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pdfNational Mental Health Study Field Test,
Supporting Statement
Attachment A-2 – Parent Questionnaire
Specifications
NATIONAL MENTAL HEALTH
STUDY (NMHS): PARENT
QUESTIONNAIRE FINAL
SPECIFICATIONS
Please see Appendix A for a summary of the content of each National Mental Health
Study (NMHS) Questionnaire module and a high-level overview of changes made to
the module when compared to the source documents originally provided to RTI.
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland
National Institute of Mental Health
Rockville, Maryland
NATIONAL MENTAL HEALTH
STUDY (NMHS): PARENT
QUESTIONNAIRE FINAL
SPECIFICATIONS
Contract No. HHSS283201300001C
RTI Project No. 0213985.301.002.001
RTI Authors:
RTI Project Director:
Rachel A. Caspar
Gretchen McHenry
Ashley Richards
Heather Ringeisen
Leyla Stambaugh
Suzanne Triplett
SAMHSA Project Officer:
Peter Tice
NIMH Author:
NIMH Project Officer:
Shelli Avenevoli
Lisa Colpe
For questions about this report, please e-mail [email protected].
Prepared for Substance Abuse and Mental Health Services Administration,
Rockville, Maryland, and National Institute of Mental Health, Rockville,
Maryland
Prepared by RTI International, Research Triangle Park, North Carolina
February 27, 2017
Recommended Citation: Center for Behavioral Health Statistics and Quality. (2016).
National Mental Health Study (NMHS): Parent Questionnaire Final Specifications
(unpublished internal documentation). Substance Abuse and Mental Health Services
Administration; National Institute of Mental Health, Rockville, MD.
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration,
Center for Behavioral Health Statistics and Quality, and the National Institute of Mental Health
by RTI International (a registered trademark and a trade name of Research Triangle Institute).
Contributors to this report at RTI include Claudia Clark, Janice Handler, and Roxanne Snaauw.
ii
Table of Contents
Section
Page
Introduction Screens ...................................................................................................................... 1
Birth and Early Development ......................................................................................................... 3
Education ........................................................................................................................................ 6
Columbia Impairment Scale .......................................................................................................... 8
Attention and Concentration .......................................................................................................... 9
Restlessness .................................................................................................................................. 12
Low Mood ..................................................................................................................................... 19
Anger and Disobedience .............................................................................................................. 23
Breaking Rules ............................................................................................................................. 26
Services ........................................................................................................................................ 29
Family and Medical History ........................................................................................................ 37
Military Service ............................................................................................................................ 44
Appendix A ................................................................................................................................... 46
iii
Introduction Screens
Begin Timestamp
DEFINE AOPSG_FILL
IF PQMODE=TEL, THEN FILL=“READ RESPONSE OPTIONS FOR FIRST THREE ROWS, THEN READ
RESPONSE OPTIONS ONLY AS NEEDED”
ELSE, FILL= “”
DEFINE WASIT_FILL
IF PQMODE=TEL, THEN FILL=“Was it…”
ELSE, FILL= “”
DEFINE PQCONSENT_FILL
IF PQMODE=WEB, THEN PQCONSENT_FILL= “If you become upset at any time during the interview and
wish to speak to a mental health professional about how you are feeling, toll-free hotline numbers are printed on
your payment receipt you received from the interviewer. It is important for you to keep in mind that you and your
child will not be given a psychological diagnosis or any mental health advice or counseling. The information we
are collecting today is only for research purposes.”
IF PQMODE=TEL, THEN PQCONSENT_FILL= “If you become upset at any time during the interview and wish to speak
to a mental health professional about how you are feeling, I will provide you with toll-free hotline numbers that are printed
on your payment receipt you received from the interviewer. It is important for you to keep in mind that I will not be
providing you with a psychological diagnosis or any mental health advice or counseling. The information we are collecting
today is only for research purposes.”
PQCONSENT This year, we are interviewing about 13,500 people across the nation. You will represent over 5,000
other people who are similar to you. The National Mental Health Study (NMHS) Parent Interview,
sponsored by the Department of Health and Human Services, asks questions about your child’s health,
development and family background. A parent’s perspective is very important in getting an accurate
description of a child’s health and development, which is why you have been selected to participate.
This interview will take approximately 30 minutes. You should answer the interview questions in a
private setting.
While the interview has some personal questions, federal law protects the privacy of your answers and
requires us to keep all of your answers confidential.
Your participation is voluntary. You may consider some of the questions to be sensitive in nature and
some of the questions may also make you feel certain emotions, such as sadness. Remember that you can
refuse to answer any questions that you do not want to answer, and you can stop the interview at any
time. [PQCONSENT_FILL]
These study details are also included on the Study Description you received from the interviewer who
met with you in your home.
We may contact you in the future to take part in another survey. When we contact you in the future, you
can decide whether or not you want to continue being in the study.
Do you consent to participate in this study?
1
2
Yes
No
1
PQREF
[IF PQCONSENT = 2] Your participation is very important. The data collected will help researchers and
policy makers learn more about adolescents’ physical and mental health experiences.
We know you are busy and your time is important to you. The interview will only take approximately 30
minutes to complete. As a thank you for your time, you received $30 from the interviewer who met with
you in your home.
Do you consent to participate in this study?
1
2
Yes
No
PQREF2
[IF PQREF = 2] Thank you for your time.
PQNAME
[IF PQCONSENT = 1 OR PQREF = 1] Recently, your adolescent took part in an important study for The
U.S Department of Health and Human Services called the National Mental Health Study. This parent
interview will ask you questions about that adolescent.
Please provide a first name or nickname for the adolescent who completed the National Mental Health
Study. We will use this name or nickname as a reminder throughout the survey.
_________Name or Nickname
DK/REF
ALLOW 15 CHARACTERS
DEFINE NAME FILL
IF PQNAME NE DK OR REF, THEN FILL WITH TEXT FROM PQNAME
IF PQNAME = DK OR REF, THEN FILL WITH “this adolescent”
2
Birth and Early Development
PQ1
Begin Timestamp
Is [NAME FILL] male or female?
1 Male
2 Female
DK/REF
PRONOUN1 FILL
IF PQ1 = 1, THEN “HE”
IF PQ1 = 2, THEN “SHE”
IF PQ1 = DK/REF, THEN “THEY”
PRONOUN2 FILL
IF PQ1 = 1, THEN “HIS”
IF PQ1 = 2, THEN “HER”
IF PQ1 = DK/REF, THEN “THEIR”
PRONOUN3 FILL
IF PQ1 = 1, THEN “HIM”
IF PQ1 = 2, THEN “HER”
IF PQ1 = DK/REF, THEN “THEM”
PRONOUN4 FILL
IF PQ1 = 1, THEN “HIMSELF”
IF PQ1 = 2, THEN “HERSELF”
IF PQ1 = DK/REF, THEN “THEMSELVES”
PRONOUN5 FILL
IF PQ1 = 1, THEN “HIS”
IF PQ1 = 2, THEN “HERS”
IF PQ1 = DK/REF, THEN “THEIRS”
PQ1b
How old is [NAME FILL]?
_______ Years Old [RANGE: 13–18]
DK/REF
DEFINE CURNTAGE
PQ1b = CURNTAGE
DEFINE PQ2_FILL
IF PQMODE=TEL, THEN FILL = “ONLY READ ANSWER OPTIONS IF NEEDED: Are you
[PROPNOUN2_FILL]…”
ELSE, FILL = “”
PQ2
What is your relationship to [NAME FILL]?
3
[PQ2_FILL]
1 Biological mother
2 Biological father
3 Step or adoptive mother
4 Step or adoptive father
5 Common law mother
6 Common law father
7 Foster mother
8 Foster father
9 Grandmother
10 Grandfather
11 Other relative
12 Guardian not biologically related
13 Other
DK/REF
PQ2OTHR
[IF PQ2 = 13] What is your relationship to [NAME FILL]?
_________________ Relationship Type
DK/REF
ALLOW 50 CHARACTERS
PQ3
The next questions are about [NAME FILL]’s birth and early development. Can you answer questions
about [NAME FILL]’s birth and early development?
1 Yes
2 No
DK/REF
DEFINE PQ4_FILL
IF PQMODE=TEL, THEN FILL=“, in pounds and ounces”
ELSE, FILL=“”
PQ4
[IF PQ3 = 1] At birth, how much did [PRONOUN1 FILL] weigh [PQ4_FILL]?
_________ Pounds ________ Ounces
DK/REF
[RANGE: 0–15 POUNDS, 0–15 OUNCES]
[FILL BLANK IN OUNCES AS 0]
PQ5a
[IF PQ3 = 1] Was [NAME FILL] born more than one week prematurely?
1 Yes
2 No
DK/REF
PQ5b
[IF PQ5a = 1] About how many weeks premature was [NAME FILL] when [PRONOUN1 FILL] was
born?
________ Number of Weeks
4
DK/REF
[RANGE: 0–22]
5
Education
PQ6a
Begin Timestamp
Did [NAME FILL] ever stay back or repeat a grade in school?
1 Yes
2 No
DK/REF
PQ6b
[IF PQ6a = 1] How many years did [PRONOUN1 FILL] stay back or repeat a grade in school?
_________ Years
DK/REF
[RANGE: 0–10]
PQ7
What was the last grade in school [PRONOUN1 FILL] completed?
1 Less than 3rd grade
2 4th grade
3 5th grade
4 6th grade
5 7th grade
6 8th grade
7 9th grade
8 10th grade
9 11th grade
10 12th grade
11 Any college, university, or technical school
DK/REF
DEFINE PQ7a_FILL
IF PQMODE=TEL, THEN FILL=“Do you expect [PRONOUN3_FILL]…”
ELSE, FILL=“”
PQ7a
How far in school do you expect [PRONOUN3 FILL] to go?
[PQ7a_FILL]
1 To receive less than a high school diploma
2 To graduate from high school
3 To attend two or more years of college
4 To finish a four- or five-year college degree
5 To earn a master's degree or equivalent
6 To finish a Ph.D., MD or other advanced degree
DK/REF
PQ8
What sort of grades did [NAME FILL] get in [PRONOUN2 FILL] last full year at school?
1 Above average
2 Average
3 Below average
DK/REF
6
PQ9
Did [NAME FILL] ever receive any of the following special school services?
Yes
No
PQ9a Placement in a special classroom in a regular school for children with learning problems?
1
2
PQ9b Placement in a special class for gifted children?
1
2
PQ9c Placement in a special class in a regular school for students with emotional or behavioral
problems?
1
2
PQ9d Special testing in school for emotional or behavioral problems?
1
2
PQ9e Placement in a special school for students with emotional or behavioral problems?
1
2
Yes
No
PQ9f Group psychological counseling or therapy delivered in school?
1
2
PQ9g Individual psychological counseling or therapy delivered in school?
