Start
ncds_65_mq
STRICTLY CONFIDENTIAL
NATIONAL CHILD DEVELOPMENT STUDY
(1958 Cohort)
SPONSORS:
Institute of Child Health, University of London
National Birthday Trust Fund
National Bureau for Co-operation in Child Care
National Foundation for Education Research in England and Wales
IN COLLABORATION WITH:
ENGLAND AND WALES
Association of Chief Education Officers
Society of Medical Officers of Health
SCOTLAND
Association of Directors of Education
Association of School Medical and Dental Officers
CHAIRMAN OF CONSULTATIVE COMMITTEE: Sir Lionel Russell, C.B.E., M.A.
CO-CHAIRMEN OF STEERING COMMITTEE:
H. L. Elvin, M.A.
W. D. Wall, B.A., Ph.D.
CO-DIRECTORS:
Neville R. Butler, M.D., M.R.C.P, D.C.H.
Mrs. M. L. Kellmor Pringle, B.A., Ph.D., Dip. Ed. Psych.
SENIOR RESEARCH OFFICER: R. Davie, B.A.
SENIOR MEDICAL OFFICER: M. J. Ball, B.Sc., M.B., B.S., D.P.H.
MEDICAL QUESTIONNAIRE
intro i

Local Authority Code Number

Local Authority Code Number
intro ii

Child's Code Number

Child's Code Number
intro iii(a)

CHILD'S NAME (Surname)

Generic text
intro iii(b)

CHILD'S NAME (Christian Names)

Generic text
intro iv

SEX

(Please ring appropriate number)

1
Boy
2
Girl
intro v

DATE OF BIRTH

Date of birth
intro vi

ADDRESS OF MEDICAL EXAMINATION

Generic text
intro vii

DATE OF MEDICAL EXAMINATION

Generic date
intro viii

NAME OF MEDICAL EXAMINER

Generic text
intro ix

DESIGNATION

Generic text
INTRODUCTORY NOTES
The Purpose of the Study
Shortly after their birth, all these children were the subject of a comprehensive investigation into the circumstances relating to the mother and child, the pregnancy and the birth. The results of this study published in the Perinatal Mortality Survey have already had a world-wide influence, and it is hoped that the many doctors and midwives who were involved feel that their efforts have been fully justified.
The National Child Development Study is a logical extension of the original investigation to the growing child. Not only is there the need to assess the present physical, educational and emotional status of the child population, but for the first time there is an opportunity to relate these assessments to the existing obstetric and social data of this large national sample.
Considerable interest is already focussed on the major handicaps of childhood, but much remains to be discovered about the true incidence of these conditions and their aetiology. Even less is known of the incidence and cause of minor disabilities, emotional maladjustments and educational handicaps. This study will throw some light on their occurence amongst children considered "at risk" of developing handicapping conditions.
This study will also reveal the numbers of children who have been exposed to such predisposing factors, but who are nevertheless developing normally.
The Scope of the Investigation
The Study is based on information gathered from three sources.
(i) The school is assessing the child's educational progress and social adjustment and is applying some attainment tests. This aspect of the investigation is being undertaken by the Local Education Department.
(ii) The mother of the child is interviewed by a Health Visitor (in most instances) who completes a Parental Questionnaire concerning the child's early life and environment. Details of illnesses, operations and a full medical history are included in this questionnaire, and on completion it will be passed on to the doctor for reference during his examination of the child.
(iii) The Medical Questionnaire comprises a medical history and examination, tests of vision, speech and hearing, physical measurements and a urine test. It is also hoped that an Audiogram will be obtained, at a time convenient to the School Health Department.
NOTES ON THE MEDICAL QUESTIONNAIRE
The form of this questionnaire has been determined by the need to utilise modern methods of handling a large volume of data. Except where stated otherwise, each question is answered by putting a ring round the appropriate number in each box.
The following order of completion is suggested as the most practical:
With the child dressed:
(1) Front page.
(2) Medical History. N.B.: Since these questions, on pages, 4, 6, 8, are identical with pages 16, 17, 18 of the Parental Questionnaire. It is not necessary for the doctor to take a second medical history if the latter is to hand and has been answered to his satisfaction.
(3) Vision, Speech and Hearing tests.
(4) Uristix urine test.
With the child undressed:
(5) Height, Weight and Head circumference.
(6) Medical examination.
(7) Completion of questionnaire.
1

Is the child accompanied at this medical examination by:

1
Mother
2
Father
3
Other relative (Specify)
4
Other person (Specify)
0
Child unaccompanied
Other
2

Is the Parental Questionnaire in hand for reference?

1
Yes
2
No
3

CHILD'S HEIGHT, without shoes, to nearest inch (e.g., for 48 1/2 inches, enter 49).

Inches I
If unable to measure, enter 00
qc_3 == '00'
3 i

and state reason

Generic text
A few areas have been issued with pocket stadiometers.
If issued with a stadiometer,
3 b

CHILD'S HEIGHT, without shoes, to nearest centimeter (e.g. for 126 cms. enter 126).

If not used, enter 000.

Centimetres
4

CHILD'S WEIGHT, in underclothes, to nearest pound (e.g. for 53 1/2 lb. enter 54).

Pounds
If unable to weigh, enter 00
qc_4 == '00'
4 i

and state reason

Generic text
5

HEAD CIRCUMFERENCE, to nearest 0.5 inch (e.g. for 20 1/2 inches enter 20.5).

Inches F
If unable to measure, enter 00.0
qc_5 == '00.0'
5 i

and state reason

Generic text
MEDICAL HISTORY
GENERAL
6 a

Has the child, to the mother's knowledge, any physical handicap or disabling condition? Specify

2
No
1
Yes
0
Don't know
Generic text
6 b

Does the mother consider the child to be particularly sensitive or highly strung? Specify

2
No
1
Yes
0
Don't know
Generic text
EAR, NOSE AND THROAT
7 a

Has the child had more than 3 throat and/or ear infections (with fever) in the past year?

2
No
1
Yes
0
Don't know
7 b

Has the child ever had: Hay fever or sneezing attacks

2
No
1
Yes
0
Don't know
7 c

Has the child ever had: Habitual snoring or mouth breathing

2
No
1
Yes
0
Don't know
7 d

Has the child ever had: Running ears (i.e. pus, not wax)

2
No
1
Yes
0
Don't know
7 d(i)

Has the child ever had: Running ears (i.e. pus, not wax) No. of times in past 12 mths.

How many
7 e

Has the child ever had: Earache, without running ears

2
No
1
Yes
0
Don't know
7 e(i)

Has the child ever had: Earache, without running ears No. of times in past 12 mths.

How many
7 f

Has the child ever had: Hearing difficulty (suspected or confirmed) Specify

7 f(i)

Has the child ever had: Hearing difficulty (suspected or confirmed) Age

Age
7 f(ii)

Has the child ever had: Hearing difficulty (suspected or confirmed) Present now?

Generic text
7 g

Has the child ever had: Other ear trouble Specify

2
No
1
Yes
0
Don't know
Other
RESPIRATORY SYSTEM
8 a

Has the child ever had: Attacks of asthma

2
No
1
Yes
0
Don't know
8 a(i)

Has the child ever had: Attacks of asthma No. of times in all

How many
8 a(ii)

Has the child ever had: Attacks of asthma No. of times in past 12 mths.

How many
8 b

Has the child ever had: Bronchitis with wheezing

2
No
1
Yes
0
Don't know
8 b(i)

Has the child ever had: Bronchitis with wheezing No. of times in past 12 mths.

How many
8 c

Has the child ever had: Pneumonia

2
No
1
Yes
0
Don't know
8 c(i)

Has the child ever had: Pneumonia At what age?

Age
8 d

Has the child ever had: Other respiratory disease Specify

2
No
1
Yes
0
Don't know
Other
C.V.S.
9 a

Has the child had: Rheumatic fever

2
No
1
Yes
0
Don't know
9 a(i)

Has the child had: Rheumatic fever At what age?

