BACKB. DISABILITY CHARACTERISTICS
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CHECKPOINT: ITEM B1a WILL ONLY BE ASKED IN WAVE 1, WAVE 2 & 3 GO TO B3a |
NLTS
|
1 |
B1a. [CHILD] is included in this study because the school district indicated at the beginning of the 1999 school year that [he/she] was a special education student. What are CHILDís learning problems or disabilities? DO NOT READ CATEGORIES (PROBE: Has he/she had any other learning problems or disabilities; that could include a speech problem?) (Circle All that Apply and/or write response IN COLUMN A.)
|
1 |
b1b. (IF MORE THAN ONE DISABILITY IN b1a) Which of these is CHILDís main learning problem or disability? (CIRCLE ONE CODE IN COLUMB B.)
|
A |
B |
||
|
GO TO B1c |
Has no problem/disability/not getting special services |
00 |
00 |
|
Learning disability/learning handicap (LD) |
01 |
01 |
|
|
Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED) |
02 |
02 |
|
|
Mental retardation (EMR, TMR, SMR, MR) |
03 |
03 |
|
|
Speech impairment/communication impairment |
04 |
04 |
|
|
Attention deficit disorder (ADD) (ADHD) |
05 |
05 |
|
|
Hard of hearing/hearing impairment |
06 |
06 |
|
|
Deafness |
07 |
07 |
|
|
Partial sight/visual impairment |
08 |
08 |
|
|
Complete blindness |
09 |
09 |
|
|
Physical or orthopedic impairment |
10 |
10 |
|
|
Traumatic Brain Injury (TBI) |
11 |
11 |
|
|
Health impairment (SPECIFY DISEASE) ______________________________ |
12 |
12 |
|
|
Deafness and blindness |
13 |
13 |
|
|
Amputation of a limb |
14 |
14 |
|
|
Aphasia |
15 |
15 |
|
|
Arthritis |
16 |
16 |
|
|
Asthma |
17 |
17 |
|
|
Autism |
18 |
18 |
|
|
Cancer/Lymphoma/Sarcoma |
19 |
19 |
|
|
Cerebral palsy (CP) |
20 |
20 |
|
|
Cystic fibrosis (CF) |
21 |
21 |
|
|
Depression |
22 |
22 |
|
|
Developmental disability or delay (DD) |
23 |
23 |
|
|
Diabetes |
24 |
24 |
|
|
Downs syndrome |
25 |
25 |
|
|
Dyslexia (reverses letters when reading) |
26 |
26 |
|
|
Educational handicap (EH) |
27 |
27 |
|
|
Emphysema |
29 |
29 |
|
|
Encephalitis |
30 |
30 |
|
|
Epilepsy |
31 |
31 |
|
|
Heart disease |
32 |
32 |
|
|
Hemophilia |
33 |
33 |
|
|
Hyperactive |
34 |
34 |
|
|
A |
B |
||
|
Leukemia |
35 |
35 |
|
|
Multiple sclerosis (MS) |
36 |
36 |
|
|
Muscular dystrophy |
37 |
37 |
|
|
Neurological impairment |
38 |
38 |
|
|
Neurosis |
39 |
39 |
|
|
Paraplegia or partial paralysis |
40 |
40 |
|
|
Polio |
41 |
41 |
|
|
Psychosis |
42 |
42 |
|
|
Quadriplegia or complete paralysis |
43 |
43 |
|
|
Schizophrenia |
44 |
44 |
|
|
Spina bifida |
45 |
45 |
|
|
Stroke |
46 |
46 |
|
|
Trouble with school subject (e.g., math or reading) |
47 |
47 |
|
|
"Just slow" |
48 |
48 |
|
|
Other (SPECIFY) ________________________________________________ |
97 |
97 |
|
|
Donít Know |
-1 |
-1 |
|
|
Refused |
-2 |
-2 |
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CHECKPOINT: CONSISTENCY CHECK WITH DISABILITY ON FILE. IF PARENT SAYS CHILD DOES NOT HAVE ANY SPEECH OR LEARNING PROBLEMS OR DISABILITIES (B1a=00), ASK B1c. ELSE GO TO CHECKPOINT BEFORE B1d |
|
1 |
B1c. Our records from the school district indicate that at the beginning of the school year CHILD had (a) (DISABILITY/IES ON FILE). Is that correct? CIRCLE ONE CODE.
