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
Teacher Survey	Form and Instruction	Removed	Available
Youth Demographic Survey (16+ years)	Form and Instruction	Removed	Available
People In My Life/Inventory of Parent and Peer Attachment	Form and Instruction	Removed	Available
People In My Life	Form and Instruction	Removed	Available
Pediatric Quality of Life (teen)	Form and Instruction	Removed	Available
Pediatric Quality of Life (Child)	Form and Instruction	Removed	Available
Form 28 ATTACHMENT C29: Teacher Survey	Form and Instruction	Modified	Available
Form 27 ATTACHMENT C28: Youth Demographic Survey (16 plus years)	Form	Modified	Available
Form 26 ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)	Form and Instruction	Modified	Available
Form 25 ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)	Form and Instruction	Modified	Available
Form 24 ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)	Form	Modified	Available
Form 23 ATTACHMENT C24: Social Inventory (High School, 14 plus years)	Form and Instruction	Modified	Available
Form 22 ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years	Form and Instruction	Modified	Available
Form 21 ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years	Form and Instruction	Modified	Available
Form 20 ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years	Form and Instruction	Modified	Available
Form 19 ATTACHMENT C20: Health Risk Behavior Survey (High School)	Form	Modified	Available
Form 18 ATTACHMENT C19: Health Risk Behavior Survey (Middle School)	Form	Modified	Available
Form 17 ATTACHMENT C18: Conflict in Adolescent Dating Relationships	Form	Modified	Available
Form 16 ATTACHMENT C17: Child Brief Sensation Seeking Scale	Form	Modified	Available
Form 15 ATTACHMENT C16: Vanderbilt Rating Scale	Form and Instruction	Modified	Available
Form 14 ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire	Form and Instruction	Modified	Available
Form 13 ATTACHMENT C14: Parent Social Isolation/Support	Form and Instruction	Modified	Available
Form 12 ATTACHMENT C13: Quarterly Update: Critical School Events	Form	Modified	Available
Form 11 ATTACHMENT C12: Parents' Questionnaire (Mental Health)	Form and Instruction	Modified	Available
Form 10 ATTACHMENT C11: Parent Child Relationship Inventory	Form and Instruction	Modified	Available
Form 9 ATTACHMENT C10: Health Risk Behavior Survey (High School)	Form	Modified	Available
Form 8 ATTACHMENT C9: Health Risk Behavior Survey (Middle School)	Form	Modified	Available
Form 7 ATTACHMENT C8: Parent Demographic Survey	Form	Modified	Available
Form 6 ATTACHMENT C7: Parent Critical Events Form (High School)	Form and Instruction	Modified	Available
Critical School Events (elementary, middle)	Form and Instruction	Modified	Available
Form 5 ATTACHMENT C6: Parent Critical Events Form (Middle School)	Form and Instruction	Modified	Available
Form 4 ATTACHMENT C5: Parent Brief Impairment Scale	Form and Instruction	Modified	Available
Form 3 ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update	Form	Modified	Repair queued
Form 2 ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire	Form	Modified	Available
Form 1 ATTACHMENT C3: Parent ADHD Communication and Knowledge	Form and Instruction	Modified	Available
Amended IRB_App_Ltr.pdf	Supplementary Document	Uploaded 2010-05-07	Available
SS.B 20100127.doc	Supporting Statement B	Uploaded 2010-02-05	Available
Attachment List Justification ADHD follow up extension 20100127.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment G SC Triage Protocol Document 3-13-07.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment F2 Age distributions SC.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment F1 sample description.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment E3 CDC reliance agreement.pdf	Supplementary Document	Uploaded 2010-02-05	Available
Attachment E2 SC IRB review.pdf	Supplementary Document	Uploaded 2010-02-05	Available
Attachment E1 CDC 5042 IRB Approval of Continuation of Protocol (Expedited).doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment D3 SC PLAY Youth Consent for Research (18+) 12-02-2009.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment D2 SC PLAY Child Assent for Research (age 9-17) 12-02-2009.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment D1 SC Parent Consent (age 9-17) 12-02-09.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment C30 DISC-IV Table of Contents.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment C2 Instrument descriptions for new or modified surveys.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment C1 Instrument Table.doc	Supplementary Document	Uploaded 2010-02-05	Available
Attachment_B_60_Day_FRN_ADHD.pdf	Supplementary Document	Uploaded 2010-02-05	Available
Attachment A2 Children's Health Act 2000.pdf	Supplementary Document	Uploaded 2010-02-05	Available
Attachment A1 Public Health Service Act 2000.pdf	Supplementary Document	Uploaded 2010-02-05	Available
SS.A 20100127.doc	Supporting Statement A	Uploaded 2010-02-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
179858	Attachment B35. Teachery Survery (Teacher)	Form and Instruction	Removed	Teacher Survey
179857	Attachment B34. Youth Demographic Survey (16+ years) (Child)	Form and Instruction	Removed	Youth Demographic Survey (16+ years)
179856	Attachment B33. People In My Life/Inventory of Parent and Peer Attachment	Form and Instruction	Removed	People In My Life/Inventory of Parent and Peer Attachment
179855	Attachment B32. People In My Life (Child)	Form and Instruction	Removed	People In My Life
179854	Attachment B31. Pediatric Quality of Life (teen) (Child)	Form and Instruction	Removed	Pediatric Quality of Life (teen)
179853	Attachment B30. Pediatric Quality of Life (child) (Child)	Form and Instruction	Removed	Pediatric Quality of Life (Child)
179852	ATTACHMENT C29: Teacher Survey	Form and Instruction	Modified	ATTACHMENT C29: Teacher Survey
179851	ATTACHMENT C28: Youth Demographic Survey (16 plus years)	Form	Modified	ATTACHMENT C28: Youth Demographic Survey (16 plus years)
179850	ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)	Form and Instruction	Modified	ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)
179849	ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)	Form and Instruction	Modified	ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)
179848	ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)	Form	Modified	ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)
179847	ATTACHMENT C24: Social Inventory (High School, 14 plus years)	Form and Instruction	Modified	ATTACHMENT C24: Social Inventory (High School, 14 plus years)
179846	ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years	Form and Instruction	Modified	ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years
179845	ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years	Form and Instruction	Modified	ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years
179844	ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years	Form and Instruction	Modified	ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years
179843	ATTACHMENT C20: Health Risk Behavior Survey (High School)	Form	Modified	ATTACHMENT C20: Health Risk Behavior Survey (High School)
179842	ATTACHMENT C19: Health Risk Behavior Survey (Middle School)	Form	Modified	ATTACHMENT C19: Health Risk Behavior Survey (Middle School)
179841	ATTACHMENT C18: Conflict in Adolescent Dating Relationships	Form	Modified	ATTACHMENT C18: Conflict in Adolescent Dating Relationships
179840	ATTACHMENT C17: Child Brief Sensation Seeking Scale	Form	Modified	ATTACHMENT C17: Child Brief Sensation Seeking Scale
179839	ATTACHMENT C16: Vanderbilt Rating Scale	Form and Instruction	Modified	ATTACHMENT C16: Vanderbilt Rating Scale
179838	ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire	Form and Instruction	Modified	ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire
179837	ATTACHMENT C14: Parent Social Isolation/Support	Form and Instruction	Modified	ATTACHMENT C14: Parent Social Isolation/Support
179836	ATTACHMENT C13: Quarterly Update: Critical School Events	Form	Modified	ATTACHMENT C13: Quarterly Update: Critical School Events
179835	ATTACHMENT C12: Parents' Questionnaire (Mental Health)	Form and Instruction	Modified	ATTACHMENT C12: Parents' Questionnaire (Mental Health)
179834	ATTACHMENT C11: Parent Child Relationship Inventory	Form and Instruction	Modified	ATTACHMENT C11: Parent Child Relationship Inventory
179833	ATTACHMENT C10: Health Risk Behavior Survey (High School)	Form	Modified	ATTACHMENT C10: Health Risk Behavior Survey (High School)
179832	ATTACHMENT C9: Health Risk Behavior Survey (Middle School)	Form	Modified	ATTACHMENT C9: Health Risk Behavior Survey (Middle School)
179831	ATTACHMENT C8: Parent Demographic Survey	Form	Modified	ATTACHMENT C8: Parent Demographic Survey
179830	ATTACHMENT C7: Parent Critical Events Form (High School)	Form and Instruction	Modified	ATTACHMENT C7: Parent Critical Events Form (High School)
179829	ATTACHMENT C6: Parent Critical Events Form (Middle School)	Form and Instruction	Modified	Critical School Events (elementary, middle)
179829	ATTACHMENT C6: Parent Critical Events Form (Middle School)	Form and Instruction	Modified	ATTACHMENT C6: Parent Critical Events Form (Middle School)
179828	ATTACHMENT C5: Parent Brief Impairment Scale	Form and Instruction	Modified	ATTACHMENT C5: Parent Brief Impairment Scale
179827	ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update	Form	Modified	ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update
179826	ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire	Form	Modified	ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire
179825	ATTACHMENT C3: Parent ADHD Communication and Knowledge	Form and Instruction	Modified	ATTACHMENT C3: Parent ADHD Communication and Knowledge

