OMB · YOUTH SURVEY ROUND 8, 1986 Introduction for Child Supplement BEGIN DECK 06 NORC-4440-101 OMB...

THIS SURVEY I S AUTHORIZED BY JTPA TITLE IV PART D SECT ION 4 5 2

CAS E I D/1 : _____ ----=--=-�---�-�-� 1- 7 / 8-9/

NORC Univers ity of Chicago

CENTE R FOR HUMAN RESOURC E RESEARCH OHIO STATE UNIVERS ITY

NAT IONAL LONGITUDINAL SURVEY OF LABOR FORC E BEHAVIOR

CHILD SUPPLEMENT

YOUTH SURVEY ROUND 8, 1986

Introduc t i o n for Chi l d Sup p l ement

BEGIN DECK 06

NORC-4440- 10 1

OMB 092 5-0 2 7 8 EXP 1 2-3 1-86

In the pas t years , NLS has been concerned wit h gatheri ng i nformat ion about the work , educat i o n , and l i f e experiences o f your generat i o n and , o f c ours e , we are cont i nuing t o d o that. But now your generation has begun to have children of its own and , be cause they are your chi ldre n , they are very important peopl e to u s .

The Na tional Ins titute o f Ch i ld Health and Human De velopment has s pons ored thi s s t udy of the deve l o pment o f the childre n of the NL S res pondent s. For each child who participat e s i n the s tudy , the (mo ther /guardian) will receive $ 5 i n appreciation f or the time spent answering the ques ti onnair e . Part s of the ques tionnaire are aske d of the (mother/ guardi an) ; parts are comp l e ted with the chi ld.

In order to as sure that the child ' s answers are his or her bes t and mos t accurate , we need to conduc t the i ntervi ew i n a quie t a tmosphere w i t h a s l i tt le noi s e and a s f ew d is tract ions as pos s i b l e .

Both your part icipation and t hat of your child are vi tal to the s uccess o f the s t udy , but are voluntary . All i nf orma t i o n will be prote cte d under the Pr iva cy Act of 197 4. Res ul t s of the s tudy will be made pub l i c only i n s ummary or s tatis tical f orm s o that indivi dual s who parti cipate canno t be identif ie d .

TIME BEGAN: -, - ,- -, - -, - , AM _I _I _I _I _I _I PM

12-15 /

CS- 1 DECK 06

SECTION 1 : CHILD BACKGROUND

MOTHER/GUARDIAN OF EACH CHILD

READ TO MOTHER/GUARDIAN:

I ' d l ike t o beg i n by verif ying (CHILD) 's name, birthdate and s chool grade.

1. RECORD CHILD ' S FULL NAME AND ID FROM CHI LDREN ' S RECORD FORM, PART A.

CHILD ' S NAME I_ I_ I 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)

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 . VERIFY CHILD ' S AGE WITH MOTHER : ( CHILD) is (YEARS AND MONTHS FROM Q.4). Is tha t correc t ?

Yes • • • • ( GO TO B ) ..... 1 No • • • • • ( GO TO A) ..... 0

A. RECALCULATE CHILD ' S AGE. CHECK CHILD ' S DOB ON CHILDREN' S RECORD FORM, PART A. WHE N RECALCULATION I S VER IFIE D, GO TO B .

B . RECORD CHILD ' S AGE ( YEARS AND MONTHS FROH Q. 4 ) ON FLAP (BOX A) AND IN MOTHER SUPPLEHENT, MS- 1 , Q. 3.

C S- 2

6 . CHE CK FLAP (BOX A). IS CHILD 2 YRS , 1 1 MO S O R OLDE R?

YES • •• • • ( GO TO A) • • • • • • • • • • • • • • • • • • • • • • • • • • 1 N O • • • • • • ( SKI P T O Q.ll AND CODE 0 0) • • • • • • • • • 0

A. CALCULATE PPVT AGE :

IF# DAYS IN Q. 4 I S 1 6 OR GREATER , ADD ' 1 ' TO MOS AND RECORD HERE

( IF# PPVT MO S = 1 2 ADD ' 1 ' TO PPVT YRS AND ZERO F ILL

# P PVT MOS . )

B . RECORD II YRS FROM Q. 4 HERE -------.3io. � l_l_l ( IF NEEDE D , SEE Q X Q. )

C . RECORD PPVT AGE ON FLAP ( BOX B ) .

7 . CHE CK FLAP ( B OX A) . I S CHI L D AGE 4 YRS OR OLDER ?

YES • • • • • • • • • • • • • • • • • • • • • • 1 NO • • •• • ( SKI P TO Q. l l

AND CODE 00) • • • • • 0

II PPVT YRS 3 6-3 7 /

8. Is ( CHILD) currently at tending o r enrol led in regular schoo l ?

Yes •• • • • • • • • • • • • • • 1 No • • • • ( ASK A) • • • • • 0

A. Has ( he/she) ever at tended regul ar school ?

Yes • • • • • • • • • • • • • • • • • • • • • • 1 No • • • • • ( SKIP TO Q. l l

AND CODE 00 ) • • • • • 0

I_ I_ I II PPVT MO S

38-39/

9 . What g rade o f regular schoo l [i s ( CHILD) a t t ending /d i d ( CHILD) last at tend ] ? ( CO DE ONE . )

Kinderga rten • • • • • •• 00 9th grade • • • • • • • • • • • 0 9 1st grade • • • • • • • • • • 0 1 l Oth grade • • • • • • • • • • 1 0 2nd grade • • • • • • • • • • 0 2 1 1th grade • • • • • • • • • • 1 1 3 r d grade • • • • • • • •• • 0 3 1 2t h g rad e • • • • • • • • • • 1 2 4th grade • • • • • • • • • • 0 4 1 s t yea r i n col lege . 1 3 5th grad e • • • • • • • • • • O S 2nd year i n coll ege. 1 4 6th grade • • • • • • • • • • 06 3rd year in co l lege. 1 5 7th grade • • • • • • • • • • 0 7 4t h yea r i n co l l ege. 1 6 8th g rade • • • • • • • • • • 08 Ungraded • • • • • • • • • • • • 95

DECK 0 6

40 /

4 1 /

4 2-4 3/

CS-3

1 0. INTERVIEWER : IS Q.9 CODE D 95, UNGRADE D ?

YES • • • • • (ASK A) • • • • • 1 N O• • • • • • •• • • • • • • • • • • 0

A. If ( CHILD) were i n a graded c l a s s , what grade woul d (he /she) be enro l l e d i n? ( CODE ONE.)

Ki nderga rten • • • • • • • 00 9th grade • • • • • • • • • • • 09 1s t grad e • • • • • • • • • • 0 1 lOth grad e •••••••••• 1 0 2nd grade • • • • • • • • • • 0 2 1 1th g rade • • • • • • • • • • 1 1 3rd g rade • • • • • • • • • • 0 3 1 2t h grade •••••••••• 1 2 4th g rade • • • • • • • • • • 0 4 1 s t year in col lege . 13 5th g rade •••••••••• OS 2nd yea r i n colleg e . 1 4 6th g rade • • • • • • • • • • 0 6 3rd year in college . 1 5 7th grade •••••••••• 0 7 4t h yea r i n col leg e . 1 6 8th grade •••••••••• 08

1 1 . INTERVIEWER : CODE CHILD 'S GRADE LEVEL FROM Q.9 OR Q.lOA .

Kindergarte n o r le ss. 00 9th g rade ••••••••••• 09 1 st grade •••••••••••• 01 lOth grade •••••••••• 10 2nd grade •••••••••••• 02 1 1th grad e •••••••••• 11 3rd g rade •••••••••••• 03 12th grade •••••••••• 12 4th grade •••••••••••• 04 1st yea r i n college •• 13 5th grade •••••••••••• 05 2nd year in col lege •• l4 6th grade •••••••••••• 06 3rd yea r i n colle ge •• 15 7th grade •••••••••••• 07 4th year in col lege •• l6 8th grade •••••••••••• 08

RECORD GRADE IN Q.ll ON FLAP ( BOX C ) .

DECK 06

4 4 /

45-46 /

4 7-48/

CS-4

THIS PAGE INTENTIONALLY BLANK

CS-5

SECTION 2: CHILD HEALTH

MOTHE R/GUARD IAN OF EACH CHILD

READ TO MOTHER /GUARDIAN :

Now I ' d l ike to ask you s ome que s t ions about ( CHILD) ' s

DECK 06

gene ra l s t a t e o f hea l t h and (hi s/he r) phys ica l characteri s t i c s .

1 . Wha t i s ( CHILD) ' s natura l hair col o r ? ( CO DE ONE. )

Light blonde • • • • • • 0 1 Blond e • • •• • • • • • • • • 0 2 Light brown •• • • • • • 0 3 Br own • • • • • • • • • • • • • 0 4 Bl ack • • • • • • • • • • • • • OS Red • • • • • • • • • • • • • • • 0 6 Ot he r ( SPEC IFY )

0 7 -----------------

2. Wha t colo r are ( CHILD) ' s eye s ? ( CODE ONE . )

Light blue • • • • • • • • 0 1 Blue • • • • • • • • • • • • • • 0 2 Light b rown • • • • • • • 0 3 Br own • • • • • • • • • • • • • 0 4 Black • • • • • • • • • • • • • 0 5 Gree n • • • • • • • • • • • • • 0 6 Ha ze l • • • • • • • • • • • • • 0 7 Grey • • • • • • • • • • • • • • 0 8 Othe r ( SPEC IFY ) ________ 0 9

Can ' t tel l yet ; Chi l d t o o youn g • • 1 0

3. INTERVIEWER: CHE CK FLAP ( B OX A) . IS CHILD AGE 4 YRS OR OLDER?

YES • • • • • • • • • • • • • • • • • • • • • • • 1 N O • • • • • ( ASK ONLY Q. 4C ) • • • • 0

4 9-50/

5 1-52/

C S- 6 DECK 06

4. Doe s ( CHILD ) have a ny physi ca l , emoti ona l , or me nta� condition that l imits o r p reve nts ( h i s /h e r ) ab i l ity t o • • •

A. att end s choo l regula r l y ?

Ye s • •• • • • • • • • •• • • • • • • • • • • 1 No • • • • • • • • • • • • • • • • • • • • • • • 0 Doe s not a t t end s choo l • • • 2

B . d o regula r s cho o l wo rk?

Ye s • • • • • • • • • • • • • • • • • • • • • • • 1 No• • • • • • • • • • • • • • • • • • • • • • • • 0 Do e s not a t tend s choo l • • • • 2

C . d o usua l chi l dhood act iviti e s s uch a s play , o r parti cipat e i n game s o r s p o rt s ?

Yes • • • • • • • • • • • • • • • • • • • • • • • 1 No• • • • • • • • • • • • • • • • • • • • • • • • 0

5 . Doe s (CHIL D) have a ny phys i ca l , emo t iona l , or menta l cond i t i o n that requ i re s • • •

6.

A. f requent a t tent ion or t reatment f rom a doct o r or o ther heal th prof e s s i ona l ?

Ye s • • • • • • • • • • • • • • • • • • • • • • • 1 No• • • • • • • • • • • • • • • • • • • • • • • • 0

B . regular us e of any med ici ne o r d rug ( o the r than v i t ami ns ) ?

Ye s • • • • • • • • • • • • • • • • • • • • • • • 1 No • • • • • • • • • • • • • • • • • • • • • • • • 0

c . us e o f any special equi pment , s uch a s a b rac e , c rutche s , a wheel chai r , s peci a l s hoes , a helme t , a special bed , a b reathing mask , a n ai r f ilte r , o r a cathe t e r and s o o n?

Ye s • • • • • • • • • • • • • • • • • • • • • • • 1 No• • • • • • • • • • • • • • • • • • • • • • • • 0

INTERVIEWER : I S ANY PART O F Q. 4 ( A-C ) O R Q. 5 ( A-C ) CODE D YE S ?

Y E S • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • ( SKIP TO Q. 8 ) • • • • • • • • • 0

53/

54/

55 /

5 6 /

5 7 /

5 8/

5 9/

CS-7 DECKS 06-0 7

7 . Wha t i s ( CH ILD) ' s hea l t h condi tion o r limitatio n? (PROB� IF NECESSARY: What i s i t called? )

RECORD VERBATil1 AND CO DE ALL THAT APPLY :

Lea rni ng disabilitY• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 01 Mi nimal b rain dysfunc t i o n , mi nimal cerebral

60-61/

dys f unc t i o n , at tent i on defici t disorde r • • • • • • • • • • • • • 0 2 6 2-6 3 / Hyperki nesi s , hyperact ivi tY• • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 3 6 4-6 5 / As t hma• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 4 6 6-6 7 / Res p i rat o ry d i s o rder • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • OS 68-69/ Speech impai rment • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 6 7 0-71/ Ser i ous hea ring d i f f i culty o r deafnes s • • • • • • • • • • • • • • • • • 0 7 7 2- 7 3 / Serious d i f f i cult y in seeing o r bl indnes s • • • • • • • • • • • • • • 0 8 7 4- 7 5 / Serious emo t i onal d i s turbance • • • • • • • • • • • • • • • • • • • • • • • • • • 0 9 7 6-7 7 / Allergi c cond i t i o n( s ) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 0 78-7 9 /

BEG IN DECK 0 7 Cri p pled , o rthopedi c handi cap • • • • • • • • • • • • • • • • • • • • • • • • • • 11 1 2- 1 3/ Me ntal retarda tion• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 2 1 4-15 / Hea r t t ro uble• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 3 1 6- 1 7 / Chroni c ne rvous d i s o rder• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 14 18-19/ Othe r ( S PEC IFY )

1 5 20-21/

8 . Du r i ng the p a s t 12 months , has (CH IL D) had any acci dents o r i nj u r ies that requi red med i c a l at tent i o n?

Yes • • • • • ( ASK A) • • • • • 1 No • • • • • • • • • • • • • • • • • • 0

A. How many such accident s or i nj u ries has ( CHILD) had i n the p as t 12 mont h s? ( RECORD NUMBER . )

2 2 /

,_,_, 23-24/

NUMBE R O F ACC IDENTS OR INJURIES

9 . During the pas t 1 2 months ha s ( CH ILD) had any i l l nesses tha t requi red med i cal a t t e ntion o r t reatment?

Yes • • • • • ( ASK A) • • • • • • 1 No • • • • • • • • • • • • • • • • • • • 0

A. How many s uch i l l nesses has ( CHILD) had i n t he p a s t 12 months? ( RECORD NUMBE R. )

,_,_, NUMBER O F ILLNESSES

25/

26- 2 7 /

C S-8

1 0 . When did ( CHILD ) las t see a doct o r for a rout ine hea l t h checku p?

Les s than 1 month ago • • • • • 0 1

1 - 3 months ago • • • • • • • • • 0 2

4 - 6 months ago • • • • • • • • • 0 3

7 - 1 1 months ago • • • • • • • • • 0 4

1 yea r - 2 3 months ago • • • • OS

2 o r mo re yea rs ago • • • • • • • 0 6

Never • • • • • • • • • • • • • • • • • • • • •

1 1. INTERV IEWER :

A. WhAT SEX I S CHILD?

0 7

MALE • • • • ( GO TO Q. 1 1 C ) • • • • 1 FEMALE • • • • • • • • • • • • • • • • • • • • 2

B . CHE CK FLAP ( BOX A) . I S CHILD AGE 8 YRS O R OLDE R?

YES • • • • ( GO TO Q. 1 2 ) • • • • • • 1 N O• • • • • • • • • • • • • • • • • • • • • • • 0

C . CHECK FLAP ( BOX A ) . I S CHILD AGE 2 YRS OR OLDER?

YE S • • • • ( SKI P TO Q . 1 3 ) • • • • 1 NO • • • • • ( SKIP TO Q. 1 4 ) • • • • 0

12. INTERVIEWER: SKIP TO CS-70 AND ADMINISTER QUESTION 12 TO MOTHER.

DECK 0 7

28-29/

30/

1 3. When did ( CHILD ) last see a dentis t for a checkup o r t o have s ome dent al wo rk done?

Les s t han 1 month ago • • • • • 0 1 3 1-32/

1 - 3 month s ago • • • • • • • • • 0 2

4 - 6 months ago • • • • • • • • • 0 3

7 - 1 1 month s ago • • • • • • • • • 0 4

1 yea r - 2 3 months ago • • • • OS

2 o r more yea r s ago • • • • • • • 0 6

Never • • • • • • • • • • • • • • • • • • • • • 0 7

CS-9 DECK 0 7

14. Is (CHILD)'s health care n ow 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 INCLUD E PUBLIC ASSISTANCE HEALTH CARE PROGRAMS . ]

Yes •••••••••••• 1 No ••••••••••••• 0

15. There is a national program called Medicaid that pay s for health care for persons in need. Is (CHILD)'s health care now covered by Medicaid?

Yes •••••••••••• 1 No ••••••••••••• 0

16. INTERVIEWER: CHECK FLAP (BOX A). IS CHILD 'S AGE 3 YEARS OR OLDER?

YES•••••••••••••••••••••••• 1 NO •••••• (SKIP TO Q. 1 8) ••••• 0

33/

34/

17. During the past 12 months has (CHILD) seen a psychiatrist, psychologist, counselor, or therapist about any behavioral, emotional or mental problem?

Yes •••• (ASK A) ••••• 1 No••••••••••••••••• 0

A. What was the problem? (RECORD VERBATIM .)

B . Was the cost covered, at least in part, by any form of insurance or benefit program?

Yes ••••• (SKIP TO Q.19) ••••• 1 No •••••• (SKIP TO Q.19) ••••• 0

18. During the past 12 months, have you felt, or has anyone suggested, that (CHILD) needed help for any behavioral, emotional, or mental problem?

