B. DISABILITY CHARACTERISTICS

CHECKPOINT: ITEM B1a WILL ONLY BE ASKED IN WAVE 1, WAVE 2 & 3 GO TO B3a

NLTS

1

   

B1a. [CHILD] is included in this study because the school district indicated at the beginning of the 1999 school year that [he/she] was a special education student. What are CHILDís learning problems or disabilities? DO NOT READ CATEGORIES (PROBE: Has he/she had any other learning problems or disabilities; that could include a speech problem?) (Circle All that Apply and/or write response IN COLUMN A.)

1

   

b1b. (IF MORE THAN ONE DISABILITY IN b1a) Which of these is CHILDís main learning problem or disability? (CIRCLE ONE CODE IN COLUMB B.)

   

A

B

GO TO B1c

Has no problem/disability/not getting special services

00

00

 

Learning disability/learning handicap (LD)

01

01

 

Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED)

02

02

 

Mental retardation (EMR, TMR, SMR, MR)

03

03

 

Speech impairment/communication impairment

04

04

 

Attention deficit disorder (ADD) (ADHD)

05

05

 

Hard of hearing/hearing impairment

06

06

 

Deafness

07

07

 

Partial sight/visual impairment

08

08

 

Complete blindness

09

09

 

Physical or orthopedic impairment

10

10

 

Traumatic Brain Injury (TBI)

11

11

 

Health impairment (SPECIFY DISEASE) ______________________________

12

12

 

Deafness and blindness

13

13

 

Amputation of a limb

14

14

 

Aphasia

15

15

 

Arthritis

16

16

 

Asthma

17

17

 

Autism

18

18

 

Cancer/Lymphoma/Sarcoma

19

19

 

Cerebral palsy (CP)

20

20

 

Cystic fibrosis (CF)

21

21

 

Depression

22

22

 

Developmental disability or delay (DD)

23

23

 

Diabetes

24

24

 

Downs syndrome

25

25

 

Dyslexia (reverses letters when reading)

26

26

 

Educational handicap (EH)

27

27

 

Emphysema

29

29

 

Encephalitis

30

30

 

Epilepsy

31

31

 

Heart disease

32

32

 

Hemophilia

33

33

 

Hyperactive

34

34

   

A

B

 

Leukemia

35

35

 

Multiple sclerosis (MS)

36

36

 

Muscular dystrophy

37

37

 

Neurological impairment

38

38

 

Neurosis

39

39

 

Paraplegia or partial paralysis

40

40

 

Polio

41

41

 

Psychosis

42

42

 

Quadriplegia or complete paralysis

43

43

 

Schizophrenia

44

44

 

Spina bifida

45

45

 

Stroke

46

46

 

Trouble with school subject (e.g., math or reading)

47

47

 

"Just slow"

48

48

 

Other (SPECIFY) ________________________________________________

97

97

 

Donít Know

-1

-1

 

Refused

-2

-2

CHECKPOINT: CONSISTENCY CHECK WITH DISABILITY ON FILE. IF PARENT SAYS CHILD DOES NOT HAVE ANY SPEECH OR LEARNING PROBLEMS OR DISABILITIES (B1a=00), ASK B1c. ELSE GO TO CHECKPOINT BEFORE B1d

1

   

B1c. Our records from the school district indicate that at the beginning of the school year CHILD had (a) (DISABILITY/IES ON FILE). Is that correct? CIRCLE ONE CODE.

 

CIRCLE CORRECT CODE/S IN B1a AND IF MORE THAN ONE DISABILITY ALSO ASK B1b, THEN GO TO CHECKPOINT BEFORE B1d.

