX A) . IS CHILD AGE 5 YRS OR OLDER?
YES • • • • • • • • • . • • • • • • • • • • • • • • • • • • NO • • • • • ( CHECK FLAP, BOX E) • • • • • 0
[STEP TWO: IF NEEDE D, READ TO MOTHER/GUARDIAN.
This section measures ( CHIL D) 's reading recognition skills. The questio ns begin at a basic level of skill and proceed to a higher l evel of skill. No one is expected to answer all the questions. )
[STEP THREE : IF NEEDED SEE Q X Q.]
STEP FOUR : PRACTICE EXERCISES ( INCLUDES INS'rRUCTIONS TO CHILD)
CHECK FLAP, BOX C : IS CHILD IN 1ST GRADE OR HIGHER?
YES • • • • • ( SKIP TO B) NO • • • • • • ( GO TO A)
A. PRACTICE EXERCISES FOR CHIL DREN NOT YET IN 1ST GRADE.
( 1) TURN TO "INTRODUCTION TO READING RECOGNITION SU BTEST" (IN FIAT VOLUME I) . READ :
Now I am going to give you some problems in readi ng. First, let's look at some more practice ones to show you what these are like. (TURN TO PRACTICE A.)
( 2 ) FOLLOW TEXT IN EASEL FOR PRACTICE EXERCISES ( A-E).
B. CHILDREN IN 1ST GRADE OR HIGHER NEE D NO PRACTICE EXERCISES. TURN TO "INTRODUCTION TO READING RECOGNITION SUBTEST" ( PIAT VOLUME 1) AND REA D :
Now we are going to do some reading. Agai n, let's skip o ver some of the very easy o nes a nd start here. GO TO STEP FIVE.
STEP FIVE : SKIP TO STARTING Q# ( SEE BOX A BELOW) , TURN TO APPROPRIATE EASEL PAGE AND PROCEED. (CHILD'S STARTING Q# = RAW SCORE FROM SECTION s , cs-43, g. s 5 c .
I I STARTING Q# - - - - - - - - - - - - - - - - - - -> j_j_j
BOX A NOTE : AFTER RECORDING RAW SCORE, RETURN TO SECTION 8 , Q.86 . CS-44.
CS- 4 6 DECKS 1 4- 1 5
I BASAL = 5 OF 5 CORREcr COUNT BACK 5 'TO ESTABLISH BASAL I CEILING = 5 OF 7 WRONG
I ONLY IF STARriNG Q# IS WRONG -JUMP BACK 5 Q# I
I
CODE ONE PLATE I TEM CODE ONE
PLATE ITEM
# # ANSWER CORRECT WRONG # # ANSWER CORRECT WRONG
CD 1 • ( 1 ) 2 3 9 / @ 3 0 . (b laze) 2 6 8 /
CD 2 . ( 2 ) 2 4 0 / 3 1 • (fea ther) 2 6 9 /
CD 3 . ( 1 ) 2 4 1 / 3 2 . (f lour) 2 7 0/
CD 4 . ( 4 ) 2 4 2 / 3 3 . (ig loo) 2 7 1 /
G) 5 . ( 3 ) 2 4 3/ 3 4 . ( liquid) 2 7 2/
® 6 . ( 2 ) 2 4 4 / 3 5 . (pu rse) 2 7 3 /
(]) 7 . ( 1 ) 2 4 5/ 3 6 . (dangerous) 2 7 4/
® 8 . ( 2 ) 2 4 6 / 3 7 . ( lodge) 2 7 5 /
CD 9 . ( 4 ) 2 4 7 / 3 8 . (s ty lish) 2 7 6/
® 1 0 . ( B b) 2 4 8 / 3 9 . (acciden t) 2 7 7 /
® 1 1 • ( A a) 2 4 9 / 4 0 . (ruin) 2 7 8/
® 1 2 . ( 0 ) 2 5 0 / 4 1 • (exercise) 2 7 9 / BEG IN D ECK 1 5
@ 1 3 . ( S ) 2 5 1 / 4 2 . (pigeon) 2 1 2/
@ 1 4 . ( N ) 2 5 2 / 4 3 . (mois ture) 2 1 3 /
® 1 5 . (c) 2 5 3/ 4 4 . (a rtificia l) 2 1 4/
1 6 . ( i) 2 5 4 / 4 5 . (anchor) 2 1 5/
1 7 . (d) 2 5 5/ @ 4 6 . (e legan t) 2 1 6/
1 8 . (m) 2 5 6 / 4 7 . (gaudy) 2 1 7 /
@ 1 9 . (run) 2 5 7 / 4 8 . ( treacherous) 2 1 8/
2 0 . (play) 2 5 8 / 4 9 . (yach t) 2 1 9 /
2 1 • (jump) 2 5 9 / 5 0 . (gue ri l la) 2 2 0 /
2 2 . (kitten) 2 6 0 / 5 1 • (bois terous) 2 2 1 /
2 3 . (wagon) 2 6 1 / 5 2 . (is thmus) 2 2 2 /
2 4 . (fishing) 2 6 2 / 5 3 . (anticipation) 1 2 2 3 /
2 5 . (b rook) 2 6 3/ 5 4 . (verteb rates) 2 2 4 /
2 6 . (gloves) 2 6 4 / 5 5 . (con temp late) 2 2 5 /
2 7 . (smile) 2 6 5/ 5 6 . (he roine) 2 2 6 /
2 8 . (co l t) 2 6 6 / 5 7 . (unpara l le led) 1 2 2 7 /
2 9 . (round) 2 6 7 / 5 8 . (inacce s sib le) 1 2 2 8 /
INTERVIEWER : I F YOU CODED 5 OF 7 WRONG , SKIP TO Q . 8 5 .
CS- 4 7 DECK 1 5
I I I BASAL = 5 OF 5 OORREcr I I OOUNT BACK 5 TO ESTABLISH BASAL I
I I I CEILING = 5 OF 7 WRONG I I ONLY IF STARriNG Q# IS WRONG -....TUMP BACK 5 Q# I
I I I
PLATE ITEM CODE ONE • • •
PLATE ITEM CODE ONE • • •
# # ANSWER CORRECT WRONG # # ANSWER CORRECT WRONG
5 9 . ( co l league ) 2 2 9 / ® 7 2 . ( aes theti c ) 2
6 0 . ( medieva l ) 2 3 0 / 7 3 . ( de luge ) 2
6 1 • ( pi nnac le ) 2 3 1 / 7 4 . ( didac tic ) 2
@ 6 2 . ( pic turesque ) 2 3 2 / 7 5 . ( ti tular ) 2
6 3 . ( adj acen t ) 2 3 3 / 7 6 . ( creduli ty ) 2
6 4 . ( navigable ) 2 3 4 / 7 7 . ( j udiciable ) 2
6 5 . ( diminutive ) 2 3 5 / @) 7 8 . ( nihi l i sm ) 2
6 6 . ( ensign ) 2 3 6/ 7 9 . ( pharyngea l ) 2
6 7 . ( di lapidated ) 2 3 7 / s o . ( pterodactyl ) 2
6 8 . ( bureaucrat ) 2 3 8 / 8 1 • ( macrocosm ) 2
6 9 . ( adulation ) 2 3 9 / 8 2 . ( chimerica l ) 2
7 0 . ( exorbi tantly) 2 4 0 / 8 3 . ( disaccharide ) 1 2
7 1 • ( epoch ) 2 4 1 / 8 4 . ( apophthegm ) 2
8 5 . INTERVIEWER : CALCULATE RAW SCORE :
A . ENTER H IG HEST CEIL ING Q# : ( LAST ITEM WRON G )
B . ENTER TOTAL # OF ERRORS BETWEEN BASAL AND CEIL ING :
C . SUBTRACT ' B ' FROM ' A ' :
D . I S CHILD ' S SCORE I N ' C ' 1 9 OR HIGHER?
