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alspac_04_mtsd
MY TEENAGE SON
All answers are confidential
This questionnaire is for the study child's mother or the person taking the role of chief carer.
This questionnaire is for the study teenager's mother or person taking the role of chief carer.
To answer simply tick the box which is most accurate in your opinion.
If you do not want to answer a question or if it does not apply to your son, put a line through it. There are no good or bad answers. Just tell us what is true for you.
THANK YOU FOR YOU HELP
SECTION A: YOUR SON'S HEALTH

How would you assess the health of your study teenager nowadays? in the past month

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

How would you assess the health of your study teenager nowadays? in the past year

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
Has he had any of the following in the past 12 months?
-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache(s )
constipation
worm infection
head lice
scabies
asthma
eczema
hay fever

Has he had any of the following in the past 12 months? other (please tick and describe)

1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other

Which of the following infections has he ever had: measles

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: chicken pox

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: mumps

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: meningitis

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: cold sores

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: whooping cough

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: urinary infection

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: eye infection

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: ear infection

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: chest infection

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: tonsillitis or laryngitis

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: german measles

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: scarlet fever

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: influenza (flu)

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: a cold

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: glandular fever

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never

Which of the following infections has he ever had: other infection (please tick & describe)

1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Other

Has your teenager been admitted to hospital since his 9th birthday?

1
Yes
2
No
If no, go to A5 on page 6
If yes,
qc_A4 == 1

how many times?

How many
please describe for each admission:
Age of child (years) Reason for admission No. of nights child stayed in hospital Write 00 if he did not stay overnight
How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many
1
2
3
If more than 3 admissions please describe on separate sheet

How often did you see him while he was in hospital? 1st admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him

How often did you see him while he was in hospital? 2nd admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him

How often did you see him while he was in hospital? 3rd admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him

Are there any foods or drinks that your teenager is or has been allergic to?

1
yes definitely
2
yes possibly
3
no, not at all
9
don't know
If no, or don't know go to A6a on page 8
If yes,
qc_A5 == 1 || qc_A5 == 2

please describe which foods or drinks

Generic text

was the reaction caused by eating or touching the food or drink?

1
eating/drinking
2
touching
3
both

what happens when he does have the reaction? (Tick all that apply) bright red rash

1
Yes
If yes,
qc_A5_c_i == 1

over what part of body?

Generic text

what happens when he does have the reaction? (Tick all that apply) hives (white raised bumps on skin)

1
Yes
If yes,
qc_A5_c_ii == 1

over what part of body?

Generic text

what happens when he does have the reaction? (Tick all that apply) wheezing or whistling in the chest

1
Yes

what happens when he does have the reaction? (Tick all that apply) vomiting

1
Yes

what happens when he does have the reaction? (Tick all that apply) diarrhoea

1
Yes

what happens when he does have the reaction? (Tick all that apply) difficulty breathing

1
Yes

what happens when he does have the reaction? (Tick all that apply) stop breathing

1
Yes

what happens when he does have the reaction? (Tick all that apply) headache

1
Yes

what happens when he does have the reaction? (Tick all that apply) swelling

1
Yes
If yes,
qc_A5_c_ix == 1

describe where

Generic text

what happens when he does have the reaction? (Tick all that apply) other reaction Please tick and describe

1
Yes
Other

How long after eating or drinking or touching does this usually happen?

1
less than 1 hr
2
1-2 hrs
3
3-5 hrs
4
6 hrs or more
9
don't know

How old was he when this first happened? ... years old

(put 00 if he was under 12 months )

Age

How many times has a reaction happened?

1
once
2
2-3 times
3
4-9 times
4
10 or more times
9
don't know

How old was he the last time a reaction happened? ... years old

Age

What treatment has your teenager been given for the problem?

1
None
2
Yes, some treatment
If Yes, some treatment to question A5h
qc_A5_h == 2

Please describe

Generic text

Apart from food and drink are there any other things to which he is allergic?

1
Yes
2
No
If no, go to A7 below
If yes,
qc_A6_a == 1

What is he allergic to? (Tick all that apply) pollen

1
Yes

What is he allergic to? (Tick all that apply) cat

1
Yes

What is he allergic to? (Tick all that apply) dog

1
Yes

What is he allergic to? (Tick all that apply) bee sting

1
Yes

What is he allergic to? (Tick all that apply) wasp sting

1
Yes

What is he allergic to? (Tick all that apply) house dust

1
Yes

What is he allergic to? (Tick all that apply) medicine

1
Yes
If yes,
qc_A6_b_vii == 1

please describe type of medicine

Generic text

What is he allergic to? (Tick all that apply) other Please tick and describe

1
Yes
Other

Has he ever had a seizure, fit or a convulsion?

1
Yes
2
No
If no, go to A8 on page 10
If yes,
qc_A7 == 1

how many has he had?

How many

did any of them last more than 15 minutes?

1
Yes
2
No
3
can't say

did his body shake and jerk on just one side?

1
Yes, right side
2
Yes, left side
3
No, it was all over
4
can't say

did he have a fever at the time?

1
Yes, each time (or only time)
2
Yes, but not each time
3
No
If no, go to A7e) below
If yes,
qc_A7_d == 1 || qc_A7_d == 2

how high was his temperature?

(put NK if you don't know)

Temperature

what was the cause of the fever(s)?

Generic text

did he have more than one episode of fitting during any feverish illness?

1
Yes
2
No

When the first fit or convulsion happened: how old was he? ... years

(If less than 1 year put 00)

Age

Were there any warning signs before he had a fit or convulsion?

1
Yes
2
No
If no, go to A8 on page 10
If yes,
qc_A7_f == 1

Please describe:

Generic text

Does he often have aches and pains in his arms or legs?

1
yes arm(s)
2
yes leg(s)
3
yes both
4
no, not often
If no, go to A9 below
If yes,
qc_A8 == 1 || qc_A8 == 2 || qc_A8 == 3

does this happen especially when he is tired?

1
Yes
2
No

what do you think is the cause ?

Generic text

do you find any particular treatment helps ?

1
Yes
2
No
if yes,
qc_A8_c == 1

please describe

Generic text

During sleep, does your study teenager: snore

1
Never
2
Sometimes
3
Often

During sleep, does your study teenager: perspire/sweat a lot

1
Never
2
Sometimes
3
Often

During sleep, does your study teenager: fidget

1
Never
2
Sometimes
3
Often

During sleep, does your study teenager: talk

1
Never
2
Sometimes
3
Often

During sleep, does your study teenager: have nightmares

1
Never
2
Sometimes
3
Often

How often does your teenager wake up in the night? to go to the toilet

1
Never
2
Sometimes
3
Often

How often does your teenager wake up in the night? because of loud or unusual noises

1
Never
2
Sometimes
3
Often

How often does your teenager wake up in the night? if worried

1
Never
2
Sometimes
3
Often

How often does your teenager wake up in the night? if excited

1
Never
2
Sometimes
3
Often

How often does your teenager wake up in the night? if feeling poorly

1
Never
2
Sometimes
3
Often

Thinking back over the last month, has your teenager been feeling tired or been lacking in energy?

1
Yes
2
No
If no, go to A16 on page 12
If yes,
qc_A11 == 1

Do you know why he has been feeling tired or lacking in energy?

