Attachment B36-2 DISC ADHD

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

START NEW CARD
DUP COL 1 - 10
MOD.

E

1

[11 - 12]

CARD NO. 0

1
b

[13 - 14]
[15]

ADHD
(INATTN)
Everybody has times when they have trouble concentrating or keeping their mind on
what they are doing. What we want to know is whether ________ has had difficulty
concentrating or keeping [his/her] mind on what [he/she] is doing most of the time.
1.

2.

In the last year – that is, since [[NAME EVENT]/[NAME CURRENT MONTH]
of last year] – did [he/she] often have trouble keeping [his/her] mind on what [he/
she] was doing for more than a short time?

0

2

7

9

[16]

IF YES, A. Did [he/she] have this trouble keeping [his/her] mind on things for six
months or longer?

0

[2]

7

9

[17]

IF YES, B. When [he/she] was at home, did [he/she] often have
trouble keeping [his/her] mind on things?

0

2

7

9

[18]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[19]

D. Now, what about the last four weeks?
Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]], has [he/she] often had
trouble keeping [his/her] mind on what [he/she] was
doing?

0

2

7

9

[20]

In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often try not to do things where [he/she] would have needed to pay
attention for a long time?

0

2

7

9

[21]

IF YES, A. Did [he/she] try not to do things like this for six months or longer?

0

2*

7

9

[22]

IF YES, B. When [he/she] was at home, did [he/she] often try to get
out of doing things where [he/she] had to pay attention
for a long time?

0

2

7

9

[23]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[24]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often tried
not to do things where [he/she] needed to pay attention
for a long time?

0

2

7

9

[25]

IF YES, GO TO NOTE 1

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 1

[5/20/98]

0=NO

3.

1=SOMETIMES/SOMEWHAT

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often dislike doing things where [he/she] had to pay attention for a long
time?

0

2

7

9

[26]

IF YES, A. Did [he/she] dislike doing things where [he/she] had to pay attention like
this for six months or longer?

0

2*

7

9

[27]

IF YES, B. When [he/she] was at home, did [he/she] often dislike
doing things where [he/she] needed to pay attention for
a long time?

0

2

7

9

[28]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[29]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] disliked
doing things where [he/she] needed to pay attention for
a long time?

0

2

7

9

[30]

0

[2]

In the last year (that is, since [NAME CURRENT MONTH] of last year), did
________ often find it hard to keep [his/her] mind on what [he/she] was doing when
other things were going on?

0

2

7

9

[32]

IF YES, A. Was [he/she] like this for six months or longer?

0

[2]

7

9

[33]

IF YES, B. When [he/she] was at home, did [he/she] often find it
hard to keep [his/her] mind on what [he/she] was doing
when other things were going on?

0

2

7

9

[34]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[35]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
found it hard to keep [his/her] mind on what [he/she]
has been doing when other things were going on?

0

2

7

9

[36]

NOTE 1:

4.

2=YES

WERE ANY * RESPONSES CODED IN Q 2 OR Q 3?

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 2

[31]

[5/20/98]

0=NO

5.

6.

7.

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

Some people are very disorganized. They can’t remember where they put their
clothes or their books or their projects. They try to do too many things at the same
time so they’re often late, or they don’t go where they’re supposed to go or they
never have time to do things properly.
In the last year (that is, since [NAME CURRENT MONTH] of last year), was
[he/she] disorganized?

0

2

7

9

[37]

IF YES, A. Was [he/she] disorganized like this for six months or longer?

0

[2]

7

9

[38]

IF YES, B. When [he/she] was at home, was [he/she] often very
disorganized?

0

2

7

9

[39]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[40]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] been
disorganized?

0

2

7

9

[41]

In the last year – that is, since [NAME CURRENT MONTH] of last year – did
[he/she] often have trouble finishing ([his/her] homework or other) things [he/she]
was supposed to do?

0

2

7

9

[42]

IF YES, A. Did [he/she] have this trouble finishing things for six months or
longer?