YES

1

 

GO TO B4a

NO, DOESNíT HAVE THAT/THOSE DISABILITIES ANY LONGER

2

 

GO TO B4a

NO, CHILD HAS NO DISABILITY

3

 

DONíT KNOW

-1

 

REFUSED

-2

CHECKPOINT: CONSISTENCY CHECK WITH DISABILITY CATEGORY ON FILE, IF FILE INDICATES CHILD HAS VISUAL OR HEARING DISABILITIES AND THIS CATEGORY HAS NOT BEEN MENTIONED BY THE PARENT (B1a NE 06 OR 07, 09 OR 09) GO TO B1d, ELSE GO TO B2a

 

 

1

   

B1d. Our records from the school district indicates that CHILD has (a visual impairment) (a hearing impairment) is that correct? CIRCLE ONE RESPONSE ON EACH LINE. ALSO CIRCLE CORRECT CODE IN B1a.

   

Yes

No

DK

Ref

 

Visual impairment

1

2

-1

-2

 

Hearing impairment

1

2

-1

-2

NLTS, NEILS

1

   

B2a. About how old was [CHILD] when he/she started having this/these difficulty/ies or condition? (ENTER NUMBER FOR AGE OR GRADE LEVEL AND/OR CIRCLE CODE, AS APPROPRIATE) (IF MORE THAN ONE DISABILITY IN B1a AND IF PARENT ASKS WHICH DISABILITY, PARENT SHOULD ANSWER FOR FIRST/EARLIEST DISABILITY).

   

Under 1 year

0

 

____________AGE
OR

Years of age

1

 

____________GRADE

Grade level

2

   

DONíT KNOW

-1

   

REFUSED

-2

NLTS, ECLS-K

1

   

B2b. About how old was [CHILD] when he/she started getting special services from a professional for this difficulty? (ENTER NUMBER FOR AGE OR GRADE LEVEL AND/OR CIRCLE CODE, AS APPROPRIATE) (IF MORE THAN ONE DISABILITY IN B1a AND IF PARENT ASKS WHICH DISABILITY, PARENT SHOULD ANSWER FOR PRIMARY DISABILITY (IN B1b).

   

Under 1 year

0

 

____________AGE OR

Years of age

1

 

____________GRADE

Grade level

2

   

Has never received special services from a professional

3

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF B2a = 0 or AGE IS 3 YEARS OR LESS or DONíT KNOW, AND B2b NE 3 (NEVER RECEIVED SERVICES) ASK B2c, ELSE GO TO CHECKPONT BEFORE B2d.

 

NEILS

1

   

B2c. Did CHILD receive early intervention services for children ages birth to 3 who have developmental delays or disabilities? Early intervention services means any special services or therapies designed to meet a childís special needs, when a child is younger than 3 years old.

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF B2a=0, OR AGE IS 5 YEARS OR LESS ASK B2d, ELSE GO TO B2f

NEILS

1

   

B2d. Did CHILD attend a preschool program, such as a nursery school?

 

GO TO B2e

YES

1

 

GO TO B2g

NO

2

 

GO TO B2g

DONíT KNOW

-1

 

GO TO B2g

REFUSED

-2

NEILS

1

   

B2e. Was that a Head Start program?

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

 

NEILS

1

   

B2f. About how many of the other children in the preschool program had special needs or disabilities? Was it...READ CATEGORIES. CODE ONE.

   

All of them

1

   

Some of them, or

2

   

None of them?

3

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

 

1

   

B2g. When did CHILD first begin receiving special education services in school? CIRCLE ONE CODE AND ENTER AGE OR GRADE IF APPROPRIATE

 

 

 

GO TO CHECKPOINT BEFORE B4a

____________AGE OR

Years of age

1

____________GRADE

Grade level

2

 

Never received special education services in school

3

 

DONíT KNOW

-1

 

REFUSED

-2

CHECKPOINT: B3a WILL ONLY BE ASKED IN WAVES 2 AND 3, ELSE GO TO CHECKPOINT BEFORE B4a.

 

2

3

B3a. When we spoke with [you/RESPONDENT NAME] last and asked about CHILDís learning problems or disabilities [you/RESPONDENT NAME] told us that CHILD had a (IMPORT INFORMATION FROM YEAR 1 ITEM B1a). Is that still correct?