l_l_l
l_l_l
l_l_l
YES e e e & e ( GQ TO E) e e e o e e e e e e e e e e e o 1 NO • • • • • • ( SKIP TO Q . S S , CS- 5 1 ) • • • • 0
5 5- 5 6 /
5 7 - 58 /
RAW SCORE 5 9 - 60/
- - - > E . RECORD RAW SCORE FROM ' C ' ABOVE I NTO S TEP N INE , BOX B, CS- 4 9 THEN
RETURN TO STEP, SIX CS-49 ..
4 2/
4 3 /
4 4 /
4 5 /
4 6 /
4 7 /
4 8 /
4 9 /
s o ;
5 1 /
5 2/
5 3 / m 5 4/
CS- 4 8
THIS PAGE INTENTIONALLY BLANK
CS-49
PART B: READING COMPREHENSION
[STEP SIX: IF NEEDED , READ TO MOTHER/GUARDIAN .
This section measures (CHILD) ' s ability to understand what (hejshe) reads. The questions begin at a very basic skill level and go to a very high skill level . No one is expected to answer all the questions .]
(STEP SEVEN: IF NEEDED, SEE Q X Q .]
STEP EIGHT: PRACTICE EXERCISES (INCLUDES INSTRUCTIONS TO CHILD) .
IS CHILD IN 1ST GRADE OR HIGHER GRADE?
YES ••• (SKIP TO B)••••• NO •••• (GO TO A) ••••••• 0
A . PRACTICE EXERCISES FOR CHILDREN NOT YET IN 1ST GRADE .
(1) TURN TO "INTRODUCTION TO READING COMPREHENSION SUBTEST " (IN PIAT VOLUME II) . READ:
Now I want to find out how well you understand and remember what you read . Let us practice again a little so you will know what I want you to do . (GO TO PRACTICE A .)
(2) FOLLOW TEXT IN EASEL FOR PRACTICE EXERCISES .
B . CHILDREN IN 1ST GRADE OR HIGHER NEED NO PRACTICE EXERCISES . TURN TO "INTRODUCTION TO THE READING COMPREHENSION SUBTEST , " IN PIAT VOLUME II AND READ:
STEP NINE:
Now I want to find out how well you can understand and remember what you read . But, first, let me explain what you are to do. I am going to show you a page . It will have only a sentence printed on it . Read this sentence silently (PAUSE) to yourself (PAUSE) just once . When you have finished , look up at me. Then
I will show you the next page which will have four pictures on it . You are to (show me/point tojtell me the number of)
the picture that best describes what you have read . Be sure to remember what you have read, once , and then look up at m e .
SKIP TO STARTING Q# (SEE BOX B BELOW) , TURN TO APPROPRIATE EASEL PAGE AND PROCEED IF RAW SCORE = 19 OR HIGHER.
( $TARTING Q# = RAW SCORE FROM PART A , CS-47 , Q .85C.)
STARTING Q#
- - - - - - -> ITI BOX B
CS-50 DECKS 15-16
BASAL = 5 OF 5 CORRECT I I COUNT BACK 5 TO ESTABLISH BASAL I I I I
CEILING = 5 OF 7 WRONG I I ONLY IF STARriNG Q# IS WRONG .. JUMP BACK 5 Q# I __________ l l _::-_-_______________ 1
PLATE RECORD CODE ONE PLATE RECORD
CODE ONE
# ANSWER RESPONSE CORRECT WRONG # ANSWER RESPONSE CORRECT WRONG
19. (3)
20. ( 1 )
21. (2)
22. (3)
23. (2)
24. ( 3)
25. (1)
26. ( 1 )
27. ( 2)
28. ( 3)
29. ( 2)
30. ( 1 )
31 • ( 3)
32. ( 4)
33. ( 2)
34. ( 4)
35. ( 3)
36. ( 4)
37. (1)
38 . ( 2)
39 . ( 3)
40. ( 1 )
41. (3)
42 . (3)
43. (1)
44 . ( 4)
4 5 . (2)
46 . (3)
47 . (1)
48 . ( 1 )
49 . ( 2)
50 . ( 3)
51 . (2)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2 BEGIN DECK 16
1 2
2
2
2
2
2
2
2
2
2
2
2
2
2
61/
62/
63/
64/
65/
66/
67/
68/
69/
70/
71/
72/
73/
74/
75/
76/
77/
78/
79/
12/
13/
14/
15/
16/
17/
18/
19/
20/
21/
22/
23/
24/
25/
52. ( 4)
53. ( 3)
54. ( 4)
55. ( 2)
56. ( 4)
57. (2)
58. ( 4)
59. (3)
60. (2)
61. ( 3)
62. ( 2)
63. (4)
64. ( 3)
65. ( 4)
66. ( 1)
67. ( 2)
68. (1)
69. ( 4)
70. (2)
71. (1)
72 . (1)
73. (4)
74. ( 4)
7 5 . ( 1 )
76 . ( 2)
77. (3)
78 . ( 4)
79 . ( 2)
80. ( 3)
81 . (3)
82 . (1)
83. (2)
84 . ( 1 )
INTERVIEWER : I F YOU CODED 5 OF 7 WRONG , GO TO Q .85 .
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
26/
27/
28/
29/
30/
31/
32/
33/
34/
35/
36/
37/
38/
39/
40/
41/
42/
43/
44/
45/
46/
47/
48/
49/
50/
51/
52/
53/
54/
55/
56/
57/
58/
CS- 5 1
INTERVIEWER REMARKS :
8 5 . HOW MANY PEOPLE WERE PRESENT DURING ADMI N I S TRATION O F THI S SECTION AND WHAT EFFEC T , IF ANY , DID THEIR PRESENCE HAVE ON THE CHILD?
EFFECT ON CHILD ' S PERFORfvlANCE SEEMED TO
IF P RESENT , CODE # PERSONS BE
,- 1_1 MOTHER 59/
FATHER 1_1 6 1 /
GUARDIAN 1_1 6 3/
ADULTS - RELA'r iVE 1_1_1 6 5 - 6 6/
FAMILY FRI END 1_1_1 68-69/
OTHER ( SPEC I F Y )
1_1_1 7 1 - 7 2
;:. S I BLING 1_1_1 7 4 - 7 5
FRI END 1_1_1 7 7 - 7 8/ CHILDREN OTHER
( SPEC I F Y )
I_ I_ I 1 2- 1 3/ ,___
8 6 . CODE CHILD ' S ENERGY
LEVEL DURING SEC'riON.
low ( tir ed )
HAill4FUL
1
1
1
1
1
1
1
1
1
8 7 . WAS THIS SECTION TERMINATED PREMATURELY?