Yes •••••••••••• 1 No . • • • • • • • • • • • • 0

35/

36/

37/

38/

CS-10 DECK 07

19. Does (CHILD) regularly take any medicines or prescr:ption drugs to help coqtrol (his/her) activity level or behavior?

Yes •••••••••••• 1 No ••••••••••••• 0

20. INTERVIEWER: ARE ANY CONDITIONS CODED IN Q.7, CS-7?

YES ••••• (GO TO A) ••••••••• 1 NO •••••• (GO TO Q .21) •••••• 0

3 9/

A . INTERVIEWER: IF CHILD HAS SERIOUS PHYSICAL OR MENTAL CONDITION THAT MAY INFLUENCE MEASUREMENT, TACTFULLY TELL MOTHER THAT SOME MEASUREMENTS MAY BE INAPPROPTIATE FOR CHILD BUT THAT YOU WILL Af.MINSTER THE ONES YOU CAN.

21. INTERVIEWER: IF (CHILD) IS NOT ALREADY PRESENT, READ TO MOTHER: Could you please bring (CHILD) into room and help me make (him/her) comfortable?

A. CHECK FLAP (BOX A): IS CHILD AGE 4 YRS OR OLDER?

YES••••••••••••••••••••••• 1 NO ••••• (SKIP TO Q.2 3) ••••• 0

22. INTERVIEWER:

IF CHILD IS •

CHILDREN 4 YRS AND OLDER NEED A GENERAL INTRODUCTION.

• •

4 YRS - 4 YRS, 11 MOS •••• (READ A) 5 YRS OR OLDER ••••••••••• (READ B)

A . 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. First we'll see how big you are and then I'll ask you some questions. I want you to give me the best answers you can. GO TO Q.23.

B. What did your mother tell you about my visit?

WAIT FOR CHILD'S RESPONSE, THEN CONTINUE:

(That's right. � 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 about (arithmetic/math), and some are about how you feel. 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.

C S- 1 1 DECK 0 7

INTERVIEWER NOTE : F O R Q. 2 3 AND Q. 2 4 BE S URE CH IL D I S NOT WEARING SHOE S O R HEAVY OUTER GARMENTS .

2 3 . I ' d l ike to f i nd ou t how tall (CHIL D ) is. Woul d you pref e r to measure (him /he r ) yoursel f or sha ll I do i t ?

RECORD HEIGHT . l_l_l FEET

l_l_l INCHE S

40-41/ 42-4 3/

24 . I ' d l ike to f ind out ( CH ILD) ' s we igh t . Woul d you pref e r to we igh (him/he r ) yourse l f or s ha l l I do it?

RECORD WEIGHT. l_l_l_l POUNDS

l_l_l OUNCE S

4 4-46/ 47-4 8/

2 5. INTERVIEWER : HOw SHY OR ANXIOUS WAS CHILD WHE N YOU F IRST MET (HIM/HER) ?

NOT AT ALL SHY & ANXI OUS/ SOC IABLE & FRIENDLY

EXTREMELY SHY/QUIET/ WITHDRAWN

1 2 3 4 5

2 6. INTERV IEWER : WAS ANYONE ELS E PRESENT, EXCLUDING YOUNG CHILDRE N, WHEN YOU ASKED THE QUESTIONS IN THIS SECT ION ?

YE S • • • • • • • • • • • • • • • • • 1 NO• • • • • • • • • • • • • • • • • • 0

2 7 . INTERVIEWER : CHE CK F LAP ( B OX A ) . I S CHILD ' S AGE • • •

0 MOS - 7 MOS • • • • • • • • • • • • • • • • ( SKIP TO SECTION 12, CS- 6 5 ) • • • • • 01

8 MOS - 1 1 MOS • • • • • • • • • • • • • • • • ( SKI P T O SECT ION 4 , C S-1 7 ) • • • • • • 02

1 2 MOS - 2 YRS , 1 1 MOS • • • • • • • • ( G O TO SECTION 3 , CS-1 3 ) • • • • • • • • 03

3 YRS - 3 YRS , 1 1 MOS • • • • • • • • ( SK I P T O SECT ION 4 , C S-1 7 ) • • • • • • 0 4

4 YRS - 6 YRS , 1 1 MOS • • • • • • • • ( SK IP TO SECT ION 5 , CS- 2 5 ) • • • • • • 0 5

7 YRS - 7 YRS , 1 1 MO S • • • • • • • • ( SK I P TO SECT ION 7 , C S-3 7 ) • • • • • • 0 6

8 YRS OR OLDER? • • • • • • • • • • • • • • • ( SKIP TO SECTION 6 , CS- 3 3 ) • • • • • • 07

4 9 /

5 0/

CS- 1 2


STEP ONE :

[STE P TWO :

CS- 1 3

SECTION 3: PARTS OF THE BODY

AGES : 1 2 �10 NTHS - 2 YEARS , 1 1 MONTHS

CHECK FLAP ( BOX A) . IS CHILD ' S AG£ 1 2 MOS - 2 YRS, 1 1 MOS ?

YES••••••••••••••••••••••••••••• 1 NO •••••• ( CHECK FLAP , BOX E) ••••• 0

IF N EEDED , READ T O MOTHE R/GUARDIAN.

We want to find out how many of the parts of the body (CHILD) can identify by their common English names. I will ask ( him/her) to point to various parts of the body. Please try not to help (him /her).]

[STEP THREE: IF NEEDED SEE Q x Q.]

STEP FOUR: INSTRUCT THE CHILD.

Let's play a game. I'd like you to show me some things.

STEP FIVE:

CS-14 DECK 07

ADMINISTER EACH QUESTION, SAYING:

Show me your • • • /Po int to you r • • • /wh ere is your • • • /How about you r • • • / Touc h you r • • • / (ONLY IF NECESSARY HAND SHOWCARD A) Show me the baby ' s •

ATTEMPT ONE

I I ATTEMPT TWO

I I ATTEMPT THREE

------ ___ c

_o

_D

_E

_Bo

_x

__

·

__ _ c

_o

_D

_E

_B

_o_x

__ , __ _ c

_o

_D

_E

_Bo

_x

----::---� � � BODY PART CORRECT WRONG ANSWER CORRECT WRONG ANSWER CORRECT WRONG ANSWER

I 1 . nos e 1 2 3 51 / 1 2 3 61 / 1

2. eye 1 I 2 3 5 2/ 1 2 3 6 2/ 1

3. ea r 1 2 3 5 3/ 1 2 3 6 3/ 1

4. mouth 1 2 3 5 4/ 1 2 3 6 4/ 1

5. hai r 1 2 3 5 5 / 1 2 3 6 5/ 1

6. chin 1 2 3 5 6 / 1 2 3 6 6 / 1

7. finge r 1 2 3 57/ 1 2 3 67/ 1

8. t oe 1 2 3 58/ 1 2 3 68/ 1

9 . eyebrow 1 2 3 5 9/ 1 2 3 6 9/ 1

1 0 . elbow 1 2 3 I 6 0/ 1 2 3 70/ 1

INTERVIEWER NOTE: IF CHILD FAILS TO ANSWER ALL 1 0 QUESTIONS . . .

(1 ) BY SKIPPING AN OCCASIONAL WORD • • •

• CONTINUE TO ASK WORDS THROUGH Q.10. • RETURN Il1MEDIATELY AND RE-ASK EACH UNANSWERED WORD

ONE MORE TIME ONLY. • RECORD CHILD'S ANSWER IN SAME ATTEMPT CODE BOX •

• MAKE NO FURTHER ATTEMPTS.� 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 CO.HPLETE AN ATTEMPT, GO TO Q.ll.

3

3

3

3

3

3

3

3

3

3

7 1 /

7 2/

7 3/

74/

7 5/

76/

77/

78/

7 9 /

80/

CS- 1 5 BEGIN DECK 08

INTERVIEWER REHARKS:

ll. HOW MANY PEOPLE WERE PRESENT DURING ADHINISTRATION OF THIS SECTION AND WHAT EFFEC T, IF ANY, DID THEIR PRESENCE HAVE ON THE CHILD?

EFFECT ON CHILD 1 S PERFORMANCE SEEMED TO NONE SEEMED TO

IF PRESENT, CODE II PERSONS B E HARMFUL O BSERVA BLE IMPROVE

MOTriER 1_1 1 2/ 1 2 3 1 3/

FATHER I_ I 1 4/ 1 2 3 1 5 /

GUARDIAN 1_1 1 6/ 1 2 3 1 7 I ADULTS RELATIVE I_LI 18-19/ 1 2 3 2 0/

FAMILY FRIEND I_LI 2 1-22/ 1 2 3 23/

OTHER (SPECIFY )

I_LI 2 4-25/ 1 2 3 26/

SIBLING I_LI 27-2 8/ 1 2 3 2 9 /

F RIEND I_LI 30-3 1 / 1 2 3 32/

CHILDREN OTHER

1 2.

1 3.

( SPECIFY )

I_LI 3 3-34/ 1 2 3 35/

CODE CHILD'S ENERGY low ( tired ) medium high L EVEL DURING SECTION. 3 6/

1 2 3

WAS THIS SECTION TERMINATED PREMATURELY?

YES ••••• (ASK A ) •••••• 1 37/

NO••••••••••••••••••• 0

A. REASON FOR PREMATURE TERMINATION OF THIS SECTION. ( CODE ALL THAT APPLY. )

PARENT /GUARDIAN TERMINATED /REFUSED •••••• 0 1

CHILD WOULD NOT RESPOND••••••••••••••••• 02

MAJOR INTERRUPTION CAUSE D TERMINATION ••• 0 3

CHILD COULD NOT UNDERSTAND TASK ••••••••• 04

CHIL D H A D LANGUAGE PRO BLEM•••••••••••••• 05

CHILD'S EMOTIONAL CONDITION ••••••••••••• 06

CHIL D'S PHYSICAL CONDITION•••••••••••••• 07

. THER ( SPECIFY )

08 -----------------------------------

IF THIS IS SECOND OR THIRD ATTEMPT, SKIP TO SECTION 11, CS-61.

38-39/

40 -4 1 /

42-4 3/

44-45/

46-4 7/

48-49/

50-5 1/

52-53/

CS- 1 6 BEG IN DECK 0 8

THI S PAGE INTENTIONALLY BLANK

STEP ONE:

[STEP TWO:

C S- 1 7

SECTION 4: MEMORY FOR LOCATIONS

AGES : 8 MONTH S - 3 YEARS , 11 HONTHS

CHECK FLAP ( BOX A ) . IS C HILD 8 MOS - 3 YRS, 11 HOS?

YE S • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • ( CHECK FLAP , BOX E ) • • • • • 0

IF NEE DE D , READ T O HOTHE R/G UARDIAN.

Chi ld ren o f d i f f e rent a ges remember the l o c a t i ons o f o bje cts f o r va rying l e ngths o f tim e . We wan t t o g e t a n ide a o f h ow l o ng ( CHILD ) ca n remembe r the l o c atio n of thi s d o ll ( S HOW DOLL) . To f i nd out, I wi l l pu t the do l l unde r one o f the se cup s. The n I w i l l h i d e the cup s f rom ( h i s/h e r ) view f or a l e ngth o f t ime . Af t e r t ha t , I wi l l a sk (h im /he r) to sh ow me whe r e t h e d o l l i s loc a t ed . ]

[ST E P THREE: IF NEEDE D , SE E Q X Q.]

STE P F OUR: INSTRUCT THE CHILD.

Le t ' s pl ay a game . I ' m go i ng to hide the d o l l u nd e r o ne of these cup s. The n I ' m g o i ng to hid e t h e cup s. Let ' s se e i f yo u c a n remembe r where the d o l l i s. OK?

C S- 1 8 DECK 08

S TE P FIVE : ADMINISTER PRACTICE QUE STIONS

PRACTICE A ( ALL CHILDREN )

(CIRCLE CHILD'S ANSWER)

USE 2 CUPS - ) 0 2

* 1 3 4 5 6

SCREENING TIME = NON E

C ORRECT • • ( S KIP TO STEP SIX) • • • 1 WRON G • • • (GO T O PRACTIC E B ) • • • • 2

PRACTICE B ( CHILDREN CODED WRONG ON PRACTICE A)

(CIRCLE CHILD'S ANSWER)

USE 2 CUPS-) 1

* 2 3 4

SCREENING T ll1E = NONE

0 5 6

CORRECT • • • • • • • • • • • • • • • • • • • • • • • • • • 1 WRONG • • • • (DO FURTHE R PRACTICE

THE N GO TO STEP S IX) • • • • 2

INTE RVIEWE R NOTE:

STEP SIX:

I F CHILD REFUSE S TO RE S POND, RE CORD NEED FOR ADDITIONAL ATTEMPT O N FLAP (BOX D ) . MAKE U P T O TWO ADDITIONAL ATTEMPTS TO GAIN COOPERATION. AFTER FINAL ATT EMPT -- WHETHER C OMPLETE D OR NO T -- SKI P T O Q. 1 1, C S- 23.

CHECK FLAP (BOX A) . IS CHILD ' S AGE • • •

8 MO S - 23 MO S • • • • • • • • • • • • (G O T O Q . 1 ) • • • • • • • • • • • • • • 1

2 YRS - 2 YRS, 1 1 MOS • • • • • ( SKIP TO Q . 4, C S- 20 ) • • • • • 2 S4/

3 YRS - 3 YRS, 11 MO S • • • • • ( SKIP T O Q. 7, C S- 21 ) • • • • • 3

1.

2 .

3 .

CS- 19

(CIRCLE ANSWER THEN CODE)

US E 2 CU PS-> I * 0 5

A.

I 1 2 3 4 6

5 5-5 6 / SCREENING T IME 1 SECOND

DECK 08

CORRECT• • • • • • • • • • • • • • • • • • 1 WRONG • • • • ( ASK A) • • • • • • • • • 2

US E 2 CUPS-) �--

1

--

�--

3

-

. _

_ 4 __ ; __ 6

_ , CORRECT• • • • • • • • • • • • • • 1 WRONG • • • ( SKIP TO Q.1 1 ,

C S-2 3 ) • • • • • • 2

USE 2 CUPS-)

A.

1

5 8- 5 9 / S CREENING TIHE = 1 SECOND

0 2 3 4

* 5 6

6 1-6 2 / SCREENING TIME = 5 SECONDS

USE 2 CUPS-> * 2

0 5

US E 2 CUPS->

A.

1

1 3 4

64-6 5 / SCREENING TIME 5 SECONDS

* 2 3 4

0 5 6

6 7-68/ SCREENING T IME = 1 0 SECOND S

6

CORRECT•••••••••••••••••• 1 WRONG • • • • (ASK A) • • • • • • • • • 2

CORRECT•••••••••••••• 1 WRONG. ( SKI P TO Q.4) • • 2


USE 2 CU PS-) 1, _

_ 1 __ � _

_ 3 __ 4 __ ; __ 6_ CORRECT • • • • • • • • • • • • • 1 WRONG • • • ( GO TO Q.4) • • 2

7 0- 7 1 / SCREENING T IME = 10 SECONDS

57 I

60/

63/

6 6 /

6 9/

72 /

4.

5 .

6 .

CS- 20

( CIRCLE ANSWER THEN CODE)

USE 4 CUPS->

A.

USE

1 0 2

0 3

* 4

0 5 6

14-15/ SCREENING T IME = 1 S ECOND

1 0 2

* 3

0 4

0 5 6

BEGIN DECK 09


CORRECT• • • • • • • • • • • • • • 1

1 6/

19/ 4 CUPS-) 1 ·-------------------------·

WRONG • • • ( SKIP TO Q. 1 1 , C S-2 3 ) • • • • • 2

1 7-18/ SCREENING TIME = 1 SECOND

USE 4 CUPS-) * 0 3

0 4

0 5

USE

A.

1 2 6

2 0-2 1/ SCREENING T IME 5 SECONDS

USE 4 CUPS-) 0 2

0 3

* 4

0 5 1

2 3-2 4 / SCREENING T IME = 5 SECOND S

4 cu Ps-> I 0 0 0 * 1 2 3 4 5 6

2 6-2 7 / SCREENING TIME = 10 SECONDS

A.

USE 4 CUPS-) 1 0 * 0 0 1 2 3 4 5

SCREENING TIHE = 10 29-30/

SECONDS

6

6

CORRECT• • • • • • • • • • • • • • • • • • 1 WRONG • • • • • (ASK A) • • • • • • • • 2

CORRECT• • • • • • • • • • • • • • 1 WRONG . ( SKI P T O Q. 7 ) • • 2

CORRECT• • • • • • • • • • • • • • • • • • 1

2 2 /

2 5 /

WRONG • • • • • ( ASK A) • • • • • • • • 2 2 8/

CORRECT • • • • • • • • • • • • • • 1 WRONG • • ( GO TO Q. 7 ) • • • 2 �1/

7 .

8.

9 .

(CIRCLE ANSWER THEN CODE)

USE 6 CUP S-) 0 1

* 2

0 3 0 4

CS-21

0 5

0 6

32-33/ SCREENING TIME = 1 SECOND

A.

DECK 09

CORRECT• • • • • • • • • • • • • • • • • • 1 WRONG • • • • • ( ASK A) • • • • • • • • 2

USE 6 CUPS-> ��

--�----�----�----�----*-5----�--' CORRECT• • • • • • • • • • • • • • 1 WRONG • • • ( SKIP TO Q. 11 ,

C S-2 3 ) • • • • • • 2 35-36/ SCREENING TIME = 1 SECOND

USE 6 CUPS-) 0 1

0 2

* 3

0 4 0 5

0 7

USE

A.