 

GO TO B3c

YES

1

 

GO TO B3b

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

 

2

3

B3a1. Does he/she still have that/those disability/ies?

 

GO TO B3c

YES

1

 

GO TO CHECKPOINT BEFORE B3b

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF ONLY ONE DISABILITY IMPORTED FROM PRIOR WAVE GO TO B3c, ELSE GO TO B3b.

 

 

 

2

3

B3b. Which ones doesnít she/he have? DO NOT READ CATEGORIES CIRCLE ALL THAT APPLY.

 

Has no problem/disability/not getting special services

00

 

Learning disability/learning handicap (LD)

01

 

Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED)

02

 

Mental retardation (EMR, TMR, SMR, MR)

03

 

Speech impairment/communication impairment

04

 

Attention deficit disorder (ADD)

05

 

Hard of hearing/hearing impairment

06

 

Deafness

07

 

Partial sight/visual impairment

08

 

Complete blindness

09

 

Physical or orthopedic impairment

10

 

Traumatic Brain Injury (TBI)

11

 

Health impairment (SPECIFY DISEASE) ______________________________

12

 

Deafness and blindness

13

 

Amputation of a limb

14

 

Aphasia

15

 

Arthritis

16

 

Asthma

17

 

Autism

18

 

Cancer/Lymphoma/Sarcoma

19

 

Cerebral palsy (CP)

20

 

Cystic fibrosis (CF)

21

 

Depression

22

 

Developmental disability or delay (DD)

23

 

Diabetes

24

 

Downs syndrome

25

 

Dyslexia (reverses letters when reading)

26

 

Educational handicap (EH)

27

 

Emphysema

29

 

Encephalitis

30

 

Epilepsy

31

 

Heart disease

32

 

Hemophilia

33

 

Hyperactive

34

 

Leukemia

35

 

Multiple sclerosis (MS)

36

 

Muscular dystrophy

37

 

Neurological impairment

38

 

Neurosis

39

 

Paraplegia or partial paralysis

40

 

Polio

41

 

Psychosis

42

 

Quadriplegia or complete paralysis

43

 

Schizophrenia

44

 

Spina bifida

45

 

Stroke

46

 

Trouble with school subject (e.g., math or reading)

47

 

"Just slow"

48

 

Other (SPECIFY) ________________________________________________

97

 

Donít Know

-1

 

Refused

-2

 

 

2

3

B3c. Are there new or additional learning problems or disabilities that have been identified since we last spoke?

 

GO TO B3d

YES

1

 

GO TO CHECKPOINT BEFORE B4a

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

 

2

3

B3d. What are the additional learning problems or disabilities? DO NOT READ CATEGORIES (Circle All that Apply and/or write response IN COLUMN A.)

 

2

3

b3e. Of all CHILDís learning problems or disabilities, which has been CHILDís main learning problem or disability? (CIRCLE ONE CODE IN COLUMB B.) THEN GO TO CHECKPOINT BEFORE B4a.

   

A

B

 

Has no problem/disability/not getting special services

00

00

 

Learning disability/learning handicap (LD)

01

01

 

Emotional disturbance/behavior disorder (ED, BD, having emotional problems, SED)

02

02

 

Mental retardation (EMR, TMR, SMR, MR)

03

03

 

Speech impairment/communication impairment

04

04

 

Attention deficit disorder (ADD)

05

05

 

Hard of hearing/hearing impairment

06

06

 

Deafness

07

07

 

Partial sight/visual impairment

08

08

 

Complete blindness

09

09

 

Physical or orthopedic impairment

10

10

 

Traumatic Brain Injury (TBI)

11

11

 

Health impairment (SPECIFY DISEASE) ______________________________

12

12

 

Deafness and blindness

13

13

 

Amputation of a limb

14

14

 

Aphasia

15

15

 

Arthritis

16

16

 

Asthma

17

17

 

Autism

18

18

 

