Attachment B36-8 DISC TIC

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

START NEW CARD
DUP COL 1 - 10

TIC
1.

9, 99=DON’T KNOW

MOD.

Now I would like to ask you about muscle jerks or twitches, called tics, which
people sometimes make. I’m talking about movements that a person can’t keep
from doing, like …

B

3

[11 - 12]

CARD NO. 0

1
b

[13 - 14]
[15]

blinking their eyes like this [DEMONSTRATE UNILATERAL EYE BLINK] …
or making other movements of the face like this [DEMONSTRATE MOUTH
TWITCH] …
or shrugging their shoulders [DEMONSTRATE] …
or jerking their heads …
or suddenly moving their arms or twisting their bodies.
In the last year – that is, since [[NAME EVENT]/[NAME CURRENT
MONTH] of last year] – has ________ had any tics or movements that it
seemed like [he/she] had to make?

0

2

7

9

[16]

IF YES, A. Please tell me about this. Can you show me the kind of movements
[he/she] made? (DESCRIBE:)
|____ ____|

NOTE 1:

WAS MORE THAN ONE TIC
DESCRIBED IN Q 1A?
IF YES:
IF NO:

0

2

0

2

[17-18]

[19]

GO TO D
CONTINUE

B. Has [he/she] had any other tics or movements?

7

9

[20]

IF YES, C. Can you show me those other tics or movements?
(DESCRIBE:)
|____ ____|

D. Was there ever a time in the last year when [he/she] had these tics
or movements many times a day?

[21-22]

0

2

7

9

[23]

E. In the last year, when [he/she] has had these tics or movements, have
they happened almost every day?

0

2*

7

9

[24]

F. Has [he/she] had these tics or movements for more than a year?

0

[2]

7

9

[25]

0

[2]

7

9

[26]

IF NO, GO TO Q 2

IF NO, G. In the last year, has [he/she] had these tics or movements for four weeks or longer?
Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 37

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

9, 99=DON’T KNOW

H. During the last year, was there a time [he/she] didn’t have these tics
or movements for three months in a row or longer?

0

2

7

9

[27]

IF NO, I. During the last year, has [he/she] gone as long as two
months without these tics or movements?

0

2

7

9

[28]

0

2

7

9

[29]

0

2

7

9

[30]

J. 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 these tics or movements?
2.

8, 88=NOT APPLICABLE

I have just been asking you about whether [he/she] has had sudden movements that
[he/she] couldn’t stop [himself/herself] from making.
Sometimes people feel they can’t stop themselves from making sounds or noises
in the same way. I don’t mean burping or sneezing or coughing. They suddenly feel
they have to make a noise or say a word … they don’t want to make these noises,
but they can’t stop themselves.
In the last year – that is, since [[NAME EVENT]/[NAME CURRENT MONTH]
of last year] – has [he/she] often made noises or sounds or words in that way?
IF YES, A. Please tell me about this. What [noises/words] did [he/she]
[make/say]? (DESCRIBE:)
|____ ____|

[31-32]

0

2

7

9

[33]

C. In the last year, when [he/she] made these noises or said these words
did [he/she] do this almost every day?

0

2*

7

9

[34]

D. Has [he/she] been making these noises or saying these words for more
than a year?

0

[2]

7

9

[35]

IF NO, E. In the last year, has [he/she] made these noises or said
these words for four weeks or longer?

0

[2]

7

9

[36]

F. During the last year, has [he/she] ever gone without making these
noises or saying these words for three months in a row or longer ?

0

2

7

9

[37]

IF NO, G. During the last year, has [he/she] gone as long as two
months without making these noises or saying these
words?

0

2

7

9

[38]

H. 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 these noises or said these
words?

0

2

7

9

[39]

B. Was there ever a time in the last year when [he/she] made these noises
or said these words many times a day?
IF NO, GO TO INSTRUCTION BOX “a”

a:

IF A * OR [ ] RESPONSE WAS CODED IN Q 1 - 2 CONTINUE
ALL OTHERS, GO TO Q 13, P. 43

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 38

[5/20/98]

0=NO

3.

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

You said that in the last year [he/she] [had tics or movements [he/she] seemed to
have to make/made noises or said words [he/she] didn’t want to ].
How old was [he/she] the first time [he/she] did [this/any of these things]?
CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->
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.)
b:

|____ ____| YRS.

[40-41]

|____ ____| GRADE

[42-43]

IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT
[AGE/GRADE], GO TO Q 4
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

[44]

0

2

7

9

[45]

0

2

7

9

[46]

IF NO, GO TO Q 4
B. Since that first time, was there ever a time when [he/she] did not
[have tics or movements [he/she] seemed to have to make/make
these noises or say these words [he/she] didn’t want to]?
IF NO, GO TO Q 4
C. Did that time when [he/she] didn’t [have these tics or movements
[he/she] seemed to have to make/make these noises or say these
words [he/she] didn’t want to] last for two months or more?
IF NO, GO TO Q 4
D. You said that [he/she] [had tics or movements [he/she] seemed to
have to make/made noises or said words [he/she] didn’t want to]
in the last year.
How old was [he/she] when [having tics or movements [he/she]
seemed to have to make/making noises or saying words [he/she]
didn’t want to] began this time?
CODE AGE (88 = NEVER STARTED AGAIN) ---------------->

|____ ____| YRS.

[47-48]

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

[49-50]

c:

IF [AGE/GRADE] GIVEN WAS CHILD’S
CURRENT [AGE/GRADE] MINUS ONE, GO TO E
ALL OTHERS, GO TO Q 4

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 39

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

E. Did [he/she] start to [have these tics or movements [he/she] seemed
to have to make/make these noises or say these words [he/she] didn’t
want to] again more than a year ago – that is, before [[NAME
EVENT]/[NAME CURRENT MONTH] of last year]?
4.

