MEMORANDUM to Users of data for the National Child Development Study, Second and Third Follow-ups

from: Survey Archive date: 17 September 1981

Information from the study is requested by specifying a list of com~I'.Jter item numbers ~rom the NCDS I coding frame, covering Sweep I (1965) and selected Perinatal data on the 1958 Cohort, the NCDS II coding frame covering Sweep 2 (1969/70) and the NCDS III coding frame covering Sweep 3 (973174),

The data subset is supplied in the form of fixed-length card-image records on magnetic tape with a line-printer layout of the items and their location in the record. The missing data codes have been standardised with the fields being filled with 8's for,DNA (Does Not Apply) and 9's for NA (Not Answered). Should a variable take either of these values as defined in the coding frame then the output field width will be increased by one to avoid ambiguity.

There are three item numbers which have significant decimal places and which may not be re-computed from existing item numbers:

339 Head Circumference to nearest 0.5 inch

1860 - Mean Terminal Unit lentth (from Test Booklet at NCDS II)

1953 - Weight (in Underclothes) in kgms.

If any of ~hese items are requested, the original value of the item will be multiplied by the appropriate power of ten in order to produce an integer number. prior to being written to tape. The item should therefore be read using a field specification which allows for the corresponding number of decimal places.

There are also five items which have significant decimal digits. but which may be re-computed from existing item numbers and for these only the integer part is transferred. Users interested in these item numbers should there-fore include the component items in their subset. The relevant item numbers are as follows:

item number component items

149 59 + 62

1721 2272 + 2275

1722 2278 + 2281

1732 2360 + 2476 + 2478

1733 2360 + 2476 + 2478

•

EDUCATIONAL

2

.......,' ......... .. local Aurhoriry Cod. Number ChM's Code Number

CoIs. 1 2 3 4 5 I 1 8 t 10 NATIONAL CHILDREN'S SUREAU, S WIldey Street, Wington, LondoIt IC1V 7QE

Educational Questionnaire NATIONAL CHILD DEVELOPMENT STUDY

(1958 Cohort) -, c __ ... ~c_: -"'~-~ ...... ~ w.o.w ........... o _._T .... _ _ , __ ... ' __ .. I ............. W .... III_C .. _,

.......... 11.'_ MO. 'lie'. DC" ... _--, =::tc-:~=-

__ •. 0_ ........ 0._.10_ Mr •. Mo. ___ ............. "" D. O.Se

_'" 0;._ ... 10 __ ISc_, c .... Ir ....... : M.JII ........ .. ao-.- .. c ___ , J. M. T_ "D. o.sc. file,. '"e._

"'_0."._'" w. o. w ...... ,,"0 _ .... _ .. _: «11,'-' ........

Third follow-up of children born 3rd - 9th March, 1958

I (a) Child'. Surname

Fir8tnanM._ ....... (in fuR)

(b) ...

("Ie.se ,ing app'0pti.'/t numbe,)

.. 'a) Child'. OMe of Birth

(~) Toder'. Date .............. /

/March 1951

/1'7.

III (a) Name and Addr ••• of pre.ent "hool

Po.tal code ..

(b) Telephon. number of .chool

(c) NatrM of h.ad or prineipa'

IV (a) Child'. previous .econd.ry school (if any)

Boy

Girl

(b) Child'. primery echool. If known, pl •••• give name

and addre .. of .chool attended by child at "ev.n.

Col 11 . 1

........ 2

Col 12-16

C:OETIO Day Monlh V.ar

(2

Notes on completion of the questionnaire

The ... I .. a ...... iI in two MClion$. lee"- A is CQIIC ..... with .....,.1IId InfonNlioft Iboul .. KhooI .... · • ......, -1MIr __ ~lIId ..., ... h....... ......... COMitIeI of qui I"'" ~ 1M -..tv child. Molt 01 ."... CW\ ~ ........... by. fomt Of dIII1NCher. t.t ;. .... c:..- if may "- neeaury 10 coneult I IUbfect tIMe". =·:: ... ~~SJJU ~IN~ ~::L .............. prOeeaing end -.lyses of Ihe MIWerS" 1M c.nw out conveniendy. You will find IN« they f." into three Cltegorita: FirIIlv ...... .,. thou Ihil require. written Inawer Ind IPKe is pnMded 10 write I few WOfds.