0

[2]

7

9

[43]

IF YES, B. When [he/she] was at home, did [he/she] often have
trouble finishing ([his/her] homework or other) things
[he/she] was supposed to do?

0

2

7

9

[44]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[45]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] had
trouble finishing ([his/her] homework or other) things
[he/she] was supposed to do?

0

2

7

9

[46]

In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often lose (things like assignments or books or other) things [he/she]
needed?

0

2

7

9

[47]

IF YES, A. Did this problem with losing things go on for six months or longer?

0

[2]

7

9

[48]

IF YES, B. When [he/she] was at home, did [he/she] often lose
things [he/she] needed?

0

2

7

9

[49]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[50]

D. Now, what about the last four weeks?
Since [[NAME EVENT]//the beginning of/the middle of /
the end of [LAST MONTH]], has [he/she] often lost
things?

0

2

7

9

[51]

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 3

[5/20/98]

0=NO

8.

9.

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

In the last year (that is, since [NAME CURRENT MONTH] of last year), did
________ often forget what [he/she] was supposed to be doing or what [he/she] had
planned to do?

0

2

7

9

[52]

IF YES, A. Was [he/she] forgetful like this for six months or longer?

0

[2]

7

9

[53]

IF YES, B. When [he/she] was at home, did [he/she] often forget
what [he/she] was supposed to be doing or what [he/
she] had planned to do?

0

2

7

9

[54]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[55]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
forgotten what [he/she] was supposed to be doing or
what [he/she] had planned to do?

0

2

7

9

[56]

In the last year (that is, since [NAME CURRENT MONTH] of last year), has
[he/she] often made a lot of mistakes because it’s hard for [him/her] to do things
carefully?

0

2

7

9

[57]

IF YES, A. Did [he/she] make careless mistakes like this for six months or
longer?

0

[2]

7

9

[58]

IF YES, B. When [he/she] was at home, did [he/she] often make a
lot of careless mistakes?

0

2

7

9

[59]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[60]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] made a lot
of careless mistakes?

0

2

7

9

[61]

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 4

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

10. In the last year – that is, since [NAME CURRENT MONTH] of last year – did
[he/she] often not listen when people were speaking to [him/her]?

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

0

2

7

9

[62]

0

[2]

7

9

[63]

IF YES, B. When [he/she] was at home, did [he/she] often not
listen when people spoke to [him/her]?

0

2

7

9

[64]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[65]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often not
listened when people were speaking to [him/her]?

0

2

7

9

[66]

E. Did [he/she] not listen because [he/she] had difficulty
hearing?

0

2

7

9

[67]

IF YES, A. Did this problem with not listening to people go on for six months
or longer?

IF YES, F. What kind of hearing problem did [he/
she] have? (DESCRIBE:)
|____ ____|

G. Has this hearing problem been diagnosed
by a doctor?

[68-69]

0

2

7

9

[70]

Has ________ been like that? In the last year (that is, since [NAME CURRENT
MONTH] of last year), did [he/she] often not finish things because [he/she] started
to do something else?

0

2

7

9

[71]

IF YES, A. Did this problem with not finishing things go on for six months or
longer?

0

2

7

9

[72]

IF YES, B. When [he/she] was at home, did [he/she] often not
finish things because [he/she] started to do something
else?

0

2

7

9

[73]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[74]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often not
finished things?

0

2

7

9

[75]

11. Some people are always starting things without finishing them. They start a game
or project or activity, but after a few minutes they think of something else, and they
start doing that other thing instead.

a:

IF 3 OR MORE [ ] RESPONSES WERE CODED IN Q 1 - 10 AND
NOTE 1 (see tally sheet), CONTINUE

CARD NO. 0

ALL OTHERS, GO TO Q 22, P. 10
Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

START NEW CARD
DUP COL 1 - 12

Page 5

2
b

[13 - 14]
[15]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

12. You said that in the last year [he/she] [NAME [ ] SYMPTOMS IN Q 1 - 10 AND NOTE 1].
How old was [he/she] the first time [he/she] started to have trouble paying attention
or concentrating?
CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->

|____ ____| YRS.