38-39/ SCREEN ING TIME 5 SECONDS

USE 6 CUPS-> 0 1

0 2

0 3

* 4

0 5

6 CUP8-) I 0 1

41-42/ SCREENING Tll-fE 5 SECONDS

0 0 0 * 0 2 3 4 5 6

44-45/ SCREENING T IME = 1 0 SECONDS

A.

0 6

CORRECT• • • • • • • • • • • • • • • • • • 1 WRONG • • • • • (ASK A) • • • • • • • • 2

CORRECT• • • • • • • • • • • • • • 1 WRONG • • • ( SKI P T O Q. 1 1,

CS- 2 3 ) • • • • • • 2

CORRECT• • • • • • • • • • • • • • • • • • 1 WRONG • • • • • ( ASK A) • • • • • • • • 2

USE 6 CUPS-> ��---�-- -� --;--�--:-::-� �:or-�--' 47-48/

SCREENING TIME = 1 0 SECONDS

CORRECT • • • • • • • • • • • • • • 1 WRONG • • • ( SKIP TO Q. 11 ,

C S-2 3 ) • • • • • • 2

34/

37 /

40/

43 /

46/

49/

10.

USE 6 CUPS-) 0 1

0 2

0 3

SCREENING TIME

A.

USE 6 CUPS-> 0 1

* 2

* 4

C S- 2 2

0 5

0 6

15 SECOND�0-5l/

0 3

0 4

0 5

53-54/ SCREENING T IME = 15 SECONDS

0 6

DECK 09

CORRECT•••••••••••••••••• 1 WRONG ••••• (ASK A) •••••••• 2

CORRECT•••••••••••••• 1 WRONG•••••••••••••••• 2

52/

5 5 /

CS-23

DECKS 09-10

INTERVIEWER REMARKS :

1 1 . HOW MANY PEOPLE WERE PRESENT DURING ADMINISTRATION OF THIS SECT ION AND WHAT EFFEC T , IF ANY , DID THEIR PRE SENCE HAVE ON THE CHILD?

IF PRESENT , CODE # PERSONS

MOTHER I 56/ FATHER I 58/ GUARDIAN I 60/

ADULTS RELATIVE I_ I_ I 62-63/ FAMILY FRIEND I_ I_ I 65-66/ OTHER (SPECIFY)

I_ I_ I 68-69/

SIBLING Ll_l 71-72/ FRIEND I_ I_ I 74-75/

CHILDREN OTHER (SPECIFY)

l_l_l 77-78/

EFFECT ON CHILD ' S PERFORMANCE SEEMED TO NONE SEEMED TO BE HARMFUL OBSERVABLE IMPROVE

1

1

1

1

1

1

1

1

1

2 2

2

2

2

2

2

2

2

3 3

3

3

3

3

3

3

3

57/ 59/ 61/

64/

67/

70/

73/

76/

79/

1 2. CODE CHILD'S ENERGY low ( tired) medium BEGIN DECK 10

high LEVEL DURING SECTION.

1

13. WAS THIS SECTION TERMINATED PREMATURELY?

YES • • • • • ( ASK A) • • • • • 1

NO• • • • • • • • • • • • • • • • • • 0

14/

2 3

15/

A. REASON FOR PREMATURE TERMINATION OF THIS SECT ION. (CODE ALL THAT APPLY.)

PARENT /GUARDIAN TERMINATED/REFUSE D• • • • • • • • • • • • • 01 16-17/ CHILD WOULD NOT RESPOND/REFUSED• •• • • • • • • • • • • • • • 02 18-19/ MAJOR INTERRUPTION CAUSED TERMINATION • • • • • • • • • • 03 20-21/ CHILD COULD NOT UNDERSTAND TASK• • • • • • •• • • • • • • • • 04 22-23/ CHILD HAD LANGUAGE PROBLEM• • • • • • • • • • • • • • • • • • • • • 05 24-25/ CHILD ' S EMOTIONAL CONDITION• • • • • • • • • • • • • • • • • • • • 06

26-27/ CHILD ' S PHYS ICAL CONDITION• • • • • • • • • • • • • • • • • • • • • 07 28-29/ OTHER ( S PECIFY)

08 30-31/

CS-24

INTERVIEWER NOTE: IF YOU HAVE NOT DONE SO, GIVE MOTHER/GARDIAN MOTHER SUPPLEMENT. IF THIS IS LAST SECTION ADMINISTERED TO CHILD, THANK CHILD FOR HELPING YOU.

14. CHECK FLAP (BOX A) . IS CHILD ' S AGE • • •

8 MOS - 2 YRS , 11 MOS . • (GO TO A) • . . . . • . . . . . • . . . . . .. • • • 1

3 YRS - 3 YRS , 11 MO S • • (GO T O SECTION 5, CS-25 ) . . . . . • • • 2

A. CHECK CS-1, Q.4. IS CHILD ' S AGE . . .

8 MOS - 2 YRS, 1 1 MOS , 15 DAYS . • • •

( SKIP TO SECTION 11, CS-6 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 YRS, 1 1 MOS, 1 6 DAYS - 2 YRS, 1 1 MOS, 3 1 DAYS . . . .

( SKIP TO SECTION 10, CS-5 3 ) . . . . . . . • . . . . . . . . . . . . . . . . . . . . . 2

IF THIS IS SECOND OR THIRD ATTEMPT , SKIP TO SECTION 11 , CS-6 1.

STEP ONE :

[ STEP TWO :

STE P 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, ll MOS?

YE S • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • • ( CHECK FLAP, BOX E ) • • • • • 0

IF NEEDE D, READ T O MOTHE R/G UARD IAN.

Ch i l d ren at d i f f e rent ages remembe r the o rde r of wo rds f o r d i f f e rent length s o f t ime . The s e que s t ions give u s a n ide a o f ( CHILD) 's ve rbal memo ry - that i s ( hi s /her) ability to remembe r a n d repea t s equence s o f word s . ]

INSTRUCTIONS FOR PART A ( WORDS ) .

ADMINISTER WORDS :

(1 ) READ AT EVEN RATE : ONE WORD/SECOND.

( 2) READ EACH QUEST ION ONLY ONCE .

( 3 ) IF NEEDED, E NCOURAGE CHILD WITH : Now i t ' s your turn. Say the wo rds back t o me.

SCORE WORDS :

( 1 ) AS CHILD REPEATS WORDS, WRITE ORDER Nill1BER ABOVE EACH WORD. IF CHILD DOE S NOT REPEAT WORD, WRITE NOTHING ABOVE I T.

( 2 ) COUNT EACH WORD WITH A NUMBER ABOVE IT. ENTER TOTAL NUHBE R IN BOX A.

( 3 ) IF CHILD HADE ANY CHANGE IN WORD ORDER, E NTER A SCORE OF '1' I N BOX �

-- IF NO REVE RSALS OCCURRED, ENTER A SCORE OF ' O ' -- DO NOT DEDUCT POINT S FOR BABY WORDS O R S LANG.

(4 ) CALCULATE BOX C SCORE FOR EACH QUESTION .

( I F NEEDE D, SE E Q X Q . ]

INSTRUCT CHILD FOR PART A.

Now I am go i ng t o s ay some wo rds and I wa nt to s ee how many of t hem you c a n s a y after me. Wait unt i l I have f i ni s he d s ayi n g al l the wo rds be f o re y o u s t art t o answe r .

BEFORE READING EACH QUEST ION , MAKE SURE CHILD IS PAY ING ATTENT ION, SAY : Li s t e n / Re ady!

Reproduced by pe rmi s s i o n f ro m HcCARTHY SCALES FOR CHILDREN 'S AB ILIT IES.

Copyr ight © 197 9 , 19 7 2 by Th e Psychol ogica l Corporation. A l l r ights reserved.

CS- 26 DECK 1 0

PART A: WORDS.

(WRITE ORDER. NUMBER. ABOVE EACH WORD) BOX A mL�us BOX B

=

1. toy 32/

chair 3 3 /

light 34 / I minus I = I

2. dol\s/

dark 3 9 /

coat 40/ I minus I = I

3. aft?.�/

color funny today I I minus I I = I 45 / 46/ 4 7 /

4. around because under never I I minus I I = I 51/ 52/ 53/ 54 /

STEP FIVE: INSTRUCTIONS FOR PART B (SENTENCES) .

ADMINISTER SENTENCES:

(1) READ EACH SENTENCE ONLY ONCE, SLOWLY AND CLEARLY. DO NOT EHPHASIZE UNDERLINED WORDS.

SCORE SENTENCES:

(1) CIRCLE ONLY UNDERLINED WORDS AS CHILD REPEATS THEH.

--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. 5 8/ 5 9 1 . 6 0 /

The � said goodbye to h�s � every

61/ 6 2 / 6 3 / 6 4 / morning before he went to scnool.

BOX C

BOX C

6. 6 7 / 6 8/ 6 9/ 70/ 71/

The � tied a pretty � nooon on

her J5{1 belJ£e she �:bt oJ€! 1�1

7. TOTAL ALL BOX C SCORES FROM Q. l-Q. 6. ENTER TOTAL IN BOX D --->

8. DOES BOX D TOTAL EQUAL 8 OR MORE?

Y ES •••• (GO TO PART C) •••••••••••••••• 1

NO ••••• (SKIP TO Q.21, CS-30) ••••••••• 0

BOX D

CCI

3 5-3 7 /

4 1-4 3/

4 8-5 0/

5 5-57 /

65-6 6 /

76-77 I

78- 79/

CS- 2 7

PART C: STORY .

[S TEP SEVE N: IF NEEDED, SEE Q X Q. ]

STE P E IGHT: INSTRUC T THE CHI LD FOR PART C (Story) .

STE P NI NE:

STE P 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 SLOWLY, CLEARLY, AND WITHOUT EMPHASIZING ANY S IGNIF ICANT WORDS OR PHRASES.

One day after school Bob wa s walking to the s t o re . On the way he saw a woman carrying s ome let t e r s t o a mailbox. Suddenly , the wind blew the woman's l et t e rs i nt o the s t reet . Bo b s houted , "I '11 get them for you!" He looked bot h ways and s aw tha t the re were no cars coming. He ran i nt o the s t reet and p i cked up all of the l e t t e r s . The woma n wa s ve r y happy to g e t he r let t e r s back . She thanked Bob f o r being such a kind and helpful boy .

RECORD CHILD ' S ANSWE R ON IDE A SHEET, NEXT PAGE.

•

•

•

BOB

SAW

CS-28

C IRCLE EXACT WORD/PHRASE I F CHILD USE D IT •

WRI TE ALTERNATE WORDS CHILD USED ABOVE PRINTE D WORD •

IF CONCE PT OMI TTED BY CHILD , RECORD NOTHI NG •

I DEA S HEET

WALKING T O STORE

WOMAN

BLEW

SHOUTED II I ILL GET THEl'l FOR YOU! II

LETTERS

WAS CAREFUL P ICKED UP/RETURNED

WAS HAPPY THANKE D BOB

, 9 I NTERV IEWER: COUNT NUMBER OF CORRECT ANSWERS AND RECORD HERE: 1_1_1 SKI P T O Q. 2 1 , C S- 3 0.

I NTERV IEWER NOTE:

1 0. Bob

1 1 . The Woma n

1 2. Le t t e r s

13. (Bob ) Walking To St o re

14. ( Bob ) Saw Woman

1 5. (Wind ) Blew Let ters

1 6.

1 7 .

(Bob Shouted,) "I '11 Get Them Fo r You!"

( Bob ) Was Careful

1 8. (Bob ) Picked Up Le t t ers

19. ( Woma n) wa s happy

2 0. ( Woma n ) Thanke d Bo b

CS-29

CODERS WILL CODE THE SE QUEST IONS .

COrrec t • • • • • • • • • • • • 1 Wro ng • • • • • • • • • • • • • • 2

Correct • • • • • • • • • • • • 1 Wr o ng • • • • • • • • • • • • • • 2

Correct • • • • • • • • • • • • 1

Wrong • • •• • • • • • • • • • • 2

Co rrect •• • • • •• • • • • • 1 Wrong ••••••• • • • • • •• 2

Co rrect •••••••••••• 1 wrong •••••••••••••• 2

Correct •••••••••••• 1 wrong •••••••••••••• 2

Co rrect •••••••••••• 1 wrong •••••••••••••• 2

Co rrect • • •• • • • • •••• 1 Wrong ••••••• • • ••••• 2

Co rrect ••• • • • • • •••• 1 wro ng • • • ••••• • • • • •• 2

Co r re c t • • • • • • • • • • • • 1

Wrong • • • • • • • • • • • • • • 2

Co r re ct • • • • • • • • • • • • 1

wrong • • • • • • • • • • • • • • 2

BEGIN DECK 11

14 /

1 5 /

16 /

1 7 /

1 8 /

1 9 /

2 0/

21/

2 2 /

23/

24 /

C S-30

DECK 11

INTERV IEWER REMARKS :

2 1. HOW MANY PEOPLE WERE PRE SENT DURING ADM INISTRATION OF THIS SECT ION ANI WHAT EFFECT, IF ANY, DID THE I R PRESENC E HAVE O N THE CHILD?

EFFECT ON CHILD ' S PERFORMANCE SEEME D TO NONE SEEME D TO

IF PRESENT, CODE II PE RSONS BE HARM FUL OBSERVABLE IMPROVE

MOTHER 1_1 25/ 1 2 3

FATHER I_ I 27/ 1 2 3

GUARDIAN I_ I 2 9/ 1 2 3

ADULTS RELATIVE l_l_l 3 1....: 32/ 1 2 3

FAMILY FRIEND l_l_l 3 4-35/ 1 2 3

OTHER ( S PECIFY )

I_ I_ I 37 -38/ 1 2 3

S IBLING l_l_l 40-4 1/ 1 2 3

FRIEND l_l_l 4 3-44/ 1 2 3

CHILDREN OTHER ( S PECIFY )

I_ I_ I 46-47/ 1 2 3

2 2. CODE CHILD ' S ENE RGY l ow ( t i red) med ium high LEVEL DURING SECTION.

1 2 3

2 3. WAS THI S SECTION TERMINATE D PREMATURELY?

YES • • • • ( ASK A) • • • • • 1

NO•• • • • • • • • • • • • • • • • 0

2 6 /

2 8/

30/

3 3/

3 6/

3 9 /

4 2/

4 5 /

4 8/

49/

5 0/

A. REASON FOR PREMATURE TERMINATION OF THIS SECT ION. (CODE ALL THAT APPLY.)

PARENT/GUARDIAN TERMINATE D/REFUSE D • • • • • • • 0 1 51-52 /

CHILD WOULD NOT RE SPOND/ REFUSED • • • • • • • • • • 02 5 3-5 4/

MAJOR INTERRUPT ION CAUSED TERMINAT ION • • • • 0 3 5 5-56/

CHILD COULD NOT UNDERSTAND TASK • • • • • • • • • • 04 5 7-5 8/

CHILD HAD LANG UAGE PROBLEM • • • • • • • • • • • • • • • 0 5 59-60/

CHILD ' S EMOT IONAL COND IT ION• • • • • • • • • • • • • • 06 6 1-62/

CHILD ' S PHYS ICAL CONDITION • • • • • • • • • • • • • • • 0 7 63-64/

OTHER ( S PEC IFY)

08 6 5-66/

CS- 3 1

24. INTERVIEWER: CHE CK F LAP ( BOX A) . I S CHILD'S AGE • • •

3 YRS - 4 YRS , 1 1 HOS • • • • ( SK I P T O SECT I O N 10 , C S-5 3) • • • • • 1

5 YRS AND OLDER • • • • • • • • • • ( S KIP TO SECT ION 8 , CS-4 1) • • • • • • 2

CS-32


STEP ONE:

[STE P TWO:

CS-33

SECT ION 6: WHAT I AM LIKE

AGES: 8 YEARS AND OLDER

CHECK FLAP ( BOX A): IS CHILD'S AGE 8 YRS OR OLDER?

YE S • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • ( CHECK FLAP, BOX E ) • • • • • 0

I F NEEDE D, READ T O MOTHE R /GUARDIAN.

Th i s se c t i o n i s meant to give u s an idei o f how ( CHILD) views ( h im /he r)se lf . ]

[STE P THREE: IF NEEDED, SEE Q X Q.]

STEP FOUR: INSTRUC T THE CHIL D.

A. All ki d s t hink and f ee l d i f f e rent ly about t hi n gs. We are intere sted in what yo u thin k yo u are li ke and h ow yo u t h i n k and f e e l. Thi s i s not a t est . The re are no right or wrong answers. Remember all kid s are dif f erent .

[HAND SHOWCARD SET B.] This Sect i on is c alled "What I Am Li ke ." Here 1 s an example of how the que st ions wo rk. I 'll read the quest ion aloud and you follow along and think about it bef ore you answer. This quest ion is about two k i nds of kids and w e want to know which kids are more like you •

.B. READ BOTH PARTS OF PRACTICE SENTENCE. EMPHASIZE THE ITALICIZED WORDS.

Some kids would ra t he r play outdoors in their

spare time BUT

ot her kids would

rat her watch TV.

C. \<That you do is this: First, decide which kids are more like you -- the kids on the '1X" side of the card (POINT TO "X" SIDE OF SHOWCARD) or the kids on the "Y" side of the card (POINT TO "Y" SIDE OF SHOWCARD).

IF NECESSARY, PROBE: Hb.ich kind of kid is more like you? The kid on the "X" side or the kid on the "Y" s ide of t he card?