Age
9 b

Has the child had: Chorea (St. Vitus' Dance)

2
No
1
Yes
0
Don't know
9 b(i)

Has the child had: Chorea (St. Vitus' Dance) At what age?

Age
9 c

Has the child had: Congenital heart condition Specify

2
No
1
Yes
0
Don't know
Generic text
9 d

Has the child had: Parent, brother or sister with congenital heart condition Specify

2
No
1
Yes
0
Don't know
Generic text
MEDICAL EXAMINATION
GENERAL
10

Is there a major handicapping or disfiguring condition? (e.g. mongolism, blindness, deafness, cerebral palsy, hydrocephalus, mental retardation, etc.) Specify

2
No
1
Yes
0
Don't know
Generic text
E.N.T. AND MOUTH
11 a

Does examination reveal: Nasal obstruction Specify

2
No
1
Yes
0
Don't know
Generic text
11 b

Does examination reveal: Nasal or postnasal discharge Specify

2
No
1
Yes
0
Don't know
Generic text
11 c

Does examination reveal: Tonsils worthy of comment Comment

2
No
1
Yes
0
Don't know
Generic text
11 d

Does examination reveal: Mouth or palate abnormality Specify

2
No
1
Yes
0
Don't know
Generic text
11 e

Does examination reveal: Please add up total missing, filled and carious teeth (e.g. for 7 enter 07)

How many
11 f

Does examination reveal: Have any permanent incisors appeared?

2
No
1
Yes
0
Don't know
11 g

Does examination reveal: Enlarged cervical glands Specify

2
No
1
Yes
0
Don't know
Generic text
11 h

Does examination reveal: Signs of past or present otitis media (if drum obscured, ring "0" Specify

2
No
1
Yes
0
Don't know
Generic text
11 i

Does examination reveal: Deformity of external ear Specify

2
No
1
Yes
0
Don't know
Generic text
11 i(i)

Does examination reveal: Deformity of external ear R. or L.

Generic text
11 j

Does examination reveal: Other ear condition Specify

2
No
1
Yes
0
Don't know
Other
R.S.
12 a

Abnormal signs in lungs Specify

2
No
1
Yes
0
Don't know
Generic text
12 b

Abnormal chest shape Specify

2
No
1
Yes
0
Don't know
Generic text
12 c

Other respiratory condition Specify

2
No
1
Yes
0
Don't know
Other
C.V.S.
13 a

Pathological heart condition Specify

2
No
1
Yes
0
Don't know
Generic text
13 b

Other heart murmur Specify

2
No
1
Yes
0
Don't know
Other
13 c

Any other sign of heart disease (e.g. clubbing, cyanosis, etc.) Specify

2
No
1
Yes
0
Don't know
Other
MEDICAL HISTORY
ALIMENTARY AND UROGENITAL SYSTEMS
14 a

Has the child ever been/or had: Periodic vomiting or bilious attacks

2
No
1
Yes
0
Don't know
14 a(i)

Has the child ever been/or had: Periodic vomiting or bilious attacks No. of times in past 12 mths.

How many
14 b

Has the child ever been/or had: Periodic abdominal pain

2
No
1
Yes
0
Don't know
14 b(i)

Has the child ever been/or had: Periodic abdominal pain No. of times in past 12 mths.

How many
14 c

Has the child ever been/or had: Recurrent mouth ulcers

2
No
1
Yes
0
Don't know
14 d

Has the child ever been/or had: Hernia of any sort

2
No
1
Yes
0
Don't know
14 d(i)

Has the child ever been/or had: Hernia of any sort Site

Generic text
14 e

Has the child ever been/or had: Other serious digestive, bowel or alimentary disorder Specify

2
No
1
Yes
0
Don't know
Other
14 f

Has the child ever been/or had: Infection in the urine (requiring medical treatment)

2
No
1
Yes
0
Don't know
14 f(i)

Has the child ever been/or had: Infection in the urine (requiring medical treatment) No. of times in all

How many
14 f(ii)

Has the child ever been/or had: Infection in the urine (requiring medical treatment) No. of times in past 12 mths.

How many
14 g

Has the child ever been/or had: Wet by day after 3 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know
14 g(i)

Has the child ever been/or had: Wet by day after 3 years of age (Ignore occasional mishaps) How often in past 12 mths.

How many
14 h

Has the child ever been/or had: Wet by night after 5 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know
14 h(i)

Has the child ever been/or had: Wet by night after 5 years of age (Ignore occasional mishaps) How often in past 12 mths.

How many
14 i

Has the child ever been/or had: Soiled by day after 4 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know
14 i(i)

Has the child ever been/or had: Soiled by day after 4 years of age (Ignore occasional mishaps) How often in past 12 mths.

How many
14 j

Has the child ever been/or had: Nephritis or other kidney or U-G disorder Specify

2
No
1
Yes
0
Don't know
Generic text
14 j(i)

Has the child ever been/or had: Nephritis or other kidney or U-G disorder Age

Age
14 k

Has the child ever been/or had: Parent, brother or sister with disorder of alimentary or U-G tract Specify

2
No
1
Yes
0
Don't know
Generic text
METABOLISM AND BLOOD
15 a

Is there a history of: Sugar diabetes

2
No
1
Yes
0
Don't know
15 a(i)

Is there a history of: Sugar diabetes Age of onset

Age
15 b

Is there a history of: Any diabetes in parents, brothers or sisters Specify

2
No
1
Yes
0
Don't know
Generic text
15 c

Is there a history of: Any thyroid, pituitary or adrenal gland disorder Specify

2
No
1
Yes
0
Don't know
Generic text
15 d

Is there a history of: Any blood disorder Specify

2
No
1
Yes
0
Don't know
Generic text
SKIN
16 a

Is there a history of: Eczema in the first year

2
No
1
Yes
0
Don't know
16 a(i)

Is there a history of: Eczema in the first year Month of onset

Generic text
16 a(ii)

Is there a history of: Eczema in the first year Sites

Generic text
16 b

Is there a history of: Eczema after the first year

2
No
1
Yes
0
Don't know
16 b(i)

Is there a history of: Eczema after the first year Any present now?

Generic text
16 b(ii)

Is there a history of: Eczema after the first year Sites

Generic text
16 c

Is there a history of: "Strawberry marks" (raised vascular naevi)

2
No
1
Yes
0
Don't know
16 c(i)

Is there a history of: "Strawberry marks" (raised vascular naevi) Age

Age
16 c(ii)

Is there a history of: "Strawberry marks" (raised vascular naevi) Site

Generic text
16 d

Is there a history of: "Port wine stains" (flat vascular naevi)

2
No
1
Yes
0
Don't know
16 d(i)

Is there a history of: "Port wine stains" (flat vascular naevi) Age

Age
16 d(ii)

Is there a history of: "Port wine stains" (flat vascular naevi) Site

Generic text
16 e

Is there a history of: Other skin condition, including hair or nail disorder Specify

2
No
1
Yes
0
Don't know
Other
MEDICAL EXAMINATION
ALIMENTARY AND UROGENITAL SYSTEMS
17 a

On examination, has the child: Inguinal hernia

2
No
1
Yes
0
Don't know
17 a(i)

On examination, has the child: Inguinal hernia R. or L.