YES • • • ( ASK A) • • • • • •
NO • • • • • • • • • • • • • • • • • 0
NONE OBSERVABLE
2
2
2
2
2
2
2
2
2
medium
2
SEEMED TO IMPROVE
3
3
3
3
3
3
3
3
6
6
6
6
7
7
7
7
0/
2/
4/
7/
Of
3/
BEGIN D
6/
9/ ECK
3 1 4/
h i g h
1 5/
3
1 6/
A o REASON FOR PREMATURE TERMINATION OF THIS SECTION . ( CODE ALL THAT APPLY . )
PARENT/GUARDIAN TERMINATED/REFUS ED • • • • • • • • • • • 0 1 1 7- 1 8/
CHILD WOULD NOT RESPOND/REFUSED • • • • • • • • • • • • • • 0 2 1 9- 20/
MAJOR INTERRUPTION CAUSED TERMINATION • • • • • • • • 0 3 2 1 - 2 2/
CHILD COULD NOT UND ERSTAND TAS K • • • • • • • • • • • • • • 0 4 2 3 - 24/
CHILD HAD LANGUAGE PROBLEM • • • • • • • • • • • • • • • • • • • 0 5 2 5 - 2 6/
CHILD ' S EMOTIONAL COND ITION • • • • • • • • • • • • • • • • • • 06 2 7 - 28 /
C H ILD ' S PHYS ICAL CONDITION • • • • • • • • • • • • • • • • • • • 0 7 2 9 - 3 0/
OTHER ( SPEC I F Y )
08 3 1 - 3 2/
CS- 5 2
THIS PAGE INTENTIONALLY BLANK
CS- 5 3
SECTION 1 0 : PEABODY PICTURE VOCABULARY TEST
AGES : 3 YEARS AND OLDER
STEP ONE : CHECK FLAP ( BOX B ) . IS CHILD ' S PPVT AGE 3 YRS OR OLDER?
YES . • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO . • • • • ( CHECK FLAP 1 BOX E ) • • • • 0
[ STEP TVm : I F NEEDED , READ TO MOTHER/GUARDIAN .
Thi s s e c tion i s des igned to measure ( CHILD ) ' s vocabulary . Chi ldren usua l ly enj oy doing thi s . I te l l ( him/he r ) a word and ( he /s h e ) looks at
four pictures and tells me which picture has the same meaning as the word I s a i d . ]
[ STEP THREE : IF NEEDED , SEE Q X Q. ]
STEP FOUR : ADMINI STER PRACTICE QUESTIONS ( INCLUDES INSTRUCTION S TO CHILD ) .
C HECK FLAP ( BOX B ) : IS CH ILD ' S PPVT AGE • • •
3 YRS - 7 YRS , 1 1 MOS • • • • • • • ( GO TO A) • • • • • • • • 1 8 YRS OR OLDER • • • • • • • • • • • • • • ( GO TO B ) • • • • • • • • 2
A . INSTRUCTIONS FOR CHILD 3 YRS - 7 YRS , 1 1 MOS .
PRACTICE A: TURN TO PPVT EAS EL , TRAIN I NG PLATE A M1D SAY TO CHILD :
I want you to look at some pictures wi th me . See a l l the pictures
on thi s page? ( POINT TO EACH PICTURE . ) I wi ll s ay a word ; then I want you to put your finge r on the picture of the word I have s a i d . If you are not sur e , j us t tel l me your bes t gues s . Let ' s
try one . Put your f i nge r on the picture of dol l .
do l l ( 4 )
fork ( 1 )
tab le ( 2 ) car ( 3 )
CORRECT • • • • GO TO PRACTICE B .
WRONG • • • • • • ASK ALTERNATE WORD S , THEN GO TO PRACTICE B .
PRACTICE B : TURN TO TRAINING PLATE B . PROCEED AS I N PRACTICE A .
man ( 2 )
comb ( 3 )
sock ( 4 ) mouth (1)
PRACTICE C : TURN TO TRAIN ING PLATE C . PROCEED AS I N PRACTICE A .
swinging ( 3 )
drinking ( 4 ) wa lki ng ( 1 ) c l imbing ( 2 ) �-------------------------------------------------------------------
m
CS- 5 4
B . INSTRUCTION S FOR CHILD 8 YRS M�D OLDER .
READ TO CHILD :
I have some pi c tures to show you/OR ( FOR OLDER CHILDREN ) I want to find out how large your vocabulary i s .
PRACTICE D : TURN TO TRAIN ING PLATE D AND READ :
See , there are four pic tures . Each of them i s numbe red ( POINT ) . I wi l l say a wor d ; then I wan t you to te l l me the number of , or
point to , the picture that bes t te l l s the meaning of whe e l . I f
you a r e n o t s u r e , te ll m e your b e s t gue s s . PROCEED AS I N PRACTICE A .
whee l ( 4 )
z ipper ( 2 ) r ope ( 1 ) rak e ( 3 )
PRACTICE E : TURN TO TRAINING PLATE E . PROCEED AS IN PRACTICE A.
giant ( 1 )
bride ( 1 ) witch ( 4 ) r oya l ( 2 )
STEP FIVE : CHECK FLAP ( BOX B : ) CODE STARTING Q# , TURN TO APPROPRIATE
EASEL PAGE AND PROCEED .
