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pdfAPPENDIX A
CHILD QUESTIONNAIRE
Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)
Spring Third-Grade National Data Collection, Fourth-Grade
Recruitment, and Fifth-Grade Tracking
OMB Clearance Package
# 1850-0750 v.15
This appendix includes the programmer specifications for the audio-CASI child questionnaire,
which indicate the exact instructions to be provided to the child and the items that will be
administered.
Social Distress
The child questionnaire to be fielded in the spring third-grade data collection will include three
items (CLQ205, CLQ220, and CLQ235) used to evaluate children’s social anxiety, specifically
their fear of negative evaluation by their peers. The exact wording of these items is not
included here because they are copyright protected.
Source: Social anxiety scale for children-revised: Factor structure and concurrent validity. © 1993 A.M. La
Greca and W.L. Stone. Used with permission.
Spring 2014 Child Assessment: ECLS-K:2011
Section
CLQOPEN
[CQ OPEN in CAPI]
Sequence: 2
CLQ005
QUESTION TEXT:
PLUG HEADPHONES INTO THE COMPUTER. POSITION LAPTOP IN FRONT OF THE CHILD.
SAY: Now you are going to use the computer to tell us a little more about yourself. The computer will read
some sentences and questions to you while you listen on the headphones [HOLD UP HEADPHONES].
SAY: Then you will pick the answer that best describes you by touching your answer on the computer screen
[TOUCH THE MIDDLE OF THE COMPUTER SCREEN WITH ONE FINGER]. If you don’t want to pick an answer,
you don’t have to.
PRESS 1 AND ENTER TO CONTINUE.
CLQ006
QUESTION TEXT:
POINT TO THE VOLUME CONTROL BUTTONS, ABOVE THE STICKER, ON THE BOTTOM RIGHT CORNER OF THE
COMPUTER SCREEN.
SAY: You can change the volume by pressing either button above the sticker.
SAY: To make the sound louder, press the right button above the sticker. [POINT TO THE RIGHT BUTTON
ABOVE STICKER.] To make the sound softer, press the left button above the sticker. [POINT TO THE LEFT
BUTTON ABOVE STICKER.] If you want to turn the sound off, just turn the volume all the way down.
SHOW THE CHILD HOW TO ADJUST THE SIZE OF THE HEADPHONES.
SAY: Once you put the headphones on, you will hear directions about what to do. Do you have any questions?
[PAUSE 2-3 SECONDS AND ANSWER ANY QUESTIONS.]
SAY: Okay, go ahead and put these headphones on now. [HAND THE CHILD THE HEADPHONES.] Do the
headphones fit okay? [ADJUST HEADPHONES IF NECESSARY.]
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQOPEN
Page 1 of 2
2013-11-08 11:15
[TURN LAPTOP AROUND. ROTATE LAPTOP SCREEN TO FACE THE CHILD.]
PRESS 1 AND ENTER TO CONTINUE.
CLQBox1
GO TO CLQ012.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQOPEN
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2013-11-08 11:15
Spring 2014 Child Assessment: ECLS-K:2011
Section
CLQ
[Child Questionnaire ACASI]
Sequence: 3
CLQGLB005
RAPID RESPONSE
IF A CHILD SELECTS A COMMAND BUTTON (NEXT, BACK) OR A RESPONSE BEFORE ACASI HAS READ THE
ENTIRE CONTENTS OF THE SCREEN, PROGRAM SHOULD ACCEPT THE CHILD'S SELECTION BY FOLLOWING
THE COMMAND OR ACCEPTING THE ANSWER.
CLQGLB010
INACTIVITY SETTINGS
FOR SCREENS CLQ012, CLQ015, AND CLQ028:
AFTER 15 SECONDS OF IDLE TIME [FROM WHEN THE LAST WORD HAS BEEN READ], THE FOLLOWING
MESSAGE SHOULD BE READ ON AUDIO.
Please touch the "NEXT" button to move to the next screen.
FOR SCREENS CLQ025, CLQ030-CLQ275:
AFTER 15 SECONDS OF IDLE TIME ON ONE SCREEN [FROM WHEN THE LAST RESPONSE CATEGORY HAS BEEN
READ], THE FOLLOWING MESSAGE SHOULD BE READ ON AUDIO.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
FOR SCREENS CLQ012-CLQ275:
AFTER THE INACTIVITY MESSAGE HAS BEEN READ THREE TIMES, REPEAT THE SCREEN TEXT.