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CIRCLE CORRECT CODE/S IN B1a AND IF MORE THAN ONE DISABILITY ALSO ASK B1b, THEN GO TO CHECKPOINT BEFORE B1d. |
YES |
1 |
|
|
GO TO B4a |
NO, DOESNíT HAVE THAT/THOSE DISABILITIES ANY LONGER |
2 |
|
|
GO TO B4a |
NO, CHILD HAS NO DISABILITY |
3 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
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CHECKPOINT: CONSISTENCY CHECK WITH DISABILITY CATEGORY ON FILE, IF FILE INDICATES CHILD HAS VISUAL OR HEARING DISABILITIES AND THIS CATEGORY HAS NOT BEEN MENTIONED BY THE PARENT (B1a NE 06 OR 07, 09 OR 09) GO TO B1d, ELSE GO TO B2a |
|
1 |
B1d. Our records from the school district indicates that CHILD has (a visual impairment) (a hearing impairment) is that correct? CIRCLE ONE RESPONSE ON EACH LINE. ALSO CIRCLE CORRECT CODE IN B1a.
|
Yes |
No |
DK |
Ref |
||
|
Visual impairment |
1 |
2 |
-1 |
-2 |
|
|
Hearing impairment |
1 |
2 |
-1 |
-2 |
NLTS, NEILS
|
1 |
B2a. About how old was [CHILD] when he/she started having this/these difficulty/ies or condition? (ENTER NUMBER FOR AGE OR GRADE LEVEL AND/OR CIRCLE CODE, AS APPROPRIATE) (IF MORE THAN ONE DISABILITY IN B1a AND IF PARENT ASKS WHICH DISABILITY, PARENT SHOULD ANSWER FOR FIRST/EARLIEST DISABILITY).
|
Under 1 year |
0 |
||
|
____________AGE |
Years of age |
1 |
|
|
____________GRADE |
Grade level |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
NLTS, ECLS-K
|
1 |
B2b. About how old was [CHILD] when he/she started getting special services from a professional for this difficulty? (ENTER NUMBER FOR AGE OR GRADE LEVEL AND/OR CIRCLE CODE, AS APPROPRIATE) (IF MORE THAN ONE DISABILITY IN B1a AND IF PARENT ASKS WHICH DISABILITY, PARENT SHOULD ANSWER FOR PRIMARY DISABILITY (IN B1b).
|
Under 1 year |
0 |
||
|
____________AGE OR |
Years of age |
1 |
|
|
____________GRADE |
Grade level |
2 |
|
|
Has never received special services from a professional |
3 |
||
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DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
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CHECKPOINT: IF B2a = 0 or AGE IS 3 YEARS OR LESS or DONíT KNOW, AND B2b NE 3 (NEVER RECEIVED SERVICES) ASK B2c, ELSE GO TO CHECKPONT BEFORE B2d. |
NEILS
|
1 |
B2c. Did CHILD receive early intervention services for children ages birth to 3 who have developmental delays or disabilities? Early intervention services means any special services or therapies designed to meet a childís special needs, when a child is younger than 3 years old.
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YES |
1 |
||
|
NO |
2 |
||
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DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
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CHECKPOINT: IF B2a=0, OR AGE IS 5 YEARS OR LESS ASK B2d, ELSE GO TO B2f |
NEILS
|
1 |
B2d. Did CHILD attend a preschool program, such as a nursery school?
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GO TO B2e |
YES |
1 |
|
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GO TO B2g |
NO |
2 |
|
|
GO TO B2g |
DONíT KNOW |
-1 |
|
|
GO TO B2g |
REFUSED |
-2 |
NEILS
|
1 |
B2e. Was that a Head Start program?
|
YES |
1 |
||
|
NO |
2 |
||
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DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
NEILS
|
1 |
B2f. About how many of the other children in the preschool program had special needs or disabilities? Was it...READ CATEGORIES. CODE ONE.