I S CHILD ' S PPVT AGE • • •
3 YRS - 3 YRS , 5 MOS • • • • • • • • • • ( GO TO Q. 1 , CS-5 5 ) • • • • • • 0 1 3 YRS , 6 MOS - 3 YRS , 1 1 MOS • • • ( SKIP TO Q . 1 0 , CS- 5 5 ) • • • 0 2 4 YRS - 4 YRS , 5 MOS • • • • • • • • • • ( SKIP TO Qo 1 5 1 CS- 5 5 ) • • • 0 3 4 YRS , 6 MOS - 4 YRS , 1 1 MOS • • • ( SKIP TO Q . 2 0 , CS-5 5 ) • • • 0 4 5 YRS - 5 YRS , 5 MOS • • • • • • • • • • ( SKIP TO Q. 3 0 , CS- 5 5 ) • • • 0 5 3 3 - 34/
5 YRS , 6 MOS - 5 YRS , 1 1 MOS • • • ( SKIP TO Q . 3 5 , CS-5 5 ) • • • 0 6 6 YRS - 6 YRS , 5 MOS • • • • • • • • • • ( SKIP TO Q. 4 0 , CS- 5 5 ) • • • 0 7 6 YRS , 6 MOS - 6 YRS , 1 1 MOS • • • ( SKIP TO Q . 5 o , CS- 5 6 ) • • • 08
7 YRS - 7 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q. 5 5 , CS- 5 6 ) • • • 09 8 YRS - 8 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 6 5 , CS- 5 6 ) • • • 1 0 9 YRS - 9 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 7 0 , CS- 5 6 ) • • • 1 1
1 0 YRS - 1 0 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 8 0 , CS- 5 6 ) • • • 1 2 1 1 YRS - 1 1 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 8 5 , CS- 5 6 ) • • • 1 3 1 2 YRS - 1 2 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 9 0 , CS-5 6 ) • • • 1 4 1 3 YRS - 1 3 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 9 5 , CS- 57 ) • • • 1 5 1 4 YRS - 1 4 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q o 1 0 0 1 C S- 5 7 ) • • 1 6 1 5 YRS - 1 5 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q. 1 0 5 , CS- 5 7 ) • • 1 7 1 6 YRS - 1 6 YRS , 1 1 MOS • • • • • • • • • ( SKIP TO Q . 1 1 0 , CS- 5 7 ) • • 1 8
WORD
1 • BUS ( 4 )
2 . HAND ( 1 )
3 . BED ( 3 )
4 . TRACTOR ( 2 )
5 . CLOSET ( 1 )
6 . SNAKE ( 4 )
7 . BOAT ( 2 )
8 . TIRE ( 3 )
9 . cow ( 1 )
1 o . LAMP ( 4 )
1 1 • DRUM ( 3 )
1 2 . KNEE ( 4 )
1 3 . HEL ICOPTER( 2 )
1 4 . ELBOW ( 4 )
1 5 . BANDAGE ( 4 )
1 6 . FEATHER ( 1 )
1 7 . EMPTY ( 3 )
1 8 . FENCE ( 4 )
1 9 . ACC IDENT ( 2 )
2 0 . NET ( 2 )
2 1 • TEARING ( 4 )
2 2 . SAIL ( 1 )
2 3 . MEASURING ( 2 )
�
BASAL = 8 OF 8 CORRECT
CEILING = 6 OF 8 WRONG
RECORD CODE ONE RESPONSE CORRECT WRONG
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
CS- 5 5
COUNT BA.CK 8 FOR BASAL 00 NOT JUMP BA.CK FOR THE PPVT
RECORD WORD RESPONSE
3 5/ 2 4 . PEEL I NG ( 3 )
3 6 / 2 5 . CAGE ( 1 )
3 7 / 2 6 . TOOL ( 4 )
3 8 / 2 7 . S QUARE ( 4 )
3 9 / 2 8 . STRETCHING ( 1 )
40/ 2 9 . ARROW ( 2 )
4 1 / 3 0 . TYING ( 2 )
4 2/ 3 1 • NEST ( 1 )
4 3 / 3 2 . ENVELOPE ( 2 )
44/ 3 3 . HOOK ( 3 )
4 5 / 3 4 . PASTING ( 4 )
46/ 3 5 . PATTING ( 1 )
4 7 / 3 6 . PENGUIN ( 1 )
48/ 3 7 . S EWING ( 2 )
49/ 3 8 . DEL IVERING ( 1 )
50/ 3 9 . D IVING ( 2 )
5 1 / 4 0 . PARACHUTE ( 3 )
5 2/ 4 1 • FURRY ( 4 )
5 3 / 4 2 . VEGETABLE ( 4 )
5 4/ 4 3 . S HOULDER ( 3 )
5 5 / 4 4 . DRIPP ING ( 2 )
56/ 4 5 . CLAW ( 4 )
5 7 / 4 6 . DECORATED ( 3 )
DECK 1 7
CODE ONE CORRECT WRONG
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
INTERVIEWER : IF YOU CODED 6 OF 8 WRONG , SKIP TO Q . 1 7 6 , CS- 5 9 .
5 8 /
5 9 /
6 0 /
6 1 /
6 2 /
6 3 /
6 4 /
6 5 /
6 6 /
m 6 7 /
6 8 /
6 9 /
7 0 /
7 1 /
7 2 /
7 3/
7 4 /
7 5/
7 6 /
7 7/
7 8 /
7 9 /
8 0 /
WORD
4 7 . FRAME ( 1 )
4 8 . FOREST ( 3 )
4 9 . FAUCET ( 2 )
5 0 . GROUP ( 3 )
5 1 . STEM ( 3 )
5 2 . VASE ( 3 )
5 3 . PEDAL ( 1 )
5 4 . CAP S ULE ( 2 )
5 5 . SURPRI SED ( 4 )
5 6 . BARK ( 2 )
5 7 . MECHANIC ( 2 )
5 8 . TAMBOURINE ( 1 )
CS- 5 6
:BASAL = 8 O F 8 CORRECT
CEILING = 6 OF 8 WRONG
I I I I I I
BEG IN D ECK 1 8
COUNT BA.CK 8 FOR :BASAL
00 NOT JUMP BA.CK FOR THE PPilT ___________ I I ___________ _
RECORD CODE ONE RECORD CODE ONE
RESPONSE CORRECT WRONG WORD RESPONSE CORRECT WRONG
2 1 2/
2 1 3/
2 1 4/
2 1 5/
2 1 6/
2 1 7/
2 1 8/
2 1 9/
2 20/
2 2 1 /
2 2 2 /
2 2 3 /
7 0 . CEREMONY ( 4 )
7 1 . CASSEROLE ( 2 )
7 2 . VEHICLE ( 4 )
7 3 . GLOBE ( 3 )
7 4 . FILING ( 3 )
7 5 . CLAMP ( 2 )
7 6 . REPTILE ( 2 )
7 7 . I SLAND ( 1 )
7 8 . SPATULA ( 3 )
7 9 . COOPERATION ( 4 )
8 0 . SCALP ( 4 )
8 1 . TWIG ( 2 )
2 3 5
2 36
2 3 7
2 38
2 39
2 4 0
2 4 1
2 4 2
2 4 3
2 44
2 4 5
2 46
5 9 . DISAPPOINTMENT ( 4 ) ( 2 24/ 8 2 . WEASEL ( 2 ) 2 4 7 > 'i
6 0 . AWARDING ( 3 )
6 1 . P I TCHER ( 3 )
6 2 . REEL ( 1 )
6 3 . S IGNAL ( 1 )
6 4 . TRUNK ( 2 )
6 5 . HUMAN ( 2 )
6 6 . NOSTRIL ( 1 )
6 7 . D I S AGREEMENT ( 1 )
6 8 . EXHAUSTED ( 2 )
6 9 . VINE ( 4 )
2 2 5/
2 2 6 /
2 2 7 /
2 2 8 /
2 29/
2 3 0 /
2 3 1 /
2 3 2 /
2 3 3 /
2 3 4 /
8 3 . DEMOLI S HING ( 4 )
8 4 . BALCONY ( 1 )
8 5 . LOCKET ( 1 )
8 6 . AMAZED ( 3 )
8 7 . TUBULAR ( 1 )
8 8 . TUSK ( 1 )
8 9 . BOLT ( 3 )
9 0 . COMMUNICATION ( 4 )
9 1 . CARPENTER ( 2 )
9 2 . ISOLATION ( 1 )
INTERV I EWER : I F YOU CODED , 6 OF 8 WRONG , SKIP TO Q . 1 7 6 , CS- 59 .
