3M_InfantBehaviorRevised3SubscalesInstructions

OMB #: 0925-0593

OMB Expiration Date: 08/31/2014

Neuro-Psychosocial Infant Behavior Questionnaire- Revised (3 Subscales) Instructions, Phase 2g

The National Children’s Study

Infant Behavior Questionnaire-Revised

(3 Subscales) Instructions

Questionnaire

Thank you for agreeing to participate in the National Children’s Study (NCS) and completing a subset of questions from the Infant Behavior Questionnaire-Revised (3 Subscales). There are 60 questions that will take about 8 minutes to complete. It includes questions that ask caregivers to rate their child on the frequency of specific temperament-related behaviors observed over the past week (7 days), unless otherwise specified. If you have more than one child in the NCS, please fill out a separate questionnaire for each child. You may use a pencil or pen to record your answers.

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 completing the questionnaire:

• Read each item carefully before you begin and select the response that best describes your child’s behavior over the PAST WEEK (or past two weeks, when specified), not just how the child is behaving today.

• There are no right or wrong answers; the goal is to obtain a snapshot of your child’s typical behavior over the past 7 days. Some questions specify the past 2 weeks, or 14 days.

• Please try not to skip any items and please select only one answer for each item.

• If you change your mind about an answer, strike through your original answer and then select your new answer.

• Before mailing the questionnaire back to the Regional Operations Center (ROC), please make sure that you have answered all of the questions and that there is only one answer for each question.

• When returning the questionnaire to the ROC, please follow the instructions on the next page and please use the prepaid envelope provided for this purpose.

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 questionnaire!

For Office Use Only:

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

{Local instructions inserted by ROC. Provide the parent/caregiver with ROC-specific instructions for returning the questionnaire to the ROC here, such as instructions about the data collector retrieving the questionnaire at the in-person visit.}

Insert ROC contact information label here.

NEU Infant Behavior Questionnaire-Revised (3Subscales) Instructions, MDES 4.0, V1.0 1