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All of them |
1 |
||
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Some of them, or |
2 |
||
|
None of them? |
3 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
|
1 |
B2g. When did CHILD first begin receiving special education services in school? CIRCLE ONE CODE AND ENTER AGE OR GRADE IF APPROPRIATE
|
GO TO CHECKPOINT BEFORE B4a |
____________AGE OR |
Years of age |
1 |
|
____________GRADE |
Grade level |
2 |
|
|
Never received special education services in school |
3 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
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CHECKPOINT: B3a WILL ONLY BE ASKED IN WAVES 2 AND 3, ELSE GO TO CHECKPOINT BEFORE B4a. |
|
2 |
3 |
B3a. When we spoke with [you/RESPONDENT NAME] last and asked about CHILDís learning problems or disabilities [you/RESPONDENT NAME] told us that CHILD had a (IMPORT INFORMATION FROM YEAR 1 ITEM B1a). Is that still correct?
|
GO TO B3c |
YES |
1 |
|
|
GO TO B3b |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
2 |
3 |
B3a1. Does he/she still have that/those disability/ies?
|
GO TO B3c |
YES |
1 |
|
|
GO TO CHECKPOINT BEFORE B3b |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
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CHECKPOINT: IF ONLY ONE DISABILITY IMPORTED FROM PRIOR WAVE GO TO B3c, ELSE GO TO B3b. |
|
2 |
3 |
B3b. Which ones doesnít she/he have? DO NOT READ CATEGORIES CIRCLE ALL THAT APPLY.
|
Has no problem/disability/not getting special services |
00 |
|
|
Learning disability/learning handicap (LD) |
01 |
|
|
Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED) |
02 |
|
|
Mental retardation (EMR, TMR, SMR, MR) |
03 |
|
|
Speech impairment/communication impairment |
04 |
|
|
Attention deficit disorder (ADD) |
05 |
|
|
Hard of hearing/hearing impairment |
06 |
|
|
Deafness |
07 |
|
|
Partial sight/visual impairment |
08 |
|
|
Complete blindness |
09 |
|
|
Physical or orthopedic impairment |
10 |
|
|
Traumatic Brain Injury (TBI) |
11 |
|
|
Health impairment (SPECIFY DISEASE) ______________________________ |
12 |
|
|
Deafness and blindness |
13 |
|
|
Amputation of a limb |
14 |
|
|
Aphasia |
15 |
|
|
Arthritis |
16 |
|
|
Asthma |
17 |
|
|
Autism |
18 |
|
|
Cancer/Lymphoma/Sarcoma |
19 |
|
|
Cerebral palsy (CP) |
20 |
|
|
Cystic fibrosis (CF) |
21 |
|
|
Depression |
22 |
|
|
Developmental disability or delay (DD) |
23 |
|
|
Diabetes |
24 |
|
|
Downs syndrome |
25 |
|
|
Dyslexia (reverses letters when reading) |
26 |
|
|
Educational handicap (EH) |
27 |
|
|
Emphysema |
29 |
|
|
Encephalitis |
30 |
|
|
Epilepsy |
31 |
|
|
Heart disease |
32 |
|
|
Hemophilia |
33 |
|
|
Hyperactive |
34 |
|
|
Leukemia |
35 |
|
|
Multiple sclerosis (MS) |
36 |
|
|
Muscular dystrophy |
37 |
|
|
Neurological impairment |
38 |
|
|
Neurosis |
39 |
|
|
Paraplegia or partial paralysis |
40 |
|
|
Polio |
41 |
|
|
Psychosis |
42 |
|
|
Quadriplegia or complete paralysis |
43 |
|
|
Schizophrenia |
44 |
|
|
Spina bifida |
45 |
|
|
Stroke |
46 |
|
|
Trouble with school subject (e.g., math or reading) |
47 |
|
|
"Just slow" |
48 |
|
|
Other (SPECIFY) ________________________________________________ |
97 |
|
|
Donít Know |
-1 |
|
|
Refused |
-2 |
|
2 |
3 |
B3c. Are there new or additional learning problems or disabilities that have been identified since we last spoke?
|
GO TO B3d |
YES |
1 |
|
|
GO TO CHECKPOINT BEFORE B4a |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
2 |
3 |
B3d. What are the additional learning problems or disabilities? DO NOT READ CATEGORIES (Circle All that Apply and/or write response IN COLUMN A.)
|
2 |
3 |
b3e. Of all CHILDís learning problems or disabilities, which has been CHILDís main learning problem or disability? (CIRCLE ONE CODE IN COLUMB B.) THEN GO TO CHECKPOINT BEFORE B4a.