Secondly. u.- .,. questions where you are offered I number of Ihemative .nswe". uc:h wilh • number by il. In IhIs CIM plelSe "flg the ft_IMr

~ 141 your...-. Yeu wiI-'so often IncI thlt tMre ... ..-:e I'IovidM 10 "- uud when your eMWeI does not ,.. ifIto any 01 !he CMegoftes oIteted. FcIf ........

ls ItIisschool: A IKGndIty IChooi CD It primIry school 2 ~ ( ..... ,..;ty) 3

For the third kind 0' question the .nsw. is In_be,. For t'- the number shoutd be written i'n the box Of bolla prOVided. FOf eumpIe.

How old is Ihe Iludy child? Ir -1-Ir--s-', ynrs If you tle/lhll Ifty InsWer needs _ QUufiCIlion or ilmplifiCilion. plelSe Idd comrMftU at thll poinl in the queslionftlirl.

Section A The school

E3

t few ........ ....., •• 1 ....... .., • lEA eM .... ..... .." ...... ....... ...... 'r .... h lCIPMPIiIII 1IUInber ..... ~to"""'", rdIoeI ..... :

c. ............. (inc;I. ~ end muItiMIfaI) ...... ( .... ..,.....,In~ __ ,. ... y IIICIdem (iIftIor ~'" in Sc:odend) -'--Tec:hflical ...... _ ... . .. _ ........ _.. ... .. . __ .. ._. __ ... _ .... _ .. . AI-. ______ .. _ ... __ .. _ ............ _ ... __ ...... _._ .... ____ .. Residential ~ (pluM apec:1fy type(s) of hlndap

Day lI*=iaI (tvPe(s) of hlndicap .. hnmigrant cenne . .... .. ....... Other (pIu .. apec:ify .

2 Fer Mhool. -' wheNy ,,*nUhtect tty • UA

P'I.uM Indic:a1e. by ringing the eppropriMe number. the UtegOry to wtMch \'OUf IChooI beIonp: Independent school (nee one c.r ... wholly or IMinfy for children who _ handicapped) ____ ._ ...... _._ ... Direct-ijrlnt IChooI (grant-lided in Scotllnd) ____ . Non-mllntalned special school (pluM specify type(s) of hlndic:ap. ___ .. _ ... __ .. __ ...... _ ..... ___ .. _._. _______ ..

Indepet dent IChoot catering wholly or INlnly for hlndicapped pupil (pl .... specify type(s) of hlndicap

Other ( ..... speeiIy.. ..... .... .." .. _ ... _._._ ........ _ ..

J ToW ntIIftber 01 pupils .. ~ on ICbool roD: ( ....... .new number In bolla) _ .. __ ........ .

4 HuInbaf of ebove who I,. I)Mrdefs ..

I Are the pupil. in your school: In boys .. III girls ........ of both .. 'UIS

• Whit ege in yNfl ere the youngest pupils in your school? (ignore isollted unusuII cases) _ ... __ .. _ .. _ ............................ .

Ind the oldest .,

-) .. )

.)

. )

",.... .. Cef 17 -- , .. 2 _3

4 .5

• .7 I

.9

Colli .. \

2

3

4 . .. 5

Enter flU""'" in bolt_

Col 19-22

I f I I I

Col 23-26

I I I I I

Pleesering Col 27

t .. .......... 2

........... 3

Plttue/ene b"nk Col 21

o Col 29

o

•

14

7 ~""'~oI"""lnyouflCMot ..... ... 1han ,e hive IMhen In ftOft·menuaf occupedone 1

• Ify.- ....................... v ..... it: 'urpoee bull

~w.

1o-1ft 2O-lft .. JO...3ft.