1
Yes
2
No
If no, go to A13 below
qc_A11_a == 2
Else
What is the main reason he has been feeling tired or lacking in energy? (please tick all that apply)
-

1 - Yes

Illness
Problems with sleep
Playing a lot of sport (or other physical exercise)
Stress or worry

What is the main reason he has been feeling tired or lacking in energy? (please tick all that apply) Other reason (please give details)

1
Yes
Other

How long has he been feeling tired or felt he had no energy? (Tick one only)

1
Less than 3 months
2
Between 3 and 5 months
3
Between 6 months and 5 years
4
More than 5 years

Does he feel better after resting?

1
Not at all
2
Only a bit
3
Definitely better

During the last month, has this tiredness or lack of energy stopped him from playing, taking part in hobbies, sports or other leisure activities?

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal

During the past year, how many days has your teenager been off school because of this tiredness or lack of energy? (If none, write 00) ... days

How many

Has he seen a doctor in the past year because of this tiredness or lack of energy?

1
Yes
2
No
SECTION B: SEEING AND HEARING
Just as some people have better long-distance vision than others, so some people are better at remembering faces they have seen, or seeing people or objects in a crowd. We would like to know how your study teenager responds in the situations described below.

However, if your study teenager's sight is so poor that you feel you cannot answer, please tick this box

1
tick
If tick to question sectionB_i then go straight to B13 on page 15.
qc_sectionB_i == 1
Else

When he sees members of his close family, does he recognise them?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he recognise friends?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he recognise people from photographs?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he lose objects around the house?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he have difficulty reaching out for and grasping objects?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he have difficulty distinguishing a step from a line on the ground?

1
Never
2
Occasionally
3
Most of the time
4
Always

Can he find objects on a patterned carpet or bedspread?

1
Never
2
Occasionally
3
Most of the time
4
Always

Can he find objects in complex pictures?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he misjudge going through doorways or along corridors?

1
Never
2
Occasionally
3
Most of the time
4
Always

Can he find his way around the house?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he have difficulty seeing things pointed out in the distance?

1
Never
2
Occasionally
3
Most of the time
4
Always

Can he find his way around in new surroundings?

1
Never
2
Occasionally
3
Most of the time
4
Always

Does he prefer music or talking to be loud or soft?

1
He hates loud sounds
2
He doesn't mind if it's loud or not
3
He loves loud sounds
4
Can't say

How do you rate his hearing?

1
Excellent
2
Good
3
OK
4
Some sounds he can't hear
5
He can't hear much at all
SECTION C: TICS AND UNINTENDED HABITS
Many teenagers have strange habits that they do not intend and often are not aware of them. Please indicate whether your study teenager has had any of these in the past year.
-

1 - Definitely

2 - Probably

3 - No, not At all

Repeated movements of parts of the face and head (e.g. eye blinking, grimacing, sticking tongue out, licking lips, spitting)
Repeated movements of the neck, shoulder or trunk (e.g. twisting around, shoulder shrugging, bending over, nodding)
Repeated movements of the arms, hands, legs or feet (e.g. clapping hands, touching himself or others, hopping, kicking)
Repeated noises and sounds (e.g. coughing, clearing throat, grunting, gurgling, hissing)
Repeated words and phrases
If definitely or probably to any of the above:
qc_C1-C5 == 1 || qc_C1-C5 ==2

Please describe what is repeated

Generic text

About how often does/did this happen in the last year?

1
Less than once a month
2
1-3 times a month
3
about once a week
4
more than once a week
5
every day

Does this happen more at particular times?

1
Yes
2
No
If yes,
qc_C6_c == 1

please tick all that apply: when tired

1
Yes

please tick all that apply: when anxious or stressed

1
Yes

please tick all that apply: other time (please tick and describe)

1
Yes
Other
SECTION D: SOCIAL SKILLS
How do you feel your study teenager compares with people of his own age in regard to the following:
-

1 - A lot worse than average

2 - A bit worse than average

3 - About average

4 - A bit better than average

5 - A lot better than average

Able to laugh around with others, e.g. accepting lighthearted teasing and responding appropriately
Easy to chat with, even if it isn't on a topic that specially interests him
Able to compromise and be flexible
Finds the right thing to say or do in order to defuse a tense or embarrassing situation
Graceful when he doesn't win or get his own way. A good loser
Other people feel at ease around him
By reading between the lines of what people say, he can work out what they are really thinking and feeling
After doing something wrong, he's able to say sorry and sort it out so that there are no hard feelings.
Can take the lead without others feeling they are being bossed about
Aware of what is and isn't appropriate in different social situations
SECTION E: ATTITUDES AND BEHAVIOUR TOWARDS ANIMALS
Some teenagers have had a liking for all animals from being very small. Others are afraid and don't like certain animals. Sometimes they try to hurt or harm animals. We would like to ask you some questions about how your teenager feels towards animals.

How often: Is he scared of dogs?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Is he scared of insects or spiders?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Is he rough with animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Does he harm animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Does he show an interest in animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Does he show an interest in insects?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

How often: Does he show concern for the suffering of animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always

My teenager has harmed animals

1
Never
2
Accidentally
3
In curiosity
4
Maybe on purpose
5
Definitely on purpose

My teenager has harmed small insects

1
Yes
2
No

My teenager has harmed the family pets

1
Yes
2
No
7
Has never had a pet

My teenager has harmed other people's pets

1
Yes
2
No

My teenager has harmed animals (not pets)

1
Yes
2
No

The last time my teenager hurt an animal was

1
Never
2
More than one year ago
3
Last week
4
Yesterday
5
Today

How often: Has he hurt animals whilst on his own ?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

How often: Has he, together with others, hurt animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

How often: Has he secretly hurt animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

How often: Has he shown pleasure when hurting animals?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

How often: Is he forgiving if an animal bites or scratches?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

How often: Will he go out of his way to fuss and stroke an animal?

1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
SECTION F: MEDICINES, PILLS, LOTIONS, CREAMS AND IMMUNISATIONS
We are interested in finding out whether children have any difficulties in correctly taking medicines by mouth. For example, you may have had to crush tablets/pills or empty out the contents of a capsule and add them to a drink or a spoonful of jam, because of difficulty in swallowing them whole or a dislike of the taste.

Is your study teenager able to swallow pills/tablets whole?

1
Yes
2
No
9
Don't know, never takes any

Has your study teenager ever been given a medicine, pill or capsule that he was unable to take in the correct manner?

1
Yes
2
No
If no, go to the top of page 23
If yes,
qc_F2_a == 1
what type of medicine was difficult for him to take?

(tick all that apply)

Yes Please give name(s) of medicines

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text
tablets
hard capsules (usually contain granules or powder)
soft capsules (may contain a liquid)
liquid medicine
_medicine < 4 _medicine < 4

What did you have to do to help him take the medicine? (If more than 1 type of medicine, answer separately for each) Name of medicine

Generic text

What did you have to do to help him take the medicine? (If more than 1 type of medicine, answer separately for each) Yes

Tick one only

1
Crush or break up tablets
2
Empty capsules
3
Add the medicine to a drink
4
Other, please tick and describe
Other
If yes,
qc_F2_b_ii == 3

what type of drink?

Generic text
Medicines often have some unwanted effects, which we know to expect, such as causing a dry mouth. However, we are interested in finding out about more severe and/or unexpected reactions, which required some further action, such as seeking advice from your doctor or pharmacist, and/or stopping or changing the medicine.

Has your son ever had a bad reaction or side effect, which was thought to be due to a medicine he was taking or using, and which required some action to be taken? (By medicine we mean pills/tablets, liquid mixture, cream or ointment, injection or vaccine, eye drops, herbal medicine etc.)

