Longitudinal follow-up of Youth with Attention-Deficit/Hyperactivity Disorder identified in Community Settings: Examining Health Status, Correlates, and Effects associated with treatment for ADHD

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment B35. Teachery Survery (Teacher)	Form and Instruction	New	Available
Attachment B34. Youth Demographic Survey (16+ years) (Child)	Form and Instruction	New	Available
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment	Form and Instruction	New	Available
Attachment B32. People In My Life (Child)	Form and Instruction	New	Available
Attachment B31. Pediatric Quality of Life (teen) (Child)	Form and Instruction	New	Available
Attachment B30. Pediatric Quality of Life (child) (Child)	Form and Instruction	New	Available
Attachment B29. Pediatric Quality of Life (young child) (Child)	Form and Instruction	New	Repair queued
Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child)	Form and Instruction	New	Available
Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child)	Form and Instruction	New	Available
Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child)	Form and Instruction	New	Available
Attachment B25. Health Risk Behavior Survey (high school) (Child)	Form and Instruction	New	Repair queued
Attachment B24. Health Risk Behavior Survey (middle school) (Child)	Form and Instruction	New	Available
Attachment B23. Health Risk Behavior Survey (elementary) (Child)	Form and Instruction	New	Available
Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child)	Form and Instruction	New	Available
Attachment B21. Vanderbilt Parent Rating Scale (Parent)	Form and Instruction	New	Available
Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent)	Form and Instruction	New	Available
Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent)	Form and Instruction	New	Available
Attachment B18. Social Isolation/Support (Parent)	Form and Instruction	New	Available
Attachment B17. Quarterly Update Events and Demographics (Parent)	Form and Instruction	New	Available
Attachment B16. Pediatric Quality of Life (teen) (Parent)	Form and Instruction	New	Repair queued
Attachment B15. Pediatric Quality of Life (child) (Parent)	Form and Instruction	New	Available
Attachment B14. Pediatric Quality of Life (young child) (Parent)	Form and Instruction	New	Available
Attachment B13. Parents' Questionnaire (Mental Health History) (Parent)	Form and Instruction	New	Available
Attachment B12. Parent-Child Relationship Inventory (Parent)	Form and Instruction	New	Available
Attachment B11. Health Risk Behavior Survey (high school) (Parent)	Form and Instruction	New	Available
Attachment B10. Health Risk Behavior Survey (middle school) (Parent)	Form and Instruction	New	Available
Attachment B9. Health Risk Behavior Survey (elementary) (Parent)	Form and Instruction	New	Repair queued
Attachment B8. Demographic Survey (Parent)	Form and Instruction	New	Available
Attachment B7. Critical School Events (high school) (Parent)	Form and Instruction	New	Repair queued
Attachment B6. Critical School Events (elementary, middle) (Parent)	Form and Instruction	New	Available
Attachment B5. Brief Impairment Scale (Parent)	Form and Instruction	New	Available
Attachment B4b. ADHD Treatment Quarterly Update (Parent)	Form and Instruction	New	Available
Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent)	Form and Instruction	New	Available
Attachment B3. ADHD Communication and Knowledge Scan (Parent)	Form and Instruction	New	Available
Attachment B36-10 DISC MHM.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-9 DISC MDD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-8 DISC TIC.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-7 DISC PTSD.pdf	Supplementary Document	Uploaded 2007-07-16	Repair queued
Attachment B36-6 DISC OCD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-5 DISC GAD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-4 DISC CD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-3 DISC ODD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-2 DISC ADHD.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36-1 DISC intro.pdf	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B36 DISC-IV Table of Contents.doc	Supplementary Document	Uploaded 2007-07-16	Available
Long-term Justification List of Attachments final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Response to OMB desk officer concerns.doc	Supplementary Document	Uploaded 2007-07-16	Available
Long-term Justification B1-5 final.doc	Supporting Statement B	Uploaded 2007-07-16	Available
Attachment I2 Kaufman Brief Intelligence.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment I1 DISC description.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment H2 SC Triage Protocol Document 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment H1 OK Triage Protocol Document 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment G2 Respondent Break Down Tables with DISC final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Attachment G1 sample description.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment F Certificate advisement language.doc	Supplementary Document	Uploaded 0000-00-00	Repair queued
Attachment E4 SC Child Assent age 9-18 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment E3 SC Child Assent age 7-8 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment E2 SC Parental Consent age 9-18 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment E1 SC Parent Consent (age 7-8) final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Attachment D3 OK Child Assent age 11-17 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Repair queued
Attachment D2 OK Child Assent age 7-10 3-13-07.doc	Supplementary Document	Uploaded 0000-00-00	Available
Attachment D1 OK Parent Consent final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Attachment C2 South Carolina IRB notice.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment C1 Oklahoma IRB notice.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment B2 Instrument descriptions final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Attachment B1 Instrument Table final.doc	Supplementary Document	Uploaded 2007-07-16	Available
Attachment A3 final 60 day notice.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment A2 Children's Health Act 2000.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Attachment A1 Public Health Service Act 2000.pdf	Supplementary Document	Uploaded 0000-00-00	Available
Long-term Justification A1-18 final.doc	Supporting Statement A	Uploaded 2007-07-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
179858	Attachment B35. Teachery Survery (Teacher)	Form and Instruction	New
179857	Attachment B34. Youth Demographic Survey (16+ years) (Child)	Form and Instruction	New
179856	Attachment B33. People In My Life/Inventory of Parent and Peer Attachment	Form and Instruction	New
179855	Attachment B32. People In My Life (Child)	Form and Instruction	New
179854	Attachment B31. Pediatric Quality of Life (teen) (Child)	Form and Instruction	New
179853	Attachment B30. Pediatric Quality of Life (child) (Child)	Form and Instruction	New
179852	Attachment B29. Pediatric Quality of Life (young child) (Child)	Form and Instruction	New
179851	Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child)	Form and Instruction	New
179850	Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child)	Form and Instruction	New
179849	Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child)	Form and Instruction	New
179848	Attachment B25. Health Risk Behavior Survey (high school) (Child)	Form and Instruction	New
179847	Attachment B24. Health Risk Behavior Survey (middle school) (Child)	Form and Instruction	New
179846	Attachment B23. Health Risk Behavior Survey (elementary) (Child)	Form and Instruction	New
179845	Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child)	Form and Instruction	New
179844	Attachment B21. Vanderbilt Parent Rating Scale (Parent)	Form and Instruction	New
179843	Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent)	Form and Instruction	New
179842	Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent)	Form and Instruction	New
179841	Attachment B18. Social Isolation/Support (Parent)	Form and Instruction	New
179840	Attachment B17. Quarterly Update Events and Demographics (Parent)	Form and Instruction	New
179839	Attachment B16. Pediatric Quality of Life (teen) (Parent)	Form and Instruction	New
179838	Attachment B15. Pediatric Quality of Life (child) (Parent)	Form and Instruction	New
179837	Attachment B14. Pediatric Quality of Life (young child) (Parent)	Form and Instruction	New
179836	Attachment B13. Parents' Questionnaire (Mental Health History) (Parent)	Form and Instruction	New
179835	Attachment B12. Parent-Child Relationship Inventory (Parent)	Form and Instruction	New
179834	Attachment B11. Health Risk Behavior Survey (high school) (Parent)	Form and Instruction	New
179833	Attachment B10. Health Risk Behavior Survey (middle school) (Parent)	Form and Instruction	New
179832	Attachment B9. Health Risk Behavior Survey (elementary) (Parent)	Form and Instruction	New
179831	Attachment B8. Demographic Survey (Parent)	Form and Instruction	New
179830	Attachment B7. Critical School Events (high school) (Parent)	Form and Instruction	New
179829	Attachment B6. Critical School Events (elementary, middle) (Parent)	Form and Instruction	New
179828	Attachment B5. Brief Impairment Scale (Parent)	Form and Instruction	New
179827	Attachment B4b. ADHD Treatment Quarterly Update (Parent)	Form and Instruction	New
179826	Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent)	Form and Instruction	New
179825	Attachment B3. ADHD Communication and Knowledge Scan (Parent)	Form and Instruction	New