D. POINTING TO ANSWER CATEGORIES ON SHOWCARD, SAY:

Now, think about the answer you just gave me and then decide if t hat is really true for you or only sort of t rue f or you.

IF NECESSARY, PROBE : OK, what do you t hin k? Really true or sort of t rue for yo u?

E. Okay , that was just f or pract ice. No w let ' s d o some more quest i ons. Turn t o the next c ard.

REALLY SORT OF TRUE TRUE

FOR ME FOR ME X

Some kids f eel they 4 3 are ve r y good a t

thei r schoo l wo rk

Some kids are of ten 1 2 u n h a p p y wi th

thems elves

Some kids f e e l l i ke 4 3 they a r e just as

smart as other kids the i r age

Some kids don't like 1 2 the way the y are

l ead i ng the i r life

Some kids a re p retty 1 2 s I ow i n f inishi ng

thei r s chool work

Some kids a re happy

4 3 wi t h th ems elve s a s a p e rs on

INTERV IEWER : INSTRUCT CHILD.

CS- 3 4

1.

BUT

2.

BUT

3.

BUT

4.

BUT

5 .

BUT

6.

BUT

y

Ot he r kids worry about about whe the r they can do the s choo l wo rk as s igne d t o them.

Othe r kids are p re t ty pleased wi t h themselve s .

Ot he r kids aren ' t s o sure and wonder if they a re as smart .

Ot he r kids d o like the wa y they a re leading the i r l i f e .

Ot he r k i d s can d o the i r schoo l wo rk quickly.

Other kids are not happ y wi th themselves .

o f t en

The re a re a f ew mo re of these. Turn to t he next card.

DECK 11

SORT OF REALLY TRUE TRUE

FOR ME FOR HE

2 1 6 7 /

3 4 68/

2 1 6 9 /

3 4 70/

3 4 71/

2 1 7 2 /

C S- 3 5 DECK 12

REALLY S ORT OF SORT OF REALLY TRUE TRUE TRUE TRUE

F OR ME FOR ME X y FOR ME FOR ME

7 . Some kid s o f t en Ot her kid s can r em em-

1 2 forget wha t they BUT her thing s easily. 3 4 14/ l earn

8. So m e kid s I Ike the Ot her kid s o f t en wish

4 3 kind o f person they BUT they wer e s om eo n e el s e. 2 1 15/ a r e

9. Som e kid s d o very Other kids don1tdo

4 3 we I I a t their BUT very wel l a t their 2 1 16/ c l a s s wo r k clas swo r k.

10 . So m e kid s a r e very Ot her kids wish they

4 3 happy b eing the way BUT wer e different. 2 1 1 7/ t hey a r e

1 1. Some kids have Ot he r kid s almos t

1 2 trouble figuri ng BUT a I ways ca n figure 3 4 18/ out the answe rs i n out t he answers . schoo l

1 2. Some kids aren't Othe r kids think the

1 2 ve ry happ y wi th BUT wa y they d o things 3 4 19/ t he way they d o i s tine.

a l o t of thi ng s

CS-36

DECK 12

INTERV IEWER REMARKS :

1 3 . HOW MANY PEOPLE WERE PRESENT DURING ADMINISTRATION OF THI S SECTION AND WHAT· EFFE C T, IF ANY, DID THE I R PRESENCE HAVE ON THE CHILD?

ADULTS

E FFECT ON CHILD ' S PERFORMANCE SEEMED TO NONE SEEMED TO

IF PRE SENT, CODE # PERSON S BE HARMFUL OBSERVABLE IMPROVE

MOTHER l_l FATHER I_ I GUARDIAN I_ I RELATIVE I_LI FAl1ILY FRIEND I_LI OTHER ( S PE C IFY )

I_LI S IBLING ·I_LI FRIEND I_LI

20 / 1

2 2 / 1

24/ 1

2 6-2 7 / 1

2 9-30 / 1

32-33/ 1

3 5-3 6 / 1

3 8-39/ 1

2

2

2

2

2

2

2

2

3

3

3

3

3

3

3

3

CHILDREN OTHER (SPEC IFY )

I_LI 41-4 2 / 1 2 3

1 4. CODE CHILD ' S E NERGY l ow ( t i red) medium LEVE L DURING SECTION.

1 2 3

1 5. WAS THI S SECTION TERMINATED PREMATURELY?

YES • • • • • (ASK A ) • • • • • • 1

N O • • • • • • • • • • • • • • • • • • • 0

high

21/

2 3 /

2 5 /

28/

31/

34/

3 7/

40/

4 3/

44/

45/

A. REASON FOR PREHATURE TERMINATION OF THI S S ECTION. (CODE ALL THAT APPLY.)

PARENT /GUARD IAN TERMINATE D/RE FUSE D • • • • • • • • • • • 0 1 4 6-4 7/

CHILD WOULD NOT RE SPOND/REFUSE D • • • • • • •• • • • • • • 02 48-49 /

MAJOR INTERRUPT ION CAUSE D TERMINAT ION • • • • • • • • 0 3 5 0-51/

CHILD COULD NOT UNDERSTAND TASK •• • • • • • • • • • • • • 04 5 2-5 3 /

CHILD HAD LANGUAGE PROBLEM• • • • • • • • • • • • • • • • • • • 0 5 54-5 5 /

CHILD ' S EMOTIONAL CONDIT ION• • • • • • • • • • • • • • • • • • 06 5 6-5 7/

CHILD ' S PHYS ICAL CONDIT ION• • • • • • • • • • • • • • • • • • • 0 7 5 8-5 9/

OTHER ( S PEC IFY)

08 60-61/

STEP ONE :

[STEP TWO :

C S-3 7

SECTION 7: MEMORY FOR. DIGIT SPAN

AGE S : 7 YEARS AND OLDER

CHECK FLAP ( BOX A) : IS CHILD ' S AGE 7 YRS OR OLDER?

YE S • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • ( CHECK FLAP, BOX E ) • • • • • 0

IF NEEDE D, READ T O MOTHER/GUARD IAN.

Thi s sect ion g i ve s us an i dea of ( CHILD) ' s memo ry f or numbe r o rd e r. Each sequence of numbe r s ha s mo re d igi t s tha n the l as t . It i s rare f o r anyone t o remembe r all the seque nces . ]

[STE P THREE : IF NEEDE D, SEE Q X Q. ]

STE P F OUR : INSTRUCTIONS FOR DIGITS FORWARD.

ADMINISTER QUESTIONS :

( 1 ) READ EACH DIGIT S PAN ONLY ONCE AT AN EVEN RATE OF 1 DIGIT PER SECON D.

( 2 ) READ PART A OF QUESTION ; PAUSE FOR RE SPONSE THEN SCORE .

( 3 ) READ PART B OF QUESTION ; PAUS E FOR RE SPONS E THE N SCORE.

( 4 ) IF CHILD DOES NOT RE SPOND, DO NOT ENCOURAGE FURTHER.

( 5 ) STO P WHEN CHILD MISS E S PART A AND PART B O F ANY ONE QUESTION.

SCORE QUE STIONS :

( 1 ) TO BE SCORED CORRECT , NO NUMBERS MAY BE OHITTED OR BE IN REVERSE D ORDER.

Rep roduced by permi s sion f rom the WECHSLER INTELLIGENCE FOR CHILDREN-REVISED. Cop yr igh t © 1 9 7 4 by t he Ps ychologica l Corporat i o n. All r ight s res e rve d .

1 .

2.

3 .

4.

5 .

6 .

7 .

CS-38

DECK 12

S TE P F IVE : I NS TRUCT THE CHILD F OR DIG ITS FORWARD.

I am g o ing t o s a y so me numbers. Li s t e n careful ly , and whe n I am through , s a y them right a f t er me. SAY : Re ady BEFORE EACH QUE STION.

DIGIT S FORWARD MEASUREMENT

CORRECT WRONG CORRECT WRONG

A. 3-8-6 1 2 B. 6- 1 -2 1 2 6 2 / 6 3 /

A. 3-4 - 1 - 7 1 2 B . 6- 1-5-8 1 2 64/ 6 5 /

A. 8-4-2-3-9 1 2 B. 5-2- 1 -8 6 1 2 6 6 / 6 7/

A. 3-8-9 -1-7-4 1 2 B . 7 -9-6-4-8-3 1 2 6 8 / 6 9/

A. 5- 1 -7 -4-2-3-8 1 2 B . 9-8-5-2-1-6-3 1 2 70/ 71/

A. 1 -6-4-5-9-7-6-3 1 2 B . 2-9-7-6-3-1-5-4 1 2 7 2 / I 7 3 /

A. 5-3-8-7- 1 -2 -4-6-9 1 2 I B. 4 -2- 6-9- 1 -7-8-3-5 1 2 7 4 / 7 5 /

STE P S IX : INSTRUCT CHILD FOR DIGITS BACKWARD.

A. READ : Now I am going t o say s ome mo r e numbe r s , bu t thi s t ime whe n I s t op , I want you t o say them backwa rds . Fo r exampl e , if I s ay 9-2- 7 , wha t woul d you s a y?

B . PAUSE FOR THE CHILD TO RESPOND. DID CHILD RES POND CORRECTLY ( 7 -2-9 ) ?

YES ( 7 -2- 9 ) • • • •• SAY :

That ' s r ight . Le t ' s g o on wi th the res t of the numbe rs .

NO ••• • • SAY :

No , you would say 7-2-9. I said 9-2-7 , s o to say i t backwa rds you woul d say 7-2- 9. Now t ry thes e n umbe r s . Remembe r you a r e t o say them backwa rd s : 3-6-5.

C . WHETHE R THE CHILD I S CORRECT OR WRONG ON THE SECOND EXAMPLE , GO TO Q. 8 AND PROCEED EXACTLY AS IN DIG ITS FORWARD.

C S- 3 9 BEGIN DECK 1 3

D IGITS BACKWARD MEASUREMENT

CORREC T WRONG I CORRECT WRONG

8 . A . 2-5 11 B . 6-3 1 2 1 2

(ANS = 5-2) ( ANS = 3-6) 14/ 15}

9 . A . 5-7 -4 B . 2-5-9 1 2 1 2

(ANS = 4-7- 5 ) � 16/ (AN S = 9-5- 2) I 1 7 /

A . 7-2-9-6 B . 8-4-9-3 I � 1 2

(ANS = 6-9-2- 7 ) ( ANS = 3- 9-4-8) 18 1 9 /

A. 4- 1-3-5-7 B . 9-7-8-5-2 I

1 0 .

1 1 . 1 2 1 2

(ANS = 7-5-3- 1- 4) 2 0/

(ANS = 2-5-8-7- 9 ) 2 1 /

1 2 . A. 1-6-5-2-9-8 B . 3-6-7 -1 - 9-4 1 2 1 2

(ANS = 8-9-2-5-6-1 ) ( ANS = 4-9-1 - 7 -6-3) 2 2 / 2 3/

1 3 . A. 8-5-9-2-3-4-2 B . 4-5-7-9 -2-8-1 1 2 1 I 2

(ANS = 2-4-3-2-9-5- 8 ) 24 /

(AN S = 1-8-2-9-7-5- 4 ) 2 5 /

1 4 . A . 6-9-1-6-3-2- 5-8 B . 3- 1 -7 -9-5-4-8-2 1 2 1 2

(ANS = 8-5-2-3-6-1- 9-6) 2 6 /

( A N S = 2-8-4-5-9-7-1-3) 2 7 /

CS-4 0

DECK 1 3

I NTERVIEWER REMARKS :

1 5 . HOW MANY PE OPLE WERE P RE S E NT DUR I NG THE ADM I NISTRAT ION OF THIS SECTION AND WHAT E F FE CT , I F ANY , DID THE I R PRE S E NCE HAVE O N THE CHIL D ?

ADULT S

C H I L DRE N

1 6 � C O D E

IF PRE S E N T , CODE # PERSONS

MOTHE R

FATHE R

GUARDIAN

RE LAT I VE

F AH I LY

FRIEND

OTHE R ( S PE C IFY )

S I BL I NG

F R I E N D

OTHER

( S PE C IFY )

I_ I I_ I I_ I I_LI I_LI

J_j_J : I ! i_L_I !_j_l : I

28/

3 0/

3 2 /

34-3 5 /

3 7- 38/

4 0-41/

43-44/

46-4 7 /

:_1_1 4 9- 5 o /

l 01-1 ( U r e d )

EFFECT ON CHI LD ' S PERFORMANCE S EEME D TO NONE SEEMED TO BE HARMFUL OBSE RVABLE IMPROVE

1

1

1

1

1

l

1

l

l

2

2

2

2

2

2

2

2

2

3

3

3

3

3

3

3 3

h i g h

2 9 /

3 1 /

3 3 /

3 6 /

3 9 /

4 2 /

4 5 /

4 8/

51 /

L E VE L D U R I N G S E C T I O N. 1"--------- ·-r--

l

Y E S • • • • • • • ( AS K A ) • • • • • • • • • l

z

5 2 /

3

5 3 /

REAS O N F O R P RE?1AT URS T �<2t-1IN A T I O N O F T H I S S E C T I O N . ( CODE ALL THAT APPLY " )

PARENT /GUARD IAN T E RiH NAT E D /RE i'USE D • • • • • • • O l C H I L D WO ULD N O T RE S P O N D / RE F U S E D • • • • • • • • • • 0 2

MAJO R I NTE RRU PT I O N CAUS E D T E RM I NAT I O N • • • • 0 3 C H I L D C O UL D NOT UNDERSTAND TAS K • • • • • • • • • • 0 4

CH I L D HAD LANG UAG E PROBLEM • • • • • • • • • • • • • • • 0 5

CHI LD ' S EMOT IONAL COND ITION • • • • • • • • • • • • • • 06

CH I L D ' S PHYS ICA L COND IT IO N • • • • • • • • • • • • • • • 07 OTHE R ( S PE CIFY )

5 6- 5 7 / 5 8- 5 9 / 60-61/

6 2 - 6 3 /

64-6 5 /

66-6 7 /

08 68-6 9 / ---------------------------------------

S TE P ONE :

[ STEP TWO :

CS-4 1

SECTION 8 : PlAT MATH TEST

AGE S : 5 YEARS AND OLDER

CHE CK FLAP ( BOX A) : IS CHILD ' S AGE 5 YRS OR OLDER?

YES • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • ( CHECK FLAP , BOX E ) • • • • • 0

IF NEEDE D , READ T O MOTHE R/GUARDIAN .

DECK 13

Th i s s e c tion measures ( CHILD) ' s mathema t ical ski l l s . The que s t ions begi n a t a ve ry basi c ski l l l eve l and g o t o a ve r y high skill level . No one i s expec ted t o answe r a l l the que s t ions . ]

[ S TE P THREE : IF NEE DE D , SEE Q X Q. ]

STE P FOUR : PRAC T ICE EXERCISES ( INCLUDE S INSTRUCTION S T O CHIL D ) .

CHECK FLAP ( BOX C ) : IS CHILD IN 1 S T GRADE OR HIGHER?

YE S • • • • • ( SKI P TO B) • • • • • 1 NO • • • • • • ( GO TO A) • • • • • • • 0

A. PRACT IC E EXERCISE S FOR CHILDRE N NOT YE T I N 1ST GRADE .

( 1 ) TURN TO " INTRODUCTION TO THE MATHEMATICS SUBTEST" ( IN P lAT VOLUME I ) . READ :

Le t ' s s tart wi th s ome math p roblems . Fi r s t , we ' ll do s ome j us t fo r p rac t i c e t o s how you wha t they a r e l i ke .

( 2 ) FOLLOW TEXT IN EASEL FOR PRACTICE EXERC ISES A - E THEN GO TO STE P F I VE .

B. CHILDREN IN 1ST GRADE OR HIGHER NEE D NO PRACT ICE EXERC ISES . READ :

STE P F IVE :

We a r e going t o s ta r t wi t h s ome mathema t i c s p robl ems . Some of the f i r s t one s would be too easy f o r you , s o l e t ' s s tart wi t h thi s one.

C ODE CHILD ' S STARTING Qll , TURN TO APPROPRIATE EASEL PAGE AND PROCEE D.