|
A |
B |
||
|
Has no problem/disability/not getting special services |
00 |
00 |
|
|
Learning disability/learning handicap (LD) |
01 |
01 |
|
|
Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED) |
02 |
02 |
|
|
Mental retardation (EMR, TMR, SMR, MR) |
03 |
03 |
|
|
Speech impairment/communication impairment |
04 |
04 |
|
|
Attention deficit disorder (ADD) |
05 |
05 |
|
|
Hard of hearing/hearing impairment |
06 |
06 |
|
|
Deafness |
07 |
07 |
|
|
Partial sight/visual impairment |
08 |
08 |
|
|
Complete blindness |
09 |
09 |
|
|
Physical or orthopedic impairment |
10 |
10 |
|
|
Traumatic Brain Injury (TBI) |
11 |
11 |
|
|
Health impairment (SPECIFY DISEASE) ______________________________ |
12 |
12 |
|
|
Deafness and blindness |
13 |
13 |
|
|
Amputation of a limb |
14 |
14 |
|
|
Aphasia |
15 |
15 |
|
|
Arthritis |
16 |
16 |
|
|
Asthma |
17 |
17 |
|
|
Autism |
18 |
18 |
|
|
Cancer/Lymphoma/Sarcoma |
19 |
19 |
|
|
Cerebral palsy (CP) |
20 |
20 |
|
|
Cystic fibrosis (CF) |
21 |
21 |
|
|
Depression |
22 |
22 |
|
|
Developmental disability or delay (DD) |
23 |
23 |
|
|
Diabetes |
24 |
24 |
|
|
Downs syndrome |
25 |
25 |
|
|
Dyslexia (reverses letters when reading) |
26 |
26 |
|
|
Educational handicap (EH) |
27 |
27 |
|
|
Emphysema |
29 |
29 |
|
|
Encephalitis |
30 |
30 |
|
|
Epilepsy |
31 |
31 |
|
|
Heart disease |
32 |
32 |
|
|
Hemophilia |
33 |
33 |
|
|
Hyperactive |
34 |
34 |
|
|
Leukemia |
35 |
35 |
|
|
Multiple sclerosis (MS) |
36 |
36 |
|
|
Muscular dystrophy |
37 |
37 |
|
|
Neurological impairment |
38 |
38 |
|
|
Neurosis |
39 |
39 |
|
|
Paraplegia or partial paralysis |
40 |
40 |
|
|
Polio |
41 |
41 |
|
|
Psychosis |
42 |
42 |
|
|
Quadriplegia or complete paralysis |
43 |
43 |
|
|
Schizophrenia |
44 |
44 |
|
|
Spina bifida |
45 |
45 |
|
|
Stroke |
46 |
46 |
|
|
Trouble with school subject (e.g., math or reading) |
47 |
47 |
|
|
"Just slow" |
48 |
48 |
|
|
Other (SPECIFY) ________________________________________________ |
97 |
97 |
|
|
Donít Know |
-1 |
-1 |
|
|
Refused |
-2 |
-2 |
|
Now I want to ask about how well [CHILD] does some things. Iím going to start with hearing.
|
CHECKPOINT: IN WAVES 1,2 AND 3 IF B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS/ BLINDNESS (13) GO TO B4b ELSE ASK B4a, IN WAVE 2 AND 3, IF B3d=06, 07 OR 13 GO TO B4b, ELSE ASK B4a. |
NEILS
|
1 |
2 |
3 |
B4a. Compared with other children about the same age, would you say CHILDÖ READ CATEGORIES, CIRCLE ONE CODE. IF ASKED, THIS ASSESSMENT SHOULD BE MADE OF CHILDíS HEARING WITHOUT ANY HEARING DEVICES LIKE A HEARING AID.
|
GO TO CHECKPOINT BEFORE B5a |
Hears normally, or |
1 |
|
|
GO TO CHECKPOINT BEFORE B4b |
Has a hearing problem |
2 |
|
|
DONíT READ, GO CHECKPOINT BEFORE B5a. |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
|
CHECKPOINT: IN WAVE 1 ASK B4c EVERYONE WITH HEARING PROBLEMS (B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS BLINDNESS (13) OR B4a = 2). IN WAVE 2 AND 3 ONLY ASK B4c IF NEWLY IDENTIFIED HEARING PROBLEM - B3c=1 (yes) AND B3d = HEARING IMPAIRMENT (06) OR DEAFNESS (07) OR DEAFNESS BLINDNESS (13) OR IF B4a=2 IN CURRENT WAVE, BUT EQUALED 1 (HEARS NORMALLY) IN PREVIOUS WAVE/S. ELSE GO TO B4c. |
B4b. OUT
NEILS
|
1 |
2 |
3 |
B4c. Is [CHILDíS] hearing loss ...