ICR Details

OMB Control No: 0920-0747	ICR Reference No: 201002-0920-008
Status: Historical Active	Previous ICR Reference No: 200704-0920-003
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/12/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/23/2010
Terms of Clearance: OMB approves data collection for waves 4 and 5 of this study. Due to concerns about diminishing response rates over time, OMB requires a continuing assessment of the potential for nonresponse bias over time and a commitment to systematically present the nonresponse bias analysis and its implications whenever the results of any of the waves are presented.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2013	36 Months From Approved	07/31/2010
Responses	6,029	0	29,943
Time Burden (Hours)	765	0	3,993
Cost Burden (Dollars)	0	0	0

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Abstract: Attention-Deficit/Hyperactivity Disorder is one of the most common neurobehavioral disorders of childhood, and 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). ADHD affects about 3-7% of school age children with recent estimates suggesting higher rates in some socio-demographic groups. 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 proposed project would follow up the participants for two additional annual assessments, i.e., wave 4 and 5, following the participants, who were initially recruited in elementary school, into older adolescence towards young adulthood. Funding will be provided to the University of South Carolina, where sufficient numbers of participants were able to be retained in the first waves of follow-up data collection. The additional waves for PLAY study follow-up will allow the CDC to address the imminent public health concerns around ADHD diagnosis and treatment and better understand and promote the health status of youth with ADHD particularly in older adolescents.