Generic text
17 b

On examination, has the child: Other hernia Specify

2
No
1
Yes
0
Don't know
Other
17 c

On examination, has the child: Urinary incontinence

2
No
1
Yes
0
Don't know
17 d

On examination, has the child: Partially or undescended testes

For girls, ring "0"

2
No
1
Yes
0
Don't know
17 d(i)

On examination, has the child: Partially or undescended testes Specify R. or L. (count retractile testes as normal)

Generic text
17 e

On examination, has the child: Been circumcised

For girls, ring "0"

2
No
1
Yes
0
Don't know
17 f

On examination, has the child: Other U-G abnormality Specify

2
No
1
Yes
0
Don't know
Other
17 g

On examination, has the child: Other abdominal abnormality Specify

2
No
1
Yes
0
Don't know
Other
SKIN, BLOOD, Etc.
18 a

On examination is there: Bruising or petechiae Specify

2
No
1
Yes
0
Don't know
Generic text
18 b

On examination is there: Any lymph gland enlargement Specify

2
No
1
Yes
0
Don't know
Generic text
18 c

On examination is there: Eczema

2
No
1
Yes
0
Don't know
18 c(i)

On examination is there: Eczema Sites

Generic text
18 c(ii)

On examination is there: Eczema Severity

Generic text
18 d

On examination is there: Birthmarks

2
No
1
Yes
0
Don't know
18 d(i)

On examination is there: Birthmarks Sites

Generic text
18 e

On examination is there: Other skin condition, including hair or nail disorder Specify

2
No
1
Yes
0
Don't know
Other
URISTIX URINE TEST
Instructions:
Dip test end of strip in urine and remove imediately.
19 i

Compare colour of tip with protein colour chart at once

1
Negative (yellow)
2
Trace
3
Positive (green)
0
Don't know or not tested
19 ii

Observe colour of band (glucose) after 10 seconds

1
Negative (red)
2
Positive (purple)
0
Don't know or not tested
MEDICAL HISTORY
C.N.S. and SKELETAL SYSTEM
20 a

Has the child had: A fit or convulsion in the first year of life

2
No
1
Yes
0
Don't know
20 a(i)

Has the child had: A fit or convulsion in the first year of life How many in first year

How many
20 a(ii)

Has the child had: A fit or convulsion in the first year of life Age at first fit

Age
20 b

Has the child had: A fit or convulsion after the first year

2
No
1
Yes
0
Don't know
20 b(i)

Has the child had: A fit or convulsion after the first year No. of times in past 12 mths.

How many
20 b(ii)

Has the child had: A fit or convulsion after the first year Total No. of fits

How many
20 c

Has the child had: Petit mal or "blank spells"

2
No
1
Yes
0
Don't know
20 c(i)

Has the child had: Petit mal or "blank spells" Age at onset

Age
20 c(ii)

Has the child had: Petit mal or "blank spells" No. of times last year

How many
20 c(iii)

Any drug treatment for conditions (a), (b), (c)?

Generic text
20 d

Has the child had: Frequent headaches or migraine

2
No
1
Yes
0
Don't know
20 d(i)

Has the child had: Frequent headaches or migraine No. of times in past 12 mths.

How many
20 e

Has the child had: Travel Sickness

2
No
1
Yes
0
Don't know
20 e(i)

Has the child had: Travel Sickness Age

Age
20 f

Has the child had: Tics or habit spasms Specify

2
No
1
Yes
0
Don't know
Generic text
20 f(i)

Has the child had: Tics or habit spasms Any in past 12 mths?

Generic text
20 g

Has the child had: Breath holding, head banging or "rocking" Specify

2
No
1
Yes
0
Don't know
Generic text
20 g(i)

Has the child had: Breath holding, head banging or "rocking" At what age?

Age
20 h

Has the child had: Concussion or head injury (with unconsciousness) Specify

2
No
1
Yes
0
Don't know
Generic text
20 h(i)

Has the child had: Concussion or head injury (with unconsciousness) Age

Age
20 i

Has the child had: Unusual size or shape of skull Specify

2
No
1
Yes
0
Don't know
Generic text
20 j

Has the child had: Any spinal trouble Specify

2
No
1
Yes
0
Don't know
Generic text
20 k

Has the child had: Congenital dislocation of hip

2
No
1
Yes
0
Don't know
20 k(i)

Has the child had: Congenital dislocation of hip R. or L. or both?

Generic text
20 l

Has the child had: Talipes Specify type

2
No
1
Yes
0
Don't know
Generic text
20 l(i)

Has the child had: Talipes R. or L. or both

Generic text
20 m

Has the child had: Any fractures

2
No
1
Yes
0
Don't know
20 m(i)

Has the child had: Any fractures Site(s)

Generic text
20 m(ii)

Has the child had: Any fractures Age(s)

Generic text
20 n

Has the child had: Any other bone or joint disorder Specify

2
No
1
Yes
0
Don't know
Other
20 o

Has the child had: Has any parent, brother or sister had a fit or convulsion Specify

2
No
1
Yes
0
Don't know
Generic text
LATERALITY
21

Does the mother think the child is:

1
Right-handed
2
Left-handed
3
Mixed R. and L.
0
Don't know
VISION
22 a

Has the child ever had: Squint or suspected squint Specify

2
No
1
Yes
0
Don't know
Generic text
22 a(i)

Has the child ever had: Squint or suspected squint Age

Age
22 a(ii)

Has the child ever had: Squint or suspected squint Present now?

Generic text
22 b

Has the child ever had: Any other eye trouble Specify

2
No
1
Yes
0
Don't know
Other
22 c

Has the child ever had: Have glasses been prescribed?

2
No
1
Yes
0
Don't know
22 c(i)

Has the child ever had: Have glasses been prescribed? At what age?

Age
22 c(ii)

Has the child ever had: Have glasses been prescribed? Reason

Generic text
MEDICAL EXAMINATION
C.N.S. AND SKELETAL
23 a

On examination is there: Cerebral palsy

1
No
2
Spastic all four limbs.
3
Spastic hemiplegia.
4
Spastic monoplegia-upper limb.
5
Spastic monoplegia-lower limb.
6
Spastic both upper limbs.
7
Spastic both lower libs.
8
Athetosis and spasticity.
9
Athetosis alone.
X
Other (Specify)
Other
23 b

On examination is there: Tics or habit spasms Specify

2
No
1
Yes
0
Don't know
Generic text
23 c

On examination is there: Congenital upper limb defect (check symmetry of hands) Specify

2
No
1
Yes
0
Don't know
Generic text
23 d

On examination is there: Any malfunction of upper limb Specify

(When shown how, the child should be able to rotate the wrists rapidly clockwise and anti-clockwise, each hand separately and both together, and with the eyes closed,touch the nose with each forefinger.)

2
No
1
Yes
0
Don't know
Generic text
23 e

On examination is there: Skull deformity Specify

2
No
1
Yes
0
Don't know
Generic text
23 f

On examination is there: Spina bifida Specify

2
No
1
Yes
0
Don't know
Generic text
23 g

On examination is there: Other spinal disorder Specify

2
No
1
Yes
0
Don't know
Other
23 h

On examination is there: Congenital lower limb defect (Check symmetry effect) Specify

2
No
1
Yes
0
Don't know
Generic text
23 i

On examination is there: Talipes

2
No
1
Yes
0
Don't know
23 i(i)

On examination is there: Talipes Type

Generic text
23 i(ii)

On examination is there: Talipes R. or L. or both

Generic text
23 j

On examination is there: Any malfunction of lower limb Specify

(When shown how, the child should be able to walk on the toes, walk on the heels, jump up and down, and hop on either foot. Also, note any abnormal gait.)

2
No
1
Yes
0
Don't know
Generic text
23 k

On examination is there: Other neurological or skeletal disorder Specify

2
No
1
Yes
0
Don't know
Other
LATERALITY TESTS
Please ask the child to carry out these tasks, and observe which hand/foot/eye is used.
24 a

Hand: Throw a crumpled paper ball. Draw a cross.

1
Only R. hand used
2
Only L. hand used
3
Both R. and L. hand used
0
Could not test
24 b

Foot: Kick crumpled paper ball. Hop on one leg.

1
Only R. foot used
2
Only L. foot used
3
Both R. and L. foot used
0
Could not test
24 c

Eye: Look through rolled paper tube. Look through hole in a card.