|
Mild, |
1 |
||
|
Moderate, or |
2 |
||
|
Severe to profound? |
3 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
|
CHECKPOINT; IN WAVE1 ASK OF ALL WHO HAVE BEEN CORRECTLY DIRECTED TO THIS QUESTION. IN WAVES 2 AND 3 ONLY ASK IF B4d=2 (NO) IN PREVIOUS WAVE/S |
NEILS
|
1 |
2 |
3 |
B4d. Has a hearing aid or other kind of hearing device been prescribed for [CHILD]?
|
YES |
1 |
||
|
NO |
2 |
||
|
GO TO B4f |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B4e. How well does [CHILD] hear with the hearing device? Would you say [he/she]...READ CATEGORIES. CODE ONE
|
Hears normally, |
1 |
||
|
Has a little trouble hearing, |
2 |
||
|
Has a lot of trouble hearing, or |
3 |
||
|
Doesnít hear at all? |
4 |
||
|
DOESNíT HAVE ONE |
5 |
||
|
DONíT READ |
WONíT WEAR IT |
6 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B4e1. How frequently does CHILD use his hearing aide at school? Would you say....READ CATEGORIES. CIRCLE ONE CODE
|
Always |
1 |
||
|
Frequently |
2 |
||
|
Sometimes |
3 |
||
|
Never |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
|
CHECKPOINT: IN WAVE 1 ASK OF ALL WHO HAVE BEEN APPROPRIATLY DIRECTED TO THIS QUESTION. IN WAVES 2 AND 3 ONLY ASK IF B4f=2 (NO) IN PREVIOUS WAVE/S, ELSE GO TO B4g. |
|
1 |
2 |
3 |
B4f. Does CHILD have a cochlear implant? IF ASKED, A COCHLEAR IMPLANT IS .........
|
YES |
1 |
||
|
NO |
2 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B4g. Does [CHILD] useÖREAD CATEGORIES, CIRCLE ONE CODE FOR EACH.
|
|
|
DONíT KNOW |
|
|||
|
a. |
Sign language? |
1 |
2 |
-1 |
-2 |
|
|
b. |
Lip reading? |
1 |
2 |
-1 |
-2 |
|
|
c. |
Cued speech? |
1 |
2 |
-1 |
-2 |
|
|
d. |
Oral speech? |
1 |
2 |
-1 |
-2 |
|
|
e. |
A communication board or book? |
1 |
2 |
-1 |
-2 |
|
CHECKPOINT: IF B4gd= 1 (YES) ASK B4h, ELSE, GO TO CHECKPOINT BEFORE B4i. |
NEILS
|
1 |
2 |
3 |
B4h. Compared with other children about the same age, how clearly does CHILD speak? Would you say he/she.... READ CATEGORIES, CIRCLE ONE CODE
|
Speaks just as well as other children, |
1 |
||
|
Has a little trouble speaking |
2 |
||
|
Has a lot of trouble speaking, or |
3 |
||
|
Doesnít speak at all? |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
CHECKPOINT: IF B4ga. = YES, ASK B4i. ELSE, GO TO CHECKPOINT BEFORE B5a.
NEILS
|
1 |
2 |
3 |
B4i. Is the sign language that [CHILD] is learning to useÖ READ CATEGORIES. CODE ONE
|
American Sign Language, |
1 |
||
|
Signed English, or |
2 |
||
|
Some other sign language system? (SPECIFY) ______________________________ |
3 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B4j. Do any other members of [CHILDís] household use sign language to communicate with (him/her)?
|
YES |
1 |
||
|
NO |
2 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
CHECKPOINT: IF B4ge = 1 (USES COMMUNICATIN BOARD) ASK B4k, ELSE GO TO CHECKPOINT BEFORE B5a. |
|
1 |
2 |
3 |
B4k. How frequently does CHILD use his communication board or book at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE
|
Always, |
1 |
||
|
Frequently, |
2 |
||
|
Sometimes, |
3 |
||
|
Never? |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
CHECKPOINT: IN WAVE GO TO B5a.. IN WAVES 2 AND 3 IF B1a. = 08 (PARTIALLY SIGHTED) OR 09 (BLINDNESS), OR 13 (DEAFNESS/BLINDNESS) GO TO B5a. IF B3d=07, 08 OR 12 GO TO B5a.