1
2
PQ9h Medications for problems with concentration, behavior, or emotions taken at school and either
given by or supervised by a school nurse or teacher?
1
2
PQ9i Other counseling or therapy in school for emotional or behavioral problems?
1
2
DK/REF
PQ9
Did [NAME FILL] ever receive any of the following special school services?
DK/REF
7
Columbia Impairment Scale
Begin Timestamp
PQ10
The following questions ask about areas of behavior for you to rate on a scale from 0 – No Problem for
[NAME FILL] to 4 – Very Bad Problem for [NAME FILL]. Rate each item by choosing the number that
best describes [PRONOUN2 FILL] behavior at the present time. Since [PRONOUN2 FILL] behavior will
change over time, only take into consideration how you feel [PRONOUN2 FILL] recent behavior,
within the past week or two, has been.
PQ11
In general, how much of a problem do you think [NAME FILL] has with…
[AOPSG_FILL]
PQ11a
getting into trouble?
PQ11b
getting along with [PRONOUN2
FILL] mother or mother figure?
getting along with [PRONOUN2
FILL] father or father figure?
feeling unhappy or sad?
[PRONOUN2 FILL] behavior at
school or at [PRONOUN2 FILL]
job?
having fun?
getting along with adults other
than [PRONOUN2 FILL]
mother or father?
PQ11c
PQ11d
PQ11e
PQ11f
PQ11g
No
Problem
Minor
Problem
Some
Problem
Bad
Problem
Very Bad
Problem
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
DK/REF
PQ12
How much of a problem does [NAME FILL] have with…
[AOPSG_FILL]
PQ12a
PQ12b
PQ12c
PQ12d
PQ12e
feeling nervous or afraid?
getting along with other kids
[PRONOUN2 FILL] age?
getting involved in activities like
sports or hobbies?
[PRONOUN2 FILL] school
work or doing [PRONOUN2
FILL] job?
[PRONOUN2 FILL] behavior at
home?
No
Problem
0
Minor
Problem
1
Some
Problem
2
Bad
Problem
3
Very Bad
Problem
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
DK/REF
PQ13
How much of a problem does [NAME FILL] have with getting along with [PRONOUN2 FILL] brothers
or sisters?
1
2
3
4
5
6
No problem
Minor problem
Some problem
Bad problem
Very bad problem
[NAME FILL] does not have any brothers or sisters
DK/REF
8
Attention and Concentration
PQ14
Begin Timestamp
Was there ever a time lasting six months or longer when [NAME FILL] often had any of the following
problems?
Yes
No
PQ14a Was unable to keep [PRONOUN2 FILL] mind on what [PRONOUN1 FILL] was doing
if things were going on nearby?
1
2
PQ14b People often said that [PRONOUN1 FILL] did not seem to be listening to them?
1
2
PQ14c Often did not finish chores, homework, or other work even when [PRONOUN1 FILL]
meant to get them done and knew how to do them?
1
2
PQ14d Quickly lost interest in games or work [PRONOUN1 FILL] was doing at home or
school?
1
2
PQ14e Often had trouble paying attention to details or made a lot of careless mistakes in
homework, work, or other activities?
1
2
Yes
No
PQ14f Disliked, stayed away from, or put off doing things that needed a lot of concentration?
1
2
PQ14g Often forgot what [PRONOUN1 FILL] was supposed to be doing?
1
2
PQ14h Got confused when [PRONOUN1 FILL] had to make plans or decide the order in which to
do things?
1
2
PQ14i Often lost things like homework or books?
1
2
DK/REF
PQ14
DK/REF
DEFINE ATTENTION
IF PQ14a = 1 OR PQ14b = 1 OR PQ14c = 1 OR PQ14d = 1 OR PQ14e = 1 OR PQ14f = 1 OR PQ14g = 1 OR PQ14h = 1
OR PQ14i = 1, THEN ATTENTION = 1
ELSE ATTENTION = 2
PQ15
[IF ATTENTION = 1] About how old was [NAME FILL] when [PRONOUN1 FILL] first started having
attention or concentration problems?
__________ Years Old
DK/REF
[RANGE: 0-CURNTAGE]
9
DEFINE PQ16_FILL
IF PQMODE=WEB, THEN FILL=“Enter 0 if [PRONOUN1 FILL] has had problems with attention or
concentration for less than a year.”
IF PQMODE=TEL, THEN FILL=“ENTER 0 IF [PRONOUN1 FILL] HAS HAD PROBLEMS WITH
ATTENTION OR CONCENTRATION FOR LESS THAN A YEAR.”
PQ16
[IF ATTENTION = 1] About how many years altogether has [PRONOUN1 FILL] had attention or
concentration problems?
[PQ16_FILL]
__________ Number of Years
DK/REF
[RANGE: 0–CURNTAGE]
PQ17
[IF ATTENTION = 1] When did [NAME FILL] most recently have attention or concentration
problems?
[WASIT_FILL]
1 In the past month
2 1 to 6 months ago
3 7 to 12 months ago
4 More than 12 months ago
DK/REF
PQ18
[IF ATTENTION = 1] When at their worst, how much did [PRONOUN2 FILL] attention or
concentration problems ever cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ18a Home life?
1
2
3
4
5
PQ18b Friendships?
1
2
3
4
5
PQ18c School or work?
1
2
3
4
5
DK/REF
PQ19
[IF ATTENTION = 1] During the past 12 months, how much did [PRONOUN2 FILL] attention or
concentration problems cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ19a Home life?
1
2
3
4
5
PQ19b Friendships?
1
2
3
4
5
PQ19c School or work?
1
2
3
4
5
DK/REF
PQ20
[IF ATTENTION = 1] How many teachers or other adults ever told you that [NAME FILL] had attention
or concentration problems?
__________ Number
DK/REF
10
[RANGE: 0–9999]
PQ21
[IF ATTENTION = 1] How many teachers or other adults ever encouraged you to see a doctor or other
professional about [PRONOUN2 FILL] attention or concentration problems?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ22
[IF ATTENTION = 1] Did [NAME FILL] receive professional treatment for attention or concentration
problems at any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ23
[IF ATTENTION = 1] Was [PRONOUN1 FILL] prescribed medication for attention or concentration
problems at any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ24
[IF ATTENTION = 1 AND PQ22 NE 1] Did [NAME FILL] ever receive professional treatment for
[PRONOUN2 FILL] attention or concentration problems?
1 Yes
2 No
DK/REF
PQ25
[IF ATTENTION = 1 AND PQ23 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for
attention or concentration problems?
1 Yes
2 No
DK/REF
11
Restlessness
PQ26
Begin Timestamp
Did [NAME FILL] ever have a time lasting six months or longer when [PRONOUN1 FILL] often had
any of the following problems with restlessness or impatience?
Yes
No
PQ26a Often was very restless or overly active?
1
2
PQ26b Usually fidgeted or squirmed a lot when sitting down?
1
2
PQ26c Often got up from [PRONOUN2 FILL] seat when not supposed to—like at dinner, at
school, or at religious services?
1
2
PQ26d Often blurted out answers before someone could finish asking the question?
1
2
PQ26e Had trouble playing quietly or doing quiet activities like reading or being read to for
more than a few minutes at a time?
1
2
DK/REF
PQ26
Yes
No
PQ26f Had a lot of trouble waiting [PRONOUN2 FILL] turn?
1
2
PQ26g Often was very active when not supposed to be—for example, climbing on things or
running around even after being asked to keep still?
1
2
PQ26h Often interrupted people or abruptly joined other people’s conversations without being
asked?
1
2
PQ26i Talked a lot more than other kids [PRONOUN2 FILL] age?
1
2
PQ26j Often tried to join games or other activities that were already happening?
1
2
DK/REF
DEFINE RESTLESS
IF PQ26a =1 OR PQ26b =1 OR PQ26c =1 OR PQ26d = 1 OR PQ26e = 1 OR PQ26f =1 OR PQ26g =1 OR PQ26h = 1 OR
PQ26i = 1 OR PQ26j =1, THEN RESTLESS = 1
ELSE RESTLESS = 2
PQ27
[IF RESTLESS = 1] About how old was [NAME FILL] when [PRONOUN1 FILL] first started having
problems with restlessness or impatience?
__________ Years Old
DK/REF
[RANGE: 1–CURNTAGE]
12
DEFINE PQ28_FILL
IF PQMODE=WEB, THEN FILL=“Enter 0 if [PRONOUN1 FILL] has had restlessness or impatience for less
than a year.”
IF PQMODE=TEL, THEN FILL=“ENTER 0 IF [PRONOUN1 FILL] HAS HAD PROBLEMS WITH
RESTLESSNESS OR IMPATIENCE FOR LESS THAN A YEAR.”
PQ28
[IF RESTLESS = 1] About how many years altogether has [PRONOUN1 FILL] had problems with
restlessness or impatience?
[PQ28_FILL]
__________ Number of Years
DK/REF
[RANGE: 0–CURNTAGE]
PQ29
[IF RESTLESS = 1] When did [NAME FILL] most recently have problems with restlessness or
impatience?
[WASIT_FILL]
1 In the past month
2 1 to 6 months ago
3 7 to 12 months ago
4 More than 12 months ago
DK/REF
PQ30
[IF RESTLESS = 1] When at their worst, how much did [PRONOUN2 FILL] problems with restlessness
or impatience ever cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ30a Home life?
1
2
3
4
5
PQ30b Friendships?
1
2
3
4
5
PQ30c School or work?
1
2
3
4
5
DK/REF
PQ31
[IF RESTLESS = 1] During the past 12 months, how much did [PRONOUN2 FILL] problems with
restlessness or impatience cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ31a Home life?
1
2
3
4
5
PQ31b Friendships?
1
2
3
4
5
PQ31c School or work?
1
2
3
4
5
DK/REF
PQ32
[IF RESTLESS = 1] How many teachers or other adults ever told you that [NAME FILL] had problems
with restlessness or impatience?
__________ Number
DK/REF
13
[RANGE: 0–9999]
PQ33
[IF RESTLESS = 1] How many teachers or other adults ever encouraged you or put pressure on you to
see a doctor or other professional about [PRONOUN2 FILL] problems with restlessness or impatience?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ34
[IF RESTLESS = 1] Did [NAME FILL] receive professional treatment for problems with restlessness or
impatience at any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ35
[IF RESTLESS = 1] Was [PRONOUN1 FILL] prescribed medication for problems with restlessness or
impatience at any time in the past 12 months?
1 Yes
2 No
D/REF
PQ36
[IF RESTLESS = 1 AND PQ34 NE 1] Did [NAME FILL] ever receive professional treatment for
problems with restlessness or impatience?
1 Yes
2 No
DK/REF
PQ37
[IF RESTLESS = 1 AND PQ35 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for
problems with restlessness or impatience?
1 Yes
2 No
DK/REF
14
Problems with Separation
PQ38
Begin Timestamp
Some children get very upset or clingy when they are separated from their mother or other loved ones
who look after them. Has [NAME FILL] ever had a time lasting one month or longer when
[PRONOUN1 FILL] had any of the following problems with separation?