ICR Details

OMB Control No: 0920-0747	ICR Reference No: 200704-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Longitudinal follow-up of Youth with Attention-Deficit/Hyperactivity Disorder identified in Community Settings: Examining Health Status, Correlates, and Effects associated with treatment for ADHD
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/25/2007
	Date Received in OIRA: 04/25/2007
Terms of Clearance: Approved consistent with revised materials submitted to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved
Responses	29,943	0	0
Time Burden (Hours)	3,993	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Attention-Deficit/Hyperactivity Disorder, one of the most common neurobehavioral disorders of childhood, is characterized by inattention, impulsivity/hyperactivity or both, such that daily functioning is compromised in multiple settings (DSM-IV-TR, 2000 diagnostic criteria; APA, 2000). CDC estimates that roughly 2.5 million children were taking medications to treat ADHD in 2003, although substantial disparities exist in rates of both parent-reported diagnosis and treatment across US states (MMWR, 2005). ADHD often persists into adolescence and can affect behavior and functioning even in adults. However, little is known about the disorder's developmental trajectory from non-clinical samples of youth identified and treated for ADHD through usual community care. The initial Project to Learn about ADHD in Youth (PLAY) study (OMB application No. 0920-0584) involved school district-wide screening at two sites (Oklahoma and South Carolina). A community-based sample of children with probable ADHD based on the screening data and a random sample of remaining children participated in an in-depth interview to provide information on diagnosis, symptoms, and associated health risk. The participants who completed the baseline interview will now be invited to participate in this proposed longitudinal follow up study, the PLAY study follow-up. Specifically, the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, has provided funding to the University of Oklahoma Health Sciences Center and University of South Carolina to study the long-term outcomes and health status of children with ADHD identified and treated in community settings through a systematic follow-up of the subjects who participated in the PLAY study. The PLAY study follow-up will allow the CDC to determine: 1) trajectory of ADHD symptoms, 2) rates and patterns of comorbid conditions among those with ADHD, 3) describe health risk behavior in ADHD youth, and 4) described current or previous receipt of and access to treatment for ADHD among school-age youth. This population-based longitudinal research study will also help CDC address the imminent public health concerns around ADHD diagnosis and treatment and better understand and promote the health status of youth with ADHD.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Section 301 of Public Health Service Act - Research and Investigations
   US Code: 42 USC 201 Name of Law: Children's Health Act of 2000
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 28867	05/18/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 16789	04/05/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 34