8, 88=NOT APPLICABLE

0

9, 99=DON’T KNOW

2

7

9

[51]

2

7

9

[52]

You said that in the last year ________ [had tics or movements [he/she] seemed to
have to make/made noises or said words [he/she] didn’t want to].
Now I’d like you to think back to the time in the last year when [having these tics
or movements/making these noises or saying these words] caused the most
problems.
At that time, did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]]
get annoyed or upset with ________ because [he/she] was [having these tics or
movements/making these noises or saying these words]?

0

1

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 .....................................................................................
5.

At that time, did [having these tics or movements/making these noises or saying
these words] keep ________ from doing things or going places with [you or [his/
her] family/[his/her] family]?

3
2
1
7
9
0

[53]

1

2

7

9

[54]

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 .....................................................................................
6.

At that time, did [having these tics or movements/making these noises or saying
these words] keep [him/her] from doing things or going places with other [children/
people [his/her] age]?

3
2
1
7
9
0

[55]

1

2

7

9

[56]

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 .....................................................................................

d:

3
2
1
7
9

[57]

IF CHILD DID NOT ATTEND SCHOOL OR WORK IN LAST
YEAR, CODE “8” IN Q 7 AND Q 8, THEN GO TO Q 9

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 40

[5/20/98]

0=NO

7.

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

When the problems were worst, did [having these tics or movements/making these
noises or saying these words][make it difficult for ________ to do [his/her]
schoolwork or cause problems with [his/her] grades/make it difficult for ________
to do [his/her] work]?

8, 88=NOT APPLICABLE

0

1

2

7

9, 99=DON’T KNOW

8

9

[58]

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 .....................................................................................
8.

At that time, did [having these tics or movements/making these noises or saying
these words] cause __________’s [teachers/boss] to be annoyed or upset with [him/
her]?

3
2
1
7
9
0

[59]

1

2

7

8

9

[60]

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 .....................................................................................
9.

When the problems were worst, did it seem like [having these tics or movements/
making these noises or saying these words] made [him/her] feel bad or made [him/
her] feel upset?

3
2
1
7
9
0

[61]

1

2

7

9

[62]

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 ......................................................................................
Refuse to answer .............................................................................
Don’t know .....................................................................................
10. In the last year – that is, since [[NAME EVENT]/[NAME CURRENT MONTH]
of last year] – has ________ been to see someone at a hospital or a clinic or at their
office because [he/she] [had tics or movements/made these noises or said these
words]?

3
2
1
7
9

[63]

0

2

7

9

[64]

0

2

7

9

[65]

IF YES, GO TO OPTIONAL DETAILS, NEXT PAGE
IF NO, A. Does [he/she] have an appointment set up to see someone because of
this?
IF YES, GO TO OPTIONAL DETAILS, NEXT PAGE

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 41

[5/20/98]

0=NO

1=SOMETIMES/SOMEWHAT

2=YES

7, 77=REFUSE TO ANSWER

8, 88=NOT APPLICABLE

9, 99=DON’T KNOW

OPTIONAL DETAILS:
11.

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

|____ ____|

[66-67]

|____ ____|

[68-69]

Profession:
Address:

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

12. In the last year – that is, since [[NAME EVENT]/[NAME CURRENT MONTH]
of last year] – has [he/she] taken any medicine for tics or Tourette’s syndrome?

0

2

7

9

[70]

IF YES, A. What is the name of the medicine?
(LIST ALL MEDICATIONS:)
|____ ____|

e:

[71-72]

If ANY [ ] RESPONSES WERE CODED IN Q 1 - 2
(see tally sheet), GO TO PICA, P. 45
ALL OTHERS, CONTINUE

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

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 42

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

Whole Life Screen
13. Now I want you to think about [his/her] whole life, back to when [he/she] turned
five years old (INTERVIEWER: point out age five on whole life chart).
Was there ever a time when [he/she] did the things I just asked you about … things
like having tics or jerky movements that [he/she] couldn’t keep from doing … or
making certain noises that [he/she] didn’t want to make … or saying words that [he/
she] didn’t really want to say?

0

2

7

9

[16]

IF YES, A. I want to ask you some questions about that time. Can you remember
what [he/she] did? Can you show me now? (DESCRIBE):
|____ ____|

[17-18]

B. Did [he/she] make these tics or movements or noises several times a
day, most days?

0

2

7

9

[19]

IF YES, C. Did [he/she] make these tics or movements or noises
for four weeks or longer?

0

2

7

9

[20]

IF YES, D. Did making these tics or movements or
noises cause any serious problems for
[him/her] at home, at school, or with [his/
her] friends?

0

2

7

9

[21]

E. Did making these tics or movements or
noises seem to make [him/her] really
unhappy or bother [him/her] a lot?

0

2

7

9

[22]

F. Did [he/she] ever see a doctor, counselor,
or some other person like that because
[he/she] made these tics or movements or
noises?

0

2

7

9

[23]

G. How old was [he/she] when [he/she] first
started to make these tics or movements
or noises?
CODE AGE ----------------------------->

|____ ____| YRS.

[24-25]

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

[26-27]

CODE AGE ----------------------------->

|____ ____| 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]

H. When [he/she] stopped doing this, how
old was [he/she] then?

Module B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 43

[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 B: Miscellaneous Disorders
Tic Disorders
DISC IV-P, past year

Page 44

[5/20/98]