'
2 4 8 _1 2 49,
2 5 4,
2 5 5 ,
2 5 6
2 5 7 ,
CS- 57 DECKS 1 8- 1 9
I I BASAL = 8 OF 8 CORREcr I I COUNT :B.li.CK 8 FOR BASAL
I I CEILING = 6 OF 8 WRONG I I 00 Nor JUMP :B.li.CK FOR THE PPIJI'
I I
RECORD CODE ONE RECORD CODE ONE
WORD RESPONSE CORRECT WRONG WORD RESPONSE CORRECT WRONG
BEGIN DECK 1 9
9 3 . INFLATED ( 3 ) 2 5 8 / 1 1 6 . PARALLELOGF.AM ( 1 ) 1 2 1 2/
9 4 . COAST ( 3 ) 2 59/ 1 1 7 . SLUMBERING ( 3 ) 2 1 3/
9 5 . ADJUSTABLE ( 2 ) 2 60/ 1 1 8 . PENINSULA ( 4 ) 2 1 4/
9 6 . FRAGILE ( 3 ) 2 6 1 / 1 1 9 . UPHOLSTERY ( 2 ) 2 1 5/
9 7 . ASSAULTING ( 1 ) 2 6 2 / 1 2 0 . BARRICADE ( 4 ) 2 1 6 /
9 8 . APPLIANCE ( 1 ) 2 6 3/ 1 2 1 • QUARTET ( 4 ) 2 1 7 /
9 9 . PYRAMI D ( 4 ) 2 6 4 / 1 2 2 . TRANQUIL ( 3 ) 2 1 8/
1 00 . BLAZING ( 1 ) 2 6 5 / 1 2 3 . ABRASIVE ( 1 ) 2 1 9 /
1 0 1 • HOISTING ( 1 ) 2 66/ 1 2 4 . FATIGUED ( 3 ) 2 20/ m 1 0 2 . ARCH ( 4 ) 2 6 7 / 1 2 5 . SPHERICAL ( 2 ) 2 2 1 /
1 0 3 . LECTURING ( 4 ) 2 68/ 1 2 6 . SYRINGE ( 2 ) 2 2 2 /
1 0 4 . D ILAP IDATED ( 4 ) 2 69/ 1 2 7 . FELINE ( 2 ) 2 2 3 /
1 0 5 . CONTEMPLATING ( 2 ) ( 2 7 0 / 1 2 8 . ARID ( 4 ) 2 2 4/
1 06 . CANI STER ( 1 ) 2 7 1 / 1 2 9 . EXTERIOR ( 1 ) 2 2 5 /
1 0 7 . D I S S ECTING ( 3 ) 2 7 2 / 1 3 0 . CONSTELLATION ( 4 ) 2 26/
1 08 . L INK ( 4 ) 2 7 3/ 1 3 1 • CORNEA ( 2 ) 2 2 7 /
1 0 9 . SOLEMN ( 3 ) 2 7 4/ 1 3 2 . MERCANTILE ( 1 ) 2 28/
1 1 0 . ARCHERY ( 2 ) 2 7 5/ 1 3 3 . ASCENDING ( 3 ) 2 29/
1 1 1 • TRANSPARENT ( 3 ) 2 7 6 / 1 3 4 . FILTRATION ( 1 ) 2 30/
1 1 2 . HUSK ( 1 ) 2 7 7/ 1 3 5 . CONSUMING ( 4 ) 2 3 1 /
1 1 3 . UTENSIL ( 2 ) 2 7 8 / 1 3 6 . CASCADE ( 4 ) 2 3 2 /
1 1 4 . CITRUS ( 3 ) 2 79/ 1 3 7 . PERPEND ICULAR ( 3 ) 2 3 3/
1 1 5 . PEDESTRIAN ( 2 ) 2 80/ 1 3 8 . REPLENIS HING ( 1 ) 2 34/
INTERVIEWER : IF YOU CODED 6 OF 8 WRONG , SKIP TO Q . 1 7 6 , CS- 5 9 .
CS- 58 DECK 1 9
I I Bi\SAL = 8 OF 8 CORRECI' I I COUNT BACK 8 FOR Bi\SAL
I I CEILING = 6 OF 8 WRONG I I 00 Nor JUMP BACK FOR THE PPVT
I I
RECORD CODE ONE RECORD CODE ONE
WORD RESPONSE CORRECT WRONG WORD RESPONSE CORRECT WRONG
1 3 9 . EMI S S I ON ( 3 ) 2 3 5 / 1 5 8 . EMAC IATED ( 2 ) 2 5 4
1 4 0 . TALON ( 3 ) 2 3 6/ 1 59 . D IVERGENCE ( 4 ) 2 5 5
1 4 1 • WRATH ( 3 ) 2 3 7 / 1 6 0 . DROMEDARY ( 2 ) 2 56,
1 4 2 . INCANDESCENT ( 4 ) 2 3 8 / 1 6 1 . EMBELLISHING ( 2 ) 2 5 7 ,
1 4 3 . ARROGANT ( 2 ) 2 3 9 / 1 6 2 . ENTOMOLOGI S T ( 3 ) 2 58 ,
1 44 . CONFIDING ( 3 ) 2 4 0 / 1 6 3 . CONSTRAIN ( 1 ) 2 59,
1 4 5 . RHOMBUS ( 3 ) 2 4 1 / 1 6 4 . INFIRM ( 1 ) 2 6 0 ,
1 46 . NAUTICAL ( 3 ) 2 4 2/ 1 65 . ANTHROPOID ( 3 ) 2 6 1 ;
1 4 7 . TANGENT ( 1 ) 2 4 3 / 1 6 6 . SPECTER ( 4 ) 2 6 2 ;
1 48 . INCLEMENT ( 4 ) 2 4 4 / 1 67 . INCERTITUDE ( 2 ) 2 6 3;
1 4 9 . TRAJECTORY ( 1 ) 2 4 5 / 1 68 . VITREOUS ( 1 ) 2 6 4 ;
1 5 0 . FETTERED ( 1 ) 2 46/ 1 69 . OBEL ISK ( 1 ) 2 6 5 ;
1 5 1 . WAI F ( 3 ) 2 4 7 / 1 7 0 . EMBOSSED ( 4 ) 2 66A
1 5 2 . JUBILANT ( 2 ) 2 4 8 / 1 7 1 . AMBULATION ( 2 ) 2 6 7) 1 5 3 . P ILFERING ( 4 ) 2 4 9 / 1 7 2 . CALYX ( 2 ) 2 68/
1 5 4 . REPOSE ( 2 ) 2 5 0/ 1 7 3 . OSCULATION ( 3 ) 2 69/
1 5 5 . CARRION ( 3 ) 2 5 1 / 1 7 4 . CUPOLA ( 4 ) 2 7 0 /
1 5 6 . IND IGENT ( 2 ) ') 5 2/ 1 7 5 . HOMUNCULUS ( 4 ) 2 7 1 / ""
1 5 7 . CONVEX ( 1 ) 2 5 3 /
INTERVIEWER : I F YOU CODED 6 OF 8 WRONG , GO TO Q . 1 7 6 .