[16-17]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE, 15 = JUNIOR,
16 = SENIOR, 17 = POST B.A.) ----------------------------------------------------->

|____ ____| GRADE

[18-19]

b:

IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT
[AGE/GRADE], GO TO INSTRUCTION BOX “d”
IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT
[AGE/GRADE] MINUS ONE, GO TO A
ALL OTHERS, GO TO B
A. Was that more than a year ago – that is, before [[NAME EVENT]/
[NAME CURRENT MONTH] of last year]?

0

2

7

9

[20]

0

2

7

9

[21]

0

2

7

9

[22]

IF NO, GO TO INSTRUCTION BOX “d”
B. Since that first time, was there ever a time when [he/she] did not have
trouble with paying attention or concentrating?
IF NO, GO TO Q 13
C. Did that time when [he/she] didn’t have trouble with paying attention
or concentrating last for six months or more?
IF NO, GO TO Q 13
D. You said that [he/she] [NAME [ ] SYMPTOMS IN Q 1 - 10 AND
NOTE 1] in the last year.
How old was [he/she] when having trouble paying attention or
concentrating started this time?
CODE AGE (88 = NEVER STARTED AGAIN) ---------------->

|____ ____| YRS.

[23-24]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE,
15 = JUNIOR, 16 = SENIOR, 17 = POST B.A.,
88 = NEVER STARTED AGAIN) ---------------------------------->

|____ ____| GRADE

[25-26]

c:

IF [AGE/GRADE] GIVEN WAS CHILD’S
CURRENT [AGE/GRADE] MINUS ONE, GO TO E
ALL OTHERS, GO TO Q 13

E. Did [he/she] start having trouble with paying attention or concentrating again more than a year ago – that is, before [[NAME EVENT]/
[NAME CURRENT MONTH] of last year]?
Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 6

0

2

7

9

[27]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

13. How old was [he/she] when trouble paying attention or concentrating started to
cause problems for [him/her]?
CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->

|____ ____| YRS.

[28-29]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE, 15 = JUNIOR,
16 = SENIOR, 17 = POST B.A.) ----------------------------------------------------->

|____ ____| GRADE

[30-31]

d:

IF CHILD DID NOT ATTEND KINDERGARTEN OR FIRST
GRADE, CODE “8” IN Q 14, THEN GO TO Q 15

14. Did [he/she] have problems in first grade or kindergarten because [he/she] had
trouble paying attention or concentrating?

0

1

2

7

0

1

2

7

8

9

[32]

9

[33]

15. You said that in the last year ________ [NAME SYMPTOMS IN Q 1 - 10 AND
NOTE 1].
Now I’d like you to think back to the time in the last year when [his/her] having
trouble paying attention or concentrating like this caused the most problems.
At that time, did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]]
get annoyed or upset with [him/her] because [he/she] was having trouble paying
attention or concentrating?
IF YES, A. How often did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]] get annoyed or upset with [him/her] because of this?
Would you say: a lot of the time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
16. At that time, did __________’s trouble with paying attention or concentrating keep
[him/her] from doing things or going places with [you (or [his/her] family)/[his/her]
family]?

3
2
1
7
9
0

[34]

1

2

7

9

[35]

IF YES, A. How often did this keep [him/her] from doing things or going places
with [you (or [his/her] family)/[his/her] family]? Would you say: a lot
of the time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 7

3
2
1
7
9

[36]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

17. At that time, did [his/her] trouble with paying attention or concentrating keep [him/
her] from doing things or going places with other [children/people [his/her] age]?