FOR SCREEN CLQ280:
ACASI SHOULD REPEAT THE SCREEN TEXT EVERY 15 SECONDS.
CLQGLB015
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CONFIRMATION SCREEN
IF THE CHILD TOUCHES THE NEXT BUTTON BEFORE TOUCHING AN ANSWER TO A QUESTION, THEN
PROGRAM SHOULD MOVE TO THE CONFIRMATION SCREEN.
DISPLAY PREVIOUS ITEM TEXT AND CONFIRMATION QUESTION AT THE TOP OF THE SCREEN. DISPLAY
RESPONSE OPTIONS IN THE MIDDLE OF THE SCREEN BELOW THE QUESTION.
PROGRAM READS CONFIRMATION QUESTION: Do you want to skip this question?
PROGRAM READS RESPONSE OPTIONS:
Yes. (1)
No. (2)
IF THE CHILD CHOOSES 1, THEN PROGRAM MOVES TO THE NEXT SCREEN WITHOUT NEEDING TO PRESS ANY
OTHER BUTTONS. 1 = REFUSED.
IF THE CHILD CHOOSES 2, THEN PROGRAM MOVES TO THE PREVIOUS SCREEN WITHOUT NEEDING TO PRESS
ANY OTHER BUTTONS.
CLQGLB020
CHANGE RESPONSE PROCEDURE
THE CHILD'S ANSWER SELECTION SHOULD ALWAYS BE READ ON AUDIO, AND THE SELECTED BUTTON
SHOULD BE VISUALLY EMPHASIZED.
IF THE CHILD WANTS TO CHANGE AN ANSWER, HE OR SHE CAN TOUCH THE "ERASE" BUTTON AND THEN
TOUCH HIS/HER NEW ANSWER. ACASI SHOULD DO THE FOLLOWING:
REMOVE THE VISUAL EMPHASIS FROM THE OLD ANSWER BUTTON
VISUALLY EMPHASIZE THE NEW RESPONSE BUTTON
READ THE NEW RESPONSE
THE CHILD CAN CHANGE AN ANSWER MULTIPLE TIMES. ACASI SHOULD ACCEPT THE LAST ANSWER.
CLQGLB025
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DISPLAY INSTRUCTIONS
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO AND VISUALLY
EMPHASIZED.
CLQGLB030
AUDIO INSTRUCTIONS
WORDS IN ALL CAPS SHOULD BE EMPHASIZED WHEN READ OVER AUDIO.
THE PHRASE "Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to
skip this question" IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO FOR ITEMS CLQ030-CLQ275.
CLQGBL035
ADMINISTRATION TIMING
FOR CQ ENTIRE ADMINISTRATION TIMINGS, BEGIN TIMING WHEN THE OPENING SCREEN FOR THE
ASSESSOR APPEARS (CLQ005) AND END TIMING WHEN THE ASSESSOR PRESSES 1 & ENTER TO LEAVE THE
CLOSING SCREEN (CLQ285).
CLQGLB040
RESPONSE BUTTON DISPLAY CHARACTERISTICS
Vertical spacing: 15 pixels
Button height: 50 pixels
Button width: 200 pixels
BUTTON DISPLAY
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF EACH SCREEN.
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PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF EACH SCREEN.
PLACE AN "ERASE" BUTTON AT THE BOTTOM CENTER OF EACH SCREEN.
CLQGLB045
BREAKOFF
ADD CTRL-B AS A KEY COMBINATION TO BREAKOFF THE INTERVIEW.
THE FIELD AT WHICH THE BREAKOFF OCCURS IS STORED IN THE WBA AUDIT TRAIL.
CLQ012
QUESTION TEXT:
Hello. Before we begin, let’s make sure the volume on the headphones is right for you. This is how loud it will
be when the sentences are read to you. If it is too loud or too soft please change the volume now or ask for
help.
In a minute, sentences will appear on the screen, and they will be read to you along with a list of answers.
Think about each sentence and decide how well it describes you. Once you've decided, touch your answer on
the computer screen. You can touch your answer even if the computer is still reading to you.
For these questions, there are no right or wrong answers, and all your answers are private. No one will be
told the answers that you pick. And remember, be sure your answers tell me about YOU.
Please touch the "NEXT" button to move to the next screen.
ENTER TEXT
PROGRAMMER INSTRUCTIONS:
TURN OFF CONFIRMATION SCREEN.