KINDERGARTEN OR LES S • • • • ( GO TO Q. 1 ' CS-42 ) • • • • • • • • • • • 00 1ST GRADE • • • • • • • • • • • • • • • (G O TO Q. l S , C S-4 2 ) • • • • • • • • • • • 0 1 2ND GRADE • • • • • • • • • • • • • • • ( GO TO Q. 2 5 , CS-4 2 ) • • • • • • • • • • • 0 2 3RD GRADE • • • • • • • • • • • • • • • ( G O T O Q. 3 0 ' C S-4 2 ) • • • • • • • • • • • 0 3 4TH GRADE • • • • • • • • • • • • • • • ( GO TO Q. 35 , CS-42 ) • • • • • • • • • • • 04 5TH GRADE • • • • • • • • • • • • • • • (GO TO Q. 4 0 , C S-4 2 ) • • • • • • • • • • • O S 6TH GRADE • • • • • • • • • • • • • • • ( GO TO Q. 4 5 , CS-4 2 ) • • • • • • • • • • • 06 7TH GRADE • • • • • • • • • • • • • • • (GO TO Q. S O , C S-4 2 ) • • • • • • • • • • • 0 7 8TH GRADE • • • • • • • • • • • • • • • ( GO TO Q. 54 , C S- 42 ) • • • • • • • • • • • 08 9TH GRADE • • • • • • • • • • • • • • • (GO TO Q. S 8 , C S-4 2 ) • • • • • • • • • • • 0 9 l OTH GRADE � • • • • • • • • • • • • • ( SKIP TO Q. 6 0 , CS-43 ) • • • • • • • • • 1 0 1 1TH GRADE • • • • • • • • • • • • • • ( SKIP TO Q. 6 2 , C S-4 3 ) • • • • • • • • • 1 1 1 2TH GRADE • • • • • • • • • • • • • • ( SKIP TO Q. 64 , C S-4 3 ) • • • • • • • • • 1 2

7 0- 71/

RECORD ( CODE O NE )

CS-42 DECKS 14-15

BEGIN DECK 1 5 RECORD ( CODE ONE )

GRADE ANSWER RE SPONSE CORREC T WRONG GRADE AN SWE R RE S PONS E C ORRECT WRONG

K 1 . ( 4 )

2 . ( 2 )

3. ( 3 )

4 . ( 1 )

5. ( 4 )

6 . ( 3 )

7 . ( 3 )

8 . ( 1 )

9 . ( 4 )

1 0 . ( 4 )

ll. ( 1 )

1 2 . ( 3 )

1 3 . ( 4 )

1 4 . ( 2 )

1 s t 1 5 . ( 4 )

1 6 . ( 3 )

1 7. ( 1 )

1 8. ( 3 )

1 9 . ( 2 )

2 0 . ( 3 )

2 1 . ( 2 )

2 2. ( 1 )

2 3. ( 2 )

24 . ( 2 )

· 2nd 2 5. ( 1 )

2 6 . ( 4 )

2 7 . ( 3 )

2 8. ( 1 )

2 9. ( 3 )

( ) 14/ 1

( ) 16 / 1

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

( (

(

(

) 18/

) 20/

) 2 2 /

) 2 4 /

) 2 6 /

) 2 8 /

) 3 0 /

) 3 2 /

) 34/

) 36/

) 38/

) 40/

) 42/

) 44/

) 4 6 /

) 48/

) 50/

) 5 2 /

) 5 4 /

) 5 6 /

) 5 8 /

) 6 0/

) 6 2 /

) 6 4 /

) 6 6 /

) 6 8/

) 70/

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2 15/ 3rd 3 0. ( 2 ) ( ) 14/

2 1 7 / 3 1 . ( 2 ) ( ) 16/

2 19/

2 2 1/

2 2 3 /

2 2 5 /

2 2 7/

2 2 9 /

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

3 1/

3 3 / 3 5 /

3 7 /

3 9 /

41/

4 3 /

4 5 /

4 7 /

4 9 /

5 1/

5 3 / 5 5 /

5 7 /

5 9 /

6 1/

6 3 /

6 5 /

6 7/

6 9 /

7 1/

3 2. ( 4 ) (

3 3 . ( 4 ) (

3 4. ( 2 ) (

4t h 35 . ( 3 ) (

3 6. ( 1 ) (

3 7 . ( 2 ) (

3 8. ( 3 )

3 9 . ( 1 )

5th 4 0. ( 3 )

4 1 . ( 4 )

4 2. ( 4 )

4 3 . ( 1 )

4 4. ( 3 )

6th 4 5 . ( 4 )

4 6. ( 2 )

4 7 . ( 1 )

4 8. ( 1)

4 9 . ( 3 )

7t h 5 0. ( 3 )

5 1 . ( 2 )

5 2. ( 4 )

5 3. ( 4 )

8t h 5 4. ( 4 )

5 5. ( 2 )

5 6. ( 3 )

5 7 . ( 1 )

9th 5 8. ( 2 )

(

(

(

(

(

(

(

( (

(

(

(

(

(

(

(

(

(

( (

(

) 18/

) 20/

) 2 2 /

) 24/

) 2 6 /

) 28 /

) 30/

) 32/

) 34/

) 36/

) 3 8 /

) 4 0 /

) 4 2 /

) 44/

) 46/

) 48/

) 50/

) 5 2 /

) 54/

) 56/

) 5 8/

) 6 0/

) 6 2 /

) 64 /

) 6 6 /

) 68 /

) 70/

INTE RV IEWER : IF YOU CODE D 5 OF 7 WRON G , SKI P TO Q. 8 5.

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2 15/

2 17/

2 19/

2 2 1/

2 2 3 /

2 2 5 /

2 2 7 /

2 2 9 /

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

31/

3 3/

3 5 /

3 7 /

3 9 /

4 1/

4 3 /

4 5 /

4 7 /

4 9 /

5 1/

5 3 /

5 5 /

5 7 /

5 9 /

61/

6 3 /

6 5 /

6 7 /

6 9 /

7 1/

C S-43

RECORD ( CODE ONE ) GRADE ANSWER RE SPONSE CORRECT WRONG GRADE

5 9 . ( 2 ) ( ) 1 4 / 1 2 1 5 / 7 2.

l Oth 60 . ( 1 ) ( ) 1 6 / 1 2 1 7 / 7 3.

6 1 . ( 3 ) ( ) 1 8/ 1 2 1 9 / 7 4 .

1 1t h 6 2 . ( 1 ) ( ) 2 0 / 1 2 2 1/ 7 5.

6 3. ( 4 ) ( ) 2 2 / 1 2 2 3 / 7 6 .

1 2t h 64 . ( 3 ) ( ) 2 4 / 1 2 2 5 / 7 7 .

6 5 . ( 2 ) ( ) 2 6 / 1 2 2 7 / 7 8.

6 6. ( 2 ) ( ) 2 8 / 1 2 2 9 / 7 9.

6 7 . ( 4 ) ( ) 30/ 1 2 31/ 8 0.

6 8. ( 4 ) ( ) 3 2 / 1 2 3 3 / 8 1 .

6 9 . ( 1 ) ( ) 34/ 1 2 3 5 / 8 2.

70. ( 1 ) ( ) 36 / 1 2 3 7 / 8 3 .

7 1 . ( 2 ) ( ) 3 8 / 1 2 3 9 / 8 4.

8 5. INTERVIEWER : CALCULATE RAW SCORE :

---> A. ENTER CEILING Q# : ( LAS T ITEH WRONG)

l_l_l

B . ENTER TOTAL # OF ERRORS BETWEEN BASAL AND CE ILING :

l_l_l

ANSWER

( 1 )

( 1 )

( 3 )

( 3 )

( 4 )

( 3 )

( 2 )

( 3 )

( 4 )

( 2 )

( 1 )

( 2 )

( 2 )

C . SUBTRACT ' B ' FROM ' A ' : l_l_l = RAW SCORE

---> D. RECORD RAW SCORE FROM ' C ' ABOVE INTO SECT ION 9 , STEP F IVE ( BOX A) , CS-4 5 , THEN RETURN TO Q. 86 , CS-44.

INTERVI EWER REMARKS :

BEGIN DECK 16

RECORD ( CODE ONE ) RESPONSE CORRECT WRONG

( ) 40/ 1 2 4 1 /

( ) 4 2 / 1 2 4 3 /

( ) 44/ 1 2 4 5 /

( ) 4 6 / 1 2 4 7 /

( ) 48 / 1 2 4 9 /

( ) 50/ 1 2 5 1 /

( ) 5 2 / 1 2 5 3 /

( ) 5 4 / 1 2 5 5 /

( ) 5 6 / 1 2 5 7 /

( ) 5 8/ 1 2 5 9 /

( ) 60/ 1 2 6 1/

( ) 6 2 / 1 2 6 3 /

( ) 64/ 1 2 6 5 /

66-6 7 /

6 8- 6 9/

7 0- 7 1 /

C S-44

BEGIN DECK 1 7

8 6. HOW MANY PE O PLE WE RE P RE SE NT DURING ADMINISTRATION OF TH IS SECT ION AND

WHAT E FFEC T , I F AN Y , D I D THE I R PRE SE NC E HAVE ON THE CHI L D ?

EFFECT ON CHILD ' S PERFORMANCE SEEMED TO NONE SEEME D TO

IF PRESENT , C O DE II PEKSONS BE HARMFUL OBSERVABLE IMPRO VE

MOTHER l_l 1 4 / 1 2 3

FATHE R I_ I 1 6 / 1 2 3

GUARDIAN I_ I 18/ 1 2 3

ADULTS RELAT I VE I_LI 2 0-2 1 / 1 2 3 FAMILY FRIEND I_LI 2 3-2 4 / 1 2 3 OTHER ( S PEC IFY ) I_LI 26- 2 7/ 1 2 3

S IBLING I_LI 29-30/ 1 2 3

F RIEND I_LI 32-33/ 1 2 3 CHILDREN OTHER

( S PEC IFY)

I_LI 35-36/ 1 2 3

87. CODE CHILD ' S ENERGY l ow ( t i red ) medium high LEVE L DURING SECTION.

1 2 3

88. WAS THI S SECT ION TERMINATE D PREMATURELY?

YES • • • • • ( ASK A) • • • • • 1

N O• • • • • • • • • • • • • • • • • • 0

15/

1 7 /

1 9 /

2 2 /

2 5 /

28/

31/

3 4/

37/

38/

39/

A. REASON F OR PREMATURE TERMINATION OF THI S SECTION. ( CODE ALL THAT APPLY . )

PARENT/GUARD IAN TERMINATED /REFUSE D • • • • • • • 0 1 4 0-41/

CHILD WOULD NOT RES POND/REFUSED • • • • • • • • • • 02 4 2-43/

MAJOR INTERRUPTION CAUSE D TERMINATI O N • • • • 0 3 44-45/

CHILD COULD NOT UNDERSTAND TASK • • • • • • • • • • 04 46-4 7 /

CHILD HAD LANGUAGE PROBLEM• • • • • • • • • • • • • • • 0 5 48-4 9 /

CHILD ' S EHOTIONAL CONDIT ION• • • • • • • • • • • • • • 0 6 5 0-51/

CHILD ' S PHYS ICAL CONDIT ION• • • • • • • • • • • • • • • 0 7 5 2-53/

OTHER ( S PEC IFY )

08 54-5 5 /

CS-45

SECTION 9 : PLAT READING

AGES : 5 YEARS AND OLDER

PART A : READ ING RECOGNIT ION

STEP ONE : CHECK F LAP ( BOX A) . IS CHILD AGE 5 YRS OR OLDER?

YE S • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 NO • • • • • ( CHECK FLAP , BOX E ) • • • • • 0

[ STEP TWO : IF NEEDE D , READ T O MOTHE R/GUARD IAN.

DECK 1 7

Th i s s e c t i on mea sures ( CHILD) ' s read i ng re cogni t ion s ki l l s . The que s t i ons beg i n at a bas i c l eve l of ski l l and p roce e d to a highe r level of ski l l . No one i s expec t ed t o answe r all t h e ques tions . ]

[ STEP THREE : IF NEEDE D SEE Q X Q. ]

STEP FOUR : PRACT ICE EXERC ISES ( INCLUDES INSTRUCTIONS TO CHILD )

CHE CK FLAP , BOX C : I S CHILD I N 1ST GRADE OR HIGHE R?

YES • • • • • ( SKIP TO B ) NO • • • • • • ( G O TO A )

A. PRACTICE EXERC I SES FOR CHILDREN NOT YET IN 1 S T GRADE .

( 1 ) TURN T O " INTRODUCTION T O READING RECOGNIT ION S UBTEST" ( I N P lAT VOLUME I ) . READ :

Now I am going t o give you s ome p roblems i n reading . Fi rs t , l e t ' s l o ok a t s ome mor e pract i c e one s t o show you what the s e a re l ike . ( T URN TO PRACT ICE A. )

( 2 ) FOLLOW TEXT I N EASE L F O R PRACTICE EXERCISE S ( A-E ) .

B . CHILDREN I N 1 S T GRADE OR HIGHER NEED N O PRACT ICE EXE RC ISES. TURN T O " INTROD UCTION TO READING RECOGNITION S UBTE S T" (P lAT VOLUME 1 ) AND READ :

Now we a re g o i ng t o do s ome read i ng . Ag a i n , l e t ' s skip ove r s ome of t h e ve ry e a s y one s and s t a r t he r e . G O TO STE P FIVE .

STEP F IVE : SKIP TO STARTING Q# ( SEE B OX A BE LOW ) , TURN TO APPROPRIATE EASEL PAGE AN D PROCEE D. ( CHILD ' S START I N G Q# = RAW SCORE FROM SECT ION 8 , CS-43 , Q. 8 5C .

STARTING Q # - - - - - - - - - - - - - - - - - - - > 1 I I BOX A

NOTE : AFTER RECORDING RAW SCORE , RETURN TO SECTION 8 , Q. 86. CS-44.

5 6-5 7 /

PLATE ITEM II II ANSWER

1.

2.

3.

4.

5.

6.

7.

8.

9.

1 0.

1 1.

1 2.

1 3.

1 4.

1 5.

1 6.

1 7 .

1 8.

1 9.

2 0.

2 1.

2 2.

2 3.

2 4.

2 5.

2 6.

2 7.

2 8.

2 9.

( 1 )

( 2 )

( 1 )

(4)

(3 )

( 2 )

( 1 )

( 2 )

(4 )

( B b )

(A a )

( O )

( S )

( N)

( c )

( i )

( d )

( m)

( run)

( play )

( j ump )

(ki t t e n)

(wagon)

( f ishing )

( brook)

(glove s )

( smi le )

( col t )

( round )

C ODE ONE • • •

CORRECT WRONG

1

1

1

1

1

1

1

1

1 1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

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

CS- 4 6

14/

1 5 /

1 6 /

1 7 /

18/

19 /

2 0/

2 1 /

2 2 /

2 3/

2 4/

2 5 /

2 6 /

2 7/

2 8/

2 9 /

30/

31/

3 2 /

3 3 /

34 /

3 5 /

3 6 /

3 7/

38/

3 9 /

40/

41 /

42 /

B EGIN DECK 18

PLATE ITEM II II ANSWER

CODE ONE • • •

CORRECT WRONG

3 0.

3 1.

3 2.

3 3.

3 4.

3 5.

3 6.

3 7.

3 8.

3 9.

4 0.

4 1.

4 2.

4 3.

4 4.

4 5.

4 6.

4 7 .

4 8.

4 9.

5 0.

5 1.

5 2.

5 3.

5 4.

5 5.

5 6.

5 7.

5 8.

(blaze ) 1

(f eathe r) 1

( f lour) 1

( iglo o) 1

( l iquid ) 1

(purs e ) 1

( dange rous ) 1

( l odg e ) 1

( s tyl ish ) 1

(accide n t ) 1

( ruin) 1

( exe rcis e ) 1

( p igeo n) 1

( mois ture ) 1

(art i f i c i a l ) 1

( a nchor) 1

( elegan t ) 1

( gaudy ) 1

( t reache rou s ) 1

( yacht ) 1

( gue r il l a ) 1

( bo i s te rous ) 1

( i s t hmu s ) 1

( anti cipat ion) 1

(vertebrat e s ) 1

( co nt emplate ) 1

(he ro i n e ) 1

( u nparal le led ) 1

( i nacces s ibl e ) 1

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

4 3 /

44/

45 /

46 /

4 7 /

4 8/

4 9/

5 0 /

5 1/

5 2 /

5 3 /

54 /

5 5 /

5 6/

5 7 /

5 8/

5 9/

60/

61/

2 6 2 /

2 6 3 /

2 6 4 /

2 65 /

2 6 6 /

2 6 7/

2 68 /

2 6 9 /

2 7 0/

2 71 /

I NTERVIEWE R : IF Y O U CODE D 5 O F 7 WRONG , SKI P TO Q . 8 5.

PLATE II

8 5.

CS- 4 7

BEGIN DECK 19

CODE ONE • • • CODE ONE • • • ITEM PLATE ITEM II ANSWER CORRECT WRONG II II ANSWER CORRECT WRONG

5 9. ( colleague ) 1 2 1 4 / 7 2. ( aesthet i c ) 1 2

6 0. ( medi eva l ) 1 2 15/ 7 3. (de l ug e) 1 2

6 1 . ( p i nnacl e ) 1 2 1 6 / 7 4. ( d idactic ) 1 2

6 2. ( pic ture s q u e ) 1 2 1 7 / 7 5 . ( t i t ul a r) 1 2

6 3 . ( adj acent) 1 2 1 8 / 7 6. ( c redul i t y) 1 2

6 4. ( navigab l e ) 1 2 1 9 / 7 7 . ( j udi ciabl e ) 1 2

6 5 . ( d imi nut ive ) 1 2 2 0/ 7 8. ( nihi lism ) 1 2

6 6. (ens ig n) 1 2 21 / 7 9. ( pha ryngea l ) 1 2

6 7 . ( di lapidated ) 1 2 2 2 / 80. ( p te rodactyl ) 1 2

6 8. ( bureauc ra t ) 1 2 2 3 / 8 1 . ( mac roco sm) 1 2

6 9 . ( adulat ion) 1 2 2 4 / 8 2 . ( chime ri ca l ) 1 2

7 0. ( exo rbitant l y ) 1 2 25 / 8 3. ( disaccha r id e ) 1 2

7 1 . ( epoch) 1 2 2 6 / 8 4. ( apophthegm ) 1 2

INTERVIEWER : CALCULATE RAW SCORE :

A . ENTER HIGHEST CE ILING Qll : ( LAS T ITEM WRONG)

B . ENTER TOTAL II OF ERRORS BETWE.EN BASAL AND CE ILING :

c . SUBTRACT ' B ' FROM ' A ' :

D. I S CHILD ' S SCORE IN ' C ' 1 9 OR HIGHER?

'- '- '

'- '- '

'- '- '

YES • • • • • ( G O TO E ) • • • • • • • • • • • • • • • • 1 NO • • • • • • ( SKI P TO Q. 8 5 , C S-5 1 ) • • • • 0

4 0-4 1/

4 2-4 3 /

= RAW SCORE 44-45/

--->E . RECORD RAW SCORE FROH ' C ' ABOVE INTO STEP N INE , BOX B , C S-4 9 THEN RETURN TO STEP , SIX CS-4 9.