Yes
No
PQ38a Often wanted to stay home from school or other places in order to stay near this
loved one?
1
2
PQ38b Often refused to go places if this person could not go with [PRONOUN3 FILL]?
1
2
PQ38c Sometimes begged this person to stay or to take [PRONOUN3 FILL] with them when
they had to leave for even a short period of time?
1
2
PQ38d Had a month or longer when [PRONOUN1 FILL] did not want to go to sleep unless
this person was near?
1
2
PQ38e Often had bad dreams about this person being hurt or something happening to
separate [PRONOUN3 FILL] from this person?
1
2
PQ38f Often got sick to [PRONOUN2 FILL] stomach or had headaches if this person was
going out or away from them?
1
2
Yes
No
PQ38g Got very sad, worried, or upset when separated from this person?
1
2
PQ38h Often feared that something bad like an accident might happen to this person?
1
2
PQ38i Often worried that something bad might happen to [PRONOUN4 FILL], like getting
lost or kidnapped, that would prevent [PRONOUN3 FILL] from seeing this person?
1
2
PQ38j Refused to sleep away from home, like at a friend’s house?
1
2
PQ38k Often worried that something else might happen, like having an accident or
becoming ill, to keep [PRONOUN3 FILL] from ever seeing this person again?
1
2
DK/REF
PQ38
DK/REF
DEFINE SEPARATION
IF PQ38a = 1 OR PQ38b =1 OR PQ38c = 1 OR PQ38d =1 OR PQ38e = 1 OR PQ38f = 1 OR PQ38g = 1 OR PQ38h =1 OR
PQ38i = 1 OR PQ38j = 1 OR PQ38k = 1, THEN SEPARATION = 1
ELSE SEPARATION = 2
PQ39
[IF SEPARATION = 1] Think of times lasting one month or longer, when these problems with
separation were the worst. During those times, how often did [NAME FILL] have worries about being
apart from [PRONOUN2 FILL] parent or parenting figure?
[WASIT_FILL]
1
2
3
4
Just about every day
Most days
About half the days
Less than half the days
15
DK/REF
PQ40
[IF SEPARATION = 1] How severe was the emotional distress caused by these worries?
[WASIT_FILL]
1 Mild
2 Moderate
3 Severe
4 Very severe
DK/REF
PQ41
[IF SEPARATION = 1] How often did [NAME FILL] feel so upset about being apart from [PRONOUN2
FILL] parent or parenting figure that nothing could cheer [PRONOUN3 FILL] up or calm [PRONOUN3
FILL] down?
[WASIT_FILL]
1 Often
2 Sometimes
3 Not very often
4 Never
DK/REF
PQ42
[IF SEPARATION = 1] How often did [NAME FILL] feel so upset about being apart from [PRONOUN2
FILL] parent or parenting figure that [PRONOUN1 FILL] could not carry out [PRONOUN2 FILL] daily
activities?
[WASIT_FILL]
1 Often
2 Sometimes
3 Not very often
4 Never
DK/REF
PQ43
[IF SEPARATION = 1] About how old was [PRONOUN1 FILL] the first time [PRONOUN1 FILL] had
frequent problems with separation from a parent or parenting figure?
__________ Years Old
DK/REF
[RANGE 0–CURNTAGE]
PQ44
[IF SEPARATION = 1] About how many different years did [NAME FILL] have problems of this sort
for a month or longer?
__________ Years
DK/REF
[RANGE: 0–CURNTAGE]
16
PQ45
[IF SEPARATION = 1] When did [PRONOUN1 FILL] most recently have problems of this sort for a
month or longer?
[WASIT_FILL]
1
2
3
4
DK/REF
PQ46
Within the past month
1 to 6 months ago
7 to 12 months ago
More than 12 months ago
[IF SEPARATION = 1] When at their worst, how much did [PRONOUN2 FILL] problems with
separation cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ46a Home life?
1
2
3
4
5
PQ46b Friendships?
1
2
3
4
5
PQ46c School or work?
1
2
3
4
5
DK/REF
PQ47
[IF SEPARATION = 1] In the past 12 months, how much did [PRONOUN2 FILL] problems with
separation cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ47a Home life?
1
2
3
4
5
PQ47b Friendships?
1
2
3
4
5
PQ47c School or work?
1
2
3
4
5
DK/REF
PQ48
[IF SEPARATION = 1] How many teachers or other adults ever told you that [NAME FILL] had
problems with separation?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ49
[IF SEPARATION = 1] How many teachers or other adults ever encouraged you or put pressure on you
to see a doctor or other professional about [PRONOUN2 FILL] problems with separation?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ50
[IF SEPARATION = 1] Did [NAME FILL] receive professional treatment for problems with separation
at any time in the past 12 months?
1 Yes
2 No
DK/REF
17
PQ51
[IF SEPARATION = 1] Was [PRONOUN1 FILL] prescribed medication for problems with separation at
any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ52
[IF SEPARATION = 1 AND PQ50 NE 1] Did [NAME FILL] ever receive professional treatment for
problems with separation?
1 Yes
2 No
DK/REF
PQ53
[IF SEPARATION = 1 AND PQ51 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for
problems with separation?
1 Yes
2 No
DK/REF
18
Low Mood
PQ54
Begin Timestamp
Has [NAME FILL] ever had episodes of low mood lasting two weeks or longer when most of the day,
nearly every day, [PRONOUN1 FILL] felt either sad, depressed, discouraged, or unable to enjoy the
things [PRONOUN1 FILL] usually enjoys?
1 Yes
2 No
DK/REF
PQ55
[IF PQ54 = 1] Think about times lasting two weeks or longer when [PRONOUN2 FILL] low mood was
worst. During those times, how often did [PRONOUN1 FILL] have any of the following problems?
All or
Almost All
the Time
Most of
the Time
Some of
the Time
A Little of
the Time
None of
the
Time
PQ55a Feeling sad or depressed?
1
2
3
4
5
PQ55b Feeling empty or hopeless?
1
2
3
4
5
PQ55c Feeling discouraged about how things
were going in [PRONOUN2 FILL] life?
1
2
3
4
5
PQ55d Taking little or no interest or becoming
bored with almost everything like school, work,
hobbies and things [PRONOUN1 FILL] likes to
do for fun?
1
2
3
4
5
PQ55e Feeling irritable, grouchy, or in a bad
mood?
1
2
3
4
5
PQ55f Feeling down on [PRONOUN4 FILL], no
good, or worthless?
1
2
3
4
5
DK/REF
PQ55
All or
Almost
All the
Time
Most of
the Time
Some of
the Time
A Little of
the Time
None of
the Time
PQ55g Having a lot more trouble concentrating,
thinking, or making decisions than usual?
1
2
3
4
5
PQ55h Talking a lot about death or making a
suicide attempt?
1
2
3
4
5
PQ55i Having a lot more trouble than usual
either falling asleep, staying asleep, waking too
early, or sleeping a lot more nearly every night?
1
2
3
4
5
PQ55j Feeling tired out, low in energy or easily
fatigued?
1
2
3
4
5
PQ55k Talking or moving more slowly than
usual?
1
2
3
4
5
PQ55l Having a poor appetite?
1
2
3
4
5
19
1
PQ55m [IF PQ55l = 4 OR 5] Eating more than
usual or having an increased appetite?
2
3
4
5
DK/REF
DEFINE MOOD
IF (((PQ55a = 1 OR 2) OR (PQ55b =1 OR 2) OR (PQ55c =1 OR 2)) OR (PQ55d = 1 OR 2) OR (PQ55e = 1 OR 2)) AND
ATLEAST 3 PQ55f-PQ55m = 1 OR 2 OR 3, THEN MOOD =1
ELSE MOOD = 2
PQ56
[IF MOOD = 1] About how old was [NAME FILL] when [PRONOUN1 FILL] first had an episode
lasting two weeks or longer when most of the time [PRONOUN1 FILL] was in a low mood and had some
of the other problems in the previous series of questions?
__________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
PQ57
[IF MOOD = 1] About how many years altogether did [PRONOUN1 FILL] have these episodes?
__________ Number of Years
DK/REF
[RANGE: 0–CURNTAGE]
PQ58
[IF MOOD= 1] Now think about [PRONOUN2 FILL] worst episode.
How severe was the emotional distress caused by the low mood episode?
[WASIT_FILL]
1 Mild
2 Moderate
3 Severe
4 Very severe
DK/REF
PQ59
[IF MOOD = 1] When did [NAME FILL] most recently have an episode of this sort that lasted two
weeks or longer?
[WASIT_FILL]
1 In the past month
2 1 to 6 months ago
3 7 to 12 months ago
4 More than 12 months ago
DK/REF
PQ60
[IF MOOD = 1] How much did these episodes of low mood ever cause difficulties in each of the
following areas?
PQ60a Home life?
Not at All
A Little
Some
A Lot
Extremely
1
2
3
4
5
20
PQ60b Friendships?
1
2
3
4
5
PQ60c School or work?
1
2
3
4
5
DK/REF
PQ61
[IF MOOD = 1] During the past 12 months, how much did these episodes of low mood cause difficulties
in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ61a Home life?
1
2
3
4
5
PQ61b Friendships?
1
2
3
4
5
PQ61c School or work?
1
2
3
4
5
DK/REF
PQ62
[IF MOOD = 1] How many teachers or other adults ever told you that [NAME FILL] had problems with
low mood?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ63
[IF MOOD = 1] How many teachers or other adults ever encouraged you or put pressure on you to see a
doctor or other professional about [PRONOUN2 FILL] low mood?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ64
[IF MOOD = 1] Did [NAME FILL] receive professional treatment for low mood at any time in the past
12 months?
1 Yes
2 No
DK/REF
PQ65
[IF MOOD = 1] Was [PRONOUN1 FILL] prescribed medication for low mood at any time in the past 12
months?
1 Yes
2 No
DK/REF
PQ66
[IF MOOD = 1 AND PQ64 NE 1] Did [NAME FILL] ever receive professional treatment for low mood?
1 Yes
2 No
DK/REF
21
PQ67
[IF MOOD = 1 AND PQ65 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for low mood?
1 Yes
2 No
DK/REF
22
Anger and Disobedience
PQ68
Begin Timestamp
How often has [NAME FILL] ever in [PRONOUN2 FILL] life had any of the following problems with
anger or disobedience?
[AOPSG_FILL]
Very Often
Often
Sometimes
Rarely
Never
PQ68a Losing [PRONOUN2 FILL] temper?
1
2
3
4
5
PQ68b Arguing with or “talking back” to
adults?
1
2
3
4
5
PQ68c Disobeying rules at home, school, or
work?
1
2
3
4
5
PQ68d Getting angry?
1
2
3
4
5
PQ68e Refusing to follow directions from
adults like parents, teachers, or bosses?