1
Only R. eye used
2
Only L. eye used
3
Both R. and L. eye used
0
Could not test
If unable to test, score 0
qc_24_a == 0 || qc_24_b == 0 || qc_24_c == 0
24 i

and state reason at foot of page.

Generic text
VISION TEST
Notes:
(1) Test at exactly 20 ft. with a standard Snellen chart of block capitals without seriphs.
(2) Hang the chart in a good light, level with the child's eyes, and free from glare.
(3) Please occlude the other eye efficiently without pressing on the eyeball.
(4) If the child does not know his letters and also gives an unsatisfactory response with the "E test", try again with the Snellen chart asking the child to "draw the letters in the air". If this fails, try a picture card.
(This order of procedure is recommended to avoid diagnosing a child with a spatio-visual difficulty as having a visual defect).
25 a

RESULT: Without glasses: R. Eye

Generic text
1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
25 b

RESULT: Without glasses: L. Eye

1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
Generic text
25 c

RESULT: With glasses: R. Eye

(If child doesn't wear glasses, score "0")

1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
0
0
Generic text
25 d

RESULT: With glasses: L. Eye

(If child doesn't wear glasses, score "0")

1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
0
0
Generic text
25 e

Is there evidence of: Squint

2
No
1
Yes
0
Don't know
25 e(i)

Is there evidence of: Squint Specify R. or L.

Generic text
25 e(ii)

Is there evidence of: Squint Type

Generic text
25 f

Is there evidence of: Latent squint (cover test and "follow finger")

2
No
1
Yes
0
Don't know
25 f(i)

Is there evidence of: Latent squint (cover test and "follow finger") Specify R. or L.

Generic text
25 f(ii)

Is there evidence of: Latent squint (cover test and "follow finger") Type

Generic text
25 g(i)

Is there evidence of: Any other eye condition affecting vision Specify

2
No
1
Yes
0
Don't know
Other
25 g(ii)

Is there evidence of: Any other eye condition not affecting vision Sepcify

2
No
1
Yes
0
Don't know
Other
25 h

ASSESSMENT

1
Normal vision
2
Visual defect but no handicap to normal schooling and everyday activities
3
Can manage ordinary school books only with difficulty
4
Requires special school books and/or special visual aids
5
Blind, or vision insufficient to use special school books
0
Don't know, or unable to assess
25 h(i)

ASSESSMENT Reason

Generic text
SPEECH TEST
Method:
(1) Position the child close to, and facing you.
(2) Please explain that you would like the test sentences repeated after you.
(3) Use a natural voice and observe the child's face during the replies.
(4) The sentences may be repeated if necessary.
(5) Please underline any mispronounced words (dropped aitches may be ignored) and record the total at the end.
(If unable to test, score 99
26

and state reason ...)

Generic text
26 a

Test sentences: Carol threaded a needle with wool. She mended her sister's frock. Roger grasped a bundle of sticks. Eating porridge gives him strength. My brother rode his bicycle to school. Phillip had scrambled eggs for breakfast. Total mispronounced words (e.g. for 8 enter 08).

How many
26 b

Is there any stammer?

1
No
2
slight
3
moderate
4
severe
0
Don't know
26 c

Assessment of intelligibility of speech:

1
Speech fully intelligible
2
Almost all words are intelligible
3
Many words are unintelligible
4
All or almost all words are unintelligible
0
Don't know or unable to test (Reason)
Generic text
HEARING TEST
Method:
(1) Conditions should be reasonably quiet.
(2) Position the child 10 feet away, with the ear under test towards you and the child's finger occluding the other ear.
(3) Ask the child to repeat each test word after you.
(4) The words should be spoken in a quiet conversational voice (not whispered), giving plenty of time for each reply.
(5) Please underline incorrect responses and record the totals.
(6) The assistance of a second person is desirable to hear the replies.
(If unable to test, score X
27

and state reason below.)

Generic text
27 a

Right Ear. Test words: shoes horse cart seat cup frock cat bike face chick fish ship Total incorrect responses

(If over 9, enter 9)

Response
27 b

Left Ear. Test words: spoon ball star feet bus sock hat knife cake pig dish ship Total incorrect responses

(If over 9, enter 9)

Response
27 c

Assessment of hearing:

1
Normal hearing
2
Some impairment of hearing (include those corrected by wearing a hearing aid)
3
Understanding of speech impaired (even with a hearing aid)
4
Speech not understood, even with a hearing aid and raised voice
0
Don't know, or unable to test
27 c(i)

Assessment of hearing: Reason

Generic text
28 a

Has the child been formally "ascertained as in need of special educational treatment"? (If uncertain about this or the following questions, please check with P.S.M.O.) If "Yes", specify category:

1
No
0
Don't know
2
Blind
3
Partially sighted
4
Deaf
5
Partially hearing
6
Educationally subnormal
7
Epileptic
8
Maladjusted
9
Physically handicapped
X
Speech defect
Y
Delicate
28 b

Is the child receiving special educational treatment in a special school?

2
No
1
Yes
0
Don't know
if "Yes",
qc_28_b == 1
28 b(i)

specify for which handicap

Generic text
28 c

Or in a special teaching unit?

2
No
1
Yes
0
Don't know
If "Yes",
qc_28_c == 1
28 c(i)

specify for which handicap

Generic text
28 d

Is the child likely to be considered for a special school?

2
No
1
Yes
0
Don't know
If "Yes",
qc_28_d == 1
28 d(i)

specify for which handicap

Generic text
29

Irrespective of local facilities, which of the following would you consider most suited to the child's educational needs?

1
Ordinary school
2
Ordinary school with remedial class or extra teaching help (for educational or mental backwardness, etc.)
3
Ordinary school with specially equipped teaching unit (for part sighted, part hearing, etc.)
4
Special school
5
Home tuition
6
Training centre (occupational centre)
7
No centre or school possible
8
Other (Specify)
0
Insufficient information
Other
SUMMARY OF ABNORMAL CONDITIONS
30 a-q
Please record any abnormal conditions under the appropriate headings. (Vision, speech and hearing have been assessed in their respective sections.)

If any condition is not a handicap to ordinary schooling ring "2". If any condition might handicap the child in an ordinary school ring "3", "4" or "5", as applicable.

-

1 - None

2 - Present but no Handicap

3 - Degree of handicap: Slight

4 - Degree of handicap: Moderate

5 - Degree of handicap: Severe

0 - Don't know
General motor handicap
Disfiguring condition
Mental retardation
Emotional maladjustment
Head and neck
Upper limb
Lower limb
Spine
Respiratory system
Alimentary system
Urogenital system
Heart
Blood, etc.
Skin
Epilepsy
Other C.N.S. condition
Diabetes
30 r

Please record any abnormal conditions under the appropriate headings. (Vision, speech and hearing have been assessed in their respective sections.) Any other conditions (Specify)

If any condition is not a handicap to ordinary schooling ring "2". If any condition might handicap the child in an ordinary school ring "3", "4" or "5", as applicable.