8, 88=NOT APPLICABLE

0

1

2

9, 99=DON’T KNOW

7

9

[37]

IF YES, A. How often did this keep [him/her] from doing things or going places
with other [children/people [his/her] age]? Would you say: a lot of the
time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................

e:

3
2
1
7
9

[38]

IF CHILD DID NOT ATTEND SCHOOL OR WORK IN LAST
YEAR, CODE “8” IN Q 18 AND Q 19, THEN GO TO Q 20

18. When the problems were worst, did having trouble paying attention or concentrating [make it difficult for [him/her] to do [his/her] schoolwork or cause problems
with [his/her] grades/make it difficult for [him/her] to do [his/her] work]?

0

1

2

7

8

9

[39]

IF YES, A. How bad were the problems [he/she] had with [his/her] [schoolwork/
work] because of this? Would you say: very bad, bad, or not too bad?
Very bad ..........................................................................................
Bad ..................................................................................................
Not too bad ......................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
19. At that time, did having trouble paying attention or concentrating cause __________’s
[teachers/boss] to be annoyed or upset with [him/her]?

3
2
1
7
9
0

[40]

1

2

7

8

9

[41]

IF YES, A. How often [were/was] [his/her] [teachers/boss] annoyed or upset
with [him/her] because of this? Would you say: a lot of the time, some
of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 8

3
2
1
7
9

[42]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

20. When the problems were worst, did it seem like having trouble paying attention or
concentrating made [him/her] feel bad or made [him/her] feel upset?

8, 88=NOT APPLICABLE

0

1

2

7

9, 99=DON’T KNOW

9

[43]

IF YES, A. How bad did this seem to make [him/her] feel? Would you say: very
bad, bad, or not too bad?
Very bad ..........................................................................................
Bad ..................................................................................................
Not too bad ......................................................................................
Refused to answer ...........................................................................
Don’t know .....................................................................................

f:

3
2
1
7
9

[44]

IF CHILD IS AGE 7 OR OLDER, CONTINUE
ALL OTHERS, GO TO Q 22

Whole Life Screen
21. You said that in the last year [he/she] [NAME SYMPTOMS IN Q 1 - 10 AND
NOTE 1].
Now I want you to think back to before the last year … since the time [he/she] turned
five years old up until the last twelve months.
(INTERVIEWER: point out age five on whole life chart.)
Since [he/she] turned five years old, was there ever a time when [he/she] had more
trouble paying attention or concentrating than [he/she] has in the last year?

0

2

7

9

[45]

IF YES, A. How old was [he/she] when it was worst?
(INTERVIEWER: IF MORE THAN ONE YEAR IS REPORTED,
ASK: “During which single year of age was [he/she] the worst?” IF
MORE THAN ONE YEAR STILL REPORTED, ENTER YOUNGEST
AGE.)
CODE AGE -------------------------------------------------------------->

|____ ____|

[46-47]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE,
15 = JUNIOR, 16 = SENIOR, 17 = POST B.A.) ------------------>

|____ ____|

[48-49]

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 9

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

(HY-IMP)
22. I would now like to ask you some questions about being overactive or hyperactive.
Everybody has times when they are very active. What we want to know is whether
________ is overactive most of the time.
In the last year – that is, since [NAME CURRENT MONTH] of last year – was
[he/she] often “on the go” or did [he/she] move around as if [he/she] was “driven
by a motor”?

0

2

7

9

[50]

IF YES, A. Did [he/she] move around this much for six months or longer?

0

[2]

7

9

[51]

IF YES, B. When [he/she] was at home, was [he/she] often “on the
go” or did [he/she] move around as if [he/she] was
“driven by a motor”?

0

2

7

9

[52]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[53]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] moved
around a lot?

0

2

7

9

[54]

23. In the last year (that is, since [NAME CURRENT MONTH] of last year), was
[he/she] often fidgety or restless? That is, fiddling with [his/her] hands or jiggling
[his/her] feet or twisting around in [his/her] seat?

0

2

7

9

[55]

0

[2]

7

9

[56]

IF YES, B. When [he/she] was at home, was [he/she] often fidgety
or restless?