1
2
3
4
5
PQ68f Feeling [PRONOUN1 FILL] was being
taken advantage of or being treated unfairly?
1
2
3
4
5
DK/REF
PQ68
[AOPSG_FILL]
Very Often
Often
Sometimes
Rarely
Never
PQ68g Annoying people on purpose by
doing or saying things just to bother them?
1
2
3
4
5
PQ68h Blaming others for [PRONOUN2
FILL] mistakes or bad behavior?
1
2
3
4
5
PQ68i Doing mean things to pay people
back for things they did that [PRONOUN1
FILL] did not like?
1
2
3
4
5
PQ68j Getting mad easily at the way
[PRONOUN1 FILL] was treated by others?
1
2
3
4
5
PQ68k Getting easily annoyed by others?
1
2
3
4
5
DK/REF
DEFINE ANGER
IF (PQ68a = 1 OR 2 OR 3) OR (PQ68b = 1 OR 2 OR 3) OR (PQ68c = 1 OR 2 OR 3) OR ((PQ68d = 1 OR 2 OR 3) OR
(PQ68k = 1 OR 2 OR 3)) OR (PQ68e = 1 OR 2 OR 3) OR (PQ68f = 1 OR 2 OR 3) OR (PQ68g = 1 OR 2 OR 3) OR
(PQ68h = 1 OR 2 OR 3) OR (PQ68i = 1 OR 2 OR 3) OR (PQ68j = 1 OR 2 OR 3) THEN ANGER = 1
ELSE ANGER = 2
PQ69
[IF ANGER = 1] About how old was [NAME FILL] when [PRONOUN1 FILL] first started having
problems with anger or disobedience?
23
__________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
DEFINE PQ70_FILL
IF PQMODE=WEB, THEN FILL=“Enter 0 if [PRONOUN1 FILL] has had problems with anger or disobedience
for less than a year.”
IF PQMODE=TEL, THEN FILL=“ENTER 0 IF [PRONOUN1 FILL] HAS HAD PROBLEMS WITH ANGER
OR DISOBEDIENCE FOR LESS THAN A YEAR.”
PQ70
[IF ANGER = 1] About how many years altogether has [PRONOUN1 FILL] had problems with anger or
disobedience?
[PQ70_FILL]
__________ Number of Years
DK/REF
[RANGE: 0–CURNTAGE]
PQ71
[IF ANGER = 1] When did [NAME FILL] most recently have problems with anger or disobedience?
[WASIT_FILL]
1 In the past month
2 1 to 6 months ago
3 7 to 12 months ago
4 More than 12 months ago
DK/REF
PQ72
[IF ANGER = 1] When at their worst, how much did [PRONOUN2 FILL] problems with anger or
disobedience cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ72a Home life?
1
2
3
4
5
PQ72b Friendships?
1
2
3
4
5
PQ72c School or work?
1
2
3
4
5
DK/REF
PQ73
[IF ANGER = 1] During the past 12 months, how much did [PRONOUN2 FILL] problems with anger or
disobedience cause difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ73a Home life?
1
2
3
4
5
PQ73b Friendships?
1
2
3
4
5
PQ73c School or work?
1
2
3
4
5
DK/REF
24
PQ74
[IF ANGER = 1] How many teachers or other adults ever told you that [NAME FILL] had problems with
anger or disobedience?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ75
[IF ANGER = 1] How many teachers or other adults ever encouraged you or put pressure on you to see a
doctor or other professional about [PRONOUN2 FILL] problems with anger or disobedience?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ76
[IF ANGER = 1] Did [NAME FILL] receive professional treatment for problems with anger or
disobedience at any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ77
[IF ANGER = 1] Was [PRONOUN1 FILL] prescribed medication for problems with anger or
disobedience at any time in the past 12 months?
1 Yes
2 No
DK/REF
PQ78
[IF ANGER = 1 AND PQ76 NE 1] Did [NAME FILL] ever receive professional treatment for problems
with anger or disobedience?
1 Yes
2 No
DK/REF
PQ79
[IF ANGER = 1 AND PQ77 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for problems
with anger or disobedience?
1 Yes
2 No
DK/REF
25
Breaking Rules
PQ80
Begin Timestamp
Many children go through times when they have behavior problems. Was there ever a time when [NAME
FILL] had any of the following behavior problems?
Yes
No
PQ80a Often “bullied,” threatened, or frightened people, including smaller or younger kids?
1
2
PQ80b Repeatedly started and got involved in physical fights?
1
2
PQ80c Used a weapon on another person, like a baseball bat, glass bottle, knife, gun, or brick?
1
2
PQ80d Was physically cruel to a person and hurt them on purpose?
1
2
PQ80e Was physically cruel to an animal and hurt it on purpose?
1
2
DK/REF
PQ80
Yes
No
PQ80f Ever robbed, mugged, or forcibly taken something from someone by threatening him or
her?
1
2
PQ80g Ever made anyone do something sexual by either forcing or threatening them?
1
2
PQ80h Set a fire to try to cause serious damage?
1
2
PQ80i Other than by setting fires, deliberately damaged someone else’s property by doing
something like breaking windows, slashing tires, vandalizing, or writing graffiti on buildings?
1
2
Yes
No
PQ80j Broke into someone’s locked car or a locked home or building?
1
2
PQ80k Often got out of doing things [PRONOUN1 FILL] was supposed to do by fooling people
or lying to them?
1
2
PQ80l Often told lies to trick people into giving [PRONOUN3 FILL] things or doing what
[PRONOUN1 FILL] wanted them to do?
1
2
PQ80m Shoplifted or stole something worth at least $20?
1
2
Yes
No
PQ80n Ran away from home overnight more than once?
1
2
PQ80o Ran away from home and stayed away for at least four days?
1
2
PQ80p Before age thirteen, often stayed out three hours or more at night without permission?
1
2
PQ80q Before age thirteen, often skipped school without permission?
1
2
DK/REF
PQ80
Was there ever a time when [NAME FILL] had any of the following behavior problems?
DK/REF
PQ80
DK/REF
26
DEFINE BEHAVIOR
IF PQ80a = 1 OR PQ80b =1 OR PQ80c = 1 OR PQ80d = 1 OR PQ80e =1 OR PQ80f = 1 OR PQ80g =1 OR PQ80h = 1 OR
PQ80i =1 OR PQ80j = 1 OR PQ80k = 1 OR PQ80l = 1 OR PQ80m = 1 OR PQ80n =1 OR PQ80o =1 OR PQ80p = 1 OR
PQ80q = 1, THEN BEHAVIOR = 1
ELSE BEHAVIOR = 2
PQ81
[IF BEHAVIOR = 1] About how old was [NAME FILL] when [PRONOUN1 FILL] first started having
any of these behavior problems?
__________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
DEFINE PQ82_FILL
IF PQMODE=WEB, THEN FILL=“Enter 0 if [PRONOUN1 FILL] has had behavior problems for less than a
year.”
IF PQMODE=TEL, THEN FILL=“ENTER 0 IF [PRONOUN1 FILL] HAS HAD BEHAVIOR PROBLEMS
FOR LESS THAN A YEAR.”
PQ82
[IF BEHAVIOR = 1] About how many years altogether had [PRONOUN1 FILL] had behavior
problems?
[PQ82_FILL]
__________ Number of Years
DK/REF
[RANGE: 0–CURNTAGE]
PQ83
[IF BEHAVIOR = 1] When did [NAME FILL] most recently have behavior problems?
[WASIT_FILL]
1 In the past month
2 1 to 6 months ago
3 7 to 12 months ago
4 More than 12 months ago
DK/REF
PQ84
[IF BEHAVIOR = 1] How much did these behavior problems ever cause difficulties in each of the
following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ84a Home life?
1
2
3
4
5
PQ84b Friendships?
1
2
3
4
5
PQ84c School or work?
1
2
3
4
5
DK/REF
27
PQ85
[IF BEHAVIOR = 1] During the past 12 months, how much did these behavior problems ever cause
difficulties in each of the following areas?
Not at All
A Little
Some
A Lot
Extremely
PQ85a Home life?
1
2
3
4
5
PQ85b Friendships?
1
2
3
4
5
PQ85c School or work?
1
2
3
4
5
DK/REFPQ86
problems?
[IF BEHAVIOR = 1] How many teachers or other adults ever told you that [NAME FILL] had behavior
__________ Number
DK/REF
[RANGE: 0–9999]
PQ87
[IF BEHAVIOR = 1] How many teachers or other adults ever encouraged you or put pressure on you to
see a doctor or other professional about [PRONOUN2 FILL] behavior problems?
__________ Number
DK/REF
[RANGE: 0–9999]
PQ88
[IF BEHAVIOR = 1] Did [NAME FILL] receive professional treatment for behavior problems at any
time in the past 12 months?
1 Yes
2 No
DK/REF
PQ89
[IF BEHAVIOR = 1] Was [PRONOUN1 FILL] prescribed medication for these behavior problems at any
time in the past 12 months?
1 Yes
2 No
DK/REF
PQ90
[IF BEHAVIOR = 1 AND PQ88 NE 1] Did [NAME FILL] ever receive professional treatment for
behavior problems?
1 Yes
2 No
DK/REF
PQ91
[IF BEHAVIOR = 1 AND PQ89 NE 1] Was [PRONOUN1 FILL] ever prescribed medication for
behavior problems?
1 Yes
2 No
DK/REF
28
Services
Begin Timestamp
DEFINE PQ92_FILL
IF PQMODE=TEL, THEN FILL=“AS NECESSARY, REPEAT THE QUESTION”
ELSE, FILL=“”
PQ92
Not counting times spent overnight, has [NAME FILL] ever received counseling or medication from any
of the following sources for problems with emotions, behavior, or mental health?
[PQ92_FILL]
Yes
No
1
2
1
2
1
2
1
2
Yes
No
PQ92e Partial hospitalization or day treatment program?
1
2
PQ92f Probation or juvenile corrections officer or court counselor?
1
2
PQ92g A minister, priest, rabbi or other spiritual advisor?
1
2
PQ92h A Certified Peer Counselor?
1
2
PQ92a Telephone hotline or computerized or internet-based mental health treatment program?
A “computerized or internet-based mental health treatment program” is a special type of self-help
program where you work through exercises that give you practice in strategies that can help you
improve your mental health. Sometimes these programs are accompanied by telephone calls or
texting sessions with mental health professionals. When this is the case, we want you to report both
receiving counseling from a mental health professional and participating in a computerized or
internet-based program.
PQ92b A self-help or support group for problems with emotions, behavior or mental health?
A “self-help or support group” for people with problems with emotions, behavior or mental health
is a group run by the people themselves without a mental health professional leading the group.
PQ92c A mental health professional?
A “mental health professional” includes a psychiatrist, psychologist, mental health counselor or
social worker, and marriage and family counselor. These professionals can be seen in one-on-one
sessions, group sessions, telephone sessions, or computerized texting sessions.