Cancer/Lymphoma/Sarcoma

19

19

 

Cerebral palsy (CP)

20

20

 

Cystic fibrosis (CF)

21

21

 

Depression

22

22

 

Developmental disability or delay (DD)

23

23

 

Diabetes

24

24

 

Downs syndrome

25

25

 

Dyslexia (reverses letters when reading)

26

26

 

Educational handicap (EH)

27

27

 

Emphysema

29

29

 

Encephalitis

30

30

 

Epilepsy

31

31

 

Heart disease

32

32

 

Hemophilia

33

33

 

Hyperactive

34

34

 

Leukemia

35

35

 

Multiple sclerosis (MS)

36

36

 

Muscular dystrophy

37

37

 

Neurological impairment

38

38

 

Neurosis

39

39

 

Paraplegia or partial paralysis

40

40

 

Polio

41

41

 

Psychosis

42

42

 

Quadriplegia or complete paralysis

43

43

 

Schizophrenia

44

44

 

Spina bifida

45

45

 

Stroke

46

46

 

Trouble with school subject (e.g., math or reading)

47

47

 

"Just slow"

48

48

 

Other (SPECIFY) ________________________________________________

97

97

 

Donít Know

-1

-1

 

Refused

-2

-2

       

 

Now I want to ask about how well [CHILD] does some things. Iím going to start with hearing.

CHECKPOINT: IN WAVES 1,2 AND 3 IF B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS/ BLINDNESS (13) GO TO B4b ELSE ASK B4a, IN WAVE 2 AND 3, IF B3d=06, 07 OR 13 GO TO B4b, ELSE ASK B4a.

 

NEILS

1

2

3

B4a. Compared with other children about the same age, would you say CHILDÖ READ CATEGORIES, CIRCLE ONE CODE. IF ASKED, THIS ASSESSMENT SHOULD BE MADE OF CHILDíS HEARING WITHOUT ANY HEARING DEVICES LIKE A HEARING AID.

 

GO TO CHECKPOINT BEFORE B5a

Hears normally, or

1

 

GO TO CHECKPOINT BEFORE B4b

Has a hearing problem

2

 

DONíT READ, GO CHECKPOINT BEFORE B5a.

DONíT KNOW

-1

 

REFUSED

-2

CHECKPOINT: IN WAVE 1 ASK B4c EVERYONE WITH HEARING PROBLEMS (B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS BLINDNESS (13) OR B4a = 2). IN WAVE 2 AND 3 ONLY ASK B4c IF NEWLY IDENTIFIED HEARING PROBLEM - B3c=1 (yes) AND B3d = HEARING IMPAIRMENT (06) OR DEAFNESS (07) OR DEAFNESS BLINDNESS (13) OR IF B4a=2 IN CURRENT WAVE, BUT EQUALED 1 (HEARS NORMALLY) IN PREVIOUS WAVE/S. ELSE GO TO B4c.

B4b. OUT

NEILS

1

2

3

B4c. Is [CHILDíS] hearing loss ...

   

Mild,

1

   

Moderate, or

2

   

Severe to profound?

3

 

DONíT READ

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT; IN WAVE1 ASK OF ALL WHO HAVE BEEN CORRECTLY DIRECTED TO THIS QUESTION. IN WAVES 2 AND 3 ONLY ASK IF B4d=2 (NO) IN PREVIOUS WAVE/S

 

NEILS

1

2

3

B4d. Has a hearing aid or other kind of hearing device been prescribed for [CHILD]?

   

YES

1

   

NO

2

 

GO TO B4f

DONíT KNOW

-1

   

REFUSED

-2

 

NEILS

1

2

3

B4e. How well does [CHILD] hear with the hearing device? Would you say [he/she]...READ CATEGORIES. CODE ONE

   

Hears normally,

1

   

Has a little trouble hearing,

2

   

Has a lot of trouble hearing, or

3

   

Doesnít hear at all?