CLQ015
DISPLAY INSTRUCTIONS:
MARIA'S ANSWER SELECTION "A LITTLE BIT TRUE" SHOULD BE HIGHLIGHTED.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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QUESTION TEXT:
For each sentence, decide how well it describes you. Is the sentence "Not at all true; A little bit true; Mostly
true; or Very true" for you?
A student, Maria, has already given an answer for one sentence to show you how to do it. The sentence read
to Maria was
I am neat and tidy.
Maria touched the button on the screen with the answer "A little bit true" because she is not very neat, but
she is not very messy either.
Please touch the "NEXT" button to move to the next screen.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
PROGRAMMER INSTRUCTIONS:
TURN OFF CONFIRMATION SCREEN.
RESPONSE OPTIONS SHOULD BE DISPLAYED, BUT SHOULD NOT BE READ OVER AUDIO.
IF USER CHANGES MARIA'S ANSWER, PROGRAM SHOULD RE-SELECT MARIA'S ANSWER AND REPEAT
SCREEN TEXT.
CLQ025
QUESTION TEXT:
If you want to change an answer, touch the "ERASE" button and then touch the new answer you want to
pick.
If you want to go back and change any of the answers you already gave, touch the "BACK" button to move to
the past screen. Once there, touch the "ERASE" button and then touch the new answer you want to pick.
Now, let's practice. Listen to the following statement. Choose the answer that best describes you. After you
choose your answer, remember to touch the "NEXT" button.
I like to watch TV.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY EXAMPLE ITEM AND RESPONSE OPTIONS.
CLQ028
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QUESTION TEXT:
Great, thank you for practicing with me.
One last thing before we begin: If there is a question that you do not want to answer, just touch the “NEXT”
button to skip over it. When you touch the “NEXT” button without answering, the computer will ask you if
you want to skip the question, just to make sure you didn’t skip the question by accident.
Please touch the "NEXT" button to move to the next screen.
ENTER TEXT
PROGRAMMER INSTRUCTIONS:
TURN OFF CONFIRMATION SCREEN.
CLQ030
QUESTION TEXT:
Let's begin.
I have lots of friends.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ035
QUESTION TEXT:
I am good at SCIENCE.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ050
QUESTION TEXT:
I enjoy doing work in SCIENCE.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ055
QUESTION TEXT:
I like READING.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ060
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QUESTION TEXT:
I make friends easily.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ065
QUESTION TEXT:
I cannot wait to do MATH each day.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ075
QUESTION TEXT:
I like SCIENCE.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ085
QUESTION TEXT:
I am interested in READING.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ090
QUESTION TEXT:
I get along with kids easily.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ095
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QUESTION TEXT:
I cannot wait to READ each day.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ100
QUESTION TEXT:
I am interested in MATH.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ105
QUESTION TEXT:
I am easy to like.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ120
QUESTION TEXT:
Other kids want me to be their friend.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ130
QUESTION TEXT:
I like MATH.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ135
QUESTION TEXT:
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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I have more friends than most other kids.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ140
QUESTION TEXT:
I am good at READING.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ145
QUESTION TEXT:
I am interested in SCIENCE.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ155
QUESTION TEXT:
I enjoy doing work in MATH.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ160
QUESTION TEXT:
I cannot wait to do SCIENCE.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ165
QUESTION TEXT:
I enjoy doing work in READING.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ170
QUESTION TEXT:
I am good at MATH.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all true
2
A little bit true
3
Mostly true
4
Very true
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ180
QUESTION TEXT:
The next set of questions and sentences are about how often things happen to you. Think about the question
or sentence and decide if these things happen "Never; Rarely; Sometimes; Often; or Very often."
During this school year, how often have other students teased you, made fun of you, or called you
names?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ185
QUESTION TEXT:
During this school year, how often have other students told lies or untrue stories about
you?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ190
QUESTION TEXT:
During this school year, how often have other students pushed, shoved, slapped, hit, or kicked
you?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
CLQ200
QUESTION TEXT:
During this school year, how often have other students left you out from playing with them on
purpose?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ215
QUESTION TEXT:
I try to cheer up other classmates who are upset or sad about something.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ230
QUESTION TEXT:
I help out other kids when they need it.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ245
QUESTION TEXT:
I say or do nice things for other classmates.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Never
2
Rarely
3
Sometimes
4
Often
5
Very often
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ250
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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QUESTION TEXT:
The next set of sentences are about how you feel about your life. Think about the sentence and decide how
well it describes you. Does the sentence describe you "Not at all; A little bit; Somewhat; Quite a bit; or Very
much"?