1
Yes
2
No
If no, go to Section G on page 28
If yes,
qc_F3_a == 1
Please give the details separately for each type of medicine that caused a bad reaction (if he had side effects to more than 3 medicines, give details for the 3 most serious or severe reactions)
_medicine < 4 _medicine < 4

Name of medicine:

Generic text

What type of medicine was it?

1
tablets/capsules/pills
2
liquid medicine (taken by mouth)
3
cream/ointment/lotion
4
injection/vaccine/immunisation
5
eye drops/eye ointment
6
other (please describe)
Other

What was the medicine being used for (e.g. chest infection, stomach upset, skin problem)?

Generic text

How old was he at the time the reaction happened? ... years

Age
Which of the following best describes the reaction or side effects?

(tick all that apply)

-

1 - Yes

skin rash
itching
feeling/being sick
breathing difficulties
effects on digestion e.g. diarrhoea
blood disorder
bleeding
bad headache(s)
dizziness/feeling faint
blurred vision
jaundice
severe allergic reaction or anaphylaxis

Which of the following best describes the reaction or side effects? other, please tick and describe

(tick all that apply)

1
Yes
Other

Please choose one of the following for each medicine, that best describes how often, and for how long each time, the side effects happened.

(Tick just one for each medicine)

1
Single isolated incident (e.g. severe allergic reaction)
2
Repeated episodes over 1-2 days (e.g. dizzy spells)
3
Repeated episodes over 3-7 days (e.g. dizzy spells or headaches)
4
Repeated episodes over more than 7 days
5
Continuous, but lasted less than 2 days (e.g. headache or skin rash)
6
Continuous, lasting 2-7 days (e.g. skin rash, itching)
7
Continuous, lasting more than 7 days (e.g. blood disorder or jaundice)
8
Other, please tick and describe
Other

How serious, severe and/or unexpected was the reaction? Unexpected (i.e. you were not aware or had not been warned that some people may experience these side effects)

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? The side effects were bad enough to prevent him doing things that he would normally have done (after allowing for the illness)

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? The side effects were bad enough for advice to be sought from a healthcare professional

(tick all that apply)

1
Yes
If so,
qc_F6_c == 1

who was this? (tick all that apply): family doctor/GP

1
Yes

who was this? (tick all that apply): hospital doctor

1
Yes

who was this? (tick all that apply): pharmacist/chemist

1
Yes

who was this? (tick all that apply): nurse

1
Yes

who was this? (tick all that apply): other (please tick and describe)

1
Yes
Other

How serious, severe and/or unexpected was the reaction? The reaction was so bad that he had to stop using the medicine (leave blank for one-off doses e.g. vaccines)

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? He was admitted to hospital because of the side effects

(tick all that apply)

1
Yes

How long did he stay in hospital? ... days

How many

How serious, severe and/or unexpected was the reaction? He recovered fully from the side effects after stopping the medicine

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? He recovered fully from the side effects and was able to continue taking the medicine

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? He has had this medicine again but did not have the same bad reaction

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? He has had this medicine again and the side effects were repeated

(tick all that apply)

1
Yes

How serious, severe and/or unexpected was the reaction? He still nowadays has some effects from having taken the medicine

(tick all that apply)

1
Yes

As medicines can react with each other, we would like to know if he was using any other medicines at that time, if you can remember.

Generic text
Generic text 2
Generic text 3
Generic text 4
SECTION G: MOODS AND FEELINGS
We are interested in studying the patterns of behaviour that children have. Please could you try to describe the kind of person your child is. When answering the questions, think about how he has tended to feel, think, and act over the past several years. Remember that there are no correct answers.
-

1 - Is often like this

2 - Is sometimes like this

3 - Is never like this

He goes to extremes to prevent those he loves from leaving him
He either loves someone or hates them, with nothing in between
He often wonders who he really is
He has tried to hurt or kill himself
He is a very moody boy
He feels his life is dull and meaningless
He has difficulty controlling his anger or temper
When he gets stressed out, things happen, e.g. he gets paranoid or complains of feeling detached from himself or things around him
As far as you know, has he done things on impulse that can get him into trouble?
-

1 - Yes

2 - No

Has he gone on eating binges?
Has he drunk too much alcohol?
Has he taken drugs?
Has he spent more money than he has?
Has he yelled at people?
Has he broken things?
Has he hit people?
Has he stolen things?
These questions are about how your teenager may have been feeling or acting recently. For each question, please say how much you think he has felt or acted this way in the past two weeks.
-

1 - True

2 - Sometimes true

3 - Not true

He felt miserable or unhappy
He didn't enjoy anything at all
He felt so tired that he just sat around and did nothing
He was very restless
He felt he was no good any more
He cried a lot
He found it hard to think properly or concentrate
He hated himself
He felt he was a bad person
He felt lonely
He thought nobody really loved him
He thought he could never be as good as other kids
He felt he did everything wrong
SECTION H: DIETING, WEIGHT AND BODY SHAPE

What is your study teenager's height at the moment (without shoes)? ... feet ... inches OR ... metres ... centimetres

feet
inches in feet
metres
centimetres in metres
9
Don't know

What is his weight at the moment? ... stones ... pounds OR ... kilos

Please fill in using kilos or stones.

stones
pounds in stones
kilos
9
Don't know

What was his lowest weight in the last 12 months? ... stones ... pounds OR ... kilos

stones
pounds in stones
kilos
9
Don't know

What was his highest weight ever? ... stones ... pounds OR ... kilos

stones
pounds in stones
kilos
9
Don't know

At present would you describe your study teenager as:

1
Very thin
2
Thin
3
Average
4
Plump
5
Fat

How do you feel he compares this year with previous years?

1
Thinner in previous years
2
About the same
3
A little thinner this year
4
A lot thinner this year

At present would he describe himself as:

1
Very thin
2
Thin
3
Average
4
Plump
5
Fat

Have you or other people (e.g. family, friend, a doctor) been seriously concerned that his weight has been bad for his physical health?

1
Yes
2
No

Does your study teenager think his weight has been bad for his physical health?

1
Yes
2
No

Is he afraid of gaining weight or getting fat?

1
No
2
A little
3
A lot
4
It really terrifies him

If a doctor told your study teenager that he needed to put on 5 pounds (2 kilos) for the sake of his health, how would he find this? He may have a physical problem that makes it hard for him to put on weight. Here we are asking if he is willing to try, not whether he can succeed.

1
Easy
2
Difficult
3
Impossible

Does he avoid the sorts of food that he thinks will make him fat?

1
No
2
A little
3
A lot

How often does he avoid fattening food?

1
Never
2
Sometimes
3
Most of the time
4
Always

Does he spend a lot of his time thinking about food?

1
Yes
2
No
9
Don't know

Sometimes people say that they have such a strong desire for food, and that this desire is so hard to resist, that it is like an addict feels about drugs or alcohol. Does this apply to your study teenager?

1
No
2
A little
3
A lot

Sometimes people lose control over what they eat, and then they eat a very large amount of food in a short time. Does your study teenager ever do this?

1
Yes
2
No
If no, go to H14 on page 33
If yes,
qc_H13 == 1

Over the last 3 months, how often has this happened?

1
Hasn't happened
2
Occasionally
3
About once a week
4
Two or more times a week

When this happens, does he have a sense of losing control over his eating?