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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
   PL: Pub.L. 106 - 310 102 Name of Law: Children's Health Act 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:
	74 FR 48749	09/24/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 6205	02/08/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 28

table that charts list of burden

IC Title	Form No.	Form Name
ATTACHMENT C10: Health Risk Behavior Survey (High School)	9	ATTACHMENT C10: Health Risk Behavior Survey (High School)
ATTACHMENT C11: Parent Child Relationship Inventory	10	ATTACHMENT C11: Parent Child Relationship Inventory
ATTACHMENT C12: Parents' Questionnaire (Mental Health)	11	ATTACHMENT C12: Parents' Questionnaire (Mental Health)
ATTACHMENT C13: Quarterly Update: Critical School Events	12	ATTACHMENT C13: Quarterly Update: Critical School Events
ATTACHMENT C14: Parent Social Isolation/Support	13	ATTACHMENT C14: Parent Social Isolation/Support
ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire	14	ATTACHMENT C15: Parent Strengths and Difficulties Questionnaire
ATTACHMENT C16: Vanderbilt Rating Scale	15	ATTACHMENT C16: Vanderbilt Rating Scale
ATTACHMENT C17: Child Brief Sensation Seeking Scale	16	ATTACHMENT C17: Child Brief Sensation Seeking Scale
ATTACHMENT C18: Conflict in Adolescent Dating Relationships	17	ATTACHMENT C18: Conflict in Adolescent Dating Relationships
ATTACHMENT C19: Health Risk Behavior Survey (Middle School)	18	ATTACHMENT C19: Health Risk Behavior Survey (Middle School)
ATTACHMENT C20: Health Risk Behavior Survey (High School)	19	ATTACHMENT C20: Health Risk Behavior Survey (High School)
ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years	20	ATTACHMENT C21: MARSH Self Description Questionnaire, 7-12 years
ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years	21	ATTACHMENT C22: MARSH Self Description Questionnaire, 13-15 years
ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years	22	ATTACHMENT C23: MARSH Self Description Questionnaire, 16 plus years
ATTACHMENT C24: Social Inventory (High School, 14 plus years)	23	ATTACHMENT C24: Social Inventory (High School, 14 plus years)
ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)	24	ATTACHMENT C25: Olweus Bullying Quesstionnaire (High School, 14 plus years)
ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)	25	ATTACHMENT C26: Pediatric Quality of Life (Child 8-12)
ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)	26	ATTACHMENT C27: Pediatric Quality of Life (Teen 13 plus)
ATTACHMENT C28: Youth Demographic Survey (16 plus years)	27	ATTACHMENT C28: Youth Demographic Survey (16 plus years)
ATTACHMENT C29: Teacher Survey	28	ATTACHMENT C29: Teacher Survey
ATTACHMENT C3: Parent ADHD Communication and Knowledge	1	ATTACHMENT C3: Parent ADHD Communication and Knowledge
ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire	2	ATTACHMENT C4A: Parent ADHD Treatment, Cost, and Client Satisfaction Questionnaire
ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update	3	ATTACHMENT C4B: Parent ADHD Treatment Quarterly Update
ATTACHMENT C5: Parent Brief Impairment Scale	4	ATTACHMENT C5: Parent Brief Impairment Scale
ATTACHMENT C6: Parent Critical Events Form (Middle School)	5, None	ATTACHMENT C6: Parent Critical Events Form (Middle School) ,   Critical School Events (elementary, middle)
ATTACHMENT C7: Parent Critical Events Form (High School)	6	ATTACHMENT C7: Parent Critical Events Form (High School)
ATTACHMENT C8: Parent Demographic Survey	7	ATTACHMENT C8: Parent Demographic Survey
ATTACHMENT C9: Health Risk Behavior Survey (Middle School)	8	ATTACHMENT C9: Health Risk Behavior Survey (Middle School)
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	6,029	29,943	0	-23,914	0	0
Annual Time Burden (Hours)	765	3,993	0	-3,228	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Data collection for Wave 4 and 5 constitutes a program change due to the revision of the data collection procedures for the youth participants who have reached high school age. The burden on the individual youth participant does not change because the People In My Life questionnaire used for the previous protocol does not need to be repeated annually and thus will not be part of Wave 4 and 5. This decreases the burden by 15 minutes per child. The Dating Violence Survey as well as the additional items on the Health Risk Behavior Survey add 15 minutes and thus result in the same overall burden. (see A.15 in the Supporting Statement for more information)

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Annual Cost to Federal Government: $540,931

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? Yes

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)? No

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: 02/23/2010

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