I am happy with my hobbies and free time activities.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ255
QUESTION TEXT:
I am happy with the clothes, games, toys, and other things I have.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ260
QUESTION TEXT:
I am happy with how much attention I get from my parents.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ265
QUESTION TEXT:
I am happy with the friends I have.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ270
QUESTION TEXT:
I am happy with my skills and talents.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ275
QUESTION TEXT:
I am happy with the neighborhood and community in which I live.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this
question.
CODES
1
Not at all
2
A little bit
3
Somewhat
4
Quite a bit
5
Very much
REFUSED
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
CLQ280
QUESTION TEXT:
Thank you for working with me. You are done answering questions on the computer. Please take off the
headphones now.
ENTER TEXT
CLQBox1
GO TO CLQ285 IN CLQCLOSE.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQ
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2013-10-15 10:20
[TURN LAPTOP AROUND. ROTATE LAPTOP SCREEN TO FACE THE CHILD.]
PRESS 1 AND ENTER TO CONTINUE.
CLQBox1
GO TO CLQ012.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQOPEN
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2013-11-08 11:15
Spring 2014 Child Assessment: ECLS-K:2011
Section
CLQCLOSE
[CQ CLOSE in CAPI]
Sequence: 4
CLQ285
QUESTION TEXT:
TAKE THE HEADPHONES FROM THE CHILD. UNPLUG HEADPHONES FROM COMPUTER.
TAKE THE LAPTOP FROM THE CHILD AND PLACE THE LAPTOP DIRECTLY IN FRONT OF YOU.
SAY: Thank you. Now we are going to do something else.
PRESS 1 AND ENTER TO CONTINUE.
Box1
GO TO R3001.
Spring 2014 Child Assessment: ECLS-K:2011 :: CLQCLOSE
Page 1 of 1
2013-11-26 13:59
APPENDIX B
CHILD QUESTIONS FOR HEARING
EVALUATIONS
Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)
Spring Third-Grade National Data Collection, Fourth-Grade
Recruitment, and Fifth-Grade Tracking
OMB Clearance Package
# 1850-0750 v.15
This appendix includes the programmer specifications for the CAPI child questions for the
hearing evaluations, which indicate the exact instructions to be provided to the child and
the items that will be administered.
Child Hearing Evaluation Questionnaire 3rd Grade:
ECLS-K:2011
Section
PTQ
[Pre-Test Questionnaire]
Sequence: 0
PTQ001
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Do you have a cold or a runny nose today?
HELP:
A COLD REFERS TO A DISORDER IN THE @UUPPER@U RESPIRATORY TRACT. IF THE CHILD IS NOT SURE IF
HE HAS/HAD A COLD, PROBE FOR SYMPTOMS FROM THE @UNECK UP@U, SUCH AS:
•STUFFY NOSE OR HEAD
•SORE THROAT
•COUGH
•ALLERGIES SHOULD BE CODED AS A @UYES@U RESPONSE IF THEY INCLUDE ANY OF THESE SYMPTOMS.
CODES
1
YES
PTQ003
2
NO
PTQ002
REFUSED
PTQ002
DON'T KNOW
PTQ002
PTQ002
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Did you have a cold or a runny nose yesterday?
HELP:
A COLD REFERS TO A DISORDER IN THE @UUPPER@U RESPIRATORY TRACT. IF THE CHILD IS NOT SURE IF
HE HAS/HAD A COLD, PROBE FOR SYMPTOMS FROM THE @UNECK UP@U, SUCH AS:
•STUFFY NOSE OR HEAD
•SORE THROAT
•COUGH
•ALLERGIES SHOULD BE CODED AS A @UYES@U RESPONSE IF THEY INCLUDE ANY OF THESE SYMPTOMS.
Child Hearing Evaluation Questionnaire 3rd Grade: ECLS-K:2011 :: PTQ
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CODES
1
YES
2
NO
REFUSED
DON'T KNOW
HELP AVAILABLE
PTQ003
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Have you had an earache today?
HELP TEXT:
Earache refers to any pain WITHIN the ear. It does not include pain on the external ear (e.g., recently pierced
ears, cuts or sores on the external ear).
CODES
1
YES
PTQ005
2
NO
PTQ004
REFUSED
PTQ004
DON'T KNOW
PTQ004
HELP AVAILABLE
PTQ004
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Did you have an earache yesterday?
HELP TEXT:
Earache refers to any pain WITHIN the ear. It does not include pain on the external ear (e.g., recently pierced
ears, cuts or sores on the external ear).
