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alspac_94_msdhab
MY DAUGHTER'S HEALTH AND BEHAVIOUR
This questionnaire asks about your child now that he is three and a half. It is like the other questionnaires you have received.Your answers will help us to understand how your child has changed in the past year. To answer simply tick the box which best describes your child or your child's situation. Please answer all questions that you can. If you cannot answer any question or if they do not apply to you please put a line through them. There are no right or wrong answers. Please just describe what happens in your situation. You may make additional comments at the end. All answers are confidential.
THANK YOU FOR YOUR HELP
SECTION A: YOUR CHILD'S HEALTH

How would you assess the health of your child? 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 child? 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 she 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
snuffles/cold
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache (s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache (s)

Has she 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

Has your child been admitted to hospital in the past 12 months?

1
Yes
2
No
If no, go to A4 on page 4
If yes,
qc_A3_a == 1

how many times?

How many
please describe for each admission:
Age of child (months) Reason for admission No. of nights child stayed
How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many
1
2
3

How often did you see her while she was in hospital? 1st admission

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

How often did you see her while she was in hospital? 2nd admission

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

How often did you see her while she was in hospital? 3rd admission

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

Has she ever had any of the following? hernia repair

1
Yes
2
No

Has she ever had any of the following? operation for squint

1
Yes
2
No

Has she ever had any of the following? tubes (grommets) put in her ears

1
Yes
2
No

Has she ever had any of the following? other operation (please tick and describe)

1
Yes
2
No
Other

In the past 12 months has she had any periods when there was wheezing with whistling on her chest when she breathed?

1
Yes
2
No
If no, go to A6 on page 5
If yes,
qc_A5_a == 1

How many separate times has this happened in the past 12 months?

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

How many days altogether would you say she had wheezed in the past 12 months?

1
one day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know

Was she breathless (struggling for breath) during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

Did she have a fever during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

What do you think brings them on? chest infection or bronchitis

1
Yes
2
No

What do you think brings them on? being in a smoky room

1
Yes
2
No

What do you think brings them on? cold weather

1
Yes
2
No

What do you think brings them on? no idea

1
Yes
2
No

What do you think brings them on? other (please tick and describe)

1
Yes
2
No
Other

Has your child had an itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms) in the past 12 months?

1
Yes
2
No
If no, go to A7a below
If yes,
qc_A6_a == 1

how bad was this?

1
very bad
2
quite bad
3
mild
4
no problem

does she have this sort of rash now?

1
Yes
2
No

did the rash ever become sore and oozy?

1
Yes
2
No

was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?

1
Yes
2
No
In the past 12 months:

Has she had an itchy, dry rash on her hands?

1
Yes
2
No

Has she had an itchy, dry rash on her feet?

1
Yes
2
No
If yes,
qc_A7_b == 1

please describe which parts of her feet

Generic text

does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)

1
Yes
2
No

has she ever had a reaction (e.g. redness or itching) which you thought was due to some food that she had eaten?

1
Yes
2
No
If no, go to A8a on page 6
If yes,
qc_A7_d == 1

please describe the most recent occasion: what was the food?

Generic text

please describe the most recent occasion: how long after the food was eaten did the reaction appear?

Generic text

please describe the most recent occasion: where was the reaction?

1
mouth
2
other part (say where)
Other

Has she had vomiting spells in the past 12 months?

1
Yes
2
No
If no, go to A9 below
If yes,
qc_A8_a == 1

How many times?

1
once
2
twice
3
3-9 times
4
10 or more times

Have these been associated with: diarrhoea

1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never

Have these been associated with: chestiness (wheezing or coughing or grunting)

1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never

Nowadays how many motions (stools) does she usually have?

1
4 or more times/day
2
2-3 times/day
3
once a day
4
once in 2-4 days
5
once a week
9
can't say

Nowadays how often are her stools: hard

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: soft

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: curdy (i.e. solid & liquid)

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: liquid

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: green

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: brown

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: black

1
Usually
2
Sometimes
3
Never

Nowadays how often are her stools: yellow

1
Usually
2
Sometimes
3
Never

In the past 12 months months has she had diarrhoea or gastro-enteritis?

1
Yes
2
No
If no, go to A12a on page 8
If yes,
qc_A11_a == 1

how many times?

How many

how many days did the worst attack last?

How many

Did you: call the doctor to come to your home

1
Yes
2
No

Did you: go to your doctor

1
Yes
2
No

Did you: treat it yourself

1
Yes
2
No

Did you: other (please tick and describe)

1
Yes
2
No
Other

Did you continue feeding as usual?

1
Yes
2
No
If yes, go to A11f on page 8
If no,
qc_A11_e == 2

how long was normal feeding disturbed?

1
less than 1 day
2
1 day
3
2 days
4
3-4 days
5
5 or more days

Was the child treated with an oral rehydration solution?

1
Yes
2
No
9
Don't know
If no or don't know go to A11g below
If yes,
qc_A11_f == 1

give type if known:

Generic text

how long was the solution given?

1
less than 1 day
2
1 day
3
2 days
4
3-4 days
5
5 or more days

What other treatment was given?

Long text

In the past 12 months has your child ever had a time when she has coughed off and on for at least 2 days?

1
Yes
2
No
If no, go to A13a below
If yes,
qc_A12_a == 1

how many times has this happened in the past 12 months?

1
once
2
twice
3
3-9 times
4
10 or more times

did she have a fever at any of these times?

1
Yes for all
2
Yes for some
3
No not at all

did she have a runny nose during any of these spells?

1
Yes for all
2
Yes for some
3
No not at all
The following questions are about your child's ears or hearing.

Nowadays, does your child listen to people or to things that happen nearby:

1
Yes usually
2
Yes often
3
Sometimes
4
Usually not
9
Don't know

Does she turn her head towards sounds?

1
only to very loud sounds
2
yes usually
3
yes sometimes
4
never turns towards sounds
9
don't know

During or after a cold, is her hearing worse than usual?

1
yes much worse
2
yes a little worse
3
no, about the same
7
has never had a cold
9
don't know
If has never had a cold to question A13c Go to A13e below
qc_A13_c == 7
Else

During a cold, is the dripping (discharge) from her nose: clear

1
Yes
2
No
9
Don't know

During a cold, is the dripping (discharge) from her nose: slightly white in colour

1
Yes
2
No
9
Don't know

During a cold, is the dripping (discharge) from her nose: thick heavy yellow and/or green in colour (catarrh)

1
Yes
2
No
9
Don't know

During a cold, is the dripping (discharge) from her nose: very little discharge occurs at all

1
Yes
2
No
9
Don't know

Does she pull, scratch or poke at her ears?