PQ92d A general medical doctor, pediatrician, nurse, or other general medical care provider?
DK/REF
PQ92
A “Certified Peer Counselor” is a person who has experienced mental health issues firsthand and
has been trained to help facilitate mental health recovery in others.
DK/REF
PROFESSIONAL SERVICES1_FILL
IF PQ92a = 1, THEN FILL “a telephone hotline or computerized or internet-based mental health treatment program”
IF PQ92b = 1, THEN FILL “a self-help or support group”
IF PQ92c = 1, THEN FILL “a mental health professional”
29
IF PQ92d = 1, THEN FILL “a general medical doctor, pediatrician, nurse, or other general medical care provider”
IF PQ92e = 1, THEN FILL “a partial hospitalization or day treatment program”
IF PQ92f = 1, THEN FILL “a probation or juvenile corrections officer or court counselor”
IF PQ92g = 1, THEN FILL “a minister, priest, rabbi or other spiritual advisor”
IF PQ92h = 1, THEN FILL “a certified peer counselor”
PROFESSIONAL SERVICES2 FILL
IF PQ92a = 1, THEN FILL “used a telephone hotline or computerized or internet-based mental health treatment program”
IF PQ92b = 1, THEN FILL “went to a self-help or support group”
IF PQ92c = 1, THEN FILL “saw a mental health professional”
IF PQ92d = 1, THEN FILL “saw a general medical doctor, pediatrician, nurse, or other general medical care provider”
IF PQ92e = 1, THEN FILL “went to a partial hospitalization or day treatment program”
IF PQ92f = 1, THEN FILL “saw a probation or juvenile corrections officer or court counselor”
IF PQ92g = 1, THEN FILL “saw a minister, priest, rabbi or other spiritual advisor”
IF PQ92h = 1, THEN FILL “saw a certified peer counselor”
PQ93a
[IF PQ92a = 1] The next questions are about the service [NAME FILL] received from [PROFESSIONAL
SERVICES FILL].
How old was [PRONOUN1 FILL] when [PRONOUN1 FILL] first [PROFESSIONAL SERVICE2 FILL]
for problems with emotions, behavior, or mental health?
_________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
PROFESSIONAL SERVICES3 FILL
IF PQ92a = 1, THEN FILL “used a telephone hotline or computerized or internet-based mental health treatment program”
IF PQ92b = 1, THEN FILL “gone to a self-help or support group”
IF PQ92c = 1, THEN FILL “seen a mental health professional”
IF PQ92d = 1, THEN FILL “seen a general medical doctor, pediatrician, nurse, or other general medical care provider”
IF PQ92e = 1, THEN FILL “gone to a partial hospitalization or day treatment program”
IF PQ92f = 1, THEN FILL “seen a probation or juvenile corrections officer or court counselor”
IF PQ92g = 1, THEN FILL “seen a minister, priest, rabbi or other spiritual advisor”
IF PQ92h = 1, THEN FILL “seen a certified peer counselor”
PQ94a
[IF PQ92a = 1] How many times has [PRONOUN1 FILL] [PROFESSIONAL SERVICES3 FILL] in
[PRONOUN2 FILL] lifetime for problems with emotions, behavior, or mental health?
__________ Number of Visits
DK/REF
[RANGE: 0–9999]
30
PROFESSIONAL SERVICES4 FILL
IF PQ92a = 1, THEN FILL “use a telephone hotline or computerized or internet-based mental health treatment program”
IF PQ92b = 1, THEN FILL “go to a self-help or support group”
IF PQ92c = 1, THEN FILL “see a mental health professional”
IF PQ92d = 1, THEN FILL “see a general medical doctor, pediatrician, nurse, or other general medical care provider”
IF PQ92e = 1, THEN FILL “go to a partial hospitalization or day treatment program”
IF PQ92f = 1, THEN FILL “see a probation or juvenile corrections officer or court counselor”
IF PQ92g = 1, THEN FILL “see a minister, priest, rabbi or other spiritual advisor”
IF PQ92h = 1, THEN FILL “see a certified peer counselor”
PQ95a
[IF PQ92a = 1] During the past 12 months, did [PRONOUN1 FILL] [PROFESSIONAL SERVICES4
FILL] for problems with emotions, behavior, or mental health?
1 Yes
2 No
DK/REF
PQ96a
[PQ95a = 1] How many times has [NAME FILL] [PROFESSIONAL SERVICES3 FILL] in the past 12
months for problems with emotions, behavior, or mental health?
________ Number of Visits
DK/REF
[RANGE: 0–9999]
PROGRAMMER: CYCLE THROUGH PREVIOUS FOUR QUESTIONS FOR ALL “Yes” RESPONSES FOR PQ92aPQ92h. VARIABLE NAMES WILL BE PQ93b, PQ93c, ETC TO MATCH PQ92 SERIES.
PQ97
Not counting times spent overnight, did [NAME FILL] ever receive services from any of the following
types of professionals for problems with substance use?
Yes
No
PQ97a Professional counseling, including counseling received at an outpatient drug or alcohol
clinic?
1
2
PQ97b A self-help group for substance use problems, such as a 12-step program?
1
2
DK/REF
PROFESSIONAL SERVICES5 FILL
IF PQ97a = 1, THEN FILL “an outpatient drug or alcohol clinic”
IF PQ97b = 1, THEN FILL “a self-help group”
PQ98a
[IF PQ97a = 1] The next questions are about the service [NAME FILL] received from [PROFESSIONAL
SERVICES5 FILL].
How old was [PRONOUN1 FILL] when [PRONOUN1 FILL] first went to [PROFESSIONAL
SERVICES5 FILL] for substance use problems?
31
_________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
PQ99a
[IF PQ97a = 1] How many times has [PRONOUN1 FILL] gone to [PROFESSIONAL SERVICES5
FILL] in [PRONOUN2 FILL] lifetime for substance use problems?
__________ Number of Visits
DK/REF
[RANGE: 0–9999]
PQ100a
[IF PQ97a = 1] During the past 12 months, did [PRONOUN1 FILL] go to [PROFESSIONAL
SERVICES5 FILL] for substance use problems?
1 Yes
2 No
DK/REF
PQ101a
[PQ100a = 1] How many times has [NAME FILL] gone to [PROFESSIONAL SERVICES5 FILL] in the
past 12 months for substance use problems?
________ Number of Visits
DK/REF
[RANGE: 0–9999]
PROGRAMMER: CYCLE THROUGH PREVIOUS FOUR QUESTIONS FOR ALL “Yes” RESPONSES FOR PQ97a
AND PQ97b. VARIABLE NAMES WILL BE PQ98b, PQ99b, ETC TO MATCH PQ97 SERIES.
PQ102
Was [NAME FILL] ever kept overnight in any of the following facilities for problems with emotions,
behavior, or mental health?
Yes
No
PQ102a General medical hospital?
1
2
PQ102b Emergency room?
1
2
PQ102c Residential treatment center or group home?
1
2
PQ102d Foster home or therapeutic foster care?
1
2
PQ102e Detention center, prison, or jail?
1
2
PQ102f Psychiatric hospital?
1
2
PQ102g Some other type of facility?
1
2
DK/REF
FACILITY FILL
IF PQ102a = 1, THEN FILL “a general medical hospital”
IF PQ102b = 1, THEN FILL “an emergency room”
IF PQ102c = 1, THEN FILL “a residential treatment center or group home”
32
IF PQ102d = 1, THEN FILL “a foster home or therapeutic foster care”
IF PQ102e = 1, THEN FILL “a detention center, prison, or jail”
IF PQ102f = 1, THEN FILL “a psychiatric hospital”
IF PQ102g = 1, THEN FILL “some other facility”
PQ103a
[IF PQ102a = 1] The next questions are about the time [NAME FILL] spent overnight in [FACILITY
FILL].
How old was [PRONOUN1 FILL] when [PRONOUN1 FILL] first spent the night in this type of facility
for problems with emotions, behavior, or mental health?
__________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
PQ104a
[IF PQ102a = 1] How many times was [PRONOUN 1 FILL] admitted to stay overnight in [FACILITY
FILL] to receive treatment for problems with emotions, behavior, or mental health. Your best estimate is
fine if you cannot remember the exact number.
__________ Number of Times
DK/REF
[RANGE: 1–150]
PQ105a
[IF PQ102a = 1] What is the total number of days [NAME FILL] ever spent in [FACILITY FILL] for
problems with emotions, behavior, or mental health?
__________ Number of Days
DK/REF
[RANGE: 0–9999]
PQ106a
[IF PQ102a = 1] During the past 12 months, did [NAME FILL] stay overnight in [FACILITY FILL] to
receive treatment for problems with emotions, behavior, or mental health?
1
Yes
2
No
DK/REF
PQ107a
[IF PQ106a = 1] What is the total number of days [PRONOUN1 FILL] spent in [FACILITY FILL] in the
past 12 months for problems with emotions, behavior, or mental health?
________ Number of Days
DK/REF
[RANGE: 0–365]
PROGRAMMER: CYCLE THROUGH PREVIOUS FIVE QUESTIONS FOR ALL “Yes” RESPONSES FOR PQ102aPQ102g. VARIABLE NAMES WILL BE PQ103b, PQ103c, ETC TO MATCH PQ102 SERIES.
33
PQ108
Was [NAME FILL] ever kept overnight in any of the following facilities for substance use problems?
Yes
No
PQ108a Drug or alcohol treatment unit?
1
2
PQ108b Emergency room?
1
2
PQ108c Psychiatric or general medical hospital?
1
2
DK/REF
FACILITY2 FILL
IF PQ108a = 1, THEN FILL “a drug or alcohol treatment unit”
IF PQ108b = 1, THEN FILL “an emergency room”
IF PQ108c = 1, THEN FILL “a psychiatric or general medication hospital”
PQ109a
[IF PQ108a = 1] The next questions are about the time [NAME FILL] spent overnight in [FACILITY
FILL].
How old was [PRONOUN1 FILL] when [PRONOUN1 FILL] first spent the night [FACILITY2 FILL]
for substance use problems?
__________ Years Old
DK/REF
[RANGE: 0–CURNTAGE]
PQ110a
[IF PQ108a = 1] How many times was [PRONOUN1 FILL] admitted to stay overnight in [FACILITY2
FILL] to receive treatment for substance use problems. Your best estimate is fine if you cannot remember
the exact number.
__________ Number of Times
DK/REF
[RANGE: 1–150]
PQ111a
[IF PQ108a = 1] What is the total number of days [NAME FILL] ever spent in [FACILITY2 FILL] for
substance use problems?
__________ Number of Days
DK/REF
[RANGE: 0–9999]
PQ112a
[IF PQ108a = 1] During the past 12 months, did [NAME FILL] stay overnight in [FACILITY2 FILL] to
receive treatment for substance use problems?