4

   

DOESNíT HAVE ONE

5

 

DONíT READ

WONíT WEAR IT

6

   

DONíT KNOW

-1

   

REFUSED

-2

1

2

3

B4e1. How frequently does CHILD use his hearing aide at school? Would you say....READ CATEGORIES. CIRCLE ONE CODE

   

Always

1

   

Frequently

2

   

Sometimes

3

   

Never

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

CHECKPOINT: IN WAVE 1 ASK OF ALL WHO HAVE BEEN APPROPRIATLY DIRECTED TO THIS QUESTION. IN WAVES 2 AND 3 ONLY ASK IF B4f=2 (NO) IN PREVIOUS WAVE/S, ELSE GO TO B4g.

 

 

1

2

3

B4f. Does CHILD have a cochlear implant? IF ASKED, A COCHLEAR IMPLANT IS .........

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

 

NEILS

1

2

3

B4g. Does [CHILD] useÖREAD CATEGORIES, CIRCLE ONE CODE FOR EACH.

     


YES


NO

DONíT KNOW


REFUSED

 

a.

Sign language?

1

2

-1

-2

 

b.

Lip reading?

1

2

-1

-2

 

c.

Cued speech?

1

2

-1

-2

 

d.

Oral speech?

1

2

-1

-2

 

e.

A communication board or book?

1

2

-1

-2

CHECKPOINT: IF B4gd= 1 (YES) ASK B4h, ELSE, GO TO CHECKPOINT BEFORE B4i.

 

NEILS

1

2

3

B4h. Compared with other children about the same age, how clearly does CHILD speak? Would you say he/she.... READ CATEGORIES, CIRCLE ONE CODE

   

Speaks just as well as other children,

1

   

Has a little trouble speaking

2

   

Has a lot of trouble speaking, or

3

   

Doesnít speak at all?

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

CHECKPOINT: IF B4ga. = YES, ASK B4i. ELSE, GO TO CHECKPOINT BEFORE B5a.

 

 

NEILS

1

2

3

B4i. Is the sign language that [CHILD] is learning to useÖ READ CATEGORIES. CODE ONE

   

American Sign Language,

1

   

Signed English, or

2

   

Some other sign language system? (SPECIFY) ______________________________

3

   

DONíT KNOW

-1

   

REFUSED

-2

 

NEILS

1

2

3

B4j. Do any other members of [CHILDís] household use sign language to communicate with (him/her)?

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF B4ge = 1 (USES COMMUNICATIN BOARD) ASK B4k, ELSE GO TO CHECKPOINT BEFORE B5a.

1

2

3

B4k. How frequently does CHILD use his communication board or book at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE

   

Always,

1

   

Frequently,

2

   

Sometimes,

3

   

Never?

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

CHECKPOINT: IN WAVE GO TO B5a.. IN WAVES 2 AND 3 IF B1a. = 08 (PARTIALLY SIGHTED) OR 09 (BLINDNESS), OR 13 (DEAFNESS/BLINDNESS) GO TO B5a. IF B3d=07, 08 OR 12 GO TO B5a.

Now Iím going to ask about [CHILDís] vision.

 

B5a. OUT

NEILS

1

2

3

B5b. Does [CHILD] wear glasses?

 

GO TO B5c

YES

1

 

GO TO B5d

NO

2

 

DONíT KNOW

-1

 

REFUSED

-2

 

NEILS

1

2

3

B5c. How well can [CHILD] see printed words with glasses? Would you say [he/she] ...? READ CATEGORIES. CIRCLE ONE CODE

 

GO TO CHECKPOINT BEFORE B5e

Sees normally,

1

 

Has a little trouble seeing, or

2

 

Has a lot of trouble seeing?

3

 

DONíT READ; GO TO B5d

DOESNíT HAVE THEM

4

 

WONíT WEAR THEM

5

 

DONíT READ; GO TO CHECKPOINT BEFORE B6a

DONíT KNOW

-1

 

REFUSED

-2

 

NEILS

1

2

3

B5d. How well can [CHILD] see printed words? Would you say [he/she] ... READ CATEGORIES.