1
quite often
2
only at times when poorly, fretful, or in pain
3
hardly ever
9
don't know

Do her ears go red and look sore for a long time? (Remember - an ear that has just been slept on may look red for a short time.)

1
quite often
2
only at times when poorly, fretful, or in pain
3
hardly ever
9
don't know

Has pus or a sticky mucus (not ear wax) ever leaked out of her ear?

1
never
2
once
3
more than once
9
don't know

Does she breathe through her mouth rather than through her nose?

1
all the time
2
much of the time
3
rarely
4
never
9
don't know

Does she snore for more than a few minutes at a time?

1
most nights
2
quite often
3
only rarely
9
don't know

When she is asleep, does she seem to stop breathing or hold her breath for several seconds at a time?

1
yes, often
2
yes, sometimes
3
no
9
don't know

Have there been times when she seems to have had a pain in her stomach in the past 12 months?

1
Yes
2
No
If no, go to A15a below
If yes,
qc_A14_a == 1

How many separate times has this happened in the past 12 months?

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

Since she was 2 years old has she had any form of convulsion, fit, seizure or other turn in which consciousness was lost or any part of the body made an abnormal movement?

1
Yes
2
No
9
Not known
If no, or not known go to A16 on page 13
If yes,
qc_A15_a == 1

Please describe the first attack since her 2nd birthday:

Long text

Did the child have a high temperature at the time?

1
Yes
2
No
9
Not known

How old was she at the time?

1
2 years old
2
3 years old
9
unsure

How many attacks has she ever had?

1
one
2
two
3
3-4
4
5 or more
By whom was the child seen for the attack(s) since her 2nd birthday (tick all that apply)
-

1 - Yes

2 - No

9 - Don't know

G.P. at home
G.P. at surgery
hospital outpatients/casualty
admitted to hospital

What investigations, if any, have been carried out?

Long text

How did later attacks differ from the first one?

Long text

What were these thought to be due to? (Tick all that apply) febrile convulsions

1
Yes
2
No
9
Don't know

What were these thought to be due to? (Tick all that apply) fainting and blackouts

1
Yes
2
No
9
Don't know

What were these thought to be due to? (Tick all that apply) epilepsy

1
Yes
2
No
9
Don't know

What were these thought to be due to? (Tick all that apply) breath holding

1
Yes
2
No
9
Don't know

What were these thought to be due to? (Tick all that apply) reaction to immunisation

1
Yes
2
No
9
Don't know

What were these thought to be due to? (Tick all that apply) other (please specify)

1
Yes
2
No
9
Don't know
Other

Has she ever had any of the following infections? measles

1
Yes
2
No

Has she ever had any of the following infections? chicken pox

1
Yes
2
No

Has she ever had any of the following infections? mumps

1
Yes
2
No

Has she ever had any of the following infections? meningitis

1
Yes
2
No

Has she ever had any of the following infections? cold sores

1
Yes
2
No

Has she ever had any of the following infections? german measles

1
Yes
2
No

Has she ever had any of the following infections? other infection (please tick and describe)

1
Yes
2
No
Other

About how many times in the last 12 months has: the family doctor come to your home because she was ill?

(put 00 if not at all)

How many

About how many times in the last 12 months has: the family doctor seen her in the surgery because she was unwell?

(put 00 if not at all)

How many

About how many times in the last 12 months has: a doctor seen her for a routine check?

(put 00 if not at all)

How many
SECTION B: SLEEPING AND CRYING

Does your child have a regular sleeping routine?

1
Yes
2
No

How many hours sleep does she usually have during the day time?

1
none
2
less than 1 hour
3
1-2 hrs
4
more than 2 hours
9
don't know

Normally what time in the evening does your child go to sleep?

Generic text

What time does she normally wake up in the morning?

Generic text

How often during the night does she usually wake? ... times

How many

How often during the day does she usually sleep? ... times

How many

In which room does she usually sleep? When you put her down at night

1
in her own room on her own
2
in a room with other children
3
in your bedroom
4
in a room with other adults
5
other place (please tick and describe)
Other

In which room does she usually sleep? When she wakes in the morning from her night sleep

1
in her own room on her own
2
in a room with other children
3
in your bedroom
4
in a room with other adults
5
other place (please tick and describe)
Other

Does she sleep on her own most nights or does she share a bed or cot? When you put her down

1
in her own bed/cot
2
in bed/cot with other children
3
in your bed with you
4
in bed with other adult
5
other place (please tick and describe)
Other

Does she sleep on her own most nights or does she share a bed or cot? When she wakes in the morning from her night sleep

1
in her own bed/cot
2
in bed/cot with other children
3
in your bed with you
4
in bed with other adult
5
other place (please tick and describe)
Other

How does she usually sleep?

1
on her back
2
on her side
3
on her front
4
varies
In the room where the child sleeps most of the night:
-

1 - Yes always

2 - Yes sometimes

3 - No not at all

is the heating on at night?
is there a window open at night?
does she sleep with a duvet?
does she have an electric blanket?
does she sleep with a pillow?

Do you feel her sleep pattern is:

1
better than other children of the same age
2
same as other children of the same age
3
worse than other children of the same age
9
don't know
In the past year has your child regularly:
-

1 - Yes, but did not worry me

2 - Yes, worried me a bit

3 - Yes, worried me greatly

4 - No, did not happen

refused to go to bed
woken very early
had difficulty going to sleep
had nightmares
continued to get up after being put to bed
woken in the night
got up after only a few hours sleep

Compared with other children would you describe the amount of time your child cries as:

1
more than other children
2
the same as other children
3
less than other children
9
don't know

All children cry. Some children also fuss and whine. How often does your child whine?

1
for long periods each day
2
for a short while each day
3
a number of times during the week
4
sometimes
5
never or hardly ever

How often does your child cry for no particular reason:

1
very often
2
quite often
3
sometimes
4
never or hardly ever

Can you usually calm your child when she cries?

1
no
2
yes, usually fairly easily
3
yes, but it takes a while
4
yes, after much effort
5
child never cries

Do you feel that your child's crying is a problem?

1
Yes
2
No

How often do you use sweets or other foods to stop her crying or fussing?

1
at least once a day
2
several times a week
3
infrequently
4
never
If never, go to Section C on page 18
qc_B12_a == 4
Else

what food do you use to stop her crying or fussing? sweets

1
Yes
2
No

what food do you use to stop her crying or fussing? chocolates

1
Yes
2
No

what food do you use to stop her crying or fussing? crisps

1
Yes
2
No

what food do you use to stop her crying or fussing? fruit

1
Yes
2
No

what food do you use to stop her crying or fussing? milk

1
Yes
2
No

what food do you use to stop her crying or fussing? other drink

1
Yes
2
No

what food do you use to stop her crying or fussing? other food (please tick and describe)

1
Yes
2
No
Other
SECTION C: YOU AND YOUR CHILD

Do you ever have a battle of wills with your child?