1
Yes
2
No
3
Not sure

Please describe how much he typically eats during one of his episodes of eating too much:

Long text
Over the last 3 months, has your study teenager done any of the following to avoid putting on weight?
-

1 - No

2 - A little

3 - A lot

4 - Tried to but not allowed

9 - Don't know

Ate less at mealtimes
Skipped meals
Went without food for long periods, e.g. all day or most of the day
Hid or threw away food that others gave him
Exercised more
Made himself sick

Over the last 3 months, has your study teenager done any of the following to avoid putting on weight? Took pills or medicines in order to lose weight Please tick & describe what he took:

1
No
2
A little
3
A lot
4
Tried to but not allowed
9
Don't know
Generic text

Over the last 3 months, has your study teenager done any of the following to avoid putting on weight? Did other things. Please tick and describe what he does:

1
No
2
A little
3
A lot
4
Tried to but not allowed
9
Don't know
Other

Has your study teenager ever thought he was fat even when other people said he was very thin?

1
Yes
2
No
9
Don't know

Would he be ashamed if other people knew how much he eats?

1
Yes
2
No
9
Don't know

Has he ever deliberately made himself sick?

1
Yes
2
No
9
Don't know

Do worries about eating really interfere with his life?

1
Yes
2
No
9
Don't know

If he eats too much, does he blame himself a lot?

1
Yes
2
No
3
Never eats too much

Is he upset or distressed about his weight or body shape?

1
No, not at all
2
Yes a little
3
Yes quite a lot
4
Yes a great deal
9
Don't know
How much do you think his eating pattern or concern about weight and body shape has interfered with:
-

1 - Not at all

2 - A little

3 - Quite a lot

4 - A great deal

how well he gets on with you and the rest of the family?
making and keeping friends?
learning or class work?
hobbies, sports or other leisure activities?

Has his eating pattern or concern about weight or body shape put a burden on you or the family as a whole?

1
Not at all
2
A little
3
Quite a lot
4
A great deal
SECTION I: STRENGTHS AND DIFFICULTIES
Please think how your teenager has been in the past 6 months
-

1 - Not true

2 - Somewhat true

3 - Certainly true

9 - Don't know

He has been considerate of other people's feelings
He has been restless, overactive, cannot stay still for long
He has often complained of headaches, stomach aches or sickness
He has shared readily with other children and teenagers (treats, toys, pencils etc.)
He has often had temper trantrums or hot tempers
He is rather solitary, tends to play alone
He is generally obedient, usually does what adults request
He has many worries, often seems worried
He is helpful if someone is hurt, upset or feeling ill
He is constantly fidgeting or squirming
He has at least one good friend
He often fights or bullies other children or teenagers
He is often unhappy, down-hearted or tearful
He is generally liked by other children
He is easily distracted, his concentration wanders
He is nervous or clingy in new situations, easily loses confidence
He is kind to younger children
He often lies or cheats
He is picked on or bullied by other children
He often volunteers to help others (parents, teachers, other children)
He thinks things out before acting
He steals from home, school or elsewhere
He gets on better with adults than with other teenagers
He has many fears, is easily scared
He sees tasks through to the end, has good attention span
SECTION J: EATING

Some teenagers just have snacks all day while others wait for meals. How would you describe your study teenager? On school days

1
snacks all day, no real meals
2
snacks all day, but also has meals
3
doesn't snack much, just has meals
4
other (please tick describe)
Other

Some teenagers just have snacks all day while others wait for meals. How would you describe your study teenager? At the weekend

1
snacks all day, no real meals
2
snacks all day, but also has meals
3
doesn't snack much, just has meals
4
other (please tick describe)
Other

How many real meals a day does your study teenager have now?

How many

In the past year have you had difficulties getting him to eat what you wanted him to?

1
Yes, great difficulty
2
Yes, some difficulty
3
Yes, occasional difficulty
4
No, no difficulty
If yes,
qc_J2 == 1 || qc_J2 == 2 || qc_J2 == 3

please describe the problems:

Generic text
In the past 18 months has he at any time:
-

1 - Yes, often

2 - Yes, occasionally

3 - Never

deliberately not eaten a sufficient amount of food
refused to eat the food you think he should eat
been choosy with food
over-eaten
been difficult to get into an eating routine/missed meals you wanted him to eat
Meals in School in the past year

In term time does your study teenager ever have a mid-day meal provided by the school?

1
Yes
2
No
If no, go to J4c below
If yes,
qc_J4_a == 1

How many times per week?

1
Rarely, ocasionally
2
Once a week
3
2 or 3 times a week
4
4 times a week
5
5 times a week or more

Does your study teenager ever have a packed lunch provided by you?

1
Yes
2
No
If no, go to J5 on page 39
If yes,
qc_J4_c == 1

How many times per week?

1
Rarely, ocasionally
2
Once a week
3
2 or 3 times a week
4
4 times a week
5
5 times a week or more
J5-J25. Thinking about all the food that you provide which he eats during the day, including packed lunches, meals bought out and takeaways, how often does he eat the following foods? Please answer every question even if he never eats the food (in this case tick "never" or "rarely"). Do not include meals provided by school.

Meat sausages, burgers

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Meat pies/pasties (pork pie, steak/meat pie etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Vegetarian Pies/pasties (cheese and onion pasties, vegetable samosa, onion bhaji, vegetable grills etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Ham, bacon, and cold meats (e.g. salami, luncheon meat, garlic sausage etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Meat roast, chops, stews and curries, shepherds pie, bolognaise etc. (e.g. beef, lamb, pork, mince)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Liver, kidney, heart, pt

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Chicken/turkey in crispy coating (e.g. chicken nuggets, turkey burgers, chicken fingers etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Poultry: roast, grilled, fried, boiled, stewed (chicken, turkey etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Shellfish (prawns, crab, cockles, mussels etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

White fish in breadcrumbs or batter (e.g. fish fingers/shapes, chip shop fish, breaded cod etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

White fish without coating (eg. grilled fish, cod in parsley sauce etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Tuna

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Other fish (pilchards, sardines, mackerel, herring, kippers, trout, salmon etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Eggs, quiche, omelettes, flan etc.

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Cheese

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Pizza

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Lunchbox snack meals e.g. Lunchables, Snack-attacks, Dunkers etc.

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Oven chips

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Chips (fried), potato waffles or croquettes, Alphabites etc.

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Roast potatoes (cooked in fat or oil)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Boiled, mashed, jacket potatoes

1
No
2
A little
3
A lot

Rice (boiled, or fried, not rice pudding)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Canned pasta (spaghetti rings, ravioli, macaroni cheese etc.) Pot Noodles, Super Noodles etc.

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Boiled pasta (e.g. spaghetti, fusilli, lasagna) bulgar wheat and cous-cous

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Fried food (e.g. fried fish, eggs, bacon, chops etc.)

1
Never or rarely
2
Once in 2 weeks
3
1-3 times a week
4
4-7 times a week
5
More than once a day

Does he eat the fat on meat?