CS- 59 DECKS 1 9- 20
INTERVIEWER REMARKS :
1 7 6 . HOW MANY PEOPLE WERE PRESENT DURING ADHI N I S TRATION OF THI S SECTI ON AND WHAT EFFECT , I F AN Y, D ID THEIR PRESENCE HAVE ON THE CHILD?
I F PRESENT, CODE # PERSON S
r-MOTHER I_ I 7 2/
FATHER I_ I 7 4/
GUARD IAN I_ I 7 6/
ADULTS - RELATIVE I_ I_ I 7 8 - 7 9/
FAMILY FRIEND I_ I_ I 1 2- 1 3/
OTHER ( SPEC I FY )
I_ I_ I 1 5- 1 6/ ;:::..
S I BL ING I_ I_ I 1 8- 1 9/
FRIEND l_l_l 2 1 - 2 2/
CHILDREN - OTHER ( SPEC I F Y )
I_ I_ I 2 4 - 2 5 /
1 7 7 . CODE CHILD ' S ENERGY LEVEL DURING SECT I ON .
low ( ti red )
EFFECT ON CHILD ' S PERFORMANCE
SEEMED TO NONE SEEHED TO BE HARMFUL OBSERVABLE I MPROVE
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
medium high
2 3
1 7 8 . WAS THIS SECTION TERMINATED PREMATURELY?
YES • • • • • ( ASK A) • • • •
N O . • • • • • • • • • • • • • • • • 0
BE
7 3/
7 5/
7 7 /
8 0/
G IN DECK 2 0
1 4/
1 7/
2 0/
2 3 /
IPP:t, 26/ IIU:I
2 7 /
2 8 /
A . REASON FOR PREMATURE TERMINATION O F THI S SECTION . ( CODE ALL THAT APPLY . )
PARENT/GUARDIAN TERMINATED/REFUSED • • • • • • • • • • • 0 1
CHILD WOULD NOT RESPOND • • • • • • • • • • • • • • • • • • • • • • 0 2
MAJOR INTERRUPTION CAUSED TERMINATION • • • • • • • • 0 3
CHILD COULD NOT UNDERSTAND TASK • • • • • • • • • • • • • • 0 4
CHILD HAD LANGUAGE PROBLEM • • • • • • • • • • • • • • • • • • • 0 5
CHILD ' S EMOTIONAL COND ITION • • • • • • • • • • • • • • • • • • 0 6
CHILD ' S P HYS ICAL CONDITION • • • • • • • • • • • • • • • • • • • 0 7
OTHER ( SP EC IFY )
------------------------------------------- 08
INTERVIEWER : THAN K CHILD AND GO TO SECTION 1 1 , CS-6 1
29- 3 0/
3 1 - 3 2/
3 3 - 3 4/
3 5 - 36/
3 7 - 3 8/
39-40/
4 1 - 4 2/
4 3 - 4 4/
C&- 6 0
T H I S PAG E I NTENTIONALLY BLANK
C S - 6 1
SECTION 1 1 : INTERVIEWER EVALUATION OF TESTING CONDITIONS
EACH CHILD
1 . DURING THE INTERV I EW , HOW WAS CHILD ' S • • • ( CODE ONE FOR EACH LETTER. )
DECK 2 0
Poor Average Exc e l lent
A .
B .
c .
D .
E .
2 . DURING
ATTITUDE TOWARD BEING TESTED? 2 3 4
RAPPORT W ITH INTERVI EWER?
PERSEVERANCE/PERS I S TENC E?
COOPERATION?
MOTIVATION/INTEREST?
THE INTERVIEW WERE THERE
A . VISUAL S HARPNE S S?
( SPEC I F Y )
B . HEARING?
( SPEC IF Y )
C . S TATE OF HEALTH?
( SPEC I F Y )
ANY
------
2 3 4
2 3 4
2 3 4
2 3 4
PRORLEMS WITH CHILD ' S
YES • • • • • • • • • • • • • • • • • • • NO • • • • • • • • • • • • • • • • • • • • 0
YES • • • • • • • • • • • • • • • • • • • NO • • • • • • • • • • • • • • • • • • • • 0
YES • • • • • • • • • • • • • • • • • • • NO • • • • • • • • • • • • • • • • • • • • 0
3 . HOW SHY AND ANXIOUS WAS CHILD AT THE END O F THE CHILD SUPPLEMENT?
5 4 5 /
5 4 6 ;
5 4 7 /
5 48/
5 4 9 /
5 0/
5 1 /
5 2/
NOT AT ALL SHY & ANXIOUS/ SOC IABLE & FRIENDLY
EXTREMELY S HY/QUIET/ WITHDRAWN
5 3 / 2 3 4 5
m
C S - 6 2
4 . DID ANY INTERFERENCES OCCUR DURING THE CHILD SUPPLEMENT?
YES • • • • • ( GO TO A ) • • • • • NO • • • • • • • • • • • • • • • • • • • • 0
A . CODE EACH CATEGORY BY AMOUNT OF INTERFERENCE .
NO'r INTERFERING INTERFERING
( 1 ) NOISE LEVEL 2 3
( 2 ) INTERRUPTIONS 2 3
( 3 ) DISTRACTIONS 2 3
( 4 ) L IGHT 2 3
( 5 ) TEMPERATURE 2 3
( 6 ) PRESENCE OF OTHERS 2 3
( 7 ) OTHER ( SP EC I F Y ) 2 3
5 . WHERE WAS THI S CHILD SUPPLEMENT ADMINISTERED?
CHILD ' S RES IDENCE • • • • • • • • • • 1 OTHER PRIVATE RES IDENCE • • • • 2
OTHER S I TE ( SP EC I FY )
3
I 4 5
4 5
4 5
4 5
4 5
4 5
4 5
6 . CHECK FLAP ( BOX F ) . IS THE MOTHER SUPPLEMENT COMPLETED?
YES . • • • • • • • • • • • • • • • • • 1 NO • • • • • ( GO TO A ) • • • • • 0
NA
NA
NA
NA
NA
NA
NA
DECK 20
5 4/
5 5 /
56/
57/
58/
59/
60/
6 1 /
6 2/
6 3 /
A . IF YOU HAVE ALREADY GIVEN � TO MOTHER , A S K HER IF SHE N EEDS ANY HELP IN COMPLETING I T . IF YOU HAVE NOT YET G IVEN M S TO MOTHER , D O S O NOW .
7 . C HECK FLAP ( BOXES D AND E ) . IS THIS CHILD SUPPLEMENT COMPLETED?
YES • • • • • ( SKIP TO SECTION 1 2 , CS-65 ) • • • • • 1 NO e o e o e e e o o e o o e e e e e e e o e o e e e e o e o o o e e e e o o o 0
6 4/
CS- 6 3
8 , WHY IS CHILD SUPPLEMENT I NCOMPLETE?