CODES
1
YES
PTQ005
Child Hearing Evaluation Questionnaire 3rd Grade: ECLS-K:2011 :: PTQ
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2
NO
PTQ006
REFUSED
PTQ006
DON'T KNOW
PTQ006
PTQ005
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
DISPLAY "LEFT" IN BOLD AND BLUE TEXT. DISPLAY "RIGHT" IN BOLD AND RED TEXT.
QUESTION TEXT:
Which ear(s) hurt?
CODES
1
LEFT
2
RIGHT
3
BOTH
REFUSED
DON'T KNOW
PTQ006
HELP AVAILABLE
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Have you listened to sounds today that were so loud you would have to shout so someone close by could
hear you?
HELP TEXT:
Sounds are considered “very loud” if either
1) The child would have had to raise his voice to speak to someone an arm’s length away, or
2) The child’s ears were ringing or felt “funny” afterwards.
3) Examples of sounds that do NOT count: parents/teachers/children yelling, dogs barking, recess, school
bells, sounds that last less than five minutes EXCEPT for firecrackers, gunfire, or other "impulse" type noises.
4) Examples of sounds that DO count: loud TV or radio, loud music, sporting events, motorbikes,
lawnmowers, firecrackers, gunfire, or any "impulse" type noise.
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CODES
1
YES
PTQ008
2
NO
PTQ007
REFUSED
PTQ007
DON'T KNOW
PTQ007
HELP AVAILABLE
PTQ007
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Did you listen to any sounds that were that loud yesterday? [Did you listen to any sounds yesterday that were
so loud you would have to shout so someone close by could hear you?]
HELP TEXT:
Sounds are considered “very loud” if either
1) The child would have had to raise his voice to speak to someone an arm’s length away, or
2) The child’s ears were ringing or felt “funny” afterwards.
3) Examples of sounds that do NOT count: parents/teachers/children yelling, dogs barking, recess, school
bells, sounds that last less than five minutes EXCEPT for firecrackers, gunfire, or other "impulse" type noises.
4) Examples of sounds that DO count: loud TV or radio, loud music, sporting events, motorbikes,
lawnmowers, firecrackers, gunfire, or any "impulse" type noise.
CODES
1
YES
2
NO
REFUSED
DON'T KNOW
PTQ008
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Do you have tubes in your ears now that a doctor put there [to keep you from getting earaches]?
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CODES
1
YES
PTQ010
2
NO
PTQ012
REFUSED
PTQ009
DON'T KNOW
PTQ009
PTQ009
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Do you have to wear earplugs when you swim or take a bath or shower?
CODES
1
YES
PTQ011
2
NO
PTQ012
REFUSED
PTQ012
DON'T KNOW
PTQ012
PTQ010
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
DISPLAY "LEFT" IN BOLD AND BLUE TEXT. DISPLAY "RIGHT" IN BOLD AND RED TEXT.
QUESTION TEXT:
In which ear do you have the tube(s)?
CODES
1
LEFT
PTQ012
2
RIGHT
PTQ012
3
BOTH
PTQ012
REFUSED
PTQ012
DON'T KNOW
PTQ012
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PTQ011
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
DISPLAY "LEFT" IN BOLD AND BLUE TEXT. DISPLAY "RIGHT" IN BOLD AND RED TEXT.
QUESTION TEXT:
In which ear do you wear the earplug(s)?
CODES
1
LEFT
2
RIGHT
3
BOTH
REFUSED
DON'T KNOW
PTQ012
DISPLAY INSTRUCTIONS:
AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
QUESTION TEXT:
Is it easier for you to hear out of one ear than the other?
CODES
1
YES
2
NO
BOX1
REFUSED
BOX1
DON'T KNOW
BOX1
PTQ013
DISPLAY INSTRUCTIONS:
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AT THE TOP OF THE SCREEN, DISPLAY:
"{NAME OF CHILD}, {CASE ID}"
FOR "NAME OF CHILD", DISPLAY THE FIRST AND LAST NAME OF THE CHILD. FOR "CASE ID", DISPLAY THE
CASE ID OF THE CHILD.
DISPLAY "LEFT" IN BOLD AND BLUE TEXT. DISPLAY "RIGHT" IN BOLD AND RED TEXT.
QUESTION TEXT:
Which ear is easier to hear with?
CODES
1
LEFT
2
RIGHT
REFUSED
DON'T KNOW
BOX1
GO TO OTOSCOPE EXAM RESULTS SECTION.
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| File Type | application/pdf |
| File Modified | 2013-12-05 |
| File Created | 2013-07-15 |