1
yes, all of it
2
yes, some of it
3
no, always leaves fat
4
no, never given meat with fat
5
never eats meat
How many times nowadays does he eat:
-

1 - Never or rarely

2 - Once in 2 weeks

3 - 1-3 times a week

4 - 4-7 times a week

5 - More than once a day

Baked beans
Peas, broad beans
Sweetcorn
Green vegetables (e.g. broccoli, cauliflower, cabbage, leeks, Brussels sprouts, courgettes, green beans etc.)
Carrots
Other root vegetables (turnip, swede, parsnip etc.)
Tomatoes (cooked or raw)
Salad (lettuce, cucumber, peppers, other raw vegetables etc.)
Pulses and pulse dishes (dahl, lentil soup, falafel, dried peas, beans, chick peas)
Quorn pieces/mince/ fillets, Quorn sausages or burgers
Soya 'Meat', TVP, Soya-type Vegeburgers, Vegebangers, Bean Curd (Tofu, Miso etc.)
Peanuts, peanut butter
Other nuts (e.g. cashew), nut roast
Canned fruit
Yoghurt, Fromage Frais
Milk puddings (e.g. rice pudding, semolina), mousse, Angel Delight etc.
Ice cream, choc ice, chocolate ice cream bar etc.
Ice lollies
Pudding (e.g. fruit pie, crumble, cheesecake, gateaux)
Custard, cream, Elmlea, Tip-Top, evaporated milk etc. on puddings
Cakes or buns (fruit cake, sponge, teacake, doughnut, flapjack, scone, custard tart, cream cake etc.)
Crispbreads (Ryvita, crackerbread etc.)
Ketchup/brown sauce etc.
Mayonnaise, salad cream or dressing etc.

Taking all foods provided by you together, in total, how many portions of vegetables e.g. broccoli, cauliflower, peas, carrots courgettes, cabbage, leeks, green beans etc. does he eat in a week? Do not include potatoes. ... portions

How many

Out of these total portions, how many are dark green leafy vegetables e.g. broccoli, Brussels sprouts, cabbage, spinach? ... portions

How many

In total how many pieces of raw fruit e.g. apple, banana, orange, Satsuma, peach, grapes, strawberries etc. does he eat in a week? (For small fruit such as grapes etc, one "piece" will be a "helping" e.g. a small dish of strawberries or a small sprig of grapes.) ... pieces

How many

Out of these, how many of them are: citrus fruit e.g. tangerine, orange, satsuma, grapefruit

How many

Out of these, how many of them are: bananas

How many

Out of these, how many of them are: apples

How many

Out of these, how many of them are: other fruit

How many

Does he eat breakfast cereals at all?

1
Yes
2
No
If no, go to J12 on page 46
If yes,
qc_J10_a == 1
What type of breakfast cereal does he eat nowadays?
-

1 - Never or rarely

2 - Once in 2 weeks

3 - 1-3 times a week

4 - 4-7 times a week

5 - More than once a day

Oat cereals (e.g. porridge, Ready Brek, Muesli, chocolate Ready Brek)
Wholegrain or bran cereals (e.g. All Bran, Bran Flakes, Weetabix, Wheatflakes, Fruit Fibre, Shreddies, Shredded Wheat, Sugar Puffs)
Other cereals (e.g . Cornflakes, Rice Krispies, Frosties, Special K, Coco Pops)
Breakfast cereal bars e.g. Rice Krispies bars, cornflakes bars
When he has breakfast cereals

How often are they sugar/honey coated or chocolate flavoured (e.g. Frosties, Coco Pops etc.)

1
Always
2
Sometimes
3
Never
If never go to J11c below
qc_J11_a == 3
Else

How many teaspoonfuls of sugar does he have on this type of cereal (i.e. sugar coated etc.)

1
None
2
1/2 teaspoon
3
One teaspoon
4
2 teaspoons
5
More than 2 teaspoons

How many teaspoonfuls of sugar does he have on other types of cereal (i.e. plain cereal)?

1
None
2
1/2 teaspoon
3
One teaspoon
4
2 teaspoons
5
More than 2 teaspoons
7
Doesn't have plain cereal

How many times per week does he have milk on cereal? ... times

How many
How many times a week nowadays does he drink:
-

1 - Never or rarely

2 - Once in 2 weeks

3 - 1-3 times a week

4 - 4-7 times a week

5 - More than once a day

Plain tap water on its own
Bottled mineral/fizzy water
Milk on its own
Flavoured milk drinks (e.g. Horlicks, Ovaltine, milkshakes) or yoghurt drinks
Fruit juice
How often does he eat each of these types of bread including in a packed lunch on school days?
-

1 - Usually

2 - Sometimes

3 - Never

white bread
soft grain white bread
brown/granary bread
wholemeal bread
chappatis, pitta bread
naan bread

How many slices of bread, rolls or chappatis provided by you does he eat on a usual day? (Include packed lunch provided from home) School days

How many

How many slices of bread, rolls or chappatis provided by you does he eat on a usual day? (Include packed lunch provided from home) Other days

How many

How many slices of bread (or rolls) spread with butter or margarine does he eat each day? (Include packed lunch provided from home) School days

How many

How many slices of bread (or rolls) spread with butter or margarine does he eat each day? (Include packed lunch provided from home) Other days

How many

How many slices of bread (or rolls) spread with jam/honey/chocolate spread etc. does he eat each day? (Include packed lunch provided from home) School days

How many

How many slices of bread (or rolls) spread with jam/honey/chocolate spread etc. does he eat each day? (Include packed lunch provided from home) Other days

How many
What sort of fat does he have:
on bread or vegetables for frying

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Butter, ghee, dripping, lard, solid cooking fat
Olive oil margarine
Full-fat polyunsaturated margarine (e.g. Flora, Vitalite, sunflower margarine)
Other full-fat margarine e.g. Stork, Blue Band, supermarket own brand, Clover, Golden Crown, Willow
Low-fat polyunsaturated margarine (e.g. Flora lite, Vitalite Lite, low-fat sunflower margarine)
Other low-fat spread, not polyunsaturated (e.g. Delight, St Ivel Gold)
Sunflower oil, corn oil, soya oil
Olive oil, hazelnut oil, rapeseed oil
Other vegetable oil
Other (please tick describe)

What sort of fat does he have: on bread or vegetables Other (please tick & describe)

Other

What sort of fat does he have: for frying Other (please tick & describe)

Other

What type(s) of milk does he have? Full fat

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Semi-skimmed

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Skimmed

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Goat/sheep milk

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Soya milk

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Flavoured milk

1
Yes usually
2
Yes sometimes
3
No not at all

What type(s) of milk does he have? Other (please describe)

1
Yes usually
2
Yes sometimes
3
No not at all
Other
How many times a week does he eat away from home in each of the following places?
-

1 - Never or rarely

2 - Once a month

3 - Once in 2 weeks

4 - 1-2 times a week

5 - 3-4 times a week

6 - 5 times a week or more

Fast food restaurant
Other café or restaurant
Grandparents or other family
Friends
Childminder

Does he drink tea?

1
Yes
2
No
If no, go to J19a on page 49
If yes,
qc_J18_a == 1

How many cups of tea does he drink in total in a day? (do not include herbal teas) ... cups a day

How many

How many spoons of sugar in each cup? ... spoons

How many

How many of the cups of tea that he drinks are decaffeinated? ... cups a day

How many

Which description best fits the amount of milk in the tea he drinks?

1
No milk
2
a little milk
3
about 1/4 milk
4
about 1/2 milk
5
about 3/4 milk
6
almost all milk

Does he drink coffee?

1
Yes
2
No
If no, go to J20a on page 50
If yes,
qc_J19_a == 1

How many cups of coffee (real, instant or decaffeinated) does he drink in total in a day? ... cups a day

How many

How many spoons of sugar in each cup? ... spoons

How many

How many of the cups of coffee he drinks are made using real coffee (i.e. not instant)? ... cups a day

How many

How many of the cups of coffee he drinks are decaffeinated? ... cups a day

How many

Which description best fits the amount of milk in the coffee he drinks?