1
never
2
rarely (less than once a week)
3
sometimes (at least once a week)
4
frequently (almost every day)
If never, go to C2 below
If yes,
qc_C1_a >= 2 && qc_C1_a <= 4

What are they usually about:

Long text

Who most often wins?

1
me
2
she does
3
about even
4
neither of us

How often does she refuse to go to bed?

1
most of the time
2
often
3
at times
4
rarely
5
never

How often does she have temper tantrums?

1
more than once a day
2
most days
3
at least once a week
4
less than once a week
5
never
If never, go to C4 on page 19
If she has temper tantrums:
qc_C3_a >= 1 && qc_C3_a <= 4

Do they occur because of: failure to get what she wants

1
Yes
2
No

Do they occur because of: failure to make herself understood

1
Yes
2
No

Do they occur because of: reaction to being corrected

1
Yes
2
No

Do they occur because of: no particular reason

1
Yes
2
No

Do they occur because of: other (please tick and describe)

1
Yes
2
No
Other
When she has temper tantrums how often do you:
-

1 - Often

2 - Sometimes

3 - Never

ignore it, let her get it out of her system
send her away for 'time out' eg. send her to her bedroom
try to hold and cuddle her
try to reason with her
leave it for someone else to cope with
try to distract her

When she has temper tantrums how often do you: other (please tick and describe)

1
Often
2
Sometimes
3
Never
Other

How often does she do the following: repeatedly rocks head or body

1
Once a week or more
2
Less than once a week
3
Never

How often does she do the following: has a tic or twitch

1
Once a week or more
2
Less than once a week
3
Never

How often does she do the following: has other unusual behaviour (please tick and describe)

1
Once a week or more
2
Less than once a week
3
Never
Other

About how often is she taken to: local shops

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: department store

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: supermarket

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: park or playground

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: visits to friends or family

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: library

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: places of interest (e.g. Zoo)

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

About how often is she taken to: places of entertainment (e.g. funfair)

1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never

Please tick which is appropriate for your child:

1
she wanders further than I like
2
she never leaves me
3
neither of above

How much choice do you allow her in deciding what foods she eats at meals?

1
she can choose from any food available
2
she is given a choice from a few alternatives that I select
3
I decide what she will eat
7
I am never in charge of preparing her meals

Do you allow her to choose what clothes she will wear?

1
she always takes part in choosing
2
she has some choice
3
I decide what she will wear
7
I am never responsible for dressing her

Does your child have: cuddly toys

1
Yes
2
No

Does your child have: push or pull toys

1
Yes
2
No

Does your child have: co-ordination toys (eg. set of blocks, shape posting box, stacking cups)

1
Yes
2
No

Does your child have: jigsaw puzzle

1
Yes
2
No

Does your child have: computer games

1
Yes
2
No

Does your child have: lego or other construction toys

1
Yes
2
No

About how many books does she have of her own?

1
none
2
1 - 2 books
3
3 - 9 books
4
10 or more

Do you try to teach your child?

1
no, she is too young
2
no, I do not have time
3
yes, sometimes
4
yes, often
If no, go to C12 on page 22
If yes,
qc_C11_a == 3 || qc_C11_a == 4

which things do you try to teach? colours

1
Yes
2
No

which things do you try to teach? alphabet

1
Yes
2
No

which things do you try to teach? numbers

1
Yes
2
No

which things do you try to teach? nursery rhymes

1
Yes
2
No

which things do you try to teach? songs

1
Yes
2
No

which things do you try to teach? shapes and sizes

1
Yes
2
No

which things do you try to teach? politeness (e.g. 'please', 'thank you')

1
Yes
2
No

which things do you try to teach? others (please tick and describe)

1
Yes
2
No
Other

How often do you talk to her while you do housework or are occupied in some other way?

1
never
2
rarely
3
sometimes
4
often
5
always

When do you have the television on?

1
all day
2
most of the day
3
mornings only
4
afternoons only
5
evenings only
6
not at all
7
do not have a TV

Does your child watch television?

1
yes, but only while playing
2
yes, concentrates and tries to understand
3
no, she ignores it
4
no, she is never allowed to see it
7
do not have a TV
If she does watch TV,
qc_C13_b == 1 || qc_C13_b == 2

what programmes does she see? children's programmes

1
Yes
2
No

what programmes does she see? other programmes

1
Yes
2
No

what programmes does she see? children's videos

1
Yes
2
No

what programmes does she see? other videos

1
Yes
2
No

When she watches television, how often does she watch it: with adults

1
Always
2
Mostly
3
Sometimes
4
Never

When she watches television, how often does she watch it: with other children

1
Always
2
Mostly
3
Sometimes
4
Never

When she watches television, how often does she watch it: on her own

1
Always
2
Mostly
3
Sometimes
4
Never

How often does she play with other children (other than brothers or sisters)?

1
every day
2
2-6 times a week
3
once a week
4
less than once a week
5
never

When you and your child meet again after being apart for an hour or more, how often does she:

7
we are never apart
If we are never apart to question C15
qc_C15 == 7
Else
When you and your child meet again after being apart for an hour or more, how often does she:
-

1 - always

2 - sometimes

3 - hardly ever

move away, avoid looking at you
push you away
run to you for a hug or cuddle
Many children have particular types of activities that they prefer or toys they play with.
How often has your daughter played with the following in the past month:
-

1 - Never

2 - Hardly ever

3 - Sometimes

4 - Often

5 - Very often

Guns (or objects used as guns)
Jewellery
Tool set
Dolls
Trains, cars or aeroplanes
Swords (or objects used as swords)
Tea set
How often in the past month has she done the following:
-

1 - Never

2 - Hardly ever

3 - Sometimes

4 - Often

5 - Very often

Played house (e.g. cleaning, cooking)
Played with girls
Pretended to be a female person (e.g. a princess)
Pretended to be a male character (e.g. a soldier)
Played at fighting
Played at being a mother or father
Played ball games
Climbed (fence, tree, climbing frame)
Played at looking after babies
Showed interest in real cars, trains and aeroplanes
Dressed up in girlish clothes
Played with boys

How often does she: Like to explore new surroundings

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

How often does she: Enjoy rough and tumble play

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

How often does she: Show interest in spiders, insects or snakes

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

How often does she: Avoid getting dirty

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

How often does she: Like pretty things

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

How often does she: Avoid taking risks

1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often

Do you feel that she dominates the household?

1
Yes, usually
2
Yes, sometimes
3
No, not at all

Do you start by being firm but then give way?