0

2

7

9

[57]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[58]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
been fidgety or restless?

0

2

7

9

[59]

In the last year (that is, since [NAME CURRENT MONTH] of last year), has
[he/she] often left [his/her] seat when [he/she] wasn’t supposed to?

0

2

7

9

[60]

IF YES, A. Did this trouble with staying in [his/her] seat go on for six months or
longer?

0

[2]

7

9

[61]

IF YES, B. When [he/she] was at home, did [he/she] often leave
[his/her] seat when [he/she] wasn’t supposed to?

0

2

7

9

[62]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[63]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often left
[his/her] seat when [he/she] wasn’t supposed to?

0

2

7

9

[64]

IF YES, A. Was [he/she] fidgety or restless like this for six months or longer?

24. Sometimes people are supposed to stay in their seats, like at school or when they
go somewhere like to the movies or to a library or to a restaurant.

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Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 10

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

25. In the last year (that is, since [NAME CURRENT MONTH] of last year), did [he/
she] often climb on things or run around when [he/she] wasn’t supposed to?

0

2

7

9

[65]

IF YES, A. Did this problem of climbing or running around too much go on for
six months or longer?

0

2*

7

9

[66]

IF YES, B. When [he/she] was at home, did [he/she] often climb on
things or run around when [he/she] wasn’t supposed to?

0

2

7

9

[67]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[68]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
climbed on things or run around when [he/she] wasn’t
supposed to?

0

2

7

9

[69]

0

2

7

9

[70]

0

2*

7

9

[71]

IF YES, B. When [he/she] was at home, did [he/she] often seem
restless when [he/she] had to sit still?

0

2

7

9

[72]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[73]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
seemed restless when [he/she] had to sit still?

0

2

7

9

[74]

IF YES, GO TO NOTE 2
26. In the last year (that is, since [NAME CURRENT MONTH] of last year), when
________ had to sit still, for say more than ten minutes, did [he/she] nearly always
seem restless, as if [he/she] wanted to kick [his/her] feet or get up and move around?
IF YES, A. Did this problem of being restless go on for six months or longer?

START NEW CARD
DUP COL 1 - 12
CARD NO. 0

NOTE 2:

WERE ANY * RESPONSES CODED IN Q 25 - 26?

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 11

0

[2]

3
b

[13 - 14]
[15]

[16]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

27. In the last year – that is, since [NAME CURRENT MONTH] of last year – did
[he/she] often talk a lot more than other [children/people [his/her] age]?

0

2

7

9

[17]

IF YES, A. Did this trouble with talking too much go on for six months or longer?

0

[2]

7

9

[18]

IF YES, B. When [he/she] was at home, did [he/she] often talk too
much?

0

2

7

9

[19]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[20]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
talked a lot more than other [children/people [his/her]
age]?

0

2

7

9

[21]

28. In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often make much more noise than other [children/people [his/her] age]
when [he/she] was [playing/having fun]?

0

2

7

9

[22]

IF YES, A. Did [he/she] often make a lot of noise when [he/she] was [playing/
having fun] for six months or longer?

0

[2]

7

9

[23]

IF YES, B. When [he/she] was at home, did [he/she] often make
much more noise than other [children/people [his/her]
age]?

0

2

7

9

[24]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[25]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
made much more noise than other [children/people
[his/her] age]?

0

2

7

9

[26]

29. In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often interrupt other people when they were talking or when they were
busy?

0

2

7

9

[27]

IF YES, A. Did [he/she] interrupt people often for six months or longer?

0

2*

7

9

[28]

IF YES, B. When [he/she] was at home, did [he/she] often interrupt
other people?

0

2

7

9

[29]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[30]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
interrupted other people?

0

2

7

9

[31]

IF YES, GO TO NOTE 3

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 12

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

30. In the last year (that is, since [NAME CURRENT MONTH] of last year), did
________ often butt in on what other people were doing?