•

U 14 .) 00.., ....... .,,.,,..,, hIw ......... fWIIlDMlJlley

lor ..... guld'i tee 1 " •• how MIMy tMc:fIera ha'M .. .. an.lll11vl ...... writI ......... 1n ........ If none ...,0_ ..... _. __ . ___ . __ ...... ____ .. _ .... _ ..... ___ ...

b) If y.I. lay hew ....a. .... II WIlt (to .. ....., hour). Ia ............ I'8duced to ... for .... WOft 1 (If ...... IhIft OM ....... 01..." . ..... give -1WrIOI .... )- .

c) .. ~ .... peid • ..-cW aIIfy in ...... of ... WOft 1 V ................ " No ... __ ._._ ......... ..

cI) How ................ W8IIt .... ....., ..... 1 (II ......... .,..... c ..... .., tMCMr wIIo ... ~ ..... · ...... '1 .

MoM ...... _ ... l-.1I1an 7 .....

. 710 16 ct.ys .. More than 15 d-vs Some. but duration unknown

'5 Will chi'*-" of Ihe SIUdy child'. age in yow ~ Mve had Ieuons specifically concemect with :

a) Physiotogicat...,.as of humen reproducYon 7 Yes .. . No ..... .

b) EmotioN! and personailipecu of_xua' reillionships?

d) Information on veneral diseases 1

VIS ....

No .

VM .... No

V.s ...... No ." .. '"" ...

,. Which OM 01 the foIowing lies« dIIcribe5 how pupiII if! the 12-13 yMI group 01 your edIooI life ........ to cIMMa 1

p~ ..... formed 01'1 the .... of ebiIiIy. CIIikItM .... 01' IIIOSI of their IeaonI with the _ ... whieh COftIeinI dIiIcfren of a r .. tricIId rMIge of ebilitvr ........ •• ~') ........... -............ ~ ...... -Permanent c:-....s .. of mixed ability but for _ subiKtI dMMS .. formed on the basil of ability in that MJbiecl r .. nine·) -.-..... AIC dnses a,e of mixed ability ....... Some other .".ngement (pIeeM specify ...

Not appliceble-no chHdren of this eve group in this school .... _._....... ... "

n Ooes the school arrange regular "'"lings of the following kinds? (PIe_ rintl the epJNopml. numben)

V ... regu .... Ve •• II No regular Nolat !Metings I ... , rIlHlinos· .. held It one. a Ad hoc leeslonce yea, when need atetm erises

a) MMtings a' whidI PIQntS discua child'. progr_ with tNChers 2 3 4

b) Occ:asions al which .,.,.nls ... pupils at wort 2 3 4

c) Meetings at which t .. chers demonat,ete , •• ching method. 01' cont.nl to pat.nts 2 3

, .'

EntM 1WIIIIIw Cofa

o CoI84-H

c.,v . 1

2 .3 .. 5

Co/68 ..... 1 . ..... 2 CoU9

.1

.2 Col 70

.. 1 • ... 2 Col 71 .... 1

2

Col 72

.... " ... 1

2 3

... 5

Col 73

Col 74

Col 75

11 7

It

" DoeIIhe 1ChocIl .......... ·., ...... ·teecMr ..,. .. 1

t. 0... the .alGOl hew • unIIorm 1 V .. No

No _. ___ . __ ........ _ ... _._ ...... . V ... N ..... c:ompu/IIcwy ___ ... __ ._....... . _. _._._.

V ... ,,·URiIorm~~ the acllooL ..... V ... IPKIIIc: ___ ~ IfIrouohout the KtIeeI .-.-.. _._ ._ .. __ ..... _ .. __ .. y ....... U .. llry 0fItr lit CMain ... ~ .. _ .. 0.- C,r-1Pdy -'-'- ......

21 Do you fHl Ih8t the work 01 your school Is limited by the IKk or lnadeQuecy of My 01 the following f8ci1iti .. ? ('''.'. ring .If eMt .pp/'f)

.) library ... ___ ..... . b) Sports facilities ... _ .... _._ ......... . c) Science '-botatan. ._._._ ..... _._ ........ .. d) DomNtic Science/Home Economics fKilities e) Mecalwork,lWoocIworIt facilities __ ...

f) Equipment for CGmINicial sub;eca g) Audio-visual equipment

Z1 How INny pupils _ ~ from your achool In the lell eudemic .,..1 PIMse ent., numbef In box in the tnargin. If none. pie ... write O. If 9 or more. please write 9._ .....