   

Sees normally,

1

   

Has a little trouble seeing, or

2

   

Has a lot of trouble seeing?

3

   

Doesnít see at all

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

CHECKPOINT: IF B1a = 08 (PARTIALLY SIGHTED) OR 09 (BLINDNESS) OR 13 (DEAFNESS/BLINDNESS) OR B5c=3 OR B5d=3 (A LOT OF TROUBLE SEEING) ASK B5e. ELSE GO TO CHECKPOINT BEFORE B6a.

 

1

2

3

B5e. Does CHILD use any of the following:.. READ CATEGORIES. CIRCLE ONE CODE.

   

Braille

1

   

Portable Braille note taker or writer

 
   

Large print type

2

   

Optical devices (E.G. NEAR VISION MAGNIFICATION SYSTEM, TELESCOPIC DEVICE, BIOPTIC LENSES)

3

   

Mobility Devices (E.G. CANES, ELECTRONIC TRAVEL AIDES)

4

   

Assistive technology, such as voice synthesizers or software to enlarge the size of the print on the computer screen.

5

   

Any other devices to help him/her see or read? SPECIFY _________________________________

6

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

N

CHECKPOINT: IN WAVES 1,2 AND 3 IF B1a=HEARING IMPAIRMENT (06), DEAFNESS (07), DEAFNESS BLINDNESS (13) GO TO B7a. IN WAVE 2 AND 3, IF B3d=06, 07 OR 13 GO TO B7a. IN WAVES 1, 2 OR 3 IF B1a= 04 OR B3d= 04 (SPEECH IMPAIRED) GO TO B6b. ELSE GO TO B6a.

 

My next questions are about [CHILDís] ability to use language.

1

2

3

B6a. Does CHILD have any problem speaking clearly, or carrying on a conversation or any other speech or language problem?

   

YES

1

 

GO TO B7a

NO

2

 

GO TO B7a

DONíT KNOW

-1

 

GO TO B7a

REFUSED

-2

1

2

3

B6b. Compared with other children about the same age, how clearly does CHILD speak? Would you say [he/she] ... READ CATEGORIES. CIRCLE ONE CODE.

 

GO TO B6d

Speaks just as clearly as other children,

1

 

GO TO B6d

Has a little trouble speaking clearly,

2

 

GO TO B6c

Has a lot of trouble speaking clearly, or

3

 

GO TO B6c

Doesnít speak at all?

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

NEILS

1

2

3

B6c. How does [CHILD] communicate with you? Does [he/she] use ...
READ CATEGORIES. CODE ALL THAT APPLY.

   

Words?

01

 

GO TO B7a

Sounds that are not words?

02

   

Gestures, including pointing?

03

   

Sign language

04

 

GO TO B6c1

A communication board or book

05

 

GO TO B7a

A computer

06

   

Anything else? (Specify: ___________________________)

07

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

 

NEILS

1

2

3

B6c1. How frequently does CHILD use his communication board at school? Would you say....READ CATEGORIES. CIRCLE ONE CODE

   

Always

1

 

GO TO B7a

Frequently

2

   

Sometimes

3

   

Never

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

1

2

3

B6d. Compared with other children about the same age, how well does CHILD carry on a conversation? Would you say he/she....READ CATEGORIES, CIRCLE ONE CODE

   

Converses just as well as other children,

1

   

Has a little trouble carrying on a conversation,

2

   

Has a lot of trouble carrying on a conversation, or

3

   

Doesnít carry on a conversation at all?

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

Next, I want to ask about [CHILDís] physical abilities.

 

NEILS

1

2

3

B7a. How well does [CHILD] use [her/his] arms and hands? Would you say [he/she]...
READ CATEGORIES. CODE ONE CATEGORY. IF RESPONDENT REPORTS DIFFERENTLY FOR EACH ARM/HAND, CODE THE ARM/HAND THAT HAS THE MOST TROUBLE. NOTE: THIS DOES NOT REFER TO TEMPORARY DIFFICULTIES, E.G., A BROKEN ARM.