1
Yes
2
No
DK/REF
PQ113a
[IF PQ112a = 1] What is the total number of days [PRONOUN1 FILL] spent in [FACILITY2 FILL] in
the past 12 months for substance use problems?
34
________ Number of Days
DK/REF
[RANGE: 0–365]
PROGRAMMER: CYCLE THROUGH PREVIOUS FIVE QUESTIONS FOR ALL “Yes” RESPONSES FOR PQ108aPQ108c. VARIABLE NAMES WILL BE PQ109b, PQ109c, ETC TO MATCH PQ108 SERIES.
PQ114
[IF ANY PQ102a – PQ102g = 1] Is [NAME FILL] still receiving services for emotions, behavior, or
mental health? Or has [PRONOUN1 FILL] stopped receiving services?
1
Still receiving
2
Stopped receiving
DK/REF
PQ115
[IF PQ114 = 2] How important was each of the following reasons for why [NAME FILL] stopped
receiving services for emotions, behavior, or mental health?
[AOPSG_FILL]
PQ115a [PRONOUN1 FILL] got better and no
longer needed help
PQ115b It was not helping; [PRONOUN1
FILL] was not getting better
PQ115c Financial reasons
PQ115d Inconvenience—for example,
problems with time, transportation, or
scheduling
PQ115e Embarrassment or concern about what
people would think if they knew
[PRONOUN1 FILL] was in treatment
PQ115f [NAME FILL] and I preferred to
handle the problem on our own or
with the help of family and friends
DK/REF
PQ116
Very
Important
Somewhat
Important
Not Very
Important
Not at All
Important
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
[IF PQ114 = 2] Was there some other important reason why [NAME FILL] stopped receiving services
for [PRONOUN2 FILL] emotions, behavior or mental health?
1 Yes
2 No
DK/REF
PQ117
[IF PQ116 = 1] Please briefly describe the other reason why [NAME FILL] stopped.
__________________ Other Important Reason [RANGE: 1–100 CHARACTERS]
DK/REF
PQ118
Did a teacher or other adult ever encourage you to take [NAME FILL] to a professional to get help for
problems with [PRONOUN2 FILL] emotions, behavior, or mental health?
35
1 Yes
2 No
DK/REF
PQ119
[IF PQ118 = 1] How old was [NAME FILL] when someone first encouraged you in this way?
__________ Years Old [RANGE: 0–CURNTAGE]
DK/REF
PQ120
Has [PRONOUN1 FILL] ever in [PRONOUN2 FILL] life received special testing or an evaluation for
problems with [PRONOUN2 FILL] emotions, behavior, or mental health?
1 Yes
2 No
DK/REF
PQ121
[IF PQ120 = 1] About how old was [PRONOUN1 FILL] the very first time [PRONOUN1 FILL] received
special testing or an evaluation for problems with [PRONOUN2 FILL] emotions, behavior, or mental health?
Your best estimate is fine if you cannot remember [PRONOUN1 FILL] exact age.
________ Years Old [RANGE: 0–CURNTAGE]
DK/REF
PQ122
[IF PQ121 = CURNTAGE – 1] Did [PRONOUN1 FILL] start this testing in the past 12 months or more than
12 months ago?
1
Past 12 months
2
More than 12 months ago
DK/REF
36
Family and Medical History
PQ123
Begin Timestamp
Please indicate whether [NAME FILL] has any of the following conditions.
Yes
No
PQ123a A learning disability?
1
2
PQ123b An intellectual disability, sometimes referred to as mental retardation?
1
2
PQ123c A speech or language delay?
1
2
PQ123d Congenital blindness?
1
2
PQ123e A hearing impairment or deafness?
1
2
PQ123f [IF PQ123e = 1] Hearing corrected with a hearing aid or cochlear implant?
1
2
Yes
No
PQ123g A developmental delay?
1
2
PQ123h Autism spectrum disorder, including Asperger’s?
1
2
PQ123i PDD-NOS or Pervasive Developmental Disorder-Not Otherwise Specified?
1
2
PQ123j A seizure disorder or Epilepsy?
1
2
PQ123k Cerebral Palsy?
1
2
Yes
No
PQ123l Down Syndrome?
1
2
PQ123m Bipolar Disorder or Manic-depression?
1
2
PQ123n Depression?
1
2
PQ123o An anxiety disorder, such as a Phobia, Panic Disorder, Generalized Anxiety
Disorder, Posttraumatic Stress Disorder, or other anxiety disorder?
1
2
PQ123p Panic attacks, also known as anxiety attacks?
1
2
PQ123q Obsessive Compulsive Disorder?
1
2
Yes
No
PQ123r Schizophrenia?
1
2
PQ123s Self-injuring behavior?
1
2
DK/REF
PQ123
DK/REF
PQ123
DK/REF
PQ123
Please indicate whether [NAME FILL] has any of the following conditions.
37
PQ123t Attention deficit hyperactivity disorder, also called ADHD?
1
2
PQ123u A behavioral disorder, such as Oppositional Defiant Disorder, Conduct
Disorder, or other behavioral disorder?
1
2
PQ123v Problems with anger control?
1
2
PQ123w Alcohol or drug problems?
1
2
Yes
No
PQ123x An eating disorder, such as Bulimia, Anorexia, or other eating disorder?
1
2
PQ123y Disrupted sleep patterns?
1
2
PQ123z Tourette Syndrome?
1
2
PQ123aa Allergies, including food, drug, insect, or other types?
1
2
PQ123bb Arthritis?
1
2
Yes
No
PQ123cc Asthma?
1
2
PQ123dd Blood disorders, such as Sickle Cell Disease, Thalassemia or Hemophilia?
1
2
PQ123ee Cystic Fibrosis?
1
2
PQ123ff Diabetes?
1
2
PQ123gg Heart Condition?
1
2
1
2
DK/REF
PQ123
DK/REF
PQ123
PQ 123hh Frequent severe headaches, including migraines
DK/REF
PQ124
How many times has [PRONOUN1 FILL] ever had a head injury or concussion?
_______ Number of Times
[RANGE: 0–9999]
DK/REF
PQ125
Using a scale from 0 to 10 where 0 means the worst possible health and 10 means the best possible
health, how would you rate [PRONOUN2 FILL] overall…
Rating
PQ125a physical health?
RANGE: 0–10
PQ125b mental health?
RANGE: 0–10
DK/REF
38
PQ126
Has [NAME FILL] ever had a parental figure who played a major role in raising [PRONOUN3 FILL]
who was not [PRONOUN2 FILL] biological parent?
1 Yes
2 No
DK/REF
PQ126a
How many parental figures helped raised [NAME FILL] who were not [PRONOUN2 FILL] biological
parent?
__________ RANGE (1-4)
DK/REF
PQ127
[IF PQ126a > 1 AND FIRST ROTATION THROUGH THESE QUESTIONS ONLY] We are going to
ask a few questions about each of these parental figures. Please think of one of these parental figures
when answering the following questions.
[SUBSEQUENT ROTATIONS THROUGH THESE QUESTIONS] Now think of the next parent figure
who played a major role in raising [NAME FILL].
[IF PQ2 NE 2 AND PQ126b = 1] Who was the parental figure who was not [PRONOUN2 FILL]
biological parent who played a major role in raising [PRONOUN3 FILL]?
[IF PQ2 = 2 AND PQ126b = 1] Who was the parental figure who was not you who played a major role in
raising [PRONOUN3 FILL]?
[ALL] Was it [PRONOUN2 FILL]…
1 Step, adoptive, or common law father
2 Step, adoptive, or common law mother
3 Foster father
4 Foster mother
5 Grandfather or another male blood relative of [PRONOUN5 FILL]
6 Grandmother or another female blood relative of [PRONOUN5 FILL]
7 Male friend of the family who is not a blood relative
8 Female friend of the family who is not a blood relative
9 Male case worker, teacher, or other professional
10 Female case worker, teacher, or other professional
DK/REF
PQ128
[IF PQ2 NE 2 AND PQ127 = 1 OR 3 OR 5 OR 7 OR 9] How many years has [NAME FILL] lived with
this father figure who was not [PRONOUN2 FILL] biological father?
[IF PQ2 = 2 AND PQ127 = 1 OR 3 OR 5 OR 7 OR 9] How many years has [NAME FILL] lived with
this father figure who was not you?
________ Number of Years
[RANGE: 0–CURNTAGE]
DK/REF
39
PQ129
[IF PQ2 NE 1 AND PQ127 = 2 OR 4 OR 6 OR 8 OR 10] How many years has [NAME FILL] lived with
this mother figure who was not [PRONOUN2 FILL] biological mother?
[IF PQ2 = 1 AND PQ127 = 2 OR 4 OR 6 OR 8 OR 10] How many years has [NAME FILL] lived with
this mother figure who was not you?
__________ Number of Years
[RANGE: 0–CURNTAGE]
DK/REF
PROGRAMMER: CYCLE THROUGH PQ127 – PQ129 ONCE FOR EACH PARENTAL FIGURE REPORTED IN
PQ126a. REPEATED QUESTIONS CAN BE DIFFERENTATED BY LETTERS, I.E. PQ127a, PQ128a,
PQ127b, PQ128b, ETC.
PQ132
[IF PQ2 NE 2] The next questions are about the physical health of [PRONOUN2 FILL] biological
parents. First, please think about [NAME FILL]’s biological father.
Is [PRONOUN2 FILL] biological father still alive?
1 Yes
2 No
DK/REF
PQ133
[IF PQ132 = 2] How did [PRONOUN2 FILL] biological father die?
1 Illness
2 Accident or injury
3 Murder
4 Suicide
DK/REF
PQ134
[IF PQ2 NE 2 AND PQ132 = 1] During the years he has helped to raise [NAME FILL], how much have
problems with his physical health interfered with his daily activities?
[IF PQ2 NE 2 AND PQ132 = 2] During the years he helped to raise [NAME FILL], how much did
problems with his physical health interfere with his daily activities?
[IF PQ2 = 2] The next questions are about the physical health of [PRONOUN2 FILL] biological parents.
During the years you have helped to raise [NAME FILL], how much have problems with your physical
health interfered with your daily activities?
[WASIT_FILL]
1 A lot
2 Some
3 A little
4 Not at all
5 [IF PQ2 NE 2] [PRONOUN2 FILL] biological father did not help to raise [PRONOUN3 FILL]
DK/REF
40
PQ135
[IF PQ2 NE 1] Now, please think about [NAME FILL]’s biological mother.
Is [PRONOUN2 FILL] biological mother still alive?
1 Yes
2 No
DK/REF
PQ136
[IF PQ135 = 2] How did [PRONOUN2 FILL] biological mother die?
[WASIT_FILL]
1 Illness
2 Accident or injury
3 Murder
4 Suicide
DK/REF
PQ137
[IF PQ2 NE 1 AND PQ135 = 1] During the years she has helped to raise [NAME FILL], how much have
problems with her physical health interfered with her daily activities?