For OffICe Use:

~rd Local Authority

Code No. No.

5

CoIl 2

U a.Iow Is • till 01 ...... ~ methods CGIftIIIOnty u.s in IdIooIa. For Mdt _ ..... 1ndIcete by ringing the eppro-~ number • ........, mIe INChod Is uMd in your IChooI.

Used 1=- 1:'-reguIerfy or oc~l!l

a) Suspension 1 2 3 b) CoJpofaI~

fCMe or any ocr- AlMna} 2 3 c) Physical ...,dM 01' menual wort

Ce.g. running 01' pdening) 2 3 d) Extra c'-ssWOtkl~

or written lines 2 3 e) Altending echooI outside

normal fIouq (e.g. 'detention') 2 3 f) Loss of ~ .... us

(e.g. prefect or monitOf) 2 3

I) Exclusion ffOrr'l popular activities Of from use 0' special equipment or rooms (e.g. sports/games. club-rooms. etc.) 2 3

II) Reporllo.,..... (by conwrulion or .... ) 2 3

i) $JIecial behaviour/work repons 2 3

-~-----. -- .. --.. -

,.,.. .. "'" Col7'

.. 1

2

Cot 77 . ... 1 .2

3

.. .5

IS

col7e 1

2 3 4

.5 6 7

Enter number in box Col 79

o Chikr. Cod. Number

,.,..,.1 •• ". bI.nlc

Col 11

Cof12

Col 13

Col 14

Col 15

Col 16

Col 17

Col 18 Col 19

10

, 8

E7

Section B The Child in School

RIStrictM m ability range ('atreamecr Of 'senecf), but not a fllfMdial dns ____ ... . Of mixed ability .. A remedial class ..................... _ .. _ ....... .. Nol appIQbI_as school is a special school Other (please specify. .. __ ............. '

b) If restricted in abifity range (i.e. you hive ringed 1 abow), please desc:ribe tIM ability range 01 this class.

c) How many dMldren are theN in this class 7 ,tu,. write ,he nufnber in the box. .. .. _ .. _............ . .... _ _ ........ _ ............ _ ... _

d) To the nearHl hour, how many hours per week do this child's English lessons occupy 7 If 9 0' more, please write 9_.

e) Can this cIIiId read well enough to cope with everydlY needs (e,g. MWSpepeIS, notices, IIC.) 1

Yes

No ._ ..

24 MIIth ___ /~.tIc (K fIG Ionge. SIUdying , .. Mlb;ect pINIe oM ..... for Iat cta. Inended)

I) II the child"s Mathematics class: 'Sa~ or 'set1ed' (bul not a remedill class) Of miMed ability A remedial class ..... .. ............... __ Not appicabI-. special school Other (pluse specify .•.

b) If. 'streamed" or 'senecf dos, please desc:ribe the ability rano- 01 this class

c) How many children in this class 7 Please wril. the number in the box" .. __ ._ ................. _ ........... .

d) To the nel'est hour, how mlny hours per week do Ihis child's Mllhematics lesions occupy 1 II 9 or more, please write 9._ .. _ ............... _____ ...... _ ....... _.... ...... __.. _ ....... ..

e) Can this chilli do • calculations nomuIlfy requi,ed by an eYefyday shopper 1

21 Is the child :

Yes.

No

A full·time boarder (i .•. including weekends) A Pin, lime boarder (e.g. weekdays only) A dlY pupil. Other (please specify