1
Yes, usually
2
Yes, sometimes
3
No, not at all
How often do you do the following when your study child is naughty?
-

1 - Never

2 - Rarely

3 - Once/month

4 - Once/week

5 - Daily

ignore her
smack her
shout at her
send her to her bedroom/naughty chair, step etc.
take away treats
tell her off
bribe her (e.g with sweets, or a treat)

How often do you do the following when your study child is naughty? other (please tick and describe)

1
Never
2
Rarely
3
Once/month
4
Once/week
5
Daily
Other

Is there any aspect of your child's behaviour that causes you concern?

1
Yes
2
No
If yes,
qc_C20 == 1

please could you describe

Long text

How often does your partner do these activities with your daughter?

7
Have no partner
If have no partner to question C21 go to C22 on page 27
qc_C21 == 7
Else
How often does your partner do these activities with your daughter?
-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

baths her
feeds her
sings to her
reads stories or shows her pictures in books
plays with toys
cuddles her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
takes her for walks

How often does your partner do these activities with your daughter? other (please tick and describe)

1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other
How often do you do these activities with your daughter?
-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

bath her
feed her
sing to her
read stories or show her pictures in books
play with toys
cuddle her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
take her for walks

How often do you do these activities with your daughter? other (please tick and describe)

1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other

Is there anyone else who regularly does these things with your daughter?

1
Yes
2
No
If yes,
qc_C23 == 1

who

Generic text
How often does this person do the following activities with your daughter:
-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

baths her
feeds her
sings to her
reads stories or shows her pictures in books
plays with toys
cuddles her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
takes her for walks

How often does this person do the following activities with your daughter: other (please tick and describe)

1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other
SECTION D: UPSETTING EVENTS
Below are listed some events that might upset some children. Please state whether any of these happened in the past 12 months?
-

1 - Yes and she was very upset

2 - Yes and she was quite upset

3 - Yes and she was a bit upset

4 - Yes but she wasn't upset

5 - No did not happen

She was taken into care*
A pet died
She moved home
She had a shock or fright*
She was physically hurt by someone*
She was sexually abused*
She was separated from her mother for at least a week*
She was separated from her father for at least a week*
She acquired a new parent*
She had a new brother or sister
She was admitted to hospital
She changed carer/care giver
She was separated from someone else*
She started a new creche or nursery
Something else*
If yes, to any marked *
qc_D1-D15$1;1,4:9,13,15 >= 1 && qc_D1-D15$1;1,4:9,13,15 <= 4

please give details below:

Long text
SECTION E: MILESTONES
Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:
-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She is able to drink from a cup without spilling
She asks for what she wants without crying for it
She copies me doing the housework
She can put on a T-shirt by herself
She helps in the house with simple tasks
She can take off her clothes with help
She can put her shoes on (without fastening them)
She can wash and dry her hands
She can brush her teeth (with help)
She can get dressed without any help
She eats with a spoon and/or fork
She plays card games or board games
She prepares breakfast cereal to eat
Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:
-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She can hold a pencil and scribble
She can draw a circle
She can copy a vertical line with a pencil
She can wiggle her thumb
She can copy a plus sign and draw it more or less
She can copy a square and draw it more or less
She grabs objects using the whole hand
She can pick up a small object using finger and thumb only
She can undo big buttons
She can fasten big buttons
She will turn the pages of a book
She can build a tower putting one object on top of the other
She can build a tower of 4 bricks
She can build a tower of 6 bricks
She can build a tower of 8 bricks
She can fit shapes in a board
She can thread beads on a string
She can use her right hand to draw
She can use her left hand to draw
Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:
-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She can walk
She can walk backwards 5 steps
From a standing position she can bend down and return to standing
She runs
She can stop from a full run within 2 steps
She can walk up steps like an adult; one foot on each step
She can walk down steps like an adult; one foot on each step
She can kick a ball
She can throw a ball
She can jump up and down
She can jump over an obstacle (e.g toys on floor)
She can balance on one foot for at least four seconds
She can hop at least twice on one foot
She can hop for at least 5 feet
She can walk on tiptoe for at least 9 feet

Are you worried about any aspects of your child's growth and development? her speech

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? her eyesight

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? her weight

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? her height

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? her behaviour

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? her general development

1
Yes I am worried
2
No not worried

Are you worried about any aspects of your child's growth and development? something else

1
Yes I am worried
2
No not worried
If yes, to any of these
qc_E4_a == 1 || qc_E4_b == 1 || qc_E4_c == 1 || qc_E4_d == 1 || qc_E4_e == 1 || qc_E4_f == 1 || qc_E4_g == 1

please describe what worries you:

Long text
This is confidential information, so we cannot make any response to what you put. If you are worried about your child's development we suggest you contact your family doctor or your health visitor.
SECTION F:
Here are some descriptions of children. Please tick the box that best describes your child nowadays.
-

1 - Certainly true

2 - Sometimes true

3 - Not true

Tries to be fair in games
Is restless, runs about or jumps up & down. Doesn't keep still
Is considerate of other people's feelings
Is squirmy, fidgety
Destroys own or others' belongings
Is spontaneously affectionate to family members
Fights with other children
Is not much liked by other children
Volunteers to help around the house or garden
Is worried, worries about many things
Tends to do things on her own, rather solitary
Is irritable, quick to fly off the handle
Will try to help someone who has been hurt
Appears miserable, unhappy, tearful or distressed
Has twitches, mannerisms or tics of the face & body
Bites nails or fingers
Is disobedient
Is kind to younger children
Has poor concentration, or short attention span
Tends to be afraid of new things or new situations
Helps other children who are feeling ill
Is fussy, or over-particular
Tells lies
Has wet or soiled herself in the past 12 months
Comforts a child who is upset
Has a stutter or stammer
Has other speech difficulty
Plays imaginatively, enjoys 'pretend' games
Bullies other children
Is inattentive
Gets on well with other children
Doesn't share toys
Cries easily
Is a forceful, determined child
Blames others for things
Shares out treats with friends
Gives up easily
Is inconsiderate of others
Is an independent, confident child
Kicks, bites other children
Is kind to animals
Stares into space (stares blankly)
Tries to stop quarrels or fights
SECTION G:
Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.
-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

With which hand does she draw?
Which hand does she use to throw a ball?
Which hand does she use to colour in?
In which hand does she hold her toothbrush?
Which hand holds a knife when she is cutting things?
Which hand does she use to hit things with?
Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.
-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

With which foot does she kick a ball?
If she wanted to try to pick up a pebble with her toes, which foot would she use?
Which foot would she use to stamp on something?
Which foot would she use to climb up a step?
Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.
-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

Which eye would she use to look through a tube? (e.g. empty toilet roll)
If she had to look into a can or bottle to see how full it was, which eye would she use?
SECTION H:

This questionnaire was completed by: mother

1
Yes
2
No

This questionnaire was completed by: father

1
Yes
2
No

This questionnaire was completed by: other (please describe)

1
Yes
2
No
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give the date of birth of your child:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comments you would like to make

Long text
End

alspac_94_msdhab

MY DAUGHTER'S HEALTH AND BEHAVIOUR
This questionnaire asks about your child now that he is three and a half. It is like the other questionnaires you have received.Your answers will help us to understand how your child has changed in the past year. To answer simply tick the box which best describes your child or your child's situation. Please answer all questions that you can. If you cannot answer any question or if they do not apply to you please put a line through them. There are no right or wrong answers. Please just describe what happens in your situation. You may make additional comments at the end. All answers are confidential.
THANK YOU FOR YOUR HELP

SECTION A: YOUR CHILD'S HEALTH

How would you assess the health of your child? 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 child? 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 she 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
snuffles/cold
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache (s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache (s)
Has she 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
Has your child been admitted to hospital in the past 12 months?
1
Yes
2
No
If no, go to A4 on page 4
how many times?
How many

please describe for each admission:

Age of child (months) Reason for admission No. of nights child stayed
How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many How manyAge in monthsGeneric textHow manyAge in monthsGeneric textAge in monthsGeneric textHow many
1
2
3
How often did you see her while she was in hospital? 1st admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with the child
How often did you see her while she was in hospital? 2nd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with the child
How often did you see her while she was in hospital? 3rd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with the child
Has she ever had any of the following? hernia repair
1
Yes
2
No
Has she ever had any of the following? operation for squint
1
Yes
2
No
Has she ever had any of the following? tubes (grommets) put in her ears
1
Yes
2
No
Has she ever had any of the following? other operation (please tick and describe)
1
Yes
2
No
Other
In the past 12 months has she had any periods when there was wheezing with whistling on her chest when she breathed?
1
Yes
2
No
If no, go to A6 on page 5
How many separate times has this happened in the past 12 months?
1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know
How many days altogether would you say she had wheezed in the past 12 months?
1
one day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know
Was she breathless (struggling for breath) during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
Did she have a fever during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
What do you think brings them on? chest infection or bronchitis
1
Yes
2
No
What do you think brings them on? being in a smoky room
1
Yes
2
No
What do you think brings them on? cold weather
1
Yes
2
No
What do you think brings them on? no idea
1
Yes
2
No
What do you think brings them on? other (please tick and describe)
1
Yes
2
No
Other
Has your child had an itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms) in the past 12 months?
1
Yes
2
No
If no, go to A7a below
how bad was this?
1
very bad
2
quite bad
3
mild
4
no problem
does she have this sort of rash now?
1
Yes
2
No
did the rash ever become sore and oozy?
1
Yes
2
No
was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?
1
Yes
2
No

In the past 12 months:

Has she had an itchy, dry rash on her hands?
1
Yes
2
No
Has she had an itchy, dry rash on her feet?
1
Yes
2
No
please describe which parts of her feet
Generic text
does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)
1
Yes
2
No
has she ever had a reaction (e.g. redness or itching) which you thought was due to some food that she had eaten?
1
Yes
2
No
If no, go to A8a on page 6
please describe the most recent occasion: what was the food?
Generic text
please describe the most recent occasion: how long after the food was eaten did the reaction appear?
Generic text
please describe the most recent occasion: where was the reaction?
1
mouth
2
other part (say where)
Other
Has she had vomiting spells in the past 12 months?
1
Yes
2
No
If no, go to A9 below
How many times?
1
once
2
twice
3
3-9 times
4
10 or more times
Have these been associated with: diarrhoea
1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never
Have these been associated with: chestiness (wheezing or coughing or grunting)
1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never
Nowadays how many motions (stools) does she usually have?
1
4 or more times/day
2
2-3 times/day
3
once a day
4
once in 2-4 days
5
once a week
9
can't say
Nowadays how often are her stools: hard
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: soft
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: curdy (i.e. solid & liquid)
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: liquid
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: green
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: brown
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: black
1
Usually
2
Sometimes
3
Never
Nowadays how often are her stools: yellow
1
Usually
2
Sometimes
3
Never
In the past 12 months months has she had diarrhoea or gastro-enteritis?
1
Yes
2
No
If no, go to A12a on page 8
how many times?
How many
how many days did the worst attack last?
How many
Did you: call the doctor to come to your home
1
Yes
2
No
Did you: go to your doctor
1
Yes
2
No
Did you: treat it yourself
1
Yes
2
No
Did you: other (please tick and describe)
1
Yes
2
No
Other
Did you continue feeding as usual?
1
Yes
2
No
If yes, go to A11f on page 8
how long was normal feeding disturbed?
1
less than 1 day
2
1 day
3
2 days
4
3-4 days
5
5 or more days
Was the child treated with an oral rehydration solution?
1
Yes
2
No
9
Don't know
If no or don't know go to A11g below
give type if known:
Generic text
how long was the solution given?
1
less than 1 day
2
1 day
3
2 days
4
3-4 days
5
5 or more days
What other treatment was given?
Long text
In the past 12 months has your child ever had a time when she has coughed off and on for at least 2 days?
1
Yes
2
No
If no, go to A13a below
how many times has this happened in the past 12 months?
1
once
2
twice
3
3-9 times
4
10 or more times
did she have a fever at any of these times?
1
Yes for all
2
Yes for some
3
No not at all
did she have a runny nose during any of these spells?
1
Yes for all
2
Yes for some
3
No not at all
The following questions are about your child's ears or hearing.
Nowadays, does your child listen to people or to things that happen nearby:
1
Yes usually
2
Yes often
3
Sometimes
4
Usually not
9
Don't know
Does she turn her head towards sounds?
1
only to very loud sounds
2
yes usually
3
yes sometimes
4
never turns towards sounds
9
don't know
During or after a cold, is her hearing worse than usual?
1
yes much worse
2
yes a little worse
3
no, about the same
7
has never had a cold
9
don't know
During a cold, is the dripping (discharge) from her nose: clear
1
Yes
2
No
9
Don't know
During a cold, is the dripping (discharge) from her nose: slightly white in colour
1
Yes
2
No
9
Don't know
During a cold, is the dripping (discharge) from her nose: thick heavy yellow and/or green in colour (catarrh)
1
Yes
2
No
9
Don't know
During a cold, is the dripping (discharge) from her nose: very little discharge occurs at all
1
Yes
2
No
9
Don't know
Does she pull, scratch or poke at her ears?
1
quite often
2
only at times when poorly, fretful, or in pain
3
hardly ever
9
don't know
Do her ears go red and look sore for a long time? (Remember - an ear that has just been slept on may look red for a short time.)
1
quite often
2
only at times when poorly, fretful, or in pain
3
hardly ever
9
don't know
Has pus or a sticky mucus (not ear wax) ever leaked out of her ear?
1
never
2
once
3
more than once
9
don't know
Does she breathe through her mouth rather than through her nose?
1
all the time
2
much of the time
3
rarely
4
never
9
don't know
Does she snore for more than a few minutes at a time?
1
most nights
2
quite often
3
only rarely
9
don't know
When she is asleep, does she seem to stop breathing or hold her breath for several seconds at a time?
1
yes, often
2
yes, sometimes
3
no
9
don't know
Have there been times when she seems to have had a pain in her stomach in the past 12 months?
1
Yes
2
No
If no, go to A15a below
How many separate times has this happened in the past 12 months?
1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know
Since she was 2 years old has she had any form of convulsion, fit, seizure or other turn in which consciousness was lost or any part of the body made an abnormal movement?
1
Yes
2
No
9
Not known
If no, or not known go to A16 on page 13
Please describe the first attack since her 2nd birthday:
Long text
Did the child have a high temperature at the time?
1
Yes
2
No
9
Not known
How old was she at the time?
1
2 years old
2
3 years old
9
unsure
How many attacks has she ever had?
1
one
2
two
3
3-4
4
5 or more