1
None
2
Present but no Handicap
3
Degree of handicap: Slight
4
Degree of handicap: Moderate
5
Degree of handicap: Severe
0
Don't know
Other
30 s

Please define any conditions recorded on this page

Generic text
END OF QUESTIONNAIRE
Would the medical examiner please thank the mother, if she is present, and glance over the questionnaire to check that:
(i) only one number in each box has been ringed;
and (ii) no question has been left unanswered (except, where appropriate, the medical history questions on pages 4, 6, 8).
End

ncds_65_mq

s_intro_i
STRICTLY CONFIDENTIAL
s_intro_ii
NATIONAL CHILD DEVELOPMENT STUDY
s_intro_iii
(1958 Cohort)
s_intro_iv
SPONSORS:
s_intro_v
Institute of Child Health, University of London
s_intro_vi
National Birthday Trust Fund
s_intro_vii
National Bureau for Co-operation in Child Care
s_intro_viii
National Foundation for Education Research in England and Wales
s_intro_ix
IN COLLABORATION WITH:
s_intro_x
ENGLAND AND WALES
s_intro_xi
Association of Chief Education Officers
s_intro_xii
Society of Medical Officers of Health
s_intro_xiii
SCOTLAND
s_intro_xiv
Association of Directors of Education
s_intro_xv
Association of School Medical and Dental Officers
s_intro_xvi
CHAIRMAN OF CONSULTATIVE COMMITTEE: Sir Lionel Russell, C.B.E., M.A.
s_intro_xvii
CO-CHAIRMEN OF STEERING COMMITTEE:
s_intro_xviii
H. L. Elvin, M.A.
s_intro_xix
W. D. Wall, B.A., Ph.D.
s_intro_xx
CO-DIRECTORS:
s_intro_xxi
Neville R. Butler, M.D., M.R.C.P, D.C.H.
s_intro_xxii
Mrs. M. L. Kellmor Pringle, B.A., Ph.D., Dip. Ed. Psych.
s_intro_xxiii
SENIOR RESEARCH OFFICER: R. Davie, B.A.
s_intro_xxiv
SENIOR MEDICAL OFFICER: M. J. Ball, B.Sc., M.B., B.S., D.P.H.
s_intro_xxv
MEDICAL QUESTIONNAIRE
intro i
Local Authority Code Number
Local Authority Code Number
intro ii
Child's Code Number
Child's Code Number
intro iii(a)
CHILD'S NAME (Surname)
Generic text
intro iii(b)
CHILD'S NAME (Christian Names)
Generic text
intro iv
SEX
1
Boy
2
Girl
intro v
DATE OF BIRTH
Date of birth
intro vi
ADDRESS OF MEDICAL EXAMINATION
Generic text
intro vii
DATE OF MEDICAL EXAMINATION
Generic date
intro viii
NAME OF MEDICAL EXAMINER
Generic text
intro ix
DESIGNATION
Generic text
s_intro_xxvi
INTRODUCTORY NOTES
s_intro_xxvii
The Purpose of the Study
s_intro_xxviii
Shortly after their birth, all these children were the subject of a comprehensive investigation into the circumstances relating to the mother and child, the pregnancy and the birth. The results of this study published in the Perinatal Mortality Survey have already had a world-wide influence, and it is hoped that the many doctors and midwives who were involved feel that their efforts have been fully justified.
s_intro_xxix
The National Child Development Study is a logical extension of the original investigation to the growing child. Not only is there the need to assess the present physical, educational and emotional status of the child population, but for the first time there is an opportunity to relate these assessments to the existing obstetric and social data of this large national sample.
s_intro_xxx
Considerable interest is already focussed on the major handicaps of childhood, but much remains to be discovered about the true incidence of these conditions and their aetiology. Even less is known of the incidence and cause of minor disabilities, emotional maladjustments and educational handicaps. This study will throw some light on their occurence amongst children considered "at risk" of developing handicapping conditions.
s_intro_xxxi
This study will also reveal the numbers of children who have been exposed to such predisposing factors, but who are nevertheless developing normally.
s_intro_xxxii
The Scope of the Investigation
s_intro_xxxiii
The Study is based on information gathered from three sources.
s_intro_xxxiv
(i) The school is assessing the child's educational progress and social adjustment and is applying some attainment tests. This aspect of the investigation is being undertaken by the Local Education Department.
s_intro_xxxv
(ii) The mother of the child is interviewed by a Health Visitor (in most instances) who completes a Parental Questionnaire concerning the child's early life and environment. Details of illnesses, operations and a full medical history are included in this questionnaire, and on completion it will be passed on to the doctor for reference during his examination of the child.
s_intro_xxxvi
(iii) The Medical Questionnaire comprises a medical history and examination, tests of vision, speech and hearing, physical measurements and a urine test. It is also hoped that an Audiogram will be obtained, at a time convenient to the School Health Department.
s_intro_xxxvii
NOTES ON THE MEDICAL QUESTIONNAIRE
s_intro_xxxviiI
The form of this questionnaire has been determined by the need to utilise modern methods of handling a large volume of data. Except where stated otherwise, each question is answered by putting a ring round the appropriate number in each box.
s_intro_xxxix
The following order of completion is suggested as the most practical:
s_intro_xl
With the child dressed:
s_intro_xli
(1) Front page.
s_intro_xlii
(2) Medical History. N.B.: Since these questions, on pages, 4, 6, 8, are identical with pages 16, 17, 18 of the Parental Questionnaire. It is not necessary for the doctor to take a second medical history if the latter is to hand and has been answered to his satisfaction.
s_intro_xliii
(3) Vision, Speech and Hearing tests.
s_intro_xliv
(4) Uristix urine test.
s_intro_xlv
With the child undressed:
s_intro_xlvi
(5) Height, Weight and Head circumference.
s_intro_xlvii
(6) Medical examination.
s_intro_xlviii
(7) Completion of questionnaire.
1
Is the child accompanied at this medical examination by:
1
Mother
2
Father
3
Other relative (Specify)
4
Other person (Specify)
0
Child unaccompanied
Other
2
Is the Parental Questionnaire in hand for reference?
1
Yes
2
No
3
CHILD'S HEIGHT, without shoes, to nearest inch (e.g., for 48 1/2 inches, enter 49).
Inches I
3 i
and state reason
Generic text
If unable to measure, enter 00
s_q3b
A few areas have been issued with pocket stadiometers.
3 b
CHILD'S HEIGHT, without shoes, to nearest centimeter (e.g. for 126 cms. enter 126).
Centimetres
If issued with a stadiometer,
4
CHILD'S WEIGHT, in underclothes, to nearest pound (e.g. for 53 1/2 lb. enter 54).
Pounds
4 i
and state reason
Generic text
If unable to weigh, enter 00
5
HEAD CIRCUMFERENCE, to nearest 0.5 inch (e.g. for 20 1/2 inches enter 20.5).
Inches F
5 i
and state reason
Generic text
If unable to measure, enter 00.0

MEDICAL HISTORY

GENERAL

6 a
Has the child, to the mother's knowledge, any physical handicap or disabling condition? Specify
2
No
1
Yes
0
Don't know
Generic text
6 b
Does the mother consider the child to be particularly sensitive or highly strung? Specify
2
No
1
Yes
0
Don't know
Generic text

EAR, NOSE AND THROAT

7 a
Has the child had more than 3 throat and/or ear infections (with fever) in the past year?
2
No
1
Yes
0
Don't know
7 b
Has the child ever had: Hay fever or sneezing attacks
2
No
1
Yes
0
Don't know
7 c
Has the child ever had: Habitual snoring or mouth breathing
2
No
1
Yes
0
Don't know
7 d
Has the child ever had: Running ears (i.e. pus, not wax)
2
No
1
Yes
0
Don't know
7 d(i)
Has the child ever had: Running ears (i.e. pus, not wax) No. of times in past 12 mths.
How many
7 e
Has the child ever had: Earache, without running ears
2
No
1
Yes
0
Don't know
7 e(i)
Has the child ever had: Earache, without running ears No. of times in past 12 mths.
How many
7 f
Has the child ever had: Hearing difficulty (suspected or confirmed) Specify
7 f(i)
Has the child ever had: Hearing difficulty (suspected or confirmed) Age
Age
7 f(ii)
Has the child ever had: Hearing difficulty (suspected or confirmed) Present now?
Generic text
7 g
Has the child ever had: Other ear trouble Specify
2
No
1
Yes
0
Don't know
Other

RESPIRATORY SYSTEM

8 a
Has the child ever had: Attacks of asthma
2
No
1
Yes
0
Don't know
8 a(i)
Has the child ever had: Attacks of asthma No. of times in all
How many
8 a(ii)
Has the child ever had: Attacks of asthma No. of times in past 12 mths.
How many
8 b
Has the child ever had: Bronchitis with wheezing
2
No
1
Yes
0
Don't know
8 b(i)
Has the child ever had: Bronchitis with wheezing No. of times in past 12 mths.
How many
8 c
Has the child ever had: Pneumonia
2
No
1
Yes
0
Don't know
8 c(i)
Has the child ever had: Pneumonia At what age?
Age
8 d
Has the child ever had: Other respiratory disease Specify
2
No
1
Yes
0
Don't know
Other

C.V.S.