1
No milk
2
a little milk
3
about 1/4 milk
4
about 1/2 milk
5
about 3/4 milk
6
almost all milk

Does he drink herbal teas at all?

1
yes, often
2
yes, occasionally
3
no, not at all
If no, go to J21 below
If yes,
qc_J20_a == 1 || qc_J20_a == 2

how many cups/mugs of herbal tea has he drunk in the past week? ... cups a week

How many

Please list the types of herbal teas he has drunk in the past 3 months:

Generic text

Apart from herbal teas, are there any other health foods (whether or not bought from a health food shop) that he often eats or drinks?

1
Yes
2
No
If no, go to J22a below
If yes,
qc_J21 == 1

please describe:

Generic text

How often does he have any of the following: wine

1
More than once a week
2
Once a week
3
Less than once a week
4
Not at all

How often does he have any of the following: beer, lager

1
More than once a week
2
Once a week
3
Less than once a week
4
Not at all

How often does he have any of the following: spirits (gin, vodka, brandy)

1
More than once a week
2
Once a week
3
Less than once a week
4
Not at all

How often does he have any of the following: other alcohol (please tick and describe)

1
More than once a week
2
Once a week
3
Less than once a week
4
Not at all
Other

What would you say best describes your teenager's alcohol drinking:

1
he has a glass of his own containing a normal adult portion
2
he has a glass of his own, but less than an adult portion
3
he just has a taste of other people's drink
4
he rarely has any alcohol
5
he never has any alcohol

Is your teenager at present a vegetarian?

1
Yes
2
No

Is your teenager at present a vegan (i.e. does not eat meat, poultry, fish, eggs, butter, milk or cheese)?

1
Yes
2
No

Is your teenager at present on any other kind of special diet?

1
Yes
2
No
If yes,
qc_J25 == 1

Which kind of special diet? gluten-free (coeliac)

1
Yes

Which kind of special diet? diabetic

1
Yes

Which kind of special diet? nut free

1
Yes

Which kind of special diet? other (please tick and describe)

1
Yes
Other
SECTION K:

This questionnaire was completed by (please tick all that apply): teenager's biological mother

1
Yes

This questionnaire was completed by (please tick all that apply): teenager's mother-figure

1
Yes

This questionnaire was completed by (please tick all that apply): teenager's biological father

1
Yes

This questionnaire was completed by (please tick all that apply): study teenager

1
Yes

This questionnaire was completed by (please tick all that apply): someone else (please describe)

1
Yes
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give your date of birth:

Date of birth

Please give your study teenager's date of birth:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comments you would like to make

Long text
NB Please remember we cannot reply to any comment unless you sign it.
When completed, please return the questionnaire to: Professor Jean Golding Children of the Nineties - ALSPAC
End

alspac_04_mtsd

MY TEENAGE SON
All answers are confidential
This questionnaire is for the study child's mother or the person taking the role of chief carer.
This questionnaire is for the study teenager's mother or person taking the role of chief carer.
To answer simply tick the box which is most accurate in your opinion.
If you do not want to answer a question or if it does not apply to your son, put a line through it. There are no good or bad answers. Just tell us what is true for you.
THANK YOU FOR YOU HELP

SECTION A: YOUR SON'S HEALTH

How would you assess the health of your study teenager nowadays? in the past month
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
How would you assess the health of your study teenager nowadays? in the past year
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

Has he had any of the following in the past 12 months?

-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache(s )
constipation
worm infection
head lice
scabies
asthma
eczema
hay fever
Has he had any of the following in the past 12 months? other (please tick and describe)
1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other
Which of the following infections has he ever had: measles
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: chicken pox
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: mumps
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: meningitis
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: cold sores
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: whooping cough
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: urinary infection
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: eye infection
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: ear infection
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: chest infection
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: tonsillitis or laryngitis
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: german measles
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: scarlet fever
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: influenza (flu)
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: a cold
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: glandular fever
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Which of the following infections has he ever had: other infection (please tick & describe)
1
Yes, in the past 12 months
2
Yes, but not not in past 12 months
3
No, never
Other
Has your teenager been admitted to hospital since his 9th birthday?
1
Yes
2
No
If no, go to A5 on page 6
how many times?
How many

please describe for each admission:

Age of child (years) Reason for admission No. of nights child stayed in hospital Write 00 if he did not stay overnight
How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many
1
2
3
If more than 3 admissions please describe on separate sheet
How often did you see him while he was in hospital? 1st admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him
How often did you see him while he was in hospital? 2nd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him
How often did you see him while he was in hospital? 3rd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with him
Are there any foods or drinks that your teenager is or has been allergic to?
1
yes definitely
2
yes possibly
3
no, not at all
9
don't know
If no, or don't know go to A6a on page 8
please describe which foods or drinks
Generic text
was the reaction caused by eating or touching the food or drink?
1
eating/drinking
2
touching
3
both
what happens when he does have the reaction? (Tick all that apply) bright red rash
1
Yes
over what part of body?
Generic text
what happens when he does have the reaction? (Tick all that apply) hives (white raised bumps on skin)
1
Yes
over what part of body?
Generic text
what happens when he does have the reaction? (Tick all that apply) wheezing or whistling in the chest
1
Yes
what happens when he does have the reaction? (Tick all that apply) vomiting
1
Yes
what happens when he does have the reaction? (Tick all that apply) diarrhoea
1
Yes
what happens when he does have the reaction? (Tick all that apply) difficulty breathing
1
Yes
what happens when he does have the reaction? (Tick all that apply) stop breathing
1
Yes
what happens when he does have the reaction? (Tick all that apply) headache
1
Yes
what happens when he does have the reaction? (Tick all that apply) swelling
1
Yes
describe where
Generic text
what happens when he does have the reaction? (Tick all that apply) other reaction Please tick and describe
1
Yes
Other
How long after eating or drinking or touching does this usually happen?
1
less than 1 hr
2
1-2 hrs
3
3-5 hrs
4
6 hrs or more
9
don't know
How old was he when this first happened? ... years old
Age
How many times has a reaction happened?
1
once
2
2-3 times
3
4-9 times
4
10 or more times
9
don't know
How old was he the last time a reaction happened? ... years old
Age
What treatment has your teenager been given for the problem?
1
None
2
Yes, some treatment
Please describe
Generic text
Apart from food and drink are there any other things to which he is allergic?
1
Yes
2
No
If no, go to A7 below
What is he allergic to? (Tick all that apply) pollen
1
Yes
What is he allergic to? (Tick all that apply) cat
1
Yes
What is he allergic to? (Tick all that apply) dog
1
Yes
What is he allergic to? (Tick all that apply) bee sting
1
Yes
What is he allergic to? (Tick all that apply) wasp sting
1
Yes
What is he allergic to? (Tick all that apply) house dust
1
Yes
What is he allergic to? (Tick all that apply) medicine
1
Yes
please describe type of medicine
Generic text
What is he allergic to? (Tick all that apply) other Please tick and describe
1
Yes
Other
Has he ever had a seizure, fit or a convulsion?
1
Yes
2
No
If no, go to A8 on page 10
how many has he had?
How many
did any of them last more than 15 minutes?
1
Yes
2
No
3
can't say
did his body shake and jerk on just one side?
1
Yes, right side
2
Yes, left side
3
No, it was all over
4
can't say
did he have a fever at the time?
1
Yes, each time (or only time)
2
Yes, but not each time
3
No
If no, go to A7e) below
how high was his temperature?
Temperature
what was the cause of the fever(s)?
Generic text
did he have more than one episode of fitting during any feverish illness?
1
Yes
2
No
When the first fit or convulsion happened: how old was he? ... years
Age
Were there any warning signs before he had a fit or convulsion?
1
Yes
2
No
If no, go to A8 on page 10
Please describe:
Generic text
Does he often have aches and pains in his arms or legs?
1
yes arm(s)
2
yes leg(s)
3
yes both
4
no, not often
If no, go to A9 below
does this happen especially when he is tired?
1
Yes
2
No
what do you think is the cause ?
Generic text
do you find any particular treatment helps ?
1
Yes
2
No
please describe
Generic text
During sleep, does your study teenager: snore
1
Never
2
Sometimes
3
Often
During sleep, does your study teenager: perspire/sweat a lot
1
Never
2
Sometimes
3
Often
During sleep, does your study teenager: fidget
1
Never
2
Sometimes
3
Often
During sleep, does your study teenager: talk
1
Never
2
Sometimes
3
Often
During sleep, does your study teenager: have nightmares
1
Never
2
Sometimes
3
Often
How often does your teenager wake up in the night? to go to the toilet
1
Never
2
Sometimes
3
Often
How often does your teenager wake up in the night? because of loud or unusual noises
1
Never
2
Sometimes
3
Often
How often does your teenager wake up in the night? if worried
1
Never
2
Sometimes
3
Often
How often does your teenager wake up in the night? if excited
1
Never
2
Sometimes
3
Often
How often does your teenager wake up in the night? if feeling poorly
1
Never
2
Sometimes
3
Often
Thinking back over the last month, has your teenager been feeling tired or been lacking in energy?
1
Yes
2
No
If no, go to A16 on page 12
Do you know why he has been feeling tired or lacking in energy?
1
Yes
2
No