PIN •• I.., Col 20

1 2 3

• .-............. 5

P' •• s.' •• ", blank

Col 21

0 Writ. numb.

in box.s Col 22-23

[JJ Col 24

0 PI •• s. ring

Col 25 ..... 1

-... _ ....... 2

PI •• s. ri",

Col 26 . 1

.. 2 . 3

4

.... . - .. 5

Pie.,. I".". bl.nk

Col 27

0 Writ. numIHr

in bolCes CcM 28-29

CD Col 30

0 Pleu. ring

Col 31 I

2

Col 32 , 2 3 4 • 9

n .. ....... lilt below elf MIjec:Is now '*-' -..led in IdIoaI by

&he dIId. , ..... iftduda In ... 11M MI\' ~ in which a GCE 01' CSE 01' set p.a" aInedot -.n ~ and which II not ROW beIne lludIM. EIIdude ...... f'l and Religious 1(..., ,..dU-. UrWII bIifto studied for 1ft uamination. lit the .. bolllVliMt Hd\ ot the subjacts which you 1is1 pIe_ Inllr aM of IN foAewiAg ~: 1-tf _ 0--" 01' SCE 0 ...... .,... ... ..., obUiMd 2-Jf a CSE or-te 1 .,... IIrudy obIIinId 3-Jf a CSE ".... gtade 2-5 Ihedy obtIinId 4--1f Gel O-Iew! or sa O-gddl wII be .. ", lIIis.,.., 5-11 this puptt .. ~. . ...... or will lie PI"~ 10 an A·tev.I

«If N ........ withouIlIling 0-'"" Of O-Vflde I-Jf CSI ""II lie ........ .,.. . 7'-tf 101M other IlttemIf eaarNna1ioR wit be I_ell this yur 8--No Ixtlmal Ix.ninllion intended or laten

Ii)

(ii)

(iii)

(iv)

(v)

(vi)

(vii)

(viii)

(ix)

(.II)

(xi)

(xii)

1:1 Please give r.tings of the chilcfs abilily in each of lhe subjecls listed below. If more than OM subject in an _ ililling studied (e.g. in Iianou.ges Of science). plea. 1fII .... an --. rating. Please ~ the raliAgllCCOf'ding 10 ... IoIowirlg 'J)p(OlCimate scale and enter the number in tha boll ..... NCh 1UbjKl. 1~ of obfMIino aft A·1avel Of Kiot*.grade pass in this subject. 2-AboYe ."........ c.p.bIe of -1ininV O-tevel or O·grade Of CSf grade 0 ....

but not of tIIUng it 10 A-1aMIf .. Higher·V'Ide. 3-Of average abifity in 1his subject. Capab .. 0' obtaining a CSE • PHS. grades 2-4. 4-Below awlau-. A possible CSE • Intranl. S-Un". if any.~abiIRy in this subjlCl. 6-Don't know. • It is hoped thll tho6e le«:hen in MelS Whtlfe CSE i. nol r.llen an nevMhe/ess .ssign the child 1o one 01 these .pp'DX;mlte gloup •.

.) Mathematics

b) English

c) Modern languages

d) Science

.) Pr.ct~ subjects (e.g. meta'· wOlk. domeslic science. etc.) ...

I) Social studies (e.g. history. geography. economics. e,tc.) __ .

CoI33-3S

Col 36-38

CoI3s-.1

CoI.2.....,

CoI.5-47

Col 48-50

Col 51-53

Col 54-56

Col 51-59

Col 60-62

CoI63-6S

CoI6tHi8

PIIIISII write codes in boXIIS

Col 69

o CoHO

o Col 11

o Col 12

o Col 13

o Col 7.

o

• 8·

u • Is 1M ..... I«.t .. .", ...... ...., widWI .. 1ChooI, lor

."., 1M ,... .... ....,..:

.) ___ 01 MY educ8tIon.t or "**' beckwardI_ V ___ .. _ .......... . Va but not _ much II rweded

No, but IUdI provilion is .............. chId .. No, and ROt ..c:.IUfY .-

b) __ .. ."., edllC8IIoMI or mental IUperioriIy V. __ .............. . Va INI .. _ much II needed No, llutlUdt ., is ~~::= ... No, 1M ... MceIAIy .

VII_._ .. Yes, but not • much as needed No. but desirable .. . No, .net nol necessary

d) ~ of tnY physiQl or sensory disabitity V.s ... _ .. __ .......

Ves, but not .. much as needed No. but desirable No, and rIOl ne

110

II How Iefte .. tile ............. KMoI (10 the ".... ~ ... )---... -.---.- ... --......... _.-._-_ ... .

14 T ......... or-.,) .......... IdndIOfful. ... M1Mr ....... '''.11'111 • vav"''' dIId ill.-t 1UMd1 (".,. ......... ..,..,

.,....ceuneet.~.~ ..