9 a
Has the child had: Rheumatic fever
2
No
1
Yes
0
Don't know
9 a(i)
Has the child had: Rheumatic fever At what age?
Age
9 b
Has the child had: Chorea (St. Vitus' Dance)
2
No
1
Yes
0
Don't know
9 b(i)
Has the child had: Chorea (St. Vitus' Dance) At what age?
Age
9 c
Has the child had: Congenital heart condition Specify
2
No
1
Yes
0
Don't know
Generic text
9 d
Has the child had: Parent, brother or sister with congenital heart condition Specify
2
No
1
Yes
0
Don't know
Generic text

MEDICAL EXAMINATION

GENERAL

10
Is there a major handicapping or disfiguring condition? (e.g. mongolism, blindness, deafness, cerebral palsy, hydrocephalus, mental retardation, etc.) Specify
2
No
1
Yes
0
Don't know
Generic text

E.N.T. AND MOUTH

11 a
Does examination reveal: Nasal obstruction Specify
2
No
1
Yes
0
Don't know
Generic text
11 b
Does examination reveal: Nasal or postnasal discharge Specify
2
No
1
Yes
0
Don't know
Generic text
11 c
Does examination reveal: Tonsils worthy of comment Comment
2
No
1
Yes
0
Don't know
Generic text
11 d
Does examination reveal: Mouth or palate abnormality Specify
2
No
1
Yes
0
Don't know
Generic text
11 e
Does examination reveal: Please add up total missing, filled and carious teeth (e.g. for 7 enter 07)
How many
11 f
Does examination reveal: Have any permanent incisors appeared?
2
No
1
Yes
0
Don't know
11 g
Does examination reveal: Enlarged cervical glands Specify
2
No
1
Yes
0
Don't know
Generic text
11 h
Does examination reveal: Signs of past or present otitis media (if drum obscured, ring "0" Specify
2
No
1
Yes
0
Don't know
Generic text
11 i
Does examination reveal: Deformity of external ear Specify
2
No
1
Yes
0
Don't know
Generic text
11 i(i)
Does examination reveal: Deformity of external ear R. or L.
Generic text
11 j
Does examination reveal: Other ear condition Specify
2
No
1
Yes
0
Don't know
Other

R.S.

12 a
Abnormal signs in lungs Specify
2
No
1
Yes
0
Don't know
Generic text
12 b
Abnormal chest shape Specify
2
No
1
Yes
0
Don't know
Generic text
12 c
Other respiratory condition Specify
2
No
1
Yes
0
Don't know
Other

C.V.S.

13 a
Pathological heart condition Specify
2
No
1
Yes
0
Don't know
Generic text
13 b
Other heart murmur Specify
2
No
1
Yes
0
Don't know
Other
13 c
Any other sign of heart disease (e.g. clubbing, cyanosis, etc.) Specify
2
No
1
Yes
0
Don't know
Other

MEDICAL HISTORY

ALIMENTARY AND UROGENITAL SYSTEMS

14 a
Has the child ever been/or had: Periodic vomiting or bilious attacks
2
No
1
Yes
0
Don't know
14 a(i)
Has the child ever been/or had: Periodic vomiting or bilious attacks No. of times in past 12 mths.
How many
14 b
Has the child ever been/or had: Periodic abdominal pain
2
No
1
Yes
0
Don't know
14 b(i)
Has the child ever been/or had: Periodic abdominal pain No. of times in past 12 mths.
How many
14 c
Has the child ever been/or had: Recurrent mouth ulcers
2
No
1
Yes
0
Don't know
14 d
Has the child ever been/or had: Hernia of any sort
2
No
1
Yes
0
Don't know
14 d(i)
Has the child ever been/or had: Hernia of any sort Site
Generic text
14 e
Has the child ever been/or had: Other serious digestive, bowel or alimentary disorder Specify
2
No
1
Yes
0
Don't know
Other
14 f
Has the child ever been/or had: Infection in the urine (requiring medical treatment)
2
No
1
Yes
0
Don't know
14 f(i)
Has the child ever been/or had: Infection in the urine (requiring medical treatment) No. of times in all
How many
14 f(ii)
Has the child ever been/or had: Infection in the urine (requiring medical treatment) No. of times in past 12 mths.
How many
14 g
Has the child ever been/or had: Wet by day after 3 years of age (Ignore occasional mishaps)
2
No
1
Yes
0
Don't know
14 g(i)
Has the child ever been/or had: Wet by day after 3 years of age (Ignore occasional mishaps) How often in past 12 mths.
How many
14 h
Has the child ever been/or had: Wet by night after 5 years of age (Ignore occasional mishaps)
2
No
1
Yes
0
Don't know
14 h(i)
Has the child ever been/or had: Wet by night after 5 years of age (Ignore occasional mishaps) How often in past 12 mths.
How many
14 i
Has the child ever been/or had: Soiled by day after 4 years of age (Ignore occasional mishaps)
2
No
1
Yes
0
Don't know
14 i(i)
Has the child ever been/or had: Soiled by day after 4 years of age (Ignore occasional mishaps) How often in past 12 mths.
How many
14 j
Has the child ever been/or had: Nephritis or other kidney or U-G disorder Specify
2
No
1
Yes
0
Don't know
Generic text
14 j(i)
Has the child ever been/or had: Nephritis or other kidney or U-G disorder Age
Age
14 k
Has the child ever been/or had: Parent, brother or sister with disorder of alimentary or U-G tract Specify
2
No
1
Yes
0
Don't know
Generic text

METABOLISM AND BLOOD

15 a
Is there a history of: Sugar diabetes
2
No
1
Yes
0
Don't know
15 a(i)
Is there a history of: Sugar diabetes Age of onset
Age
15 b
Is there a history of: Any diabetes in parents, brothers or sisters Specify
2
No
1
Yes
0
Don't know
Generic text
15 c
Is there a history of: Any thyroid, pituitary or adrenal gland disorder Specify
2
No
1
Yes
0
Don't know
Generic text
15 d
Is there a history of: Any blood disorder Specify
2
No
1
Yes
0
Don't know
Generic text

SKIN

16 a
Is there a history of: Eczema in the first year
2
No
1
Yes
0
Don't know
16 a(i)
Is there a history of: Eczema in the first year Month of onset
Generic text
16 a(ii)
Is there a history of: Eczema in the first year Sites
Generic text
16 b
Is there a history of: Eczema after the first year
2
No
1
Yes
0
Don't know
16 b(i)
Is there a history of: Eczema after the first year Any present now?
Generic text
16 b(ii)
Is there a history of: Eczema after the first year Sites
Generic text
16 c
Is there a history of: "Strawberry marks" (raised vascular naevi)
2
No
1
Yes
0
Don't know
16 c(i)
Is there a history of: "Strawberry marks" (raised vascular naevi) Age
Age
16 c(ii)
Is there a history of: "Strawberry marks" (raised vascular naevi) Site
Generic text
16 d
Is there a history of: "Port wine stains" (flat vascular naevi)
2
No
1
Yes
0
Don't know
16 d(i)
Is there a history of: "Port wine stains" (flat vascular naevi) Age
Age
16 d(ii)
Is there a history of: "Port wine stains" (flat vascular naevi) Site
Generic text
16 e
Is there a history of: Other skin condition, including hair or nail disorder Specify
2
No
1
Yes
0
Don't know
Other

MEDICAL EXAMINATION

ALIMENTARY AND UROGENITAL SYSTEMS

17 a
On examination, has the child: Inguinal hernia
2
No
1
Yes
0
Don't know
17 a(i)
On examination, has the child: Inguinal hernia R. or L.
Generic text
17 b
On examination, has the child: Other hernia Specify
2
No
1
Yes
0
Don't know
Other
17 c
On examination, has the child: Urinary incontinence
2
No
1
Yes
0
Don't know
17 d
On examination, has the child: Partially or undescended testes
2
No
1
Yes
0
Don't know
17 d(i)
On examination, has the child: Partially or undescended testes Specify R. or L. (count retractile testes as normal)
Generic text
17 e
On examination, has the child: Been circumcised
2
No
1
Yes
0
Don't know
17 f
On examination, has the child: Other U-G abnormality Specify
2
No
1
Yes
0
Don't know
Other
17 g
On examination, has the child: Other abdominal abnormality Specify
2
No
1
Yes
0
Don't know
Other

SKIN, BLOOD, Etc.