What is the main reason he has been feeling tired or lacking in energy? (please tick all that apply)

-

1 - Yes

Illness
Problems with sleep
Playing a lot of sport (or other physical exercise)
Stress or worry
What is the main reason he has been feeling tired or lacking in energy? (please tick all that apply) Other reason (please give details)
1
Yes
Other
How long has he been feeling tired or felt he had no energy? (Tick one only)
1
Less than 3 months
2
Between 3 and 5 months
3
Between 6 months and 5 years
4
More than 5 years
Does he feel better after resting?
1
Not at all
2
Only a bit
3
Definitely better
During the last month, has this tiredness or lack of energy stopped him from playing, taking part in hobbies, sports or other leisure activities?
1
Not at all
2
Only a little
3
Quite a lot
4
A great deal
During the past year, how many days has your teenager been off school because of this tiredness or lack of energy? (If none, write 00) ... days
How many
Has he seen a doctor in the past year because of this tiredness or lack of energy?
1
Yes
2
No

SECTION B: SEEING AND HEARING

Just as some people have better long-distance vision than others, so some people are better at remembering faces they have seen, or seeing people or objects in a crowd. We would like to know how your study teenager responds in the situations described below.
However, if your study teenager's sight is so poor that you feel you cannot answer, please tick this box
1
tick
When he sees members of his close family, does he recognise them?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he recognise friends?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he recognise people from photographs?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he lose objects around the house?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he have difficulty reaching out for and grasping objects?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he have difficulty distinguishing a step from a line on the ground?
1
Never
2
Occasionally
3
Most of the time
4
Always
Can he find objects on a patterned carpet or bedspread?
1
Never
2
Occasionally
3
Most of the time
4
Always
Can he find objects in complex pictures?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he misjudge going through doorways or along corridors?
1
Never
2
Occasionally
3
Most of the time
4
Always
Can he find his way around the house?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he have difficulty seeing things pointed out in the distance?
1
Never
2
Occasionally
3
Most of the time
4
Always
Can he find his way around in new surroundings?
1
Never
2
Occasionally
3
Most of the time
4
Always
Does he prefer music or talking to be loud or soft?
1
He hates loud sounds
2
He doesn't mind if it's loud or not
3
He loves loud sounds
4
Can't say
How do you rate his hearing?
1
Excellent
2
Good
3
OK
4
Some sounds he can't hear
5
He can't hear much at all

SECTION C: TICS AND UNINTENDED HABITS

Many teenagers have strange habits that they do not intend and often are not aware of them. Please indicate whether your study teenager has had any of these in the past year.

-

1 - Definitely

2 - Probably

3 - No, not At all

Repeated movements of parts of the face and head (e.g. eye blinking, grimacing, sticking tongue out, licking lips, spitting)
Repeated movements of the neck, shoulder or trunk (e.g. twisting around, shoulder shrugging, bending over, nodding)
Repeated movements of the arms, hands, legs or feet (e.g. clapping hands, touching himself or others, hopping, kicking)
Repeated noises and sounds (e.g. coughing, clearing throat, grunting, gurgling, hissing)
Repeated words and phrases
Please describe what is repeated
Generic text
About how often does/did this happen in the last year?
1
Less than once a month
2
1-3 times a month
3
about once a week
4
more than once a week
5
every day
Does this happen more at particular times?
1
Yes
2
No
please tick all that apply: when tired
1
Yes
please tick all that apply: when anxious or stressed
1
Yes
please tick all that apply: other time (please tick and describe)
1
Yes
Other

SECTION D: SOCIAL SKILLS

How do you feel your study teenager compares with people of his own age in regard to the following:

-

1 - A lot worse than average

2 - A bit worse than average

3 - About average

4 - A bit better than average

5 - A lot better than average

Able to laugh around with others, e.g. accepting lighthearted teasing and responding appropriately
Easy to chat with, even if it isn't on a topic that specially interests him
Able to compromise and be flexible
Finds the right thing to say or do in order to defuse a tense or embarrassing situation
Graceful when he doesn't win or get his own way. A good loser
Other people feel at ease around him
By reading between the lines of what people say, he can work out what they are really thinking and feeling
After doing something wrong, he's able to say sorry and sort it out so that there are no hard feelings.
Can take the lead without others feeling they are being bossed about
Aware of what is and isn't appropriate in different social situations

SECTION E: ATTITUDES AND BEHAVIOUR TOWARDS ANIMALS

Some teenagers have had a liking for all animals from being very small. Others are afraid and don't like certain animals. Sometimes they try to hurt or harm animals. We would like to ask you some questions about how your teenager feels towards animals.
How often: Is he scared of dogs?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Is he scared of insects or spiders?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Is he rough with animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Does he harm animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Does he show an interest in animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Does he show an interest in insects?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
How often: Does he show concern for the suffering of animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
My teenager has harmed animals
1
Never
2
Accidentally
3
In curiosity
4
Maybe on purpose
5
Definitely on purpose
My teenager has harmed small insects
1
Yes
2
No
My teenager has harmed the family pets
1
Yes
2
No
7
Has never had a pet
My teenager has harmed other people's pets
1
Yes
2
No
My teenager has harmed animals (not pets)
1
Yes
2
No
The last time my teenager hurt an animal was
1
Never
2
More than one year ago
3
Last week
4
Yesterday
5
Today
How often: Has he hurt animals whilst on his own ?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
How often: Has he, together with others, hurt animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
How often: Has he secretly hurt animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
How often: Has he shown pleasure when hurting animals?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
How often: Is he forgiving if an animal bites or scratches?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know
How often: Will he go out of his way to fuss and stroke an animal?
1
Never
2
Rarely
3
Sometimes
4
Often
5
Always
9
Don't know

SECTION F: MEDICINES, PILLS, LOTIONS, CREAMS AND IMMUNISATIONS

We are interested in finding out whether children have any difficulties in correctly taking medicines by mouth. For example, you may have had to crush tablets/pills or empty out the contents of a capsule and add them to a drink or a spoonful of jam, because of difficulty in swallowing them whole or a dislike of the taste.
Is your study teenager able to swallow pills/tablets whole?
1
Yes
2
No
9
Don't know, never takes any
Has your study teenager ever been given a medicine, pill or capsule that he was unable to take in the correct manner?
1
Yes
2
No
If no, go to the top of page 23

what type of medicine was difficult for him to take?