   

Uses both [his/her] arms and hands normally,

1

   

Has a little trouble using one or both,

2

   

Has a lot of trouble using one or both, or

3

   

Has no use at all of one or both of [his/her] arms or hands?

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

 

NEILS

1

2

3

B7b. How well does [CHILD] use [her/his] legs and feet? Would you say [he/she] ... READ CATEGORIES. CODE ONE CATEGORY. IF RESPONDENT REPORTS DIFFERENTLY FOR EACH LEG/FOOT, CODE THE LEG/FOOT THAT HAS THE MOST TROUBLE. NOTE: THIS DOES NOT REFER TO TEMPORARY DIFFICULTIES, E.G., A BROKEN LEG.

 

GO TO B8a

Uses both [his/her] legs and feet normally,

1

   

Has a little trouble using one or both,

2

   

Has a lot of trouble using one or both, or

3

   

Has no use at all of one or both of [his/her] legs and feet?

4

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

 

NEILS

1

2

3

B7c. Does [CHILD] use any equipment to help [him/her] get around such as crutches, a walker, or a wheelchair?

 

GO TO B7d

YES

1

 

GO TO B8a

NO

2

 

DONíT KNOW

-1

 

REFUSED

-2

1

2

3

B7d. What is the equipment he/she uses? DO NOT READ CATEGORIES. CIRCLE ALL THAT APPLY.

   

Crutches

1

   

Walker

2

   

Leg braces

3

   

Wheelchair

4

   

Other SPECIFY _________________________

5

   

DONíT KNOW

-1

   

REFUSED

-2

1

2

3

B7e. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.

   

Always

1

   

Frequently

2

   

Sometimes

3

   

Never

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

Now, I have some questions about [CHILDís] health

NHIS

1

2

3

B8a. Compared with other children about the same age, would you say [CHILDís] general health is... READ CATEGORIES, CIRCLE ONE CODE

   

Excellent,

1

   

Very good,

2

   

Good,

3

   

Fair, or

4

   

Poor?

5

 

DONíT READ

DONíT KNOW

-1

 

DONíT READ

REFUSED

-2

CHECKPOINT: IF B1c=3 (PARENT SAYS NO DISABILITY) GO TO B9a. ELSE ASK B8b.

NHIS

1

2

3

B8b. Is CHILD now taking any prescription medicine for a condition or problem related to his/her disability?

   

YES

1

 

GO TO CHECKPOINT BEFORE B8f

NO

2

 

DONíT KNOW

-1

 

REFUSED

-2

1

2

3

B8c. Is CHILD taking Ritalin?

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF A5c=06, 07, OR 08 (LIVES IN FACILITY) GO TO B8f, ELSE ASK B8d.

1

2

3

B8d. Does he/she take his/her medication while he/she is at school?

 

GO TO B8e

YES

1

 


GO TO B8f

NO

2

 

DONíT KNOW

-1

 

REFUSED

-2

 

 

1

2

3

B8e. Does someone at the school give him/her the medication?

   

YES

1

   

NO

2

   

DONíT KNOW

-1

   

REFUSED

-2

CHECKPOINT: IF B8a=1 (EXCELLENT HEALTH) GO TO B9a. ELSE GO TO B8f.

1

2

3

B8f. Does [CHILD] use any kind of medical equipment or device, like an oxygen tank, or a catheter? THIS DOES NOT INCLUDE MOBILITY DEVICES, LIKE A WHEEL CHAIR, WALKER, CANE, ETC.

   

YES

1

 

GO TO CHECKPOINT BEFORE B8h

NO

2

 

DONíT KNOW

-1

 

REFUSED

-2

1

2

3

B8g. What is the equipment or device[s]? DO NOT READ CATEGORIES, CIRCLE CODE AND/OR WRITE ANSWER.