Now Iím going to ask about [CHILDís] vision.
B5a. OUT
NEILS
|
1 |
2 |
3 |
B5b. Does [CHILD] wear glasses?
|
GO TO B5c |
YES |
1 |
|
|
GO TO B5d |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B5c. How well can [CHILD] see printed words with glasses? Would you say [he/she] ...? READ CATEGORIES. CIRCLE ONE CODE
|
GO TO CHECKPOINT BEFORE B5e |
Sees normally, |
1 |
|
|
Has a little trouble seeing, or |
2 |
||
|
Has a lot of trouble seeing? |
3 |
||
|
DONíT READ; GO TO B5d |
DOESNíT HAVE THEM |
4 |
|
|
WONíT WEAR THEM |
5 |
||
|
DONíT READ; GO TO CHECKPOINT BEFORE B6a |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B5d. How well can [CHILD] see printed words? Would you say [he/she] ... READ CATEGORIES.
|
Sees normally, |
1 |
||
|
Has a little trouble seeing, or |
2 |
||
|
Has a lot of trouble seeing? |
3 |
||
|
Doesnít see at all |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
|
CHECKPOINT: IF B1a = 08 (PARTIALLY SIGHTED) OR 09 (BLINDNESS) OR 13 (DEAFNESS/BLINDNESS) OR B5c=3 OR B5d=3 (A LOT OF TROUBLE SEEING) ASK B5e. ELSE GO TO CHECKPOINT BEFORE B6a. |
|
1 |
2 |
3 |
B5e. Does CHILD use any of the following:.. READ CATEGORIES. CIRCLE ONE CODE.
|
Braille |
1 |
||
|
Portable Braille note taker or writer |
|||
|
Large print type |
2 |
||
|
Optical devices (E.G. NEAR VISION MAGNIFICATION SYSTEM, TELESCOPIC DEVICE, BIOPTIC LENSES) |
3 |
||
|
Mobility Devices (E.G. CANES, ELECTRONIC TRAVEL AIDES) |
4 |
||
|
Assistive technology, such as voice synthesizers or software to enlarge the size of the print on the computer screen. |
5 |
||
|
Any other devices to help him/her see or read? SPECIFY _________________________________ |
6 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
N
|
CHECKPOINT: IN WAVES 1,2 AND 3 IF B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS BLINDNESS (13) GO TO B7a. IN WAVE 2 AND 3, IF B3d=06, 07 OR 13 GO TO B7a. IN WAVES 1, 2 OR 3 IF B1a= 04 OR B3d= 04 (SPEECH IMPAIRED) GO TO B6b. ELSE GO TO B6a. |
My next questions are about [CHILDís] ability to use language.
|
1 |
2 |
3 |
B6a. Does CHILD have any problem speaking clearly, or carrying on a conversation or any other speech or language problem?
|
YES |
1 |
||
|
GO TO B7a |
NO |
2 |
|
|
GO TO B7a |
DONíT KNOW |
-1 |
|
|
GO TO B7a |
REFUSED |
-2 |
|
1 |
2 |
3 |
B6b. Compared with other children about the same age, how clearly does CHILD speak? Would you say [he/she] ... READ CATEGORIES. CIRCLE ONE CODE.
|
GO TO B6d |
Speaks just as clearly as other children, |
1 |
|
|
GO TO B6d |
Has a little trouble speaking clearly, |
2 |
|
|
GO TO B6c |
Has a lot of trouble speaking clearly, or |
3 |
|
|
GO TO B6c |
Doesnít speak at all? |
4 |
|
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B6c. How does [CHILD] communicate with you? Does [he/she] use ...