2 7 /

2 8/

2 9 /

30/

31/

32/

3 3 /

34/

35/

36/

3 7 /

3 8 /

39 /

C S- 4 8

THI S PAGE INTENTIONALLY BLANK

CS- 4 9

PART B : READ ING COMPREHENS ION

DECK 19

[ STEP S IX : IF NEEDE D , READ TO MOTHE R/GUARD IAN .

Thi s s e ct ion me asures ( CHILD) ' s abi l i ty t o unde rs tand what (he/she) reads . The q ue s t i ons begi n at a ve ry bas i c ski l l l eve l and go to a ve ry high skil l leve l. No one i s exp ec t ed to answer a l l the q ues t ions . ]

( STEP S EVEN : IF NEEDE D , SEE Q X Q . ]

STEP EIGHT : PRACTICE EXE RC I SE S ( I NCLUDES INSTRUCT IONS TO CHILD ) .

I S CHILD I N 1ST GRADE O R HIGHER GRADE ?

YE S • • • ( SK IP TO B ) • • • • • 1 NO • • • • (GO TO A) • • • • • • • 0

A. PRACTICE EXERCI SE S FOR CHILDREN NOT YET I N 1 S T GRAD E .

( 1 ) TURN T O "INTRODUCTION TO READING C OMPREHENSION S UBTE S T" ( I N P lAT VOLUME I I ) . READ :

Now I want t o f ind ou t how we l l you unde rstand and remember wha t you read. Le t us pract i c e again a l i t t l e s o you wil l know what I want you t o do. (GO TO PRACTICE A. )

( 2 ) FOLLOW T EXT IN EASEL F O R PRACTICE EXERCI SE S .

B . CHILDREN I N 1 S T GRADE O R H IGHER NEED NO PRACTICE EXE RCI SE S . TURN TO " INTRODUCTION TO THE READING C OMPREHENSION S UBTE S T , " IN P lAT VOL UME I I AND READ :

S TEP NINE :

Now I want t o f ind ou t how we l l you can unde rs tand and remember wha t you read . Bu t , f i rs t , l e t me e xplain wha t you are to d o. I am go i ng t o s how you a p age. It wi l l have only a s entence printed on i t . Re ad thi s sentence s i len t ly ( PAUS E ) to yours e l f ( PAU SE) j u s t once. When you have f inished , look u p a t me . Then I wil l show you the next page whi ch wil l have f our p i c t ure s

on i t . You a r e t o ( s how me /p o int to/t ell me the number of ) the p i cture tha t bes t describes wha t you h ave read . Be s ure t o remember what you have read, once , and then look up a t me .

SK IP TO STARTING Q# ( SEE BOX B BELOW) , TURN TO AP PROPRIATE EASEL PAGE AND PROCEED IF RAW SCORE = 1 9 OR HIGHER.

( STARTING Q11 = RAW SCORE FROM PART A , C S- 47 , Q . 8'5C . )

STARTING Q# - - - - - - -> II I 4 6- 4 7

BOX B

BEGIN DECK 20 PLATE RECORD

# ANSWER RE SPONSE

CODE ONE • • •

CORRECT WRONG

1 9 . ( 3 ) (

2 0. ( 1 ) (

2 1 . ( 2 ) (

2 2. ( 3) (

2 3 . ( 2 ) (

2 4. ( 3 ) (

2 5. ( 1 ) (

2 6. ( 1 ) (

2 7 . ( 2 ) (

2 8. ( 3) (

29 . ( 2 ) (

3 0. ( 1 ) (

3 1 . ( 3 ) (

3 2. ( 4 ) (

3 3. ( 2 ) . (

3 4. ( 4 ) (

3 5 . ( 3 ) (

3 6. ( 4 ) (

3 7 . ( 1 )

38. ( 2 )

39 . ( 3 )

4 0. ( 1 )

4 1 . ( 3 )

. 4 2. ( 3 )

43. ( 1 )

4 4. ( 4 )

45 . ( 2 )

4 6. ( 3 )

4 7 . ( 1 )

4 8. ( 1 )

4 9. ( 2 )

5 0. ( 3 )

5 1 . ( 2 )

(

(

(

(

(

(

(

(

(

(

(

(

(

(

(

) 1 4 / 1 ) 16/ 1 ) 18/ 1

) 20/ 1

) 2 2 / 1

) 24/ 1

) 2 6 / 1

) 28/ 1 ) 30/ 1 ) 3 2 / 1

) 34/ 1

) 36/ 1

) 38/ 1 ) 40/ 1

) 4 2 / 1 ) 44/ 1

) 46/ 1

) 48/ 1

) 50/ 1

) 52/ 1

) 54/ 1

) 56/ 1

) 5 8/ 1

) 60/ 1

) 6 2 / 1

) 64/ 1

) 66/ 1 ) 68/ 1

) 70/ 1 ) 7 2 / 1

) 7 4 / 1

) 7 6 / 1

) 7 8 / 1

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

CS-50

15 /

17/

19/

21/

23/

25 /

2 7 /

2 9/

31/

33/

35 /

3 7 /

3 9 /

4 1 /

43/

45/

4 7 /

49/

51/

5 3/

55/

5 7 /

5 9/

61/

63/ 65 /

6 7 /

6 9/

71/

7 3/

75 /

7 7 /

7 9 /

DECKS 20-21

BEGl}l DECK 21 PLATE RECORD CODE ONE • • •

CORRECT WRONG # ANSWER RESPONSE

5 2. ( 4 ) (

5 3. ( 3 ) (

5 4. ( 4 ) (

5 5. ( 2 ) (

5 6. ( 4 ) (

5 7. ( 2 ) (

5 8. ( 4 ) (

5 9. ( 3 ) (

60. ( 2 ) (

6 1 . ( 3 ) (

6 2. ( 2 ) (

6 3. ( 4 ) (

64. ( 3 ) (

6 5. ( 4 ) (

6 6. ( 1 ) (

6 7. ( 2 ) (

68. ( 1 ) (

6 9. ( 4 ) (

7 0. ( 2 ) (

7 1 . ( 1 ) ( .

7 2. ( 1 ) (

7 3. ( 4 ) (

7 4. ( 4 ) (

7 5. ( 1 ) (

7 6. ( 2 ) (

7 7 . ( 3 ) (

7 8. ( 4 ) (

7 9. ( 2 ) (

80. ( 3 ) (

8 1 . ( 3 ) (

82 . ( 1 ) (

8 3. ( 2 ) (

84. ( 1 ) (

) 14/ 1

) 16/ 1 ) 18/ 1 ) 20/ 1

) 2 2 / 1

) 24/ 1

) 26/ 1

) 28/ 1

) 30/ 1

) 32/ 1

) 34/ 1

) 36/ 1

) 38/ 1 ) 40/ 1

) 4 2 / 1

) 44/ 1

) 46/ 1

) 48/ 1

) 5 0/ 1

) 52/ ) 54/ ) 5 6/

) 5 8/

) 60/

) 62/

) 64/

) 66/

) 68/

) 70/

) 7 2 / ) 74/ ) 76/ ) 78/

1

1

1

1

1

1 1

1

1 1

1 1

1 1

2 15 /

2 1 7 /

2 19/

2 21/

2 2 3/

2 25/

2 2 7 /

2 2 9/

2 31/

2 33/

2 35/

2 3 7 /

2 3 9 /

2 41/

2 43/

2 45/

2 4 7 /

2 49/

2 51/

2

2

2

2

2

2

2

2

2

2

2

2

2

2

5 3/

55/

5 7/

5 9/

61/

63/

65/

67/

69/

7 1 /

73/

7 5 /

7 7 /

7 9 /

I NTERVIEWER : IF YO U CODE D 5 OF 7 WRON G , G O TO Q. 8 5 .

C S- 5 1 BEGIN DECK 2 2

INTERVIEWER REMARKS :

85 . HOW MANY PEOPLE WERE PRESENT DURING ADM INISTRATION OF THIS SECTION AND WHAT EFFEC T , IF ANY , DID THE IR PRESENCE HAVE ON THE CHILD?

EFFECT ON CHILD ' S PERFORMANCE SEEMED TO NONE

IF PRESENT , CODE II PERSONS BE HARHFUL OBSERVABLE

MOTHER I_ I 14 / 1

FATHER I_ I 16/ 1

GUARDIAN I_ I 18/ 1

ADULTS RELAT I VE l_l_l 2 0-21/ 1

FAMILY FRIEND I_ I_ I 2 3-2 4 / 1

OTHER ( S PEC IFY )

I_ I_ I 26-2 7 / 1

S IBLING l_l_l 2 9- 30/ 1

FRIEND I_ I_ I 32-33/ 1 CHILDREN OTHER

( SPEC IFY)

I_ I_ I 35-3 6 / 1

8 6 . CODE CHILD ' S ENERGY l ow ( t ired ) LEVEL DURING SECTION.

1

8 7 . WAS THI S SECTION TERMINATED PREMATURELY?

YES • • • ( ASK A) • • • • • • 1

NO• • • • • • • • • • • • • • • • • 0

2

2

2

2

2

2

2

2

2

medium

2

SEEMED TO IMPROVE

3

3

3

3

3

3

3

3

3

high

3

15/

17 /

19/

2 2 /

2 5 /

2 8 /

3 1/

34/

3 7 /

38/

3 9/

A. REASON F OR PREMAT URE TERMINAT ION OF THIS SECTION. ( CODE ALL 'IJ:lA'r APPLY . )

PARENT /GUARDIAN TERMINATED/REFUSE D• • • • • • • • • • • 0 1 40-4 1 /

CHILD WOULD NOT RES POND/REFUSED• • • • • • • • • • • • • • 0 2 42-4 3/

MAJOR INTERRUPT ION CAUSED TERMINATION • • • • • • • • 0 3 44-4 5 /

CHILD COULD NOT UNDERSTAND TASK• • • • • • • • • • • • • • 04 46-4 7/

CHILD HAD LANG UAGE PROBLEM• • • • • • • • • • • • • • • • • • • 0 5 48-49 /

CHILD ' S EMOTIONAL CONDITION• • • • • • • • • • • • • • • • • • 0 6 50-51 / CHILD ' S PHYS ICAL CONDIT ION• • • • • • • • • • • • • • • • • • • 0 7 52-5 3 / OTHER ( S PEC IFY )

08 54-5 5/

CS-52

THIS PAGE INTENT IONALLY BLANK

CS- 5 3

SECTI ON 1 f/J : PEABODY P ICTURE VOCABULARY TEST - REVISED ( FORM L )

AGES : 3 YEARS AND OLDER

STEP ONE : CHECK FLAP ( BOX B ) . I S CH ILD ' S P P VT AGE 3 YRS OR OLDER?

YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . ( CHECK FLAP , BOX E ) . . . . 0

[ STEP TWO : I F NEEDED , READ TO MOTHER / GUARD IAN .

Thi s s e c t i o n is des igned t o measure ( CHILD) ' s vocabul a ry . Chi ld ren usual ly e nj oy do i ng t hi s . I te l l (h im /he r ) a wo r d and (h e /s h e ) look s a t f our pi ctures and t e l l s me which p i c ture has t he s ame meani ng a s the wo rd I s a i d . ]

[ STEP THREE : IF NEE DE D , SEE Q X Q. ]

STEP FOUR : ADMIN ISTER PRACTICE QUESTIONS ( INCLUDES INSTRUCTIONS TO CHILD ) .

CHECK FLAP ( BOX B ) : I S CHILD ' S PPVT AGE • • •

3 YRS - 7 YRS , 1 1 MOS • • • • • • • ( GO TO A) • • • • • • • • 1 8 YRS OR OLDER • • • • • • • • • • • • • • (G O T O B ) • • • • • • • • 2

A. INSTRUCT IONS FOR CHILD 3 YRS - 7 YRS , 1 1 MOS .

PRACTICE A: TURN TO PPVT EASEL , TRAINING PLATE A AND SAY TO CHILD :

I want you t o look a t s ome pi ctures wi th me . Se e a l l t he pictures on thi s p ag e ? ( PO INT T O EACH P ICTURE . ) I wi l l s a y a wo rd ; the n I want you t o put your f i nge r on t he p i c tu re of the wo rd I have s a i d. If yo u are no t sure , jus t te l l me you r be s t gue s s . Le t ' s t ry one . Put your f inge r o n the p i cture o f d ol l .

dol l ( 4 )

f o rk ( 1 ) table ( 2 ) c a r ( 3 )

CORRECT • • • • G O T O PRACT IC E B .

WRONG • • • • • • ASK ALTERNATE WORDS , THEN G O T O PRAC T ICE B .

PRACTICE B : TURN TO TRAINING PLATE B . PROCEED AS IN PRACT ICE A.

ma n ( 2 )

comb ( 3 ) s o ck ( 4 ) mouth ( 1 )

PRACTICE C : TURN TO TRAINING PLATE C . PROCEE D AS I N PRACT ICE A.

swing ing ( 3 )

d r i nki ng ( 4 ) wa lki ng ( 1 ) c l imbi ng ( 2 )

C S- 5 4

B . INSTRUC T IONS FOR CHILD 8 YRS AND OLDER.

READ T O CHILD :

DE CK 2 2

I hav e s ome p i c t u r e s t o s how you/OR ( FOR OLDER CHILDREN ) I want t o f i nd ou t how l a rg e yo u r vocabul a ry i s .

PRACTICE 0 : TURN T O TRAIN ING PLATE 0 AND READ :

Se e , t he re a re f ou r p i c t u re s . Ea ch o f t hem i s numbe red ( PO I NT ) . I wi l l s a y a wo r d ; then I wan t you t o t e l l me t h e n umbe r o f , o r p o i nt t o , the p i c t ure t ha t b e s t t e l l s the meaning o f whe e l . If yo u a r e no t s u r e , t e l l me yo u r b e s t gues s . PROCEE D AS I N PRACTICE A.

whee l ( 4 ) z i pp e r ( 2 ) rope ( 1 ) r ake ( 3 )

PRACTICE E : TURN T O TRAIN ING PLATE E . PROCEED A S I N PRACTICE A.

g iant ( 1 )

bride ( 1 ) wi t ch ( 4 ) r oya l (2 )

STEP F IVE : CHECK FLAP ( BOX B : ) CODE S TART ING Q# , TURN TO APPROPR IATE EAS E L PAGE AND PROC E E D.

I S CHILD ' S PPVT AGE • • •

3 YRS - 3 YRS , 5 M9S • • • • • • • • • • ( GO TO Q. 1 , CS-5 5 ) • • • • • • 0 1 3 YRS , 6 HOS - 3 YR S , 1 1 MO S • • • ( SKI P T O Q. 1 0 , C S-5 5 ) • • • 0 2 4 YRS - 4 YRS , 5 MOS • • • • • • • • • • ( S KIP TO Q. 1 5 , C S- 5 5 ) • • • 0 3 4 YR S , 6 MOS - 4 YR S , 1 1 MO S • • • ( SKI P TO Q. 2 0 , C S- 5 5 ) • • • 0 4 5 YRS - 5 YRS , 5 MOS • • • • • • • • • • ( S KIP TO Q. 3 0 , C S-5 5 ) • • • O S 5 YRS , 6 MO S - 5 YRS , 1 1 MOS • • • ( SKI P T O Q. 3 5 , C S-5 5 ) • • • 0 6 6 YRS - 6 YRS , 5 MOS • • • • • • • • • • ( S KIP TO Q. 40 , C S-5 5 ) • • • 0 7 6 YRS , 6 MOS - 6 YR S , 1 1 MOS • • • ( SKI P T O Q. S O , C S-5 6 ) • • • 0 8 7 YRS - 7 YRS , 1 1 MOS • • • • • • • • • ( S KI P TO Q. S S , C S - 5 6 ) • • • 0 9 8 YRS - 8 YRS , 1 1 MOS • • • • • • • • • ( SK I P T O Q. 6 5 , C S-5 6 ) • • • 1 0 9 YRS - 9 YRS , 1 1 MOS • • • • • • • • • ( S KIP TO Q. 7 0 , C S- 5 6 ) • • • 1 1

1 0 YRS - 1 0 YRS , 1 1 MOS • • • • • • • • • ( S KI P T O Q. 8 0 , C S-5 6 ) • • • 1 2 1 1 YRS - 1 1 YRS , 1 1 MOS • • • • • • • • • ( S KIP T O Q. 8 5 , C S - 5 6 ) • • • 1 3 1 2 YRS - 1 2 YRS , 1 1 MO S • • • • • • • • • ( SKI P T O Q . 9 0 , C S-5 6 ) • • • 1 4 1 3 YRS - 1 3 YRS , 1 1 MOS • • • • • • • • • ( S KIP TO Q. 9 5 , C S-5 7 ) • • • 1 5 1 4 YRS - 1 4 YRS , 1 1 MO S • • • • • • • • • ( SKI P T O Q. 1 0 0 , C S-5 7 ) • • 1 6 1 5 YRS - 1 5 YRS , 1 1 MOS • • • • • • • • • ( S KIP TO Q. 1 0 5 , C S -5 7 ) • • 1 7 1 6 YRS - 1 6 YR S , 1 1 MO S • • • • • • • • • ( SKI P T O Q. l l 0 , C S- 5 7 ) • • 1 8

5 6-5 7 /

BEGIN DECK 2 3 RECORD CODE ONE

WORD RESPONS E CORRECT WRONG

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 . c ow ( 1 )

O. LAMP (4 )

1 . DRUM ( 3 )