By whom was the child seen for the attack(s) since her 2nd birthday (tick all that apply)

-

1 - Yes

2 - No

9 - Don't know

G.P. at home
G.P. at surgery
hospital outpatients/casualty
admitted to hospital
What investigations, if any, have been carried out?
Long text
How did later attacks differ from the first one?
Long text
What were these thought to be due to? (Tick all that apply) febrile convulsions
1
Yes
2
No
9
Don't know
What were these thought to be due to? (Tick all that apply) fainting and blackouts
1
Yes
2
No
9
Don't know
What were these thought to be due to? (Tick all that apply) epilepsy
1
Yes
2
No
9
Don't know
What were these thought to be due to? (Tick all that apply) breath holding
1
Yes
2
No
9
Don't know
What were these thought to be due to? (Tick all that apply) reaction to immunisation
1
Yes
2
No
9
Don't know
What were these thought to be due to? (Tick all that apply) other (please specify)
1
Yes
2
No
9
Don't know
Other
Has she ever had any of the following infections? measles
1
Yes
2
No
Has she ever had any of the following infections? chicken pox
1
Yes
2
No
Has she ever had any of the following infections? mumps
1
Yes
2
No
Has she ever had any of the following infections? meningitis
1
Yes
2
No
Has she ever had any of the following infections? cold sores
1
Yes
2
No
Has she ever had any of the following infections? german measles
1
Yes
2
No
Has she ever had any of the following infections? other infection (please tick and describe)
1
Yes
2
No
Other
About how many times in the last 12 months has: the family doctor come to your home because she was ill?
How many
About how many times in the last 12 months has: the family doctor seen her in the surgery because she was unwell?
How many
About how many times in the last 12 months has: a doctor seen her for a routine check?
How many

SECTION B: SLEEPING AND CRYING

Does your child have a regular sleeping routine?
1
Yes
2
No
How many hours sleep does she usually have during the day time?
1
none
2
less than 1 hour
3
1-2 hrs
4
more than 2 hours
9
don't know
Normally what time in the evening does your child go to sleep?
Generic text
What time does she normally wake up in the morning?
Generic text
How often during the night does she usually wake? ... times
How many
How often during the day does she usually sleep? ... times
How many
In which room does she usually sleep? When you put her down at night
1
in her own room on her own
2
in a room with other children
3
in your bedroom
4
in a room with other adults
5
other place (please tick and describe)
Other
In which room does she usually sleep? When she wakes in the morning from her night sleep
1
in her own room on her own
2
in a room with other children
3
in your bedroom
4
in a room with other adults
5
other place (please tick and describe)
Other
Does she sleep on her own most nights or does she share a bed or cot? When you put her down
1
in her own bed/cot
2
in bed/cot with other children
3
in your bed with you
4
in bed with other adult
5
other place (please tick and describe)
Other
Does she sleep on her own most nights or does she share a bed or cot? When she wakes in the morning from her night sleep
1
in her own bed/cot
2
in bed/cot with other children
3
in your bed with you
4
in bed with other adult
5
other place (please tick and describe)
Other
How does she usually sleep?
1
on her back
2
on her side
3
on her front
4
varies

In the room where the child sleeps most of the night:

-

1 - Yes always

2 - Yes sometimes

3 - No not at all

is the heating on at night?
is there a window open at night?
does she sleep with a duvet?
does she have an electric blanket?
does she sleep with a pillow?
Do you feel her sleep pattern is:
1
better than other children of the same age
2
same as other children of the same age
3
worse than other children of the same age
9
don't know

In the past year has your child regularly:

-

1 - Yes, but did not worry me

2 - Yes, worried me a bit

3 - Yes, worried me greatly

4 - No, did not happen

refused to go to bed
woken very early
had difficulty going to sleep
had nightmares
continued to get up after being put to bed
woken in the night
got up after only a few hours sleep
Compared with other children would you describe the amount of time your child cries as:
1
more than other children
2
the same as other children
3
less than other children
9
don't know
All children cry. Some children also fuss and whine. How often does your child whine?
1
for long periods each day
2
for a short while each day
3
a number of times during the week
4
sometimes
5
never or hardly ever
How often does your child cry for no particular reason:
1
very often
2
quite often
3
sometimes
4
never or hardly ever
Can you usually calm your child when she cries?
1
no
2
yes, usually fairly easily
3
yes, but it takes a while
4
yes, after much effort
5
child never cries
Do you feel that your child's crying is a problem?
1
Yes
2
No
How often do you use sweets or other foods to stop her crying or fussing?
1
at least once a day
2
several times a week
3
infrequently
4
never
what food do you use to stop her crying or fussing? sweets
1
Yes
2
No
what food do you use to stop her crying or fussing? chocolates
1
Yes
2
No
what food do you use to stop her crying or fussing? crisps
1
Yes
2
No
what food do you use to stop her crying or fussing? fruit
1
Yes
2
No
what food do you use to stop her crying or fussing? milk
1
Yes
2
No
what food do you use to stop her crying or fussing? other drink
1
Yes
2
No
what food do you use to stop her crying or fussing? other food (please tick and describe)
1
Yes
2
No
Other