READ CATEGORIES. CODE ALL THAT APPLY.
|
Words? |
01 |
||
|
GO TO B7a |
Sounds that are not words? |
02 |
|
|
Gestures, including pointing? |
03 |
||
|
Sign language |
04 |
||
|
GO TO B6c1 |
A communication board or book |
05 |
|
|
GO TO B7a |
A computer |
06 |
|
|
Anything else? (Specify: ___________________________) |
07 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B6c1. How frequently does CHILD use his communication board at school? Would you say....READ CATEGORIES. CIRCLE ONE CODE
|
Always |
1 |
||
|
GO TO B7a |
Frequently |
2 |
|
|
Sometimes |
3 |
||
|
Never |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B6d. Compared with other children about the same age, how well does CHILD carry on a conversation? Would you say he/she....READ CATEGORIES, CIRCLE ONE CODE
|
Converses just as well as other children, |
1 |
||
|
Has a little trouble carrying on a conversation, |
2 |
||
|
Has a lot of trouble carrying on a conversation, or |
3 |
||
|
Doesnít carry on a conversation at all? |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
Next, I want to ask about [CHILDís] physical abilities.
NEILS
|
1 |
2 |
3 |
B7a. How well does [CHILD] use [her/his] arms and hands? Would you say [he/she]...
READ CATEGORIES. CODE ONE CATEGORY. IF RESPONDENT REPORTS DIFFERENTLY FOR EACH ARM/HAND, CODE THE ARM/HAND THAT HAS THE MOST TROUBLE. NOTE: THIS DOES NOT REFER TO TEMPORARY DIFFICULTIES, E.G., A BROKEN ARM.
|
Uses both [his/her] arms and hands normally, |
1 |
||
|
Has a little trouble using one or both, |
2 |
||
|
Has a lot of trouble using one or both, or |
3 |
||
|
Has no use at all of one or both of [his/her] arms or hands? |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B7b. How well does [CHILD] use [her/his] legs and feet? Would you say [he/she] ... READ CATEGORIES. CODE ONE CATEGORY. IF RESPONDENT REPORTS DIFFERENTLY FOR EACH LEG/FOOT, CODE THE LEG/FOOT THAT HAS THE MOST TROUBLE. NOTE: THIS DOES NOT REFER TO TEMPORARY DIFFICULTIES, E.G., A BROKEN LEG.
|
GO TO B8a |
Uses both [his/her] legs and feet normally, |
1 |
|
|
Has a little trouble using one or both, |
2 |
||
|
Has a lot of trouble using one or both, or |
3 |
||
|
Has no use at all of one or both of [his/her] legs and feet? |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
NEILS
|
1 |
2 |
3 |
B7c. Does [CHILD] use any equipment to help [him/her] get around such as crutches, a walker, or a wheelchair?
|
GO TO B7d |
YES |
1 |
|
|
GO TO B8a |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B7d. What is the equipment he/she uses? DO NOT READ CATEGORIES. CIRCLE ALL THAT APPLY.
|
Crutches |
1 |
||
|
Walker |
2 |
||
|
Leg braces |
3 |
||
|
Wheelchair |
4 |
||
|
Other SPECIFY _________________________ |
5 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B7e. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.
|
Always |
1 |
||
|
Frequently |
2 |
||
|
Sometimes |
3 |
||
|
Never |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
Now, I have some questions about [CHILDís] health
NHIS
|
1 |
2 |
3 |
B8a. Compared with other children about the same age, would you say [CHILDís] general health is... READ CATEGORIES, CIRCLE ONE CODE
|
Excellent, |
1 |
||
|
Very good, |
2 |
||
|
Good, |
3 |
||
|
Fair, or |
4 |
||
|
Poor? |
5 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
DONíT READ |
REFUSED |
-2 |
|
CHECKPOINT: IF B1c=3 (PARENT SAYS NO DISABILITY) GO TO B9a. ELSE ASK B8b. |
NHIS
|
1 |
2 |
3 |
B8b. Is CHILD now taking any prescription medicine for a condition or problem related to his/her disability?
|
YES |
1 |
||
|
GO TO CHECKPOINT BEFORE B8f |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B8c. Is CHILD taking Ritalin?
|
YES |
1 |
||
|
NO |
2 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
CHECKPOINT: IF A5c=06, 07, OR 08 (LIVES IN FACILITY) GO TO B8f, ELSE ASK B8d. |
|
1 |
2 |
3 |
B8d. Does he/she take his/her medication while he/she is at school?
|
GO TO B8e |
YES |
1 |
|
|
|
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B8e. Does someone at the school give him/her the medication?