. 2. KNEE (4 )

( ) 1 4 / 1

( ) 16/ 1

( ) 18/ 1

( ) 2 0/ 1

( ) 2 2 / 1

< ) 24 I 1

( ) 2 6 / 1

( ) 2 8/ 1

( ) 3 0/ 1

( ) 3 2 / 1

( ) 34 / 1

( ) 36/ 1

3. HEL ICOPTER ( 2 ) ( ) 38 / 1

4. ELBOW (4 )

5. BANDAGE (4)

6. FEATHER ( 1 )

7 . EHPTY ( 3 )

. 8 . FENCE (4 )

( ) 4 0/ 1

( ) 4 2 / 1

( ) 44 / 1

( ) 46 / 1

( ) 48/ 1

9. ACCIDENT ( 2 ) ( ) 5 0/ 1

�0. NET (2 )

� 1 . TEARING (4)

� 2. SAIL ( 1 )

( ) 5 2 / 1

( ) 5 4 / 1

( ) 5 6 / 1

� 3. HEAS URING ( 2 ) ( ) 5 8/ 1

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

C S- 5 5

15/

17/

1 9 /

2 1 /

2 3 /

2 5 /

2 7 /

2 9 /

31 /

3 3 /

35 /

3 7 /

3 9 /

41/

43 /

4 5 /

4 7 /

4 9 /

5 1 /

5 3 /

5 5 /

5 7 /

5 9 /

DECKS 2 3-2 4

BEGIN DECK 24 RECORD CODE ONE

WORD RE SPONS E CORRECT WRONG

2 4. PEELING ( 3 ) ( ) 14 / 1

2 5. CAGE ( 1 ) ( ) 16/ 1

2 6. TOOL (4 ) ( ) 18/ 1

2 7. SQUARE (4 ) ( ) 20/ 1

2 8. STRETCHING ( 1 ) ( ) 2 2 / 1

2 9. ARROW ( 2 )

3 0. TYING ( 2)

3 1 . NEST ( 1 )

( ) 24 / 1

( ) 26 / 1

( ) 2 8/ 1

3 2. ENVELOPE ( 2 ) ( ) 30/ 1

3 3. HOOK ( 3 )

3 4. PASTING (4 )

3 5. PATTING ( 1 )

3 6. PENGUIN ( 1 )

3 7 . SEWING (2 )

( ) 3 2 / 1

( ) 34/ 1

( ) 36/ 1

( ) 38/ 1

( ) 40/ 1

3 8. DELIVERING ( 1 ) ( ) 42 / 1

3 9. DIVING (2 ) ( ) 44 / 1

4 0. PARACHUTE ( 3) ( ) 4 6/ 1

4 1. FURRY (4 ) ( ) 4 8/ 1

4 2. VEGETABLE (4) ( ) 5 0 / 1

4 3. SHOULDER ( 3 ) ( ) 5 2 / 1

4 4. DRIPPING ( 2 ) ( ) 5 4 / 1

4 5. CLAW ( 4 ) ( ) 5 6 / 1

4 6. DECORATED ( 3 ) ( ) 5 8/ 1

2 15/

2 1 7 /

2 1 9 /

2 2 1 /

2 2 3/

2 2 5 /

2 2 7/

2 2 9 /

2 31/

2 33/

2 35/

2 3 7 /

2 39/

2 4 1/

2 4 3 /

2 4 5 /

2 4 7 /

2 4 9 /

2 5 1 /

2 5 3/

2 5 5 /

2 5 7 I

2 5 9 /

INTERVIEWER : IF YOU CODE D 6 OF 8 WRONG , SKI P TO Q. 1 7 6 , C S-5 9.


C S- 5 6

BEGIN DECK 2 6

DECKS 2 5-26

RECORD CODE ONE WORD RESPONS E CORRECT WRONG WORD RESPONSE CORRECT WRONG

4 7. FRAME ( 1 )

48. FOREST (3 )

4 9. FAUCET ( 2 )

SO. GROUP (3 )

5 1. STEM (3 )

5 2. VASE (3 )

5 3. PEDAL ( 1 )

54. CAPSULE (2 )

5 5. SURPRISED (4 )

5 6. BARK (2 )

5 7. MECHANIC ( 2 )

58. TAMBOURINE ( 1 )

( ) 14 / 1

( ) 16/ 1

( ) 18/ 1

( ) 20 / 1

( ) 2 2 / 1

( ) 2 4 / 1

( ) 2 6 / 1

( ) 2 8 / 1

( ) 30/ 1

( ) 3 2 / 1

( ) 34 / 1

( ) 36/ 1

5 9. DISAPPOINTMENT (4) ( ) 38/ 1

60. AWARDING (3 )

6 1 . PITCHER (3 )

6 2. REEL ( 1 )

6 3. SIGNAL ( 1 )

6 4. TRUNK (2 )

6 5. HUMAN (2 )

6 6. NOSTRIL ( 1 )

( ) 40/ 1

( ) 4 2 / 1

( ) 44 / 1

( ) 4 6/ 1

( ) 48 / 1

( ) 5 0 / 1

( ) 5 2 / 1

6 7. DISAGREEMENT ( 1) ( ) 54 / 1

6 8. EXHAUSTED (2 )

6 9. VINE (4 )

( ) 5 6 / 1

( ) 58/ 1

2 1 5 /

2 1 7 /

2 19/

2 21/

7 0. CEREMONY (4 )

7 1. CASSEROLE (2 )

7 2. VEHICLE (4 )

7 3. GLOBE (3 )

2 2 3 / 7 4. FILING (3 )

2 2 5 / 7 5. CLAMP (2 )

2 2 7 / 7 6. REPTILE ( 2 )

2 2 9 / 7 7. ISLAND ( 1 )

( ) 14/ 1

( ) 16/ 1

( ) 18/ 1

( ) 20/ 1

( ) 2 2 / 1

( ) 2 4 / 1

( ) 2 6 / 1

( ) 28/ 1

2 31/ 7 8. S PATULA (3 ) ( ) 30 / 1

2 3 3 / 7 9. COOPERAT ION (4 ) ( ) 3 2 / 1

2 35/ 8 0. SCALP (4 ) ( ) 34 / 1

2 3 7/ 8 1. TWIG ( 2 )

2 39/ 8 2. WEASEL ( 2 )

( ) 3 6 / 1

( ) 3 8/ 1

2 4 1/ 8 3. DEMOLISHING ( 4 ) ( ) 4 0/ 1

2 43/ 8 4. BALCONY ( 1 )

2 45/ 8 5. LOCKET ( 1 )

2 4 7/ 8 6. AMAZED (3 )

2 49/ 8 7. TUBULAR ( 1 )

2 51/ 8 8. TUSK ( 1 )

2 5 3 / 8 9. BOLT (3 )

( ) 42 / 1

( ) 44 / 1

( ) 4 6 / 1

( ) 48 / 1

( ) 5 0 / 1

( ) 5 2 / 1

2 5 5 / 9 0. COMMUN ICAT ION ( 4 ) ( ) 5 4 / 1

2 5 7 / 9 1. CARPENTER (2 )

2 59/ 9 2. ISOLATION ( 1 )

( ) 5 6 / 1

( ) 58 / 1

INTERVIEWER : IF YOU CODED , 6 OF 8 WRONG , SKI P TO Q. 1 7 6 , CS-59 .

2 1 5 /

2 1 7 /

2 19/

2 21/

2 2 3 /

2 2 5 /

2 2 7 /

2 2 9 /

2 3 1 /

2 3 3 /

2 3 5 /

2 3 7 /

2 3 9 /

2 4 1 ;

2 4 3 ;

2 4 5 ;

2 4 7 1

2 4 9 1

2 5L

2 5 9 ,


C S-5 7 DECKS 2 7-28

RECORD CODE ONE WORD RE SPONS E CORRECT WRONG

BEGIN DECK 2 8

WORD RE SPONSE CORRECT WRONG

1 3. INFLATED ( 3) ( ) 14 / 1

1 4 . COAST ( 3 ) ( ) 16/ 1

1 5. ADJUSTABLE ( 2 ) ( ) 18/ 1

1 6 . FRAGILE ( 3 ) ( ) 2 0 / 1

1 7 . ASSAULTING ( 1 ) ( ) 2 2 / 1

l. APPLIANCE ( 1 ) ( ) 2 4 / 1

1 9. PYRAMID ( 4 ) ( ) 2 6 / 1

)0. BLAZ ING ( 1 ) ( ) 2 8 / 1

) 1 . HOISTING ( 1 ) ( ) 30/ 1

)2. ARCH ( 4 ) ( ) 3 2 / 1

) 3. LECTURING ( 4 ) ( ) 34 / 1

)4. DILAPIDATED ( 4) ( ) 36/ 1

) 5. CONTEMPLAT ING ( 2) ( ) 3 8/ 1

) 6 . CANISTER ( 1 )

) 7 . DISSECTING ( 3 )

)8. LINK ( 4 )

) 9. SOLEMN ( 3 )

L O . ARCHERY ( 2 )

( ) 4 0/ 1

(

(

) 4 2 / 1

) 44/ 1

( ) 46/ 1

( ) 48/ 1

L 1 . TRANS PARENT ( 3 ) ( ) 5 0/ 1

L 2. HUSK ( 1 )

L 3. UTENS IL ( 2 )

L 4 . C ITRUS ( 3 )

( ) 5 2 / 1

( ) 54 / 1

( ) 5 6/ 1

L 5 . PEDESTRIAN ( 2 ) ( ) 5 8/ 1

2 15 / 1 1 6. PARALLELOGRAM ( 1 ) ( ) 14/ 1

2 1 7 / 1 1 7 . SLUMBERING ( 3 )

2 19/ 1 1 8. PENINSULA ( 4)

2 2 1/ 1 1 9. UPHOLSTERY ( 2 )

2 2 3 / 1 2 0. BARRICADE ( 4)

2 25 / 1 2 1 . QUARTET ( 4 )

2 2 7 / 1 2 2. TRANQUIL ( 3 )

2 2 9/ 1 2 3. ABRAS IVE (1)

2 31/ 1 2 4. FATIGUED ( 3 )

2 33/ 1 2 5. SPHERICAL ( 2 )

2 35 / 1 2 6. SYRINGE ( 2)

2 3 7 / 1 2 7. FE LINE ( 2 )

2 39/ 1 2 8. ARI D ( 4)

2 4 1 / 1 2 9. EXTERIOR ( 1 )

( ) 16/ 1

( ) 18/ 1

( ) 20/ 1

( ) 2 2 / 1

( ) 24 / 1

( ) 2 6/ 1

( ) 2 8 / 1

( ) 30/ 1

( ) 32/ 1

( ) 34/ 1

( ) 36 / 1

( ) 3 8/ 1

( ) 4 0/ 1

2 4 3 / 1 3 0. CONSTELLAT ION ( 4 ) ( ) 4 2 / 1

)44/ 1 2 4 5 / 1 3 1 . CORNEA ( 2 ) (

2 4 7 / 1 3 2. MERCANT ILE ( 1 )

2 4 9 / 1 33. ASCENDING ( 3 )

2 5 1/ 1 3 4. F ILTRAT ION ( 1 )

2 5 3 / 1 35. CONSUMING ( 4)

2 5 5 / 1 3 6. CASCADE ( 4 )

( ) 4 6/ 1

( ) 48/ 1

( ) 5 0/ 1

( ) 5 2 / 1

( ) 54/ 1

2 5 7/ 1 3 7. PERPENDICULAR ( 3 ) ( ) 5 6/ 1

2 5 9 / 1 3 8. REPLENISHING ( 1 ) ( ) 5 8/ 1

INTERVIEweR : IF YOU CODE D 6 OF 8 WRONG , SKI P T O Q. 1 7 6 , C S-5 9.

2 1 5 /

2 1 7 /

2 1 9 /

2 2 1 /

2 2 3 /

2 2 5 /

2 2 7/

2 2 9 /

2 31/

2 33/

2 35/

2 37/

2 39/

2 4 1/

2 4 3 /

2 4 5/

2 4 7 /

2 49/

2 5 1/

2 53/

2 55/

2 5 7 /

2 5 9/

C S-5 8 DECKS 2 9- 3 0

BEGIN DECK 2 9 BEGIN DECK 3 0

RECORD CODE ONE RECORD CODE ONE WORD RE SPONSE CORRECT WRONG WORD RE SPON S E CORRECT WRONG

1 3 9. EMISS ION ( 3 ) ( ) 1 4 / 1 2 1 5 / 1 5 8. EMAC IATED ( 2 ) ( ) 1 4 / 1 2 1 5 /

1 40. TALON ( 3 ) ( ) 1 6 / 1 2 1 7/ 1 5 9. DIVERGENCE ( 4 ) ( ) 1 6 / 1 2 1 7 /

1 4 1 . WRATH ( 3 ) ( ) 18/ 1 2 1 9 / 1 6 0. DROMEDARY ( 2 ) ( ) 18/ 1 2 19/

1 4 2. INCANDESCENT ( 4 ) ( ) 2 0/ 1 2 2 1 / 1 6 1 . EMBELLISHING ( 2 ) ( ) 20/ 1 2 2 1 /

1 4 3. ARROGANT ( 2) ( ) 2 2 / 1 2 2 3/ 1 6 2. ENTOMOLOGIST ( 3) ( ) 2 2 / 1 2 2 3/

1 44 . CONF IDING ( 3 ) ( ) 2 4 / 1 2 25/ 1 63 . CONSTRAIN ( 1 ) ( ) 2 4 / 1 2 2 5 /

1 4 5. RHOMBUS ( 3 ) ( ) 2 6 / 1 2 2 7/ 1 6 4. INF IRM ( 1 ) ( ) 2 6 / 1 2 2 7 /

1 4 6. NAUTICAL ( 3 ) ( ) 2 8 / 1 2 2 9/ 1 65. ANTHROPO ID ( 3 ) ( ) 2 8 / 1 2 2 9 /

1 4 7 . TANGENT ( 1 ) ( ) 30/ 1 2 31/ 1 6 6. SPECTER ( 4 ) ( ) 30/ 1 2 31/

1 4 8. INCLEMENT ( 4 ) ( ) 32 / 1 2 3 3 / 1 6 7 . INCERT ITUDE ( 2 ) ( ) 3 2 / 1 2 33 /

1 4 9. TRAJECTORY ( 1 ) ( ) 34/ 1 2 35/ 1 6 8. VITREOUS ( 1 ) ( ) 34/ 1 2 35 /

1 50. FETTERED ( 1 ) ( ) 3 6 / 1 2 3 7 / 1 6 9. OBELISK ( 1 ) ( ) 36 / 1 2 37 /

1 5 1 . WAIF ( 3) ( ) 38/ 1 2 39/ 1 7 0. EMBOSSED ( 4 ) ( ) 3 8/ 1 2 3 9/

1 52. JUB ILANT ( 2 ) ( ) 40/ 1 2 41/ 1 7 1 . AMBULATION ( 2 ) ( ) 4 0/ 1 2 41/

1 5 3. PILFERING ( 4) ( ) 42 / 1 2 4 3/ 1 7 2. CALYX ( 2 ) ( ) 4 2 / 1 2 4 3 /

1 54 . REPOSE ( 2 ) ( ) 44/ 1 2 45/ 1 7 3. OSCULATION ( 3 ) ( ) 44 / 1 2 45 /

1 5 5. CARRION ( 3 ) ( ) 4 6 / 1 2 4 7 I 1 7 4. CUPOLA ( 4 ) ( ) 4 6 / 1 2 4 7 /

1 56. INDIGENT ( 2 ) ( ) 4 8/ 1 2 4 9/ 1 7 5. HOMUNCULUS ( 4 ) ( ) 48/ 1 2 4 9 /

1 5 7 . CONVEX ( 1 ) ( ) 50/ 1 2 51/

INTERVIEWER : IF YOU CODE D 6 O F 8 WRON G , G O TO Q. 1 7 6 .

C S-59 DECKS 30- 3 1

INTERVIEWER REMARKS:

1 7 6. HOW MANY PEOPLE WERE PRE SE NT DUR ING ADHINI STRAT ION OF THIS SECTION AND WHAT EFFE C T , IF ANY , DID THE IR PRESENCE HAVE O N THE CHILD?

EFFECT ON CHILD'S PERFORMANCE SEEMED TO NONE SEEMED TO

IF PRE SENT , CODE II PERS ONS BE HARMFUL OBSERVABLE IMPROVE

MOTHER I_ I 5 0 / 1 2 3 51/

FATHER I_ I 5 2 / 1 2 3 5 3 /

GUARDIAN I_ I 5 4 / 1 2 3 55 /

ADULTS RELATI VE l_l_l 5 6- 5 7 / 1 2 3 58 /

FAMILY FRIEND I_ I_ I 59-60/ 1 2 3 61/

OTHER ( S PEC IFY )

I_LI 62-63/ 1 2 3 64/

S IBLING I_ I_ I 65-66/ 1 2 3 6 7 /

FRIEND I_ I_ I 68-69/ 1 2 3 70/

CHILDREN OTHER ( SPEC IFY )

I_LI 71-72 / 1 2 3 73/

1 7 7. CODE CHILD ' S ENERGY low ( t ired ) medium high LEVEL DURING SECTION.

74/

1 2 3

1 7 8. WAS THI S SECT ION TERMINATED PREMATURELY?