S ECTIONS INCOMPLETE • • • • • • • ( GO TO A) • • • • • • • • 1
TERMINATED P ERMATURELY • • • • • • • • • • • • • • • • • • • • • 2
A . ATTEMP'r TO COMPLETE SECTIONS NOW . AFTER ATTEMPT ( WHETHER SUCCESS FUL OR NOT ) RETURN HERE AND RECORD RESULTS .
DECK 20
65/
NOW COMPLETE • • • • • • ( SKIP TO SECTION 1 2 , CS-6 5 ) • • • • • • • • • 1 6 6/ INCOMPLETE • • • • • • • • ( SKIP TO SECTION 1 2 , CS-65 ) • • • • • • • • • 2
9 . WHY WAS CHILD SUPPLEMENT TERMINA'rED PREMATURELY?
PARENT/GUARD IAN TERMINATED • • • • • 6 7 /
CHILD TERMINATED • • • • • • • • • • • • • • • 2
INTERRUPT I ON TERMINATED • • • • • • • • 3
CHILD NOT PRESEN T • • • • • • • • • • • • • • 4
OTHER ( SPEC I F Y )
5 m
C S- 6 4
T HIS PAG E INTENTI ONALLY BLANK
C S - 6 5
SECTION 1 2 : INTERVIEWER OBSERVATIONS OF HOME ENVIRONMENT
EACH CHILD
---------------------STEP ONE :
STEP TWO :
ANSWER ON THE BAS IS OF YOUR PERSONAL OBS ERVATION OF THE HOME
ENVIRONMENT OF EACH CHILD IN STUDY AT TIME OF YOUR V I S IT .
RECORD OBSERVATIONS AT CONCLUS ION OF THE ENTIRE INTERVI EW FOR THI S C HILD .
STEP THREE : I S CHILD ' S AGE • • •
LESS THAN 3 YRS OLD • • • • • • • • ( GO TO PART A, CS-66 ) • • • • • • • • • •
3 YRS - 5 YRS , 1 1 MOS • • • • • • ( SKIP TO PART B , C S - 6 7 ) • • • • • • • • 2
6 YRS AND OLDER • • • • • • • • • • • • ( SKIP TO PART C , C S - 6 8 ) • • • • • • • • 3
NOTE : FOR PURPOSES OF SECTION 1 2 , CHILD ' S " HOME" I S ( HI S/HER) OFFICIAL PERMANENT RES IDENCE . I F C HILD L I VES IN INSTITUTION , IN GROUP HOME OR AT SCHOOL , C I RCLE CODE ' 2 ' , NOT OBSERVED , FOR EACH ANSWER .
CS-66
PART A: CHILD LESS THAN 3 YRS
1 . ( MOTHER/GUARDIAN ) SPONTANEOUSLY SPOKE TO CHILD TWICE OR MORE ( EXCLUDING SCOLDING ) .
2 . ( MOTHER/GUARDIAN ) RESPONDED VERBALLY TO CHILD ' S SPEEC H .
3 . ( MOTHER/GUARDIAN ) CARESSED , K I S S ED , OR HUGGED CHILD AT LEAST ONCE .
4 . ( MOTHER/GUARDIAN ) SLAPPED OR SPANKED CHILD AT LEAST ONCE .
5 . ( MOTHER/GUARD IAN ) INTERFERED W I TH CHI LD ' S ACTIONS OR RESTRICTED CHILD FROM EXPLORING MORE THAN 3 TIMES .
6 . ( MOTHER/GUARDIAN ) PROVIDED TOYS OR INTERESTING ACTIVITIES FOR C HI LD .
7 . ( MOTHER/GUARDIAN ) KEPT C HILD IN VIEW/COULD S EE CHILD/LOOKED AT ( HI M/HE R ) OFTEN .
8 . CHILD ' S PLAY ENVIRONMENT I S SAFE ( NO POTENTIALLY
DANGEROUS HEALTH OR STRUCTURAL HAZARDS WITHIN A TODDLER ' S OR INFANT ' S RANGE ) .
( E . G . , FALLING PLASTER , P EELING PAINT, RODENTS , GLASS , POISONS AND CLEANING MATERIALS , FLAMES & HEAT , FRAYED ELECTRICAL W IRES ) .
YES
TIME ENDED :
I I I I AM l_l_l l_l_l PM.
9 . INTERVI EWER : SKIP TO Q . 1 0 , C S - 6 9 .
HR M I N
NO
0
0
0
0
0
0
0
0
DECK 2 0
NOT OBSERVED
2
2
2
2
2
2
2
2
68/
69/
7 0 /
7 1 /
7 2 /
7 3/
7 4 /
7 5/
7 6- 7 9 /
CS- 67
PART B : CHILD 3 YRS - 5 YRS , 1 1 MOS
1 . ( MOTHER/GUARDIAN ) ' S VOICE CONVEYED POS I TIVE FEELING ABOUT THIS CHILD .
2 . ( MOTHER/GUARDIAN ) CONVERSED WITH CHILD AT LEAST TWICE ( EXCLUDING SCOLDING OR SUSPIC IOUS COMMENTS ) .
3 . ( MOTHER/GUARDIAN ) ANSWERED CHILD ' S QUESTIONS OR REQUESTS VERBALLY .
4 . ( MOTHER/GUARDIAN ) CARESSED , KISSED , OR HUGGED CHILD AT LEAST ONC E .
5 . ( MOTHER/GUARDIAN ) INTRODUCED INTERVIEWER TO CHILD BY NAME .
6 . ( MOTHER/GUARDIAN ) PHYS ICALLY RESTRICTED OR ( SHOOK/ GRABBED ) C HILD .
7 . ( MOTHER/GUARDIAN ) SLAPPED OR SPANKED CHILD AT LEAST ONC E .
8 . CHILD ' S PLAY ENVIRONMENT I S SAFE ( NO POTENTIALLY DANGEROUS S TRUCTURAL OR HEALTH HAZARDS W I THIN A PRESCHOOLER ' S RANG E ) .
( E . G . FALLING PLASTER, PEELING PAIN T , RODENTS , GLASS , POI SON S AND CLEAN ING MATERIALS , FLAMES AND HEAT , FRAYED ELECTRICAL W IRES ) .
9 . INTERIOR OF THE HOME IS DARK OR PERCEPTUALLY
MONOTONOUS .
1 0 . ALL VIS IBLE ROOMS OF HOUS E/APARTMENT ARE REASONABLY CLEAN .
1 1 . ALL VIS I BLE ROOMS OF HOUSE/APARTMENT ARE M IN IMALLY CLUTTERED .
YES
TIME ENDED : \_1_! \ I / :
INTERVIEWER: SKIP TO Q . 1 0 , CS-69 .
HR MIN
NO
0
0
0
0
0
0
0
0
0
0
0
BEGIN DECK 2 1
NOT OBSERVED
2
2
2
2
2
2
2
2
2
2
2
1 2/
1 3/
1 4/
1 5/
1 6/
1 7 I
1 8/
1 9/
2 0 /
2 1 /
2 2/
2 3- 26 /
CS-68
PART C : CHILD 6 YRS AND OLDER
1 . ( MOTHER/GUARDIAN ) ENCOURAGED C HILD TO CONTRI BUTE TO THE CONVERSATION .