0

2

7

9

[32]

IF YES, A. Did [he/she] often butt in on what other people were doing for six
months or longer?

0

2*

7

9

[33]

IF YES, B. When [he/she] was at home, did [he/she] often butt in
on what other people were doing?

0

2

7

9

[34]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[35]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
butted in on what other people were doing?

0

2

7

9

[36]

0

[2]

31. In the last year – that is, since [NAME CURRENT MONTH] of last year – did [he/
she] often blurt out answers before someone could finish asking the question?

0

2

7

9

[38]

IF YES, A. Did [he/she] often blurt out answers like this for six months or longer?

0

[2]

7

9

[39]

IF YES, B. When [he/she] was at home, did [he/she] often blurt out
answers before someone could finish their question?

0

2

7

9

[40]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[41]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
blurted out answers before someone could finish their
question?

0

2

7

9

[42]

32. In the last year (that is, since [NAME CURRENT MONTH] of last year), has [he/
she] often had trouble waiting for [his/her] turn, like when [he/she] was standing
in line … or playing a game?

0

2

7

9

[43]

IF YES, A. Did this trouble with waiting for [his/her] turn go on for six months
or longer?

0

[2]

7

9

[44]

IF YES, B. When [he/she] was at home, did [he/she] have trouble
waiting for [his/her] turn?

0

2

7

9

[45]

C. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[46]

D. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often had
trouble waiting for [his/her] turn?

0

2

7

9

[47]

NOTE 3:

WAS A * RESPONSE CODED IN Q 29 OR Q 30?

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 13

[37]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

33. In the last year (that is, since [NAME CURRENT MONTH] of last year), did
[he/she] often get [himself/herself] into a dangerous situation where [he/she] could
have been injured because [he/she] wasn’t thinking?

8, 88=NOT APPLICABLE

0

2

7

9, 99=DON’T KNOW

9

[48]

IF YES, A. Please tell me about this. (DESCRIBE:)
|____ ____|

[49-50]

B. Was this something [he/she] did suddenly, without thinking about it
first?

0

2

7

9

[51]

C. Did [he/she] do dangerous things like this for six months or longer?

0

2

7

9

[52]

IF YES, D. When [he/she] was at home, did [he/she] often get
[himself/herself] into a dangerous situation because
[he/she] wasn’t thinking?

0

2

7

9

[53]

E. How about when [he/she] was (at [school/work] or)
other places?

0

2

7

9

[54]

F. Now, what about the last four weeks?
Since [[NAME EVENT]//the beginning/the middle of/
the end of [LAST MONTH]], has [he/she] gotten
[himself/herself] into a dangerous situation because
[he/she] wasn’t thinking?

0

2

7

9

[55]

IF NO, GO TO INSTRUCTION BOX “g”

g:

IF 3 OR MORE [ ] RESPONSES WERE CODED IN Q 22 - 32
AND NOTES 2 - 3 (see tally sheet), CONTINUE
ALL OTHERS, GO TO Q 44, P. 18

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 14

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

34. You said that in the last year [he/she] [NAME [ ] SYMPTOMS IN Q 22 - 32 AND
NOTES 2 - 3].
How old was [he/she] the first time [he/she] started to be overactive?
CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->

|____ ____| YRS.

[56-57]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE, 15 = JUNIOR,
16 = SENIOR, 17 = POST B.A.) ----------------------------------------------------->

|____ ____| GRADE

[58-59]

h:

IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT
[AGE/GRADE], GO TO INSTRUCTION BOX “j”
IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT
[AGE/GRADE] MINUS ONE, GO TO A
ALL OTHERS, GO TO B

A. Was that more than a year ago – that is, before [[NAME EVENT]/
[NAME CURRENT MONTH] of last year]?

0

2

7

9

[60]

0

2

7

9

[61]

0

2

7

9

[62]

IF NO, GO TO INSTRUCTION BOX “j”
B. Since that first time, was there ever a time when [he/she] was not
overactive?
IF NO, GO TO Q 35
C. Did that time when [he/she] wasn’t overactive last for six months or
more?
IF NO, GO TO Q 35
D. You said that [he/she] [NAME [ ] SYMPTOMS IN Q 22 - 32 AND
NOTES 2 - 3] in the last year.
How old was [he/she] when being overactive began this time?
CODE AGE (88 = NEVER STARTED AGAIN) ---------------->

|____ ____| YRS.

