ASQ3PhoneInstructions

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

Neuro-Psychosocial Ages and Stages-3 (ASQ-3™) Instructions: Telephone, Phase 2g

The National Children’s Study

Ages and Stages-3 (ASQ-3™) Instructions

Telephone Questionnaire

Thank you for agreeing to participate in the National Children’s Study (NCS) and completing the Ages and Stages Questionnaire, Third Edition (ASQ-3™). This telephone questionnaire will take about 13 minutes to complete. It includes questions about activities that children may do. Your child may have done some of these activities already and there may be some activities your child has not started doing yet. If you have more than one child in the NCS, the telephone interviewer will ask you about each child separately. A copy of the ASQ-3™ is enclosed to allow you time to observe these behaviors in your child previous to the telephone call.

Your answers are important to us. We will keep everything that you tell us confidential.

Listed below are several points that you may find helpful in answering these questions:

• Please review the enclosed hardcopy ASQ-3™ questionnaire because information in the questionnaire will help you respond to the questions.

• The ASQ-3™ consists of questions about children’s behaviors. Some of the questions have pictures that show you what the behavior looks like.

• Review the questions and look for the behaviors and skills in your child; then think about whether your child always performs the skill, sometimes does it, or does not do it yet.

• Note that there is no need to try out any of these behaviors with your child. Rather, you should respond on the basis of your child’s typical, everyday behavior.

• There are no right or wrong answers.

• Please keep this questionnaire handy so you will have it available when an NCS staff member calls you on the phone to ask you about your child’s behavior.

If you have any questions, please call the local contact number located on the last page.

Thank you for taking the time to complete this telephone questionnaire!

For Office Use Only:

Instructions for returning the questionnaire to the Regional Operations Center (ROC):

{Local instructions inserted by ROC. If the visit is done by phone, the ROC will provide information about returning it to the ROC.}

Insert ROC contact information label here.

NEU ASQ-3™ Instructions: Telephone, MDES 4.0, V2.0 1