2 . ( MOTHER/GUARDIAN ) ANSWERED CHILD ' S QUESTIONS OR REQUESTS VERBALLY.
3 . ( MOTHER/GUARDIAN ) ' S VOICE CONVEYED POS ITIVE FEELING ABOUT THI S CHILD .
4 . ( MOTHER/GUARDIAN ) CONVERSED WITH CHILD EXCLUDING SCOLDING OR SUSPICIOUS COMMENTS .
5 . ( MOTHER/GUARDIAN ) , INTRODUCED INTERVI EWER TO CHILD
BY NAM E .
6 . INTERIOR OF THE HOME IS DARK OR PERCEPTUALLY MONOTONOUS .
7 . ALL V I S I BLE ROOMS OF THE HOUSE/APARTMENT ARE REASONABLY CLEAN .
8 . ALL VISIBLE ROOMS OF THE HOUS E/APARTMENT ARE MINIMALLY CLUTTERED .
9 . BUILDING HAS NO POTENTIALLY DANGEROUS STRUCTURAL OR HEALTH HAZARDS WITHIN A SCHOOL-AGED CHILD ' S RANG E .
( E . G . FALLING PLASTER , PEELING PAINT , RODENTS , GLAS S , POISONS AND CLEANING MATERIALS , FLAMES AND HEAT ,
FRAYED ELECTRICAL WIRES ) .
YES
T IME ENDED : lii li/ :
INTERVIEWER : GO TO Q. 1 0 , CS-69 .
HR MIN
NO
0
0
0
0
0
0
0
0
0
DECK 2 1
NOT OBS ERVED
2
2
2
2
2
2
2
2
2
2 7 /
2 8 /
2 9 /
3 0/
3 1 /
3 2/
3 3/
3 4/
3 5 /
3 6 - 3 9 /
CS-69 DECK 21
CARETAKER LOCATING INFORMATION SHEET
1 0 . INTERVIEWER: DID CARETAKER ANSWER CS SECTIONS 1 AND 2, AND THE MS?
YES • • • • • • • ( GO TO A. ) • • • • • • • • NO. • • • • • • • • • • • • • • • • • • • • • • • • • 0
A. We would like some locating information about persons who would always know (CHILD') S whereabouts. (INTERVIEWER SUGGEST THE FOLLOWING) :
Grandpare nt: Name ---------------------------------------------------Street �--��--------------------�----------------�-----------City/State/Zip -------------------"�--------------��-----------Phone ------------------------------------------------------------
Child's Other Relative: Name Street
---------------------------------------�--��--------------------�----------------�-----------
City/State/Zip -------------------"�--------------��-----------Phone ------------------------------------------------------------
Caretaker's Work # Name of Busi ness:
Street ----��------------------�------------------�-----------City/State/Zip -----------------·�----------------��----------Phone ------------------------------------------------------------
40/
Street --------------------------�-------------------------------City/State/Zip --------------��------------------��----------
Name --------------------------------------------------- m Other:
Phone ------------------------------------------------------------
11. INTERVIEWER:
A. RETRIEVE MS FROM MOTHER/GUARDIAN. CHECK � COVER TO SEE IF ALL SECTIONS ARE COMPLETE. IF THEY ARE COMPLETE, MARK IN CS FLAP (BOX F).
B. DOES CHILD HAVE ANY MORE SIBLINGS TO BE INTERVIEWED?
YES • • • (ADMINISTER NEXT CS) • • • 1 NO • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 41 I
THANK MOTHER FOR HER OWN AND HER CHILD'S PARTICIPATION. OBTAIN RECEIPT FOR CASH PAYMENT FOR $ 5 . 00 ON BEHALF OF CHILD.
,_ ,_ ,_,_,_,_, 42-47/ INTERVIEWER ID
� k�� t:.: !'-
CS- 7 0
1 2 . Has ( CH I LD ) ever had a mens trual pe r i od?
Yes • • • ( ASK A ) • • • • • • • • • • • • • • • • • • •
No • • • • ( RETURN TO Q . 1 3 , CS- 8 ) • • • • 0
A . How old was ( CHILD ) when she had her f i r s t mens trua l pe r iod?
l_l_l YEARS
B . I n what month and year did she have her f i r s t per i od?
I_ I_ I I_ I_ I MONTH YEAR
INTERVIEWER : GO BACK TO Q. 1 3 , CS-8 .
DECK 2 1
48/
49- 5 0/
5 1 - 54/
-
CS F LAP
CH I L D'S NAt"lE ( N ICKNAME ) -------------·
BOX A 6GE
,____.____,I CTJ YEARS MONTHS
BOX B: PPVI 6GE
LIJ I � �----� YEARS MONTHS
BOX C: GR6DE
K OR L ESS D
GRADE [IJ
BOX Q· NEED FtJBTHER ATTEMPT
SEC. 3 2ND __ 3RD __ SEC. 4 2ND __ 3RD __
BOX E : SECT ION X AGE GRI D
SECTION NAME
1 . BACKGROUND 2. CH I L D HEALTH 3. PARTS Of THE BODY 4. M E MORY FOR LOCAT I ONS 5. VERBAL M EMORY 6. WHAT I ' M L I K E
PAGE
CS- 1 CS- 5 CS- 1 3 CS- 1 7 CS- 2 5 CS- 33
C I RCLE SECT I ONS TO B E ADM I N I STERED .
SECTION NAME
7. M EMORY FOR D IG ITS 8 . P lAT MAT H 9. P lAT R EADI NG
1 0. P PVT
1 1 . I NTV EVALUAT I ON 1 2. I NTV OBSERVAT I ONS
SLASH THROUGH WHEN COMPLETED. SECT I ONS T HAT NEED MORE WORK B EFORE COMP L E T I ON.
-
CHI LD'S AGE SECT I ONS TO B E COMP L ETED
0 MOS - 7 MOS 1 2
8 MOS - 1 1 M OS 1 2 4
1 2 MOS - 2 YRS , 1 1 MOS* 1 2 3 4 *
3 YRS - 3 YRS , 1 1 MOS 1 2 4 5 1 0
4 YRS - 4 YRS, 1 1 MOS 1 2 5 1 0
5 YRS - 5 YRS, 1 1 MOS 1 2 5 8 9 1 0
6 YRS - 6 YRS , 1 1 MOS I 2 5 8 9 1 0
7 YRS - 7 YRS , 1 1 M OS 1 2 1 8 9 1 0
8 YRS AND OLDER 1 2 6 1 8 9 1 0
!?AG.E.
CS- 3 7 CS- 4 1 CS- 45 CS-53 CS- 6 1 CS- 6 5
CHECK ( >/ )
1 2
1 1 1 2
1 1 1 2
1 1 1 2
1 1 1 2
1 1 1 2
1 1 1 2
1 1 1 2
1 1 1 2
* FOR CHI L D 2 YRS, 1 1 MOS, 1 6- 3 1 DAYS ( P PVT AGE = 3 YRS) DO SECT I ON 1 0.
BOX F - M OTHER'S SECT I ON COMP L ET E D ? Y E S __ N O _