Yes Please give name(s) of medicines

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text
tablets
hard capsules (usually contain granules or powder)
soft capsules (may contain a liquid)
liquid medicine

_medicine < 4

What did you have to do to help him take the medicine? (If more than 1 type of medicine, answer separately for each) Name of medicine
Generic text
What did you have to do to help him take the medicine? (If more than 1 type of medicine, answer separately for each) Yes
1
Crush or break up tablets
2
Empty capsules
3
Add the medicine to a drink
4
Other, please tick and describe
Other
what type of drink?
Generic text
Medicines often have some unwanted effects, which we know to expect, such as causing a dry mouth. However, we are interested in finding out about more severe and/or unexpected reactions, which required some further action, such as seeking advice from your doctor or pharmacist, and/or stopping or changing the medicine.
Has your son ever had a bad reaction or side effect, which was thought to be due to a medicine he was taking or using, and which required some action to be taken? (By medicine we mean pills/tablets, liquid mixture, cream or ointment, injection or vaccine, eye drops, herbal medicine etc.)
1
Yes
2
No
If no, go to Section G on page 28
Please give the details separately for each type of medicine that caused a bad reaction (if he had side effects to more than 3 medicines, give details for the 3 most serious or severe reactions)

_medicine < 4

Name of medicine:
Generic text
What type of medicine was it?
1
tablets/capsules/pills
2
liquid medicine (taken by mouth)
3
cream/ointment/lotion
4
injection/vaccine/immunisation
5
eye drops/eye ointment
6
other (please describe)
Other
What was the medicine being used for (e.g. chest infection, stomach upset, skin problem)?
Generic text
How old was he at the time the reaction happened? ... years
Age

Which of the following best describes the reaction or side effects?

-

1 - Yes

skin rash
itching
feeling/being sick
breathing difficulties
effects on digestion e.g. diarrhoea
blood disorder
bleeding
bad headache(s)
dizziness/feeling faint
blurred vision
jaundice
severe allergic reaction or anaphylaxis
Which of the following best describes the reaction or side effects? other, please tick and describe
1
Yes
Other
Please choose one of the following for each medicine, that best describes how often, and for how long each time, the side effects happened.
1
Single isolated incident (e.g. severe allergic reaction)
2
Repeated episodes over 1-2 days (e.g. dizzy spells)
3
Repeated episodes over 3-7 days (e.g. dizzy spells or headaches)
4
Repeated episodes over more than 7 days
5
Continuous, but lasted less than 2 days (e.g. headache or skin rash)
6
Continuous, lasting 2-7 days (e.g. skin rash, itching)
7
Continuous, lasting more than 7 days (e.g. blood disorder or jaundice)
8
Other, please tick and describe
Other
How serious, severe and/or unexpected was the reaction? Unexpected (i.e. you were not aware or had not been warned that some people may experience these side effects)
1
Yes
How serious, severe and/or unexpected was the reaction? The side effects were bad enough to prevent him doing things that he would normally have done (after allowing for the illness)
1
Yes
How serious, severe and/or unexpected was the reaction? The side effects were bad enough for advice to be sought from a healthcare professional
1
Yes
who was this? (tick all that apply): family doctor/GP
1
Yes
who was this? (tick all that apply): hospital doctor
1
Yes
who was this? (tick all that apply): pharmacist/chemist
1
Yes
who was this? (tick all that apply): nurse
1
Yes
who was this? (tick all that apply): other (please tick and describe)
1
Yes
Other
How serious, severe and/or unexpected was the reaction? The reaction was so bad that he had to stop using the medicine (leave blank for one-off doses e.g. vaccines)
1
Yes
How serious, severe and/or unexpected was the reaction? He was admitted to hospital because of the side effects
1
Yes
How long did he stay in hospital? ... days
How many
How serious, severe and/or unexpected was the reaction? He recovered fully from the side effects after stopping the medicine
1
Yes
How serious, severe and/or unexpected was the reaction? He recovered fully from the side effects and was able to continue taking the medicine
1
Yes
How serious, severe and/or unexpected was the reaction? He has had this medicine again but did not have the same bad reaction
1
Yes
How serious, severe and/or unexpected was the reaction? He has had this medicine again and the side effects were repeated
1
Yes
How serious, severe and/or unexpected was the reaction? He still nowadays has some effects from having taken the medicine
1
Yes
As medicines can react with each other, we would like to know if he was using any other medicines at that time, if you can remember.
Generic text
Generic text 2
Generic text 3
Generic text 4

SECTION G: MOODS AND FEELINGS

We are interested in studying the patterns of behaviour that children have. Please could you try to describe the kind of person your child is. When answering the questions, think about how he has tended to feel, think, and act over the past several years. Remember that there are no correct answers.

-

1 - Is often like this

2 - Is sometimes like this

3 - Is never like this

He goes to extremes to prevent those he loves from leaving him
He either loves someone or hates them, with nothing in between
He often wonders who he really is
He has tried to hurt or kill himself
He is a very moody boy
He feels his life is dull and meaningless
He has difficulty controlling his anger or temper
When he gets stressed out, things happen, e.g. he gets paranoid or complains of feeling detached from himself or things around him

As far as you know, has he done things on impulse that can get him into trouble?

-

1 - Yes

2 - No

Has he gone on eating binges?
Has he drunk too much alcohol?
Has he taken drugs?
Has he spent more money than he has?
Has he yelled at people?
Has he broken things?
Has he hit people?
Has he stolen things?

These questions are about how your teenager may have been feeling or acting recently. For each question, please say how much you think he has felt or acted this way in the past two weeks.

-

1 - True

2 - Sometimes true

3 - Not true

He felt miserable or unhappy
He didn't enjoy anything at all
He felt so tired that he just sat around and did nothing
He was very restless
He felt he was no good any more
He cried a lot
He found it hard to think properly or concentrate
He hated himself
He felt he was a bad person
He felt lonely
He thought nobody really loved him
He thought he could never be as good as other kids
He felt he did everything wrong

SECTION H: DIETING, WEIGHT AND BODY SHAPE

What is your study teenager's height at the moment (without shoes)? ... feet ... inches OR ... metres ... centimetres
feet
inches in feet
metres
centimetres in metres
9
Don't know
What is his weight at the moment? ... stones ... pounds OR ... kilos
stones
pounds in stones
kilos
9
Don't know
What was his lowest weight in the last 12 months? ... stones ... pounds OR ... kilos
stones
pounds in stones
kilos
9
Don't know
What was his highest weight ever? ... stones ... pounds OR ... kilos
stones
pounds in stones
kilos
9
Don't know
At present would you describe your study teenager as:
1
Very thin
2
Thin
3
Average
4
Plump
5
Fat
How do you feel he compares this year with previous years?
1
Thinner in previous years
2
About the same
3
A little thinner this year
4
A lot thinner this year
At present would he describe himself as:
1
Very thin
2
Thin
3
Average
4
Plump
5
Fat