18 a
On examination is there: Bruising or petechiae Specify
2
No
1
Yes
0
Don't know
Generic text
18 b
On examination is there: Any lymph gland enlargement Specify
2
No
1
Yes
0
Don't know
Generic text
18 c
On examination is there: Eczema
2
No
1
Yes
0
Don't know
18 c(i)
On examination is there: Eczema Sites
Generic text
18 c(ii)
On examination is there: Eczema Severity
Generic text
18 d
On examination is there: Birthmarks
2
No
1
Yes
0
Don't know
18 d(i)
On examination is there: Birthmarks Sites
Generic text
18 e
On examination is there: Other skin condition, including hair or nail disorder Specify
2
No
1
Yes
0
Don't know
Other

URISTIX URINE TEST

s_q19_i
Instructions:
s_q19_ii
Dip test end of strip in urine and remove imediately.
19 i
Compare colour of tip with protein colour chart at once
1
Negative (yellow)
2
Trace
3
Positive (green)
0
Don't know or not tested
19 ii
Observe colour of band (glucose) after 10 seconds
1
Negative (red)
2
Positive (purple)
0
Don't know or not tested

MEDICAL HISTORY

C.N.S. and SKELETAL SYSTEM

20 a
Has the child had: A fit or convulsion in the first year of life
2
No
1
Yes
0
Don't know
20 a(i)
Has the child had: A fit or convulsion in the first year of life How many in first year
How many
20 a(ii)
Has the child had: A fit or convulsion in the first year of life Age at first fit
Age
20 b
Has the child had: A fit or convulsion after the first year
2
No
1
Yes
0
Don't know
20 b(i)
Has the child had: A fit or convulsion after the first year No. of times in past 12 mths.
How many
20 b(ii)
Has the child had: A fit or convulsion after the first year Total No. of fits
How many
20 c
Has the child had: Petit mal or "blank spells"
2
No
1
Yes
0
Don't know
20 c(i)
Has the child had: Petit mal or "blank spells" Age at onset
Age
20 c(ii)
Has the child had: Petit mal or "blank spells" No. of times last year
How many
20 c(iii)
Any drug treatment for conditions (a), (b), (c)?
Generic text
20 d
Has the child had: Frequent headaches or migraine
2
No
1
Yes
0
Don't know
20 d(i)
Has the child had: Frequent headaches or migraine No. of times in past 12 mths.
How many
20 e
Has the child had: Travel Sickness
2
No
1
Yes
0
Don't know
20 e(i)
Has the child had: Travel Sickness Age
Age
20 f
Has the child had: Tics or habit spasms Specify
2
No
1
Yes
0
Don't know
Generic text
20 f(i)
Has the child had: Tics or habit spasms Any in past 12 mths?
Generic text
20 g
Has the child had: Breath holding, head banging or "rocking" Specify
2
No
1
Yes
0
Don't know
Generic text
20 g(i)
Has the child had: Breath holding, head banging or "rocking" At what age?
Age
20 h
Has the child had: Concussion or head injury (with unconsciousness) Specify
2
No
1
Yes
0
Don't know
Generic text
20 h(i)
Has the child had: Concussion or head injury (with unconsciousness) Age
Age
20 i
Has the child had: Unusual size or shape of skull Specify
2
No
1
Yes
0
Don't know
Generic text
20 j
Has the child had: Any spinal trouble Specify
2
No
1
Yes
0
Don't know
Generic text
20 k
Has the child had: Congenital dislocation of hip
2
No
1
Yes
0
Don't know
20 k(i)
Has the child had: Congenital dislocation of hip R. or L. or both?
Generic text
20 l
Has the child had: Talipes Specify type
2
No
1
Yes
0
Don't know
Generic text
20 l(i)
Has the child had: Talipes R. or L. or both
Generic text
20 m
Has the child had: Any fractures
2
No
1
Yes
0
Don't know
20 m(i)
Has the child had: Any fractures Site(s)
Generic text
20 m(ii)
Has the child had: Any fractures Age(s)
Generic text
20 n
Has the child had: Any other bone or joint disorder Specify
2
No
1
Yes
0
Don't know
Other
20 o
Has the child had: Has any parent, brother or sister had a fit or convulsion Specify
2
No
1
Yes
0
Don't know
Generic text

LATERALITY

21
Does the mother think the child is:
1
Right-handed
2
Left-handed
3
Mixed R. and L.
0
Don't know

VISION

22 a
Has the child ever had: Squint or suspected squint Specify
2
No
1
Yes
0
Don't know
Generic text
22 a(i)
Has the child ever had: Squint or suspected squint Age
Age
22 a(ii)
Has the child ever had: Squint or suspected squint Present now?
Generic text
22 b
Has the child ever had: Any other eye trouble Specify
2
No
1
Yes
0
Don't know
Other
22 c
Has the child ever had: Have glasses been prescribed?
2
No
1
Yes
0
Don't know
22 c(i)
Has the child ever had: Have glasses been prescribed? At what age?
Age
22 c(ii)
Has the child ever had: Have glasses been prescribed? Reason
Generic text

MEDICAL EXAMINATION

C.N.S. AND SKELETAL

23 a
On examination is there: Cerebral palsy
1
No
2
Spastic all four limbs.
3
Spastic hemiplegia.
4
Spastic monoplegia-upper limb.
5
Spastic monoplegia-lower limb.
6
Spastic both upper limbs.
7
Spastic both lower libs.
8
Athetosis and spasticity.
9
Athetosis alone.
X
Other (Specify)
Other
23 b
On examination is there: Tics or habit spasms Specify
2
No
1
Yes
0
Don't know
Generic text
23 c
On examination is there: Congenital upper limb defect (check symmetry of hands) Specify
2
No
1
Yes
0
Don't know
Generic text
23 d
On examination is there: Any malfunction of upper limb Specify
2
No
1
Yes
0
Don't know
Generic text
23 e
On examination is there: Skull deformity Specify
2
No
1
Yes
0
Don't know
Generic text
23 f
On examination is there: Spina bifida Specify
2
No
1
Yes
0
Don't know
Generic text
23 g
On examination is there: Other spinal disorder Specify
2
No
1
Yes
0
Don't know
Other
23 h
On examination is there: Congenital lower limb defect (Check symmetry effect) Specify
2
No
1
Yes
0
Don't know
Generic text
23 i
On examination is there: Talipes
2
No
1
Yes
0
Don't know
23 i(i)
On examination is there: Talipes Type
Generic text
23 i(ii)
On examination is there: Talipes R. or L. or both
Generic text
23 j
On examination is there: Any malfunction of lower limb Specify
2
No
1
Yes
0
Don't know
Generic text
23 k
On examination is there: Other neurological or skeletal disorder Specify
2
No
1
Yes
0
Don't know
Other