[63-64]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE,
15 = JUNIOR, 16 = SENIOR, 17 = POST B.A.,
88 = NEVER STARTED AGAIN) ---------------------------------->

|____ ____| GRADE

[65-66]

i:

IF [AGE/GRADE] GIVEN WAS CHILD’S
CURRENT [AGE/GRADE] MINUS ONE, GO TO E
ALL OTHERS, GO TO Q 35

E. Did [he/she] start being overactive again more than a year ago – that is,
before [[NAME EVENT]/[NAME CURRENT MONTH] of last year]?
Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 15

0

2

7

9

[67]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

35. How old was [he/she] when being overactive started to cause problems for [him/her]?
CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->

|____ ____| YRS.

[68-69]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE, 15 = JUNIOR,
16 = SENIOR, 17 = POST B.A.) ----------------------------------------------------->

|____ ____| GRADE

[70-71]

START NEW CARD
DUP COL 1 - 12
CARD NO. 0
j:

4
b

[13 - 14]
[15]

IF CHILD DID NOT ATTEND KINDERGARTEN OR FIRST
GRADE, CODE “8” IN Q 36, THEN GO TO Q 37

36. Did being overactive cause problems back when [he/she] was in first grade or
kindergarten?

0

1

2

7

0

1

2

7

8

9

[16]

9

[17]

37. You said that in the last year ________ [NAME [ ] SYMPTOMS IN Q 22 - 32 AND
NOTES 2 - 3].
Now I’d like you to think back to the time in the last year when ________’s being
overactive caused the most problems.
At that time, did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]]
get annoyed or upset with [him/her] because [he/she] was overactive?
IF YES, A. How often did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]] get annoyed or upset with [him/her] because [he/she] was
like that? Would you say: a lot of the time, some of the time, or hardly
ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
38. At that time, did being overactive keep ________ from doing things or going places
with [you or [his/her] family/[his/her] family]?

3
2
1
7
9
0

[18]

1

2

7

9

[19]

IF YES, A. How often did being overactive keep [him/her] from doing things or
going places with [you or [his/her] family/[his/her] family]? Would
you say: a lot of the time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 16

3
2
1
7
9

[20]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

39. At that time, did being overactive keep [him/her] from doing things or going places
with other [children/people [his/her] age]?

8, 88=NOT APPLICABLE

0

1

2

9, 99=DON’T KNOW

7

9

[21]

IF YES, A. How often did being overactive keep [him/her] from doing things or
going places with other [children/people [his/her] age]? Would you
say: a lot of the time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................

k:

3
2
1
7
9

[22]

IF CHILD DID NOT ATTEND SCHOOL OR WORK IN LAST
YEAR, CODE “8” IN Q 40 AND Q 41, THEN GO TO Q 42

40. When the problems were worst, did being overactive [make it difficult for [him/her]
to do [his/her] schoolwork or cause problems with [his/her] grades/make it difficult
for [him/her] to do [his/her] work]?

0

1

2

7

8

9

[23]

IF YES, A. How bad were the problems [he/she] had with [his/her] [schoolwork/
work] because [he/she] was like that? Would you say: very bad, bad,
or not too bad?
Very bad ..........................................................................................
Bad ..................................................................................................
Not too bad ......................................................................................
Refused to answer ...........................................................................
Don’t know .....................................................................................
41. At that time, did being overactive cause __________’s [teachers/boss] to be
annoyed or upset with [him/her]?