[IF PQ2 NE 1 AND PQ135 = 2] During the years she helped to raise [NAME FILL], how much did
problems with her physical health interfere with her daily activities?
[IF PQ2 = 1] Now, please think about yourself. During the years you have helped to raise [NAME FILL],
how much have problems with your physical health interfered with your daily activities?
[WASIT_FILL]
1 A lot
2 Some
3 A little
4 Not at all
5 [IF PQ2 NE 1] [PRONOUN2 FILL] biological mother did not help to raise [PRONOUN3 FILL]
DK/REF
PQ138
These next questions are about the mental health of [PRONOUN2 FILL] biological parents.
[IF PQ2 NE 2 AND PQ132 = 1] First, please think about [NAME FILL]’s biological father. During the
years he has helped to raise [NAME FILL], how much have problems with his mental health interfered
with his daily activities?
[IF PQ2 NE 2 AND PQ132 = 2] First, please think about [NAME FILL]’s biological father. During the
years he helped to raise [NAME FILL], how much did problems with his mental health interfere with his
daily activities?
[IF PQ2 = 2] First, please think about yourself. During the years you have helped to raise [NAME FILL],
how much have problems with your mental health interfered with your daily activities?
[WASIT_FILL]
1
2
3
A lot
Some
A little
41
4 Not at all
5 [IF PQ2 NE 2] [PRONOUN2 FILL] biological father did not help to raise [PRONOUN3 FILL]
DK/REF
PQ139
[IF PQ2 NE 2 AND PQ132 = 1] How often has [PRONOUN2 FILL] biological father…
[IF PQ2 NE 2 AND PQ132 = 2] How often did [PRONOUN2 FILL] biological father…
[IF PQ2 = 2] How often have you…
[AOPSG_FILL]
All the
Time
Most of
the Time
Some of
the Time
Never
PQ139a [IF PQ132 = 2, then “have” ELSE “had”] episodes of
being very sad or depressed?
1
2
3
4
PQ139b [IF PQ132 = 2, then “have” ELSE “had”] episodes of
being very nervous, worried, or anxious?
1
2
3
4
PQ139c [IF PQ132 = 2, then “have” ELSE “had”] sudden
attacks of fear or panic?
1
2
3
4
PQ139d [IF PQ132 = 2, then “have” ELSE “had”] problems
with alcohol or drugs that interfered with responsibilities at
home or work?
1
2
3
4
DK/REF
PQ140
[IF PQ2 NE 1 AND PQ135 = 1] Now think about [NAME FILL]’s biological mother. During the years
she has helped to raise [NAME FILL], how much have problems with her mental health interfered with
her daily activities?
[IF PQ2 NE 1 AND PQ135 = 2] Now think about [NAME FILL]’s biological mother. During the years
she helped to raise [NAME FILL], how much did problems with her mental health interfere with her
daily activities?
[IF PQ2 = 1] Now think about yourself. During the years you have helped to raise [NAME FILL], how
much have problems with your mental health interfered with your daily activities?
[WASIT_FILL]
1 A lot
2 Some
3 A little
4 Not at all
5 [IF PQ2 NE 1] [PRONOUN2 FILL] biological mother did not help to raise [PRONOUN3 FILL]
DK/REF
42
PQ141
[IF PQ2 NE 1 AND PQ135 = 1] How often has [PRONOUN2 FILL] biological mother…
[IF PQ2 NE 1 AND PQ135 = 2] How often did [PRONOUN2 FILL] biological mother…
[IF PQ2 = 1] How often have you…
[AOPSG_FILL]
All the
Time
Most of
the Time
Some of
the Time
Never
PQ141a [IF PQ135 = 2, then “have” ELSE “had”] episodes of
being very sad or depressed?
1
2
3
4
PQ141b [IF PQ135 = 2, then “have” ELSE “had”] episodes of
being very nervous, worried, or anxious?
1
2
3
4
PQ141c [IF PQ135 = 2, then “have” ELSE “had”] sudden
attacks of fear or panic?
1
2
3
4
PQ141d [IF PQ135 = 2, then “have” ELSE “had”] problems
with alcohol or drugs that interfered with responsibilities at
home or work?
1
2
3
4
DK/REF
43
Military Service
PQ142
Begin Timestamp
Has [NAME FILL] ever had a biological parent or other parental figure who has been in the United States
Armed Forces?
1 Yes
2 No
DK/REF
DEFINE PQ143_FILL
IF PQMODE=WEB, FILL=“Please check all that apply.”
IF PQMODE=TEL, FILL=“Please tell me everyone who has served in the military who has taken care of [NAME
FILL].”
PQ143
[IF PQ142 = 1] Who is this person or persons? [PQ143_FILL]
[CHECK ALL THAT APPLY BOXES]
1 Biological mother
2 Biological father
3 Step or adoptive mother
4 Step or adoptive father
5 Other parental figure
DK/REF
DEFINE RELATION FILL
IF PQ143 = 1, THEN FILL “biological mother”
IF PQ143 = 2, THEN FILL “biological father”
IF PQ143 = 3, THEN FILL “step or adoptive mother”
IF PQ143 = 4, THEN FILL “step or adoptive father”
IF PQ143 = 5, THEN FILL “other parental figure”
PQ144a
[IF (PQ143 = 3 AND PQ2 NE 3) OR (PQ143 = 4 AND PQ2 NE 4) OR PQ143 = 5] Is [PRONOUN2
FILL] [RELATION FILL] still living?
1 Yes
2 No
DK/REF
PQ145a
[IF PQ144a = 2 OR (PQ143 = 1 AND PQ2 NE 1 AND PQ135 = 2) OR (PQ143 = 2 AND PQ2 NE 2
AND PQ132 = 2)] Did [PRONOUN2 FILL] [RELATION FILL] die while on deployment?
1 Yes
2 No
DK/REF
44
PQ146a
[IF (PQ143 = 1 AND PQ2 = 1) OR (PQ143 = 2 AND PQ2 = 2) OR (PQ143 = 3 AND PQ2 = 3) OR
(PQ143 = 4 AND PQ2 = 4)] Are you currently on active duty in the United States Armed Forces, are
you in a Reserve component, or are you now separated or retired from the military?
[IF PQ144a = 1 OR DK OR REF AND ((PQ143 = 1 AND PQ2 NE 1 AND PQ135 NE 2) OR (PQ143 = 2
AND PQ2 NE 2 AND PQ132 NE 2) OR (PQ143 = 3 AND PQ2 NE 3) OR (PQ143 = 4 AND PQ2 NE 4)
OR PQ135 = 5)] Is [PRONOUN2 FILL] [RELATION FILL] currently on active duty in the United
States Armed Forces, currently in a Reserve component, or now separated or retired from the military?
1 On Active Duty in the Armed Forces
2 In a Reserve Component
3 Now Separated or Retired From the Military
DK/REF
PQ147a
[IF PQ144a = 1 AND (PQ143 = 1 AND PQ2 = 1) OR (PQ143 = 2 AND PQ2 = 2) OR (PQ143 = 3 AND
PQ2 = 3) OR (PQ143 = 4 AND PQ2 = 4)] How many times have you been deployed?
[IF PQ144a = 1 AND ((PQ143 = 1 AND PQ2 NE 1 AND PQ135 NE 2) OR (PQ143 = 2 AND PQ2 NE 2
AND PQ132 NE 2) OR (PQ143 = 3 AND PQ2 NE 3) OR (PQ143 = 4 AND PQ2 NE 4) OR PQ143 = 5)]
How many times has [PRONOUN2 FILL] [RELATION FILL] been deployed?
__________ Times [RANGE: 0–50]
DK/REF
PQ148a
[IF PQ147a > 0 AND ((PQ143 = 1 AND PQ2 = 1) OR (PQ143 = 2 AND PQ2 = 2) OR (PQ143 = 3 AND
PQ2 = 3) OR (PQ143 = 4 AND PQ2 = 4) OR PQ143 = 5)] Did you deploy in support of Operation
Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn?
[IF PQ147a > 0 AND ((PQ143 = 1 AND PQ2 NE 1 AND PQ135 NE 2) OR (PQ143 = 2 AND PQ2 NE 2
AND PQ132 NE 2) OR (PQ143 = 3 AND PQ2 NE 3) OR (PQ143 = 4 AND PQ2 NE 4) OR PQ143 = 5)]
Did [PRONOUN2 FILL] [RELATION FILL] deploy in support of Operation Enduring Freedom,
Operation Iraqi Freedom, or Operation New Dawn?
1 Yes
2 No
DK/REF
PROGRAMMERS: CREATE LOOP OF PQ144a – PQ148a FOR ALL INDICATED RESPONSES IN PQ143.
VARIABLE NAMES WILL BE PQ144b, PQ144c, ETC FOR EACH POSSIBLE RESPONSE OPTION IN PQ143.
THANKR
Thank you for completing this interview.
45
Appendix A
Summary of Module Content
46
Introduction
This document briefly summarizes the content of each National Mental Health Study (NMHS)
Parent Questionnaire module and provides a high-level overview of the changes made to the module
when compared to the source documents originally provided to RTI.
Changes
All modules were revised as follows.
•
Inclusion Logic. All logic instructions were translated to question-by-question inclusion
logic. This logic, which appears at the beginning of a question, indicates which respondents
should be asked each question. If no inclusion logic appears in the specifications, the
question will be asked of all parent respondents.
•
Logic-Processing Variables. Where logic is complicated, it has been divided into smaller
units, each with its own variable name. Programmers and instrument testers will use these
variables to help ensure the instrument functions as intended. However, respondents will
not see the processing variables or their associated logic.
•
Web and Phone Adaptations. Where needed, items were revised to enable telephone and
web administration.
•
Ranges. Wherever a question asks for an open-ended numerical answer, a specified range is
documented within which the respondents’ answers must fall in order to be considered
valid by the system. When a respondent enters a response outside the allowable range, the
system will generate a message alerting the respondent that the response must be revised.
Such range limits help to improve data quality by alerting respondents to what are typically
either keying errors or errors caused by the respondent misunderstanding what information
is being requested.
•
Yes/No Grids. Most check-all-that-apply questions were converted to grids of Yes/No
questions. The Yes/No format ensures that respondents consider each individual item rather
than skimming the list and, perhaps, only attending to one or two items. This approach
should be more effective in the ACASI environment where an interviewer is not able to
prompt a respondent to consider all items in the list.
•
Don’t Know and Refuse Responses. Inclusion logic is provided where needed to clarify
what should happen after a respondent enters a “don’t know” answer or refuses a question.
•
Fills. Separate variables have been defined to create the text fills needed to tailor questions
based on a respondent’s answers to previous questions.
•
Renumbering. All items have been renumbered, in some cases several times, for logical
flow throughout the specifications. Renumbering will not be listed specifically in the
module by module summaries.
•
Module order. Modules were reordered several times during drafting. These changes are not
marked because the source documents were not specifically ordered when received by RTI.