table that charts list of burden

IC Title	Form No.	Form Name
Attachment B3. ADHD Communication and Knowledge Scan (Parent)	None	ADHD Attachment B3 Parent Communication and Knowledge
Attachment B4a. ADHD Treatment, Cost, and Client Satisfaction Questionnaire (Parent)	None	ADHD Treatment, Cost, and Client Satisfaction Questionnaire
Attachment B4b. ADHD Treatment Quarterly Update (Parent)	None	ADHD Treatment Quarterly Update Scan
Attachment B5. Brief Impairment Scale (Parent)	None	Brief Impairment Scale
Attachment B6. Critical School Events (elementary, middle) (Parent)	None	Critical School Events (elementary, middle)
Attachment B7. Critical School Events (high school) (Parent)	None	Critical School Events (high school) (Parent)
Attachment B8. Demographic Survey (Parent)	None	Demographic Survey
Attachment B9. Health Risk Behavior Survey (elementary) (Parent)	None	Health Risk Behavior Survey (elementary)
Attachment B10. Health Risk Behavior Survey (middle school) (Parent)	None	Health Risk Behavior Survey (middle school)
Attachment B11. Health Risk Behavior Survey (high school) (Parent)	None	Health Risk Behavior Survey (high school)
Attachment B12. Parent-Child Relationship Inventory (Parent)	None	Parent-Child Relationship Inventory
Attachment B13. Parents' Questionnaire (Mental Health History) (Parent)	None	Parents' Questionnaire (Mental Health History) (Parent)
Attachment B14. Pediatric Quality of Life (young child) (Parent)	None	Pediatric Quality of Life (young child) (Parent)
Attachment B21. Vanderbilt Parent Rating Scale (Parent)	None	Vanderbilt Parent Rating Scale
Attachment B22. Brief Sensation Seeking Scale (11+ years) (Child)	None	Brief Sensation Seeking Scale (+11 years) (Child)
Attachment B23. Health Risk Behavior Survey (elementary) (Child)	None	Health Risk Behavior Survey (elementary) (Child)
Attachment B24. Health Risk Behavior Survey (middle school) (Child)	None	Health Risk Behavior Survey (middle school)
Attachment B25. Health Risk Behavior Survey (high school) (Child)	None	Health Risk Behavior Survey (high school)
Attachment B26. MARSH Self Description Questionnaire (7-12 years) (Child)	None	MARSH Self Description Questionnaire (7-12 years) (Child)
Attachment B27. MARSH Self Description Questionnaire (13-15 years) (Child)	None	MARSH Self Description Questionnaire (13-15 years)
Attachment B28. MARSH Self Description Questionnaire (16+ years) (Child)	None	MARSH Self Description Questionnaire (16+ years) (Child)
Attachment B29. Pediatric Quality of Life (young child) (Child)	None	Pediatric Quality of Life (young child)
Attachment B15. Pediatric Quality of Life (child) (Parent)	None	Pediatric Quality of Life (child) (Parent)
Attachment B16. Pediatric Quality of Life (teen) (Parent)	None	Pediatric Quality of Life (teen)
Attachment B17. Quarterly Update Events and Demographics (Parent)	None	Quarterly Update Events and Demographics (Parent)
Attachment B18. Social Isolation/Support (Parent)	None	Social Isolation/Support
Attachment B19. Strengths and Difficulties Questionnaire (4-10) (Parent)	None	Strengths and Difficulties Questionnaire (4-10)
Attachment B20. Strengths and Difficulties Questionnaire (11-17) (Parent)	None	Strengths and Difficulties Questionnaire (11-17)
Attachment B30. Pediatric Quality of Life (child) (Child)	None	Pediatric Quality of Life (Child)
Attachment B31. Pediatric Quality of Life (teen) (Child)	None	Pediatric Quality of Life (teen)
Attachment B32. People In My Life (Child)	None	People In My Life
Attachment B33. People In My Life/Inventory of Parent and Peer Attachment	None	People In My Life/Inventory of Parent and Peer Attachment
Attachment B34. Youth Demographic Survey (16+ years) (Child)	None	Youth Demographic Survey (16+ years)
Attachment B35. Teachery Survery (Teacher)	None	Teacher Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	29,943	0	0	29,943	0	0
Annual Time Burden (Hours)	3,993	0	0	3,993	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $766,451

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/25/2007

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