SECTION C: YOU AND YOUR CHILD

Do you ever have a battle of wills with your child?
1
never
2
rarely (less than once a week)
3
sometimes (at least once a week)
4
frequently (almost every day)
If never, go to C2 below
What are they usually about:
Long text
Who most often wins?
1
me
2
she does
3
about even
4
neither of us
How often does she refuse to go to bed?
1
most of the time
2
often
3
at times
4
rarely
5
never
How often does she have temper tantrums?
1
more than once a day
2
most days
3
at least once a week
4
less than once a week
5
never
If never, go to C4 on page 19
Do they occur because of: failure to get what she wants
1
Yes
2
No
Do they occur because of: failure to make herself understood
1
Yes
2
No
Do they occur because of: reaction to being corrected
1
Yes
2
No
Do they occur because of: no particular reason
1
Yes
2
No
Do they occur because of: other (please tick and describe)
1
Yes
2
No
Other

When she has temper tantrums how often do you:

-

1 - Often

2 - Sometimes

3 - Never

ignore it, let her get it out of her system
send her away for 'time out' eg. send her to her bedroom
try to hold and cuddle her
try to reason with her
leave it for someone else to cope with
try to distract her
When she has temper tantrums how often do you: other (please tick and describe)
1
Often
2
Sometimes
3
Never
Other
How often does she do the following: repeatedly rocks head or body
1
Once a week or more
2
Less than once a week
3
Never
How often does she do the following: has a tic or twitch
1
Once a week or more
2
Less than once a week
3
Never
How often does she do the following: has other unusual behaviour (please tick and describe)
1
Once a week or more
2
Less than once a week
3
Never
Other
About how often is she taken to: local shops
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: department store
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: supermarket
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: park or playground
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: visits to friends or family
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: library
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: places of interest (e.g. Zoo)
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
About how often is she taken to: places of entertainment (e.g. funfair)
1
Nearly every day
2
Once a week
3
Once a month
4
A few times per year
5
Never
Please tick which is appropriate for your child:
1
she wanders further than I like
2
she never leaves me
3
neither of above
How much choice do you allow her in deciding what foods she eats at meals?
1
she can choose from any food available
2
she is given a choice from a few alternatives that I select
3
I decide what she will eat
7
I am never in charge of preparing her meals
Do you allow her to choose what clothes she will wear?
1
she always takes part in choosing
2
she has some choice
3
I decide what she will wear
7
I am never responsible for dressing her
Does your child have: cuddly toys
1
Yes
2
No
Does your child have: push or pull toys
1
Yes
2
No
Does your child have: co-ordination toys (eg. set of blocks, shape posting box, stacking cups)
1
Yes
2
No
Does your child have: jigsaw puzzle
1
Yes
2
No
Does your child have: computer games
1
Yes
2
No
Does your child have: lego or other construction toys
1
Yes
2
No
About how many books does she have of her own?
1
none
2
1 - 2 books
3
3 - 9 books
4
10 or more
Do you try to teach your child?
1
no, she is too young
2
no, I do not have time
3
yes, sometimes
4
yes, often
If no, go to C12 on page 22
which things do you try to teach? colours
1
Yes
2
No
which things do you try to teach? alphabet
1
Yes
2
No
which things do you try to teach? numbers
1
Yes
2
No
which things do you try to teach? nursery rhymes
1
Yes
2
No
which things do you try to teach? songs
1
Yes
2
No
which things do you try to teach? shapes and sizes
1
Yes
2
No
which things do you try to teach? politeness (e.g. 'please', 'thank you')
1
Yes
2
No
which things do you try to teach? others (please tick and describe)
1
Yes
2
No
Other
How often do you talk to her while you do housework or are occupied in some other way?
1
never
2
rarely
3
sometimes
4
often
5
always
When do you have the television on?
1
all day
2
most of the day
3
mornings only
4
afternoons only
5
evenings only
6
not at all
7
do not have a TV
Does your child watch television?
1
yes, but only while playing
2
yes, concentrates and tries to understand
3
no, she ignores it
4
no, she is never allowed to see it
7
do not have a TV
what programmes does she see? children's programmes
1
Yes
2
No
what programmes does she see? other programmes
1
Yes
2
No
what programmes does she see? children's videos
1
Yes
2
No
what programmes does she see? other videos
1
Yes
2
No
When she watches television, how often does she watch it: with adults
1
Always
2
Mostly
3
Sometimes
4
Never
When she watches television, how often does she watch it: with other children
1
Always
2
Mostly
3
Sometimes
4
Never
When she watches television, how often does she watch it: on her own
1
Always
2
Mostly
3
Sometimes
4
Never
How often does she play with other children (other than brothers or sisters)?
1
every day
2
2-6 times a week
3
once a week
4
less than once a week
5
never
When you and your child meet again after being apart for an hour or more, how often does she:
7
we are never apart

When you and your child meet again after being apart for an hour or more, how often does she:

-

1 - always

2 - sometimes

3 - hardly ever

move away, avoid looking at you
push you away
run to you for a hug or cuddle
Many children have particular types of activities that they prefer or toys they play with.

How often has your daughter played with the following in the past month:

-

1 - Never

2 - Hardly ever

3 - Sometimes

4 - Often

5 - Very often

Guns (or objects used as guns)
Jewellery
Tool set
Dolls
Trains, cars or aeroplanes
Swords (or objects used as swords)
Tea set

How often in the past month has she done the following:

-

1 - Never

2 - Hardly ever

3 - Sometimes

4 - Often

5 - Very often

Played house (e.g. cleaning, cooking)
Played with girls
Pretended to be a female person (e.g. a princess)
Pretended to be a male character (e.g. a soldier)
Played at fighting
Played at being a mother or father
Played ball games
Climbed (fence, tree, climbing frame)
Played at looking after babies
Showed interest in real cars, trains and aeroplanes
Dressed up in girlish clothes
Played with boys
How often does she: Like to explore new surroundings
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
How often does she: Enjoy rough and tumble play
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
How often does she: Show interest in spiders, insects or snakes
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
How often does she: Avoid getting dirty
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
How often does she: Like pretty things
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
How often does she: Avoid taking risks
1
Never
2
Hardly ever
3
Sometimes
4
Often
5
Very often
Do you feel that she dominates the household?
1
Yes, usually
2
Yes, sometimes
3
No, not at all
Do you start by being firm but then give way?
1
Yes, usually
2
Yes, sometimes
3
No, not at all

How often do you do the following when your study child is naughty?

-

1 - Never

2 - Rarely

3 - Once/month

4 - Once/week

5 - Daily

ignore her
smack her
shout at her
send her to her bedroom/naughty chair, step etc.
take away treats
tell her off
bribe her (e.g with sweets, or a treat)
How often do you do the following when your study child is naughty? other (please tick and describe)
1
Never
2
Rarely
3
Once/month
4
Once/week
5
Daily
Other
Is there any aspect of your child's behaviour that causes you concern?
1
Yes
2
No
please could you describe
Long text
How often does your partner do these activities with your daughter?
7
Have no partner

How often does your partner do these activities with your daughter?