3
2
1
7
9
0

[24]

1

2

7

8

9

[25]

IF YES, A. How often [were/was] [his/her] [teachers/boss] annoyed or upset
with [him/her] because [he/she] was like that? Would you say: a lot
of the time, some of the time, or hardly ever?
A lot of the time ..............................................................................
Some of the time .............................................................................
Hardly ever .....................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
42. When the problems were worst, did it seem like being overactive made [him/her]
feel bad or made [him/her] feel upset?

3
2
1
7
9
0

[26]

1

2

7

9

[27]

IF YES, A. How bad did being overactive seem to make [him/her] feel? Would
you say: very bad, bad, or not too bad?
Very bad ..........................................................................................
Bad ..................................................................................................
Not too bad ......................................................................................
Refused to answer ...........................................................................
Don’t know .....................................................................................

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 17

3
2
1
7
9

[28]

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

l:

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

IF CHILD IS AGE 7 OR OLDER, CONTINUE
ALL OTHERS, GO TO Q 44

Whole Life Screen
43. You said that in the last year [he/she] [NAME SYMPTOMS IN Q 22 - 32 AND
NOTES 2 - 3].
Now I want you to think back to before the last year … since the time [he/she] turned
five years old up until the last twelve months.
(INTERVIEWER: point out age five on whole life chart.)
Since [he/she] turned five years old, was there ever a time when [he/she] was more
overactive than [he/she] has been in the last year?

0

2

7

9

[29]

IF YES, A. How old was [he/she] when it was worst?
(INTERVIEWER: IF MORE THAN ONE YEAR IS REPORTED,
ASK: “During which single year of age was [he/she] the worst?” IF
MORE THAN ONE YEAR STILL REPORTED, ENTER YOUNGEST
AGE.)
CODE AGE -------------------------------------------------------------->

|____ ____|

[30-31]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?
CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE,
15 = JUNIOR, 16 = SENIOR, 17 = POST B.A.) ------------------>

|____ ____|

[32-33]

44. In the last year, has [he/she] taken any medicine for being overactive, being
hyperactive, or having trouble paying attention?

0

2†

7

9

[34]

IF YES, A. What medicine did [he/she] take?
(RECORD ALL MEDICATIONS:)
|____ ____|

m:

[35-36]

B. Did [he/she] take this medicine most of the time during the last year?

0

2

7

9

[37]

C. Now, what about the last four weeks?
(Since [[NAME EVENT]//the beginning of/the middle of/the end of
[LAST MONTH]]), has [he/she] taken any medicine for being overactive, being hyperactive, or having trouble paying attention?

0

2

7

9

[38]

IF 3 OR MORE [ ] RESPONSES WERE CODED IN Q 1 - 32 AND
NOTES 1 - 3 OR A † RESPONSE WAS CODED IN Q 44 (see tally
sheet), CONTINUE
ALL OTHERS, GO TO ODD, P. 21

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 18

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

45. In the last year – that is, since [NAME CURRENT MONTH] of last year – has [he/
she] been to see someone at a hospital or a clinic or at their office because [he/she]
was overactive, hyperactive, or had problems paying attention?

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

0

2

7

9

[39]

0

2

7

9

[40]

IF YES, GO TO OPTIONAL DETAILS
IF NO, A.

Does [he/she] have an appointment set up to see someone because of
this?
IF YES, GO TO OPTIONAL DETAILS

OPTIONAL DETAILS:
46.

Who [did ________ see/is ________ going to see]? (WRITE IN:)

|____ ____|

[41-42]

|____ ____|

[43-44]

Name:
Profession:
Address:

A. IF SOMEONE WAS SEEN, ASK:
What did the person [he/she] saw say was the matter?

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 19

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

INTENTIONALLY LEFT BLANK

Module E: Disruptive Behavior Disorders
Attention-deficit/Hyperactivity Disorder
DISC IV-P, past year

Page 20

[5/20/98]