YES • • • • • ( ASK A) • • • • 1

NO• • • • • • • • • • • • • • • • • 0 75/

BEGIN DECK 31

A. REAS ON FOR PREMATURE TERMINAT ION OF THIS SECTION. (CODE ALL THAT APPLY . )

PARENT /GUARDIAN TERMINATE D/RE FUSE D • • • • • • • • • • • 0 1 15-16/

CHILD WOULD NOT RESPOND• • • • • • • • • • • • • • • • • • • • • •

MAJOR INTERRUPT ION CAUSE D TERHINAT ION • • • • • • • •

CHILD COUL D NOT UNDERSTAND TASK • • • • • • • • • • • • • •

CHIL D HAD LANGUAGE PROBLEM• • • • • • • • • • • • • • • • • • •

CHILD'S EMOT IONAL CONDIT ION• • • • • • • • • • • • • • • • • •

CHILD'S PHYS ICAL CONDITION• • • • • • • • • • • • • • • • • • •

OTHER ( S PEC IFY)

INTERVIEWER: THANK CHILD AND GO TO SECTION 1 1 , CS-6 1

0 2 1 7 -1 8 /

0 3 19-2 0/

04 2 1-2 2 /

05 2 3-24/

06 25- 2 6 /

0 7 2 7-28/

0 8 2 9-30/

CS-60


CS-6 1 DECK 31

SECTION 1 1 : INTERVIEWER EVALUATION OF TESTING CONDITIONS

EAC H CHILD

1 . DURING T H E INTERVIEW , HOW WAS CHILD 1 S • • • ( CODE ONE FOR EACH LETTER. )

Po o r Average Ex cellent

2.

A. ATTITUDE T OWARD BEING TESTE D? 1 2 3 4

B . RAPPORT WITH INTERVIEWER? 1 2 3 4

c . PERSEVERANCE /PERS ISTENC E ? 1 2 3 4

D. COOPERATION? 1 2 3 4

E. MOTI VAT ION /INTEREST? 1 2 3 4

DURING THE INTERVIEW WERE THERE ANY PROBLEM S WITH CHILD ' S

A. VIS UAL SHARPNESS?

( S PEC IFY)

B . HEARING ?

( S PEC IFY) ____ _

C . STATE OF HEALTH?

( S PEC IFY) ____ _

YE S • • • • • • • • • • • • • • • • • • • 1 N O• • • • • • • • • • • • • • • • • • • • 0

YES• • • • • • • • • • • • • • • • • • • 1 NO• • • • • • • • • • • • • • • • • • • • 0

YES• • • • • • • • • • • • • • • • • • • 1 NO• • • • • • • • • • • • • • • • • • • • 0

3. HOW SHY AN D ANXIOUS WAS CHILD AT THE END OF THE CHILD SUPPLEMENT?

5

5

5

5

5

NOT AT ALL SHY & ANXIOUS/ S OC IABLE & FRIENDLY

EXTREMELY SHY /QUIET / WITHDRAWN

I I 1 2 3 4 5

31/

3 2 /

3 3 /

34 /

35 /

36 /

3 7 /

3 8 /

3 9 /

C S-62

4 . DID ANY I NTERFERE NCES OCCUR DURING THE CHILD SUPPLEMENT?

YE S • • • • • (G O T O A ) • • • • • 1 NO • • • • • • • • • • • • • • • • • • • • 0

A. CODE EAC H CATEGORY BY AMOUNT OF INTERFERE NCE .

NOT INTERFERING INTERFERING

I ( 1 ) NO I S E LEVE L 1 2 3

( 2 ) INTERRUPT IONS 1 2 3

( 3 ) DISTRACT IONS 1 2 3

( 4 ) LIGHT 1 2 3

( 5 ) TEMPERATURE 1 2 3

( 6 ) PRESENC E O F OTHERS 1 2 3

( 7 ) OTHER ( S PEC IFY ) 1 2 3

5 . WHERE WAS THIS CHILD SUPPLEMENT ADMINISTERED?

CHILD ' S RES IDENCE • • • • • • • • • • 1 OTHER PRIVATE RES IDENCE • • • • 2 OTHER S ITE ( S PEC IFY )

3

I 4 5

4 5

4 5

4 5

4 5

4 5

4 5

6. CHE CK F LAP ( BOX F ) . I S THE MOTHE R S UPPLEMENT C OMPLETE D ?

YES • • • • • • • • • • • • • • • • • • 1 NO • • • • • (GO T O A) • • • • • 0

NA

NA

NA

NA

NA

NA

NA

DECK 3 1

41/

42 /

4 3 /

4 4 /

4 5 /

4 6 /

4 7 /

4 8/

4 9 /

A . IF YOU HAVE ALREADY G I VE N M S T O MOTHER , ASK HE R IF SHE NE EDS ANY HE LP IN C OMPLETING IT. IF YOU HAVE NOT YE T G I VE N HS TO MOTHE R , DO SO NOW.

7 . CHE CK FLAP ( BOXE S D AND E ) . I S THI S CHILD SUPPLEMEN T C OHPLETE D ?

Y E S • • • • • ( SKIP TO SECTION 1 2 , C S - 6 5 ) • • • • • 1 NO• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0

50/

CS-63

8. WHY I S CHILD SUPPLEHENT INCOHPLETE ?

SECTIONS INCOMPLETE • • • • • • • ( GO TO A) • • • • • • • • 1 TERHINATED PERMATURELY • • • • • • • • • • • • • • • • • • • • • 2

A. ATTEMPT TO COHPLETE SECTIONS NOW. AFTER ATTEHPT ( WHETHER S UCCES SFUL OR NOT ) RETURN HERE AND RECORD RE SULTS.

DECK 31

NOW C OMPLETE • • • • • • ( SKI P T O SECT ION 1 2 , C S-6 5 ) • • • • • • • • • 1 INCOMPLETE • • • • • • • • ( SKIP TO SECTION 1 2 , C S-65 ) • • • • • • • • • 2

9 . WHY WAS CHILD SUPPLEMENT TERMINATED PREMATURELY?

PARENT /GUARD IAN TERMINATE D • • • • • 1

CHILD TERMINATED• • • • • • • • • • • • • • • 2

INTERRUPTION TERMINATE D • • • • • • • • 3

CHILD NOT PRESENT• • • • • • • • • • • • • • 4

OTHER ( S PEC IFY )

5

51/

5 2 /

53/

CS-64


S TEP ONE :

S TEP TWO :

CS-65

SECTION 1 2 : INTERVIEWER OBSERVATIONS OF HOME ENVIRONMENT

EACH CHILD

ANSWER ON THE BAS IS OF YOUR PERSONAL OBSERVATION OF THE HOME ENVIRONMENT OF EAC H CHIL D IN STUDY AT T IME OF YOUR VIS I T.

RECORD OBSERVATIONS AT CONCLUS ION OF THE ENT IRE INTERVIEW FOR THIS CHIL D.

STE P THREE : I S CHILD ' S AGE • • •

LES S THAN 3 YRS OLD • • • • • • • • ( GO TO PART A, C S-6 6 ) • • • • • • • • • • 1

3 YRS - 5 YRS , 1 1 MOS • • • • • • ( SKI P TO PART B , CS-6 7 ) • • • • • • • • 2

6 YRS AND OLDER • • • • • • • • • • • • ( SKIP TO PART C , CS- 6 8 ) • • • • • • • • 3

NOTE : FOR PURPOSE S OF SECTION 1 2 , CHILD ' S "HOME" I S (HI S /HER ) OFF IC IAL PERMANENT RES IDENCE. IF CHILD LIVES IN INST ITUT ION , IN GROUP HOME OR AT SCHOO L , C IRCLE CODE ' 2 ' , NOT OBSERVE D , FOR EACH ANSWER.

CS- 6 6

PART A: CHILD LESS THAN 3 YRS

YES

1 . (MOTHER/GUARDIAN ) S PONTANEOUSLY SPOKE T O CHILD TWICE OR MORE ( E XC L UDING SCOLDING) . 1

2 . (MOTHER/GUARDIAN ) RES PONDED VERBALLY TO CHILD ' S S PEECH. 1

3 . ( MOTHER/GUARDIAN) CARESSED , KISSED , OR HUGGED CHILD AT LEAST ONCE. 1

4. (MOTHER/GUARDIAN ) S LAPPED OR S PAN KE D CHILD AT LEAST ONCE. 1

5 . (MOTHER/GUARDIAN ) INTERFERED WITH CHILD ' S ACT IONS OR RESTRICTED CHILD FROM EXPLORING MORE THAN 3 T IME S . 1

6. (MOTHER/GUARDIAN ) PROVIDE D TOYS OR INTEREST ING ACTIVITIES F OR CHILD. 1

7 . (MOTHER/GUARDIAN) KEPT CHILD IN VIEW/COULD SEE CHILD/LOOKED AT (H IM/HER) OFTEN. 1

8 . CHILD ' S P LAY E NVIRONMENT I S SAFE (NO POTENT IALLY DANGEROUS HEALTH OR STRUCTURAL HAZARDS WITHIN A TODDLER ' S OR INFANT ' S RANGE ) .

(E . G. , FALLING PLASTER , PEELING PAINT , RODENTS , GLASS , POISONS AND CLEANING MATERIALS , FLAME S & HEAT , FRAYE D E LECTRICAL WIRES ) . 1

T IME ENDED : II\ III �

9 . INTERVIEWER : SKIP TO Q. 1 0 , C S-69 .

HR MI N

DECK 3 1

NOT NO OBSERVE D

0 2 5 4 /

0 2 5 5 /

0 2 5 6 /

0 2 5 7 /

0 2 5 8 /

0 2 5 9 /

0 2 6 0 /

0 2 6 1 /

6 2 - 6 5 /

CS- 6 7 DECK 3 1

PART B : CHILD 3 YRS - 5 YRS , 1 1 MOS

1 . ( MOTHER/GUARDIAN) ' S VO IC E CONVEYE D POS IT I VE FEELING ABOUT THIS CHILD.

2 . (MOTHER/GUARDIAN ) CONVERSED WITH CHILD AT LEAST TWICE ( EXC LUDING SCOLDING OR SUSPIC IOUS COMMENTS ) .

3 . ( MOTHER/GUARDIAN ) ANSWERED CHILD ' S QUESTIONS OR REQUESTS VERBALLY.

4. ( MOTHER/GUARD IAN ) CARESSE D , KISSE D , OR HUGGE D CHILD AT LEAST ONCE .

5 . ( MOTHER/GUARDIAN ) INTRODUCED INTERV IEWER TO CHILD BY NAME.

6. (MOTHER/GUARDIAN) PHYS ICALLY RESTRICTE D OR ( SHOOK/ GRABBED) CHILD.

7. ( MOTHER/GUARDIAN) S LAPPED OR SPANKED CHILD AT LEAST ONCE.

8. CHILD ' S PLAY ENVIRONMENT I S SAFE (NO POTENT IALLY DANGEROUS STRUCTURAL OR HEALTH HAZARDS WITHI N A PRESCHOOLER 1 S RANGE ) .

( E . G. FALLING PLASTER , PEELING PAINT , RODENT S , GLAS S , POISONS AND CLEAN ING MATERIALS , FLAME S AN D HEAT , FRAYED ELECTRICAL WIRES ) .

9 . INTERIOR O F THE HOME I S DARK O R PERCEPTUALLY MONOTONOUS.

1 0. ALL VIS IBLE ROOM S OF HOUSE /APARTMENT ARE REASONABLY CLEAN .

1 1 . ALL VIS IBLE ROOMS OF HOUSE/APARTMENT ARE M IN IMALLY CLUTTERE D.

NOT YES NO OBSERVE D

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

1 0 2

6 6 /

6 7/

6 8/

6 9 /

7 0/

71/

72/

7 3 /

74/

7 5 /

76/

T IME E NDED : III III : 7 7-80/

INTERVIEWER: SKIP TO Q. 1 0 , CS-69.

HR MI N

T IME ENDE D :

INTERVIEWER : GO TO Q. l O , C S-6 9.

LC/ LCI � HR M IN

2 1-24/

C S-6 9

CARETAKER LOCATING INFORMATION SHEET

1 0 . INTERVIEWER: DID CARETAKER ANSWER CS SECT IONS 1 AND 2 , AND THE MS ?

YES • • • • • • • ( GO TO A. ) • • • • • • • • 1 N O• • • • • • • • • • • • • • • • • • • • • • • • • • 0

DECK 3 2

2 5 /

A. We would l ike s ome locating information about persons who would always know ( CHILD ' ) S whereabouts . ( INTERVIEWER SUGGEST THE FOLLOWING ) :

Grandparent : Name --------------------------------------------St ree t Ci ty/ St_a

_t_e...,./=-Zl.':"'". p--_-_-_-_

-_-::::::��::::;::_:_:_-:_-:_-:_-_-_-_-_-_-_-.....:__,../_-:::::��:--Phone ----------------------------------------------------

Child ' s Other Relative : Name St ree t ----------------------------------

Ci ty/St_a_t_e..,./=zl.':"'". P--_-_

-_-_-_-_-::::::��==7::_:_-:_-:_-:_-:_-_-_-_-_-_-_-.....:-/-:_-:_-:_-:_-:_-:_-:_-:_-:_-: Phone ----------------------------------------------------

Caretake r ' s Work # Name of Bus iness : --------------------------------------------

Stree t __ ��----------------�----------------�--------

Ci ty / State/Zi p --------.....:/ _________ / _____ _

Phone ----------------------------------------------------

Othe r : Name Stree t --------------------------------------------

Ci ty / State/Zi p --------------��-----------------..:/ ____ _

Phone ----------------------------------------------------

1 1 . INTERVIEWER:

A. RETRIEVE l'iS FROM MOTHER/GUARDIAN. CHECK MS COVE R TO SEE IF ALL SECT IONS ARE C OMPLETE.--IF THEY ARE C OMPLETE , MARK IN C S F LAP ( BOX F ) .

B . DOES CHILD HAVE ANY MORE S IBLINGS TO B E I NTERV IEWED?

YE S • • • ( ADMINISTE R NEXT C S ) . . . 1 NO • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 2 6/

THANK MOTHE R FOR HER OWN AN D HE R CHILD ' S PART IC I PAT IO N. OBTAI N RECE IPT FOR CAS H PA�1ENT FOR $ 5 . 0 0 ON BEHALF OF CHILD.

l_ l_ l_l_l_ l_ l INTERVIEWE R ID

2 7-3 2 /

C S- 7 0

1 2. Ha s ( CHILD ) eve r had a mens t rua l p e r i o d ?

Ye s • • • ( ASK A) • • • • • • • • • • • • • • • • • • • 1

No • • • • ( RETURN TO Q. l 3 , C S-8 ) • • • • 0

A. How o l d wa s ( CHILD ) whe n she had he r f i rs t mens t rua l p e ri o d ?

1_1_1 YEARS

B . In wha t month and ye a r d id s he have he r f i r s t p e r i o d ?

I_ I_ I I_ I_ I MONTH YEAR

INTERVIEWER: GO BACK TO Q. l 3, CS-8.

33/

34-3 5/

36-39 /

' DECK 32

CS FLAP

CH I L D 'S NAME ( N I CKNAME ) -------------

BQ� t,· 6GE BQ� B · eeYI 6GE BQ� G· GB6C!E BOX C!· �EEL! El.UUt:lEB

I I I I I K OR L E SS D AUE M P T

SEC. 3 2 N D __ 3 R D __

YEARS MONTHS Y EARS MONTHS

GRAD E I I SEC. 4 2ND __ 3RD __

40- 4 3 44-4 7 / 50-5 1/

BOX E : SECT I ON X AGE GR I D

SECTION NAME

1 . BACKGROUND

2. CHI LD HEALTH 3. PARTS O f T H E BODY 4. MEMORY FOR LOCAT IONS

5. VE RBAL M E MORY

6. WHAT I ' M L I KE

PAGE

CS- 1

CS- 5 CS- 1 3

CS- 1 7

CS - 2 5

CS- 33

CI RCL E SECT I ONS TO B E ADM I N I ST E R E D .

4 8-4 9/

SECTION NAME

7. M EMORY FOR D I GI TS 8. P lAT MAT H

9. P lAT READI NG 1 0. P PVT

1 1 . I NTV EVALUAT ION 1 2. I NTV OBSERVAT IONS

SLASH THROUGH W H E N COM P L E T E D. SECT I ONS THAT NEED MOR E WORK B E FORE COM P L ET I ON.

CH I L D'S AGE SECT IONS TO B E COMP L ETED

0 MOS - 7 MOS 1 2

8 MOS - 1 1 MOS 1 2 4

1 2 MOS - 2 YRS I 1 1 MOS* t 2 3 4 *

3 YRS - 3 YRS I 1 1 MOS t 2 4 5 1 0

4 YRS - 4 YRS I I I MOS 1 2 5 1 0

5 YRS - 5 YRS I 1 1 MOS 1 2 5 8 9 1 0

6 YRS - 6 YRS I 1 1 MOS 1 2 5 8 9 1 0

7 YRS - 7 YRS I

1 1 MOS 1 2 7 8 9 1 0

8 YRS AND OLDER 1 2 6 7 8 9 1 0

E.A6E.

CS- 3 7 CS- 4 1 CS- 45 CS- 53 CS- 6 1

CS- 65

CHECK ( o/ )

1 2

1 1 1 2

1 t 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 CH I L D 2 YRS 1 1 1 MOS . 1 6- 3 1 DAYS ( P PVT AGE = 3 YRS) DO SECT I ON 1 0.

BOX F - MOTHER'S SECT I ON COM P L ETED? YES __ NO __

OMB · YOUTH SURVEY ROUND 8, 1986 Introduction for Child Supplement BEGIN DECK 06 NORC-4440-101 OMB...

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Transcript of OMB · YOUTH SURVEY ROUND 8, 1986 Introduction for Child Supplement BEGIN DECK 06 NORC-4440-101 OMB...