   

Oxygen tank

1

   

Catheter

2

   

Feeding tube

3

   

Other, SPECIFY __________

4

   

DONíT KNOW

-1

   

REFUSED

-2

1

2

3

B8g1. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.

   

Always

1

   

Frequently

2

   

Sometimes

3

   

Never

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

 

CHECKPOINT: IF B8b=1 [TAKES MEDICATION] AND B4d=2 [NO HEARING AID], AND B6c DOES NE 05 OR 06(NO COMMUNICATION BOARD OR COMPUTER), AND B7c=2 [NO MOBILITY DEVICE] AND B8g=2 [NO MEDICAL DEVICES] ASK B8h, OTHERWISE GO TO B9a.

1

2

3

B8h. Does CHILD use any equipment or devices because of his/her disability?

 

GO TO B8i

YES

1

 

GO TO B9a

NO

2

 

GO TO B9a

DONíT KNOW

-1

 

GO TO B9a

REFUSED

-2

1

2

3

B8i. What equipment or devices? DO NOT READ CATEGORIES, CIRCLE ONE CODE AND/OR WRITE ANSWER.

   

Protective helmet

1

   

Computer

2

   

calculator

3

   

Other, SPECIFY __________

4

   

DONíT KNOW

-1

   

REFUSED

-2

1

2

3

B8j. How frequently does CHILD use this equipment at school? Would you say.... READ CATEGORIES. CIRCLE ONE CODE.

   

Always

1

   

Frequently

2

   

Sometimes

3

   

Never

4

 

DONíT READ

DONíT KNOW

-1

 

REFUSED

-2

 

 

NHIS, NLTS

1

2

3

B9a. During this school year has CHILD received any of the following services?

1

2

3

B9b. Was that from or through his/her school?

FOR EACH SERVICE READ SERVICE AND CODE CORRECT RESPONSE IN COLUMN A, IF RESPONSE IS YES, ALSO READ B9b FOR THAT SERVICE. IF RESPONDENT SAYS STUDENT IS NOT IN SCHOOL, CODE B9c AND DO NOT ASK B9b FOR THE REST OF THE SERVICES.

1

2

3

B9c.

STUDENT IS NOT IN SCHOOL

1

 

   

A. Received Service

B. From or through the school

 

Service

Y

N

DK

R

Y

N

DK

R

a

Speech or language therapy

1

2

-1

-2

1

2

-1

2

b

Audiology services for hearing problems

1

2

-1

-2

1

2

-1

2

c

Psychological or mental health services or counseling

1

2

-1

-2

1

2

-1

2

d

Physical therapy

1

2

-1

-2

1

2

-1

2

e

Social work services

1

2

-1

-2

1

2

-1

2

f

Occupational therapy or life skills therapy

1

2

-1

-2

1

2

-1

2

g

Recreational therapy

1

2

-1

-2

1

2

-1

2

h

Orientation and mobility services

1

2

-1

-2

1

2

-1

2

i

Medical services for diagnosis or evaluation

1

2

-1

-2

1

2

-1

2

j

Nursing care

1

2

-1

-2

1

2

-1

2

k

Personal assistant/aide

1

2

-1

-2

1

2

-1

2

l

Tutor

1

2

-1

-2

1

2

-1

2

m

Reader or interpreter, including sign language

1

2

-1

-2

1

2

-1

2

n

Assistive technology services or devices, such as help selecting, getting or using assistive technology devices. IF ASKED, ASSISTIVE TECHNOLOGY COVERS A WIDE VARIETY OF DEVICES ANYTHING FROM A WHEEL CHAIR TO SOFTWARE ON A COMPUTER TO A CALCULATOR

1

2

-1

-2

1

2

-1

2

o

Transportation

1

2

-1

-2

1

2

-1

2

p

Service coordination or case management

1

2

-1

-2

1

2

-1

2

 

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