LATERALITY TESTS

s_lateralitytests_i
Please ask the child to carry out these tasks, and observe which hand/foot/eye is used.
24 a
Hand: Throw a crumpled paper ball. Draw a cross.
1
Only R. hand used
2
Only L. hand used
3
Both R. and L. hand used
0
Could not test
24 b
Foot: Kick crumpled paper ball. Hop on one leg.
1
Only R. foot used
2
Only L. foot used
3
Both R. and L. foot used
0
Could not test
24 c
Eye: Look through rolled paper tube. Look through hole in a card.
1
Only R. eye used
2
Only L. eye used
3
Both R. and L. eye used
0
Could not test
24 i
and state reason at foot of page.
Generic text
If unable to test, score 0

VISION TEST

s_visiontest_i
Notes:
s_visiontest_ii
(1) Test at exactly 20 ft. with a standard Snellen chart of block capitals without seriphs.
s_visiontest_iii
(2) Hang the chart in a good light, level with the child's eyes, and free from glare.
s_visiontest_iv
(3) Please occlude the other eye efficiently without pressing on the eyeball.
s_visiontest_v
(4) If the child does not know his letters and also gives an unsatisfactory response with the "E test", try again with the Snellen chart asking the child to "draw the letters in the air". If this fails, try a picture card.
s_visiontest_vi
(This order of procedure is recommended to avoid diagnosing a child with a spatio-visual difficulty as having a visual defect).
25 a
RESULT: Without glasses: R. Eye
Generic text
1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
25 b
RESULT: Without glasses: L. Eye
1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
Generic text
25 c
RESULT: With glasses: R. Eye
1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
0
0
Generic text
25 d
RESULT: With glasses: L. Eye
1
6/6
2
6/9
3
6/12
4
6/18
5
6/24
6
6/36
7
6/60
8
over 6/60 or blind
9
Unable to test Reason
0
0
Generic text
25 e
Is there evidence of: Squint
2
No
1
Yes
0
Don't know
25 e(i)
Is there evidence of: Squint Specify R. or L.
Generic text
25 e(ii)
Is there evidence of: Squint Type
Generic text
25 f
Is there evidence of: Latent squint (cover test and "follow finger")
2
No
1
Yes
0
Don't know
25 f(i)
Is there evidence of: Latent squint (cover test and "follow finger") Specify R. or L.
Generic text
25 f(ii)
Is there evidence of: Latent squint (cover test and "follow finger") Type
Generic text
25 g(i)
Is there evidence of: Any other eye condition affecting vision Specify
2
No
1
Yes
0
Don't know
Other
25 g(ii)
Is there evidence of: Any other eye condition not affecting vision Sepcify
2
No
1
Yes
0
Don't know
Other
25 h
ASSESSMENT
1
Normal vision
2
Visual defect but no handicap to normal schooling and everyday activities
3
Can manage ordinary school books only with difficulty
4
Requires special school books and/or special visual aids
5
Blind, or vision insufficient to use special school books
0
Don't know, or unable to assess
25 h(i)
ASSESSMENT Reason
Generic text

SPEECH TEST

s_speechtest_i
Method:
s_speechtest_ii
(1) Position the child close to, and facing you.
s_speechtest_iii
(2) Please explain that you would like the test sentences repeated after you.
s_speechtest_iv
(3) Use a natural voice and observe the child's face during the replies.
s_speechtest_v
(4) The sentences may be repeated if necessary.
s_speechtest_vi
(5) Please underline any mispronounced words (dropped aitches may be ignored) and record the total at the end.
26
and state reason ...)
Generic text
(If unable to test, score 99
26 a
Test sentences: Carol threaded a needle with wool. She mended her sister's frock. Roger grasped a bundle of sticks. Eating porridge gives him strength. My brother rode his bicycle to school. Phillip had scrambled eggs for breakfast. Total mispronounced words (e.g. for 8 enter 08).
How many
26 b
Is there any stammer?
1
No
2
slight
3
moderate
4
severe
0
Don't know
26 c
Assessment of intelligibility of speech:
1
Speech fully intelligible
2
Almost all words are intelligible
3
Many words are unintelligible
4
All or almost all words are unintelligible
0
Don't know or unable to test (Reason)
Generic text

HEARING TEST

s_hearingtest_i
Method:
s_hearingtest_ii
(1) Conditions should be reasonably quiet.
s_hearingtest_iii
(2) Position the child 10 feet away, with the ear under test towards you and the child's finger occluding the other ear.
s_hearingtest_iv
(3) Ask the child to repeat each test word after you.
s_hearingtest_v
(4) The words should be spoken in a quiet conversational voice (not whispered), giving plenty of time for each reply.
s_hearingtest_vi
(5) Please underline incorrect responses and record the totals.
s_hearingtest_vii
(6) The assistance of a second person is desirable to hear the replies.
27
and state reason below.)
Generic text
(If unable to test, score X
27 a
Right Ear. Test words: shoes horse cart seat cup frock cat bike face chick fish ship Total incorrect responses
Response
27 b
Left Ear. Test words: spoon ball star feet bus sock hat knife cake pig dish ship Total incorrect responses
Response
27 c
Assessment of hearing:
1
Normal hearing
2
Some impairment of hearing (include those corrected by wearing a hearing aid)
3
Understanding of speech impaired (even with a hearing aid)
4
Speech not understood, even with a hearing aid and raised voice
0
Don't know, or unable to test
27 c(i)
Assessment of hearing: Reason
Generic text
28 a
Has the child been formally "ascertained as in need of special educational treatment"? (If uncertain about this or the following questions, please check with P.S.M.O.) If "Yes", specify category:
1
No
0
Don't know
2
Blind
3
Partially sighted
4
Deaf
5
Partially hearing
6
Educationally subnormal
7
Epileptic
8
Maladjusted
9
Physically handicapped
X
Speech defect
Y
Delicate
28 b
Is the child receiving special educational treatment in a special school?
2
No
1
Yes
0
Don't know
28 b(i)
specify for which handicap
Generic text
if "Yes",
28 c
Or in a special teaching unit?
2
No
1
Yes
0
Don't know
28 c(i)
specify for which handicap
Generic text
If "Yes",
28 d
Is the child likely to be considered for a special school?
2
No
1
Yes
0
Don't know
28 d(i)
specify for which handicap
Generic text
If "Yes",
29
Irrespective of local facilities, which of the following would you consider most suited to the child's educational needs?
1
Ordinary school
2
Ordinary school with remedial class or extra teaching help (for educational or mental backwardness, etc.)
3
Ordinary school with specially equipped teaching unit (for part sighted, part hearing, etc.)
4
Special school
5
Home tuition
6
Training centre (occupational centre)
7
No centre or school possible
8
Other (Specify)
0
Insufficient information
Other

SUMMARY OF ABNORMAL CONDITIONS

30 a-q

Please record any abnormal conditions under the appropriate headings. (Vision, speech and hearing have been assessed in their respective sections.)

-

1 - None

2 - Present but no Handicap

3 - Degree of handicap: Slight

4 - Degree of handicap: Moderate

5 - Degree of handicap: Severe

0 - Don't know
General motor handicap
Disfiguring condition
Mental retardation
Emotional maladjustment
Head and neck
Upper limb
Lower limb
Spine
Respiratory system
Alimentary system
Urogenital system
Heart
Blood, etc.
Skin
Epilepsy
Other C.N.S. condition
Diabetes
30 r
Please record any abnormal conditions under the appropriate headings. (Vision, speech and hearing have been assessed in their respective sections.) Any other conditions (Specify)
1
None
2
Present but no Handicap
3
Degree of handicap: Slight
4
Degree of handicap: Moderate
5
Degree of handicap: Severe
0
Don't know
Other
30 s
Please define any conditions recorded on this page
Generic text
s_outro_i
END OF QUESTIONNAIRE
s_outro_ii
Would the medical examiner please thank the mother, if she is present, and glance over the questionnaire to check that:
s_outro_iii
(i) only one number in each box has been ringed;
s_outro_iv
and (ii) no question has been left unanswered (except, where appropriate, the medical history questions on pages 4, 6, 8).
Name

NCDS Age 7 Medical Questionnaire