-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

baths her
feeds her
sings to her
reads stories or shows her pictures in books
plays with toys
cuddles her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
takes her for walks
How often does your partner do these activities with your daughter? other (please tick and describe)
1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other

How often do you do these activities with your daughter?

-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

bath her
feed her
sing to her
read stories or show her pictures in books
play with toys
cuddle her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
take her for walks
How often do you do these activities with your daughter? other (please tick and describe)
1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other
Is there anyone else who regularly does these things with your daughter?
1
Yes
2
No
who
Generic text

How often does this person do the following activities with your daughter:

-

1 - Nearly every day

2 - 3-5 times a week

3 - 1-2 times a week

4 - less than once a week

5 - Never

baths her
feeds her
sings to her
reads stories or shows her pictures in books
plays with toys
cuddles her
imitation games (pat-a-cake, peek-a-boo)
physical play (eg. rolling over, bouncing)
takes her for walks
How often does this person do the following activities with your daughter: other (please tick and describe)
1
Nearly every day
2
3-5 times a week
3
1-2 times a week
4
less than once a week
5
Never
Other

SECTION D: UPSETTING EVENTS

Below are listed some events that might upset some children. Please state whether any of these happened in the past 12 months?

-

1 - Yes and she was very upset

2 - Yes and she was quite upset

3 - Yes and she was a bit upset

4 - Yes but she wasn't upset

5 - No did not happen

She was taken into care*
A pet died
She moved home
She had a shock or fright*
She was physically hurt by someone*
She was sexually abused*
She was separated from her mother for at least a week*
She was separated from her father for at least a week*
She acquired a new parent*
She had a new brother or sister
She was admitted to hospital
She changed carer/care giver
She was separated from someone else*
She started a new creche or nursery
Something else*
please give details below:
Long text

SECTION E: MILESTONES

Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:

-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She is able to drink from a cup without spilling
She asks for what she wants without crying for it
She copies me doing the housework
She can put on a T-shirt by herself
She helps in the house with simple tasks
She can take off her clothes with help
She can put her shoes on (without fastening them)
She can wash and dry her hands
She can brush her teeth (with help)
She can get dressed without any help
She eats with a spoon and/or fork
She plays card games or board games
She prepares breakfast cereal to eat

Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:

-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She can hold a pencil and scribble
She can draw a circle
She can copy a vertical line with a pencil
She can wiggle her thumb
She can copy a plus sign and draw it more or less
She can copy a square and draw it more or less
She grabs objects using the whole hand
She can pick up a small object using finger and thumb only
She can undo big buttons
She can fasten big buttons
She will turn the pages of a book
She can build a tower putting one object on top of the other
She can build a tower of 4 bricks
She can build a tower of 6 bricks
She can build a tower of 8 bricks
She can fit shapes in a board
She can thread beads on a string
She can use her right hand to draw
She can use her left hand to draw

Below is a list of things which children gradually learn to do as they get older. Some of them your child may be doing and others she won't have started yet. Please indicate which she is doing:

-

1 - Yes, can do well

2 - Yes, does but not very well

3 - Has not yet done

She can walk
She can walk backwards 5 steps
From a standing position she can bend down and return to standing
She runs
She can stop from a full run within 2 steps
She can walk up steps like an adult; one foot on each step
She can walk down steps like an adult; one foot on each step
She can kick a ball
She can throw a ball
She can jump up and down
She can jump over an obstacle (e.g toys on floor)
She can balance on one foot for at least four seconds
She can hop at least twice on one foot
She can hop for at least 5 feet
She can walk on tiptoe for at least 9 feet
Are you worried about any aspects of your child's growth and development? her speech
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? her eyesight
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? her weight
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? her height
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? her behaviour
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? her general development
1
Yes I am worried
2
No not worried
Are you worried about any aspects of your child's growth and development? something else
1
Yes I am worried
2
No not worried
please describe what worries you:
Long text
This is confidential information, so we cannot make any response to what you put. If you are worried about your child's development we suggest you contact your family doctor or your health visitor.

SECTION F:

Here are some descriptions of children. Please tick the box that best describes your child nowadays.

-

1 - Certainly true

2 - Sometimes true

3 - Not true

Tries to be fair in games
Is restless, runs about or jumps up & down. Doesn't keep still
Is considerate of other people's feelings
Is squirmy, fidgety
Destroys own or others' belongings
Is spontaneously affectionate to family members
Fights with other children
Is not much liked by other children
Volunteers to help around the house or garden
Is worried, worries about many things
Tends to do things on her own, rather solitary
Is irritable, quick to fly off the handle
Will try to help someone who has been hurt
Appears miserable, unhappy, tearful or distressed
Has twitches, mannerisms or tics of the face & body
Bites nails or fingers
Is disobedient
Is kind to younger children
Has poor concentration, or short attention span
Tends to be afraid of new things or new situations
Helps other children who are feeling ill
Is fussy, or over-particular
Tells lies
Has wet or soiled herself in the past 12 months
Comforts a child who is upset
Has a stutter or stammer
Has other speech difficulty
Plays imaginatively, enjoys 'pretend' games
Bullies other children
Is inattentive
Gets on well with other children
Doesn't share toys
Cries easily
Is a forceful, determined child
Blames others for things
Shares out treats with friends
Gives up easily
Is inconsiderate of others
Is an independent, confident child
Kicks, bites other children
Is kind to animals
Stares into space (stares blankly)
Tries to stop quarrels or fights

SECTION G:

Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.

-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

With which hand does she draw?
Which hand does she use to throw a ball?
Which hand does she use to colour in?
In which hand does she hold her toothbrush?
Which hand holds a knife when she is cutting things?
Which hand does she use to hit things with?

Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.

-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

With which foot does she kick a ball?
If she wanted to try to pick up a pebble with her toes, which foot would she use?
Which foot would she use to stamp on something?
Which foot would she use to climb up a step?

Please read each of the questions below. Decide which hand, foot or eye your child uses for each activity and tick the appropriate box. If your are unsure of any answer try it with your child first to see which she uses.

-

1 - Left

2 - Right

3 - Either

7 - Doesn't do this at all

Which eye would she use to look through a tube? (e.g. empty toilet roll)
If she had to look into a can or bottle to see how full it was, which eye would she use?

SECTION H:

This questionnaire was completed by: mother
1
Yes
2
No
This questionnaire was completed by: father
1
Yes
2
No
This questionnaire was completed by: other (please describe)
1
Yes
2
No
Other
Please give the date on which you completed this questionnaire:
Generic date
Please give the date of birth of your child:
Date of birth
THANK YOU VERY MUCH FOR YOUR HELP
Space for any additional comments you would like to make
Long text
Name

My Son's/Daughter's Health and Behaviour