Because the changes noted above were made throughout the Parent Questionnaire, these
categories of changes are not repeated in the module-specific overviews that follow. Each module is
divided into a separate section throughout this document.
47
Introduction Screens
•
Overview
– Provides informed consent information and collects consent to participate from
respondent.
•
Changes from Original
– No original provided by NIMH. Text drafted by RTI.
Birth and Early Development
•
Overview
– Establishes gender and age of adolescent being reported on, and relationship of
respondent to adolescent.
– Asks about weight at birth and premature birth.
•
Changes from Original
– Added PQ1 and PQ1b to ask gender and age of adolescent being reported on.
– Added PQ2 and PQ2OTHR to ask relationship of respondent to adolescent.
– Added PQ3 to ensure that the respondent can answer questions about the adolescent’s
birth and early development.
– Removed A2 and A3, which asked about age of biological parents at adolescent’s birth.
– Removed A4, which asked if adolescent has a twin.
– Added PQ5a to ask if the adolescent was born more than one week premature.
Residential History
•
Overview
– Module removed.
48
Education
•
Overview
– Asks about performance in school, educational attainment, and expected lifetime
educational attainment.
– Asks about special school services received by the adolescent.
•
Changes from Original
– Removed D1, which asked about number of different schools attended.
– Added PQ6a, which asked if the adolescent ever repeated a grade in school.
– Removed D3, which asked if the adolescent was ever suspended from school.
– Added response options to PQ7.
– Removed D5, which asked if the adolescent was still attending school.
– Revised response options in PQ7a.
– Added PQ8, which asks about grades received.
– Revised D8a–h, to be only Yes/No questions. Removed the age, frequency, and recency
items from these questions.
– Revised D8a–h question text to be more clear.
Personality
•
Overview
– Module removed.
Talents and Abilities
•
Overview
– Module removed.
Physical Health
•
Overview
– Module removed.
49
Strengths and Difficulties
•
Overview
– Module removed.
Columbia Impairment Scale
•
Overview
– Asks 13 questions designed to assess impairment across four areas of functioning:
interpersonal relations, broad psychosocial domains, functioning in job or schoolwork,
and use of leisure time.
•
Changes from Original
– Was not included in original modules provided by NIMH.
– Minor revisions to original Columbia Impairment Scale for web implementation.
Attention and Concentration
•
Overview
– Asks a series of questions about problems with attention and concentration.
– If an adolescent has had at least one problem with attention or concentration lasting
more than six months, the parent is routed into follow-up questions, which include:
•
Age of onset
Duration of problem(s)
Frequency of problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about a problem with attention or concentration
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Edited PQ14 to ask about problems in the last six months, regardless of age of onset.
– Reordered grid items in PQ14.
50
Restlessness
•
Overview
– Asks a series of questions about problems with restlessness and impatience.
– If an adolescent has had at least one problem with restlessness or impatience lasting
more than six months, the parent is routed into follow-up questions, which include:
•
Age of onset
Duration of problem(s)
Frequency of problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about a problem with restlessness or impatience
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Edited PQ26 to ask about problems in the last six months, regardless of age of onset.
– Reordered grid items in PQ26.
– Removed K1c, which asked if an adolescent ever “often on the go taking little time to
rest”.
Problems with Separation
•
Overview
– Asks a series of questions about problems with separation.
– If an adolescent has had at least one problem with separation lasting one month or
longer, the parent is routed into follow-up questions, which include:
•
Age of onset
Duration of problem(s)
Frequency of problem(s)
Severity of distress caused by problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about a problem with separation
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Removed instruction to report behaviors that occurred when the adolescent was older
than five in PQ38.
– Reordered grid items in PQ38.
51
Low Mood
•
Overview
– Asks a series of questions about problems with low mood lasting two weeks or longer.
– If the parent’s answers indicate the adolescent meets the criteria for low mood by
endorsing a particular series of symptoms, the parent is routed into follow-up questions,
which include:
•
Age of onset
Duration of problem(s)
Recency of problem(s)
Severity of distress caused by problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about a problem with low mood
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Symptom items in PQ55 were edited from yes/no questions to frequency items with a
response scale ranging from All or Almost All of the Time to None of the Time.
– Added PQ55a, PQ55b, PQ55c, PQ55d, PQ55e, and PQ55k from the symptoms grid.
– Removed M2c, which asked about being more restless than usual, from the symptoms
grid.
– Divided M2a into PQ55l and PQ55m, which ask about decreased appetite and increased
appetite as separate items.
– Reordered the items in the PQ55 grid.
– Added PQ58, which asks about the severity of the adolescent’s worst low mood
episode.
52
Anger and Disobedience
•
Overview
– Asks a series of questions about lifetime problems with anger and disobedience.
– If the parent’s answers indicate the adolescent meets the criteria for anger and
disobedience issues by the parent responding Very Often, Often, or Sometimes to any
symptom question, the parent is routed into follow-up questions, which include:
•
Age of onset
Duration of problem(s)
Recency of problem(s)
Severity of distress caused by problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about a problem with anger and disobedience
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Symptom items in PQ68 were edited from yes/no questions to frequency items with a
response scale ranging from Very Often to Never.
– Removed N1e, which asked if the adolescent was angry a lot of the time.
– Added PQ68d, which asks about getting angry.
53
Breaking Rules
•
Overview
– Asks a series of questions about the adolescent’s lifetime behavior problems.
– If the parent endorses any behavior problem symptom, the parent is routed into followup questions, which include:
•
Age of onset
Duration of problem(s)
Recency of problem(s)
Severity of distress caused by problem(s)
Effect of the problem(s) on friendships, home, and work or school
If teachers or other adults ever told a parent about behavior problems
If the adolescent received professional treatment or took medication for the problem(s)
Changes from Original
– Reordered the items in the PQ80 grid.
54
Services
•
Overview
– Asks a series of questions about counseling or medication received from a variety of
sources for problems with emotions, behavior, or mental health.
For each source of services the parent endorses, they are asked to report number of visits,
for lifetime and past 12 months, and recency of service.
– Asks if the adolescent has received counseling, by a professional or self-help group, for
problems with substance use.
For each source of counseling the parent endorses, they are asked to report age of first use,
frequency of visits, and recency of visits.
– Asks if the adolescent has been kept overnight in a variety of facilities for problems
with emotions, behavior, or mental health.
For each facility type the parent endorses, they are asked to report age of first visit,
frequency of visits, total number of days spent in the facility, and recency of visits.
– Asks if the adolescent has been kept overnight in a variety of facilities for problems
with substance use.
For each facility type the parent endorses, they are asked to report age of first visit,
frequency of visits, total number of days spent in the facility, and recency of visits.
– Asks if the adolescent stopped receiving treatment for problems with emotions,
behavior, or mental health.
If the adolescent has stopped receiving treatment, the parent is asked to report how
important various reasons were in the decision to stop treatment.
– Asks if a teacher or other adult had ever encouraged the parent to take the adolescent to
a profession for help for problem with emotions, behavior, or mental health.
If so, parents are asked to report age of first encouragement.
– Asks if the adolescent has ever received special testing or evaluations for problems with
emotions, behavior, or mental health.
•
If so, asked about age of first testing and recency of testing.
Changes from Original
– Revised Q1a–m to be only Yes/No questions. Removed the age, lifetime visits, and
number of visits in the past 12 months from these questions. Removed items appear
later in the module as standalone questions for each service endorsed.
– Separated Q1a–m and Q2a–g into four questions:
PQ92, which asks about outpatient care for problems with emotions, behavior, or mental
health only
PQ97, which asks about outpatient care for problems with substance use only
PQ102, which asks about overnight care in a facility for problems with emotions, behavior,
or mental health only
PQ108, which asks about overnight care in a facility for problems with substance use only
– Removed Q1c, Q1h, Q1i, Q1l, and Q1m.
– Added PQ92c and PQ92h.
– Removed Q2g.
55
– Added PQ102b, PQ102f, and PQ102g.
– Added PQ108b and PQ108c.
– Removed Q4a–c, which asked about medication taken.
– Added PQ114, PQ115a–f, PQ116, and PQ117, which ask about reasons for stopping
treatment.
– Added PQ120, PQ121, and PQ122, which ask about testing.
56
Biological Parents and Other Parental Figures
•
Overview
– Module removed. Similar items were added to the Family and Medical History module.
Your Relationship with the Adolescent
•
Overview
– Module removed.
Your Background
•
Overview
– Module removed.
Your Finances
•
Overview
– Module removed.
57
Family and Medical History
•
Overview
– Asks a series of questions about the adolescent’s medical conditions and general health.
– Asks if there are any non-biological parental figures.
If so, asks how many non-biological parental figures, who these figures are, and how long
the adolescent has lived with each of these figures.
– Asks for physical and mental health information for biological parents.
•
Changes from Original
– Rephrased PQ123h to read “Autism spectrum disorder, including Asperger’s?”.
– Removed Rett Syndrome, Tuberous Sclerosis Complex, Fragile X Syndrome, and
Neurofibromatosis I from the PQ123 grid.
– Added PQ123p, PQ123aa, PQ123bb, PQ123cc, PQ123dd, PQ123ee, PQ123ff,
PQ123gg, and PQ123hh.
– Revised PQ123v to read “Problems with anger control” instead of “A behavioral
disorder, such as Oppositional Defiant Disorder, Conduct Disorder, or other behavioral
disorder”.
– Added PQ126a, which asks how many non-biological parental figures helped raise the
adolescent. The respondent will receive questions about each parental figure indicated
in this question.
– Added more comprehensive response options to PQ127, which asks the relationships of
the parental figure to the adolescent. This item now collects information on male and
female parental figures for each person indicated in PQ126a.
– Restructured questions asking about non-biological parental figures and biological
parents to ask all items about each person in a set rather than asking about physical
health of all indicated parents and parental figures and then asking about mental health
of all indicated parents and parental figures.
– Removed items asking how often the biological parents and non-biological parental
figures had “gotten in trouble with the law or participated in illegal activity”.
– Removed items asking about the quality of the relationship between the adolescent and
each biological parent.
58
Military Service
•
Overview
– Asks if a biological parent or non-biological parental figure has ever served in the
military.
If so, the respondent is asked to indicate all persons who have served in the military.
– Asks if biological parents and non-biological parental figures who have served in the
military died while on deployment, if they are on active duty, number of deployments,
and if they deployed in certain recent operations.
•
Changes from Original
– RTI and NIMH created this content. It was not included in the original parent
questionnaire.
– Included non-biological parental figures and their relationships to the adolescent
through the module.
– Restructured module to collect number of parents and parental figures at the beginning
of the module and then rotate through follow-up questions for each person indicated,
rather than asking about only biological father and biological mother.
59
| File Type | application/pdf |
| Author | allewis |
| File Modified | 2017-04-13 |
| File Created | 2017-04-13 |