|
YES |
1 |
||
|
NO |
2 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
CHECKPOINT: IF B8a=1 (EXCELLENT HEALTH) GO TO B9a. ELSE GO TO B8f. |
|
1 |
2 |
3 |
B8f. Does [CHILD] use any kind of medical equipment or device, like an oxygen tank, or a catheter? THIS DOES NOT INCLUDE MOBILITY DEVICES, LIKE A WHEEL CHAIR, WALKER, CANE, ETC.
|
YES |
1 |
||
|
GO TO CHECKPOINT BEFORE B8h |
NO |
2 |
|
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B8g. What is the equipment or device[s]? DO NOT READ CATEGORIES, CIRCLE CODE AND/OR WRITE ANSWER.
|
Oxygen tank |
1 |
||
|
Catheter |
2 |
||
|
Feeding tube |
3 |
||
|
Other, SPECIFY __________ |
4 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B8g1. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.
|
Always |
1 |
||
|
Frequently |
2 |
||
|
Sometimes |
3 |
||
|
Never |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
|
CHECKPOINT: IF B8b=1 [TAKES MEDICATION] AND B4d=2 [NO HEARING AID], AND B6c DOES NE 05 OR 06(NO COMMUNICATION BOARD OR COMPUTER), AND B7c=2 [NO MOBILITY DEVICE] AND B8g=2 [NO MEDICAL DEVICES] ASK B8h, OTHERWISE GO TO B9a. |
|
1 |
2 |
3 |
B8h. Does CHILD use any equipment or devices because of his/her disability?
|
GO TO B8i |
YES |
1 |
|
|
GO TO B9a |
NO |
2 |
|
|
GO TO B9a |
DONíT KNOW |
-1 |
|
|
GO TO B9a |
REFUSED |
-2 |
|
1 |
2 |
3 |
B8i. What equipment or devices? DO NOT READ CATEGORIES, CIRCLE ONE CODE AND/OR WRITE ANSWER.
|
Protective helmet |
1 |
||
|
Computer |
2 |
||
|
calculator |
3 |
||
|
Other, SPECIFY __________ |
4 |
||
|
DONíT KNOW |
-1 |
||
|
REFUSED |
-2 |
|
1 |
2 |
3 |
B8j. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.
|
Always |
1 |
||
|
Frequently |
2 |
||
|
Sometimes |
3 |
||
|
Never |
4 |
||
|
DONíT READ |
DONíT KNOW |
-1 |
|
|
REFUSED |
-2 |
NHIS, NLTS
|
1 |
2 |
3 |
B9a. During this school year has CHILD received any of the following services?
|
1 |
2 |
3 |
B9b. Was that from or through his/her school?
FOR EACH SERVICE READ SERVICE AND CODE CORRECT RESPONSE IN COLUMN A, IF RESPONSE IS YES, ALSO READ B9b FOR THAT SERVICE. IF RESPONDENT SAYS STUDENT IS NOT IN SCHOOL, CODE B9c AND DO NOT ASK B9b FOR THE REST OF THE SERVICES.
|
1 |
2 |
3 |
B9c.
|
STUDENT IS NOT IN SCHOOL |
1 |
|
A. Received Service |
B. From or through the school |
||||||||
|
Service |
Y |
N |
DK |
R |
Y |
N |
DK |
R |
|
|
a |
Speech or language therapy |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
b |
Audiology services for hearing problems |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
c |
Psychological or mental health services or counseling |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
d |
Physical therapy |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
e |
Social work services |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
f |
Occupational therapy or life skills therapy |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
g |
Recreational therapy |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
h |
Orientation and mobility services |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
i |
Medical services for diagnosis or evaluation |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
j |
Nursing care |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
k |
Personal assistant/aide |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
l |
Tutor |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
m |
Reader or interpreter, including sign language |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
n |
Assistive technology services or devices, such as help selecting, getting or using assistive technology devices. IF ASKED, ASSISTIVE TECHNOLOGY COVERS A WIDE VARIETY OF DEVICES ANYTHING FROM A WHEEL CHAIR TO SOFTWARE ON A COMPUTER TO A CALCULATOR |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
o |
Transportation |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
|
p |
Service coordination or case management |
1 |
2 |
-1 |
-2 |
1 |
2 |
-1 |
2 |
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