..... .. • CaIIge of Iduc:et-

...... ..,.IICId (i.e. ........ " ...... or __ til) ~.:: ...... II .... ~ fJI e ...

=::,.;;. ~ .. E~i,;~··~=-.. =:_::~ .. ~ - . ..... 3 _ ....... 4 0tMr ........... ~ .. ___ ... __ ....... _ ........... . Part· .... educl1ion In ~1Iioa ,.,. • ptDf ... ionaI quaIIfiaIion ( •. g. law, KcourQIICy •• te.) .. .. Other pert-time actuatJon "_"''''''''_' _ . Nona of IMM _.. ....... _ ... __ .......... _.-

II .) Do you think 'hil child would banafn IIOIn st..,ing.' achoeI aftef the minimum IMvinG age 1

v ...... __ ... No .. __ .. _

UncafUin

b) II you do _t Ppect him/tiel" 10 stay on, could you indicate briefty the renons lor ....

• What do you .... II -' likely 10 be this child'i first job 1 " ~ ..... tJIte of;.b tIo yeN expect this child 10 •• up1

r7 Has 'hil child evar baan in trouble with the police 7

ltV •• :

V •. No ... _ ...... Don', know

a) Was the Social SeMcaa [)ecMnmen, also involved Val No Don', know .. ..... .

b) Wuthecna Taken to cou'n (or a Childr.n', Hearing in Scotland) Dealt with by a caution ... _ ............ _ ....... _ .............. . Otharwiw dealt with ...................... _ ... .. Don', know ... ............ __ .................. _ ..................... .

. ... 6

.. ........... _. _ 7

. ......... a

CoI2S

.. .. 1 - ___ .... 2

._ _ .......... _ ..... _ 3

CoIlS

O· Cot 30-31

CO

P"ase ring Col 32

1

2 . ..... 3

Col 33 ..... 1 ... 2

....... 3 Col 34 .... 1 . .. 2

. ... 3 ..4

,. . . ,

111

• ............... "11 ............. ...., __ ., ...... chMM. ......... the IPP'GII ......... in NCh caM to ttww .... .... • wfIk:tI .... ..., dIIII .. ,..., the beheviour ....... ...... .... 1 ... on IN .... of IhI chile:!". behaviour In the .... ,2 ......

Doaaft', I~ll= ",...IN". AIIPIY MMt

i) v.y ........... ~ ataying ....... fcwieng 2 3 C • .,6

i) TNMtI from acMeI , 2 3 c.tat ii) s..umv. fidtMy 2 3 Cel37 iv) Oftan dlltlOyl or daINgas own or

others· property 2 3 CC)l.38

v) F,.quentIy fiohts Of •• namely quarreilOme with other children 2 3 Col 39

vi) Nol much liked by ethef children 2 3 Col 40

vii) Often worrill. worrias about many things 2 3 (AI.' viii) Tand.lo be on own-rather solitary 2 3 Col 42

iJI) 1nitabIa. touchy. is quick to 'fty off the handle' 1 2 3 Col 43

x) Otten appears miserable, unhappy. tNrful or distressed 2 3 Col 44

xi) Has twitches. mannerisms or tics of the face or body 2 3 Col4S

llii) fqquancty IUCb IhuInb Of finger 2 3 Co146

xiii) fNquen1ly bites Mila or ...,. 2 3 Col 41

xiv} Tands 10 be absMl flam school for trivial rauons 2 3 Col 48

xv) Is often disobedient 2 3 Col 49

xvi) Cannot Hnle to anyU1ing for _e than a f_ I1IOfYIeIIts 2 3 Col SO

xvii) Tands to be fNrfuI or afraid of new situations and n_ things 2 3 CoIS1

xviii) Fussy or over panicular 2 3 CoIS2

xix) Otten tells lies 2 3 CotS3

xx) Hn stolan things on one or more occasions in the pasl12 months 2 3 Col 54

xxi) Unrllponsive. ine" or apathetic 2 3 CoIS5

xxii) Ohan complains of ~ or pains 2 3 CoI5e

xxiii) Has had ... Oft Ifriv .. at sdIool Of has refused to come into the building in lhe past 12 months 1. 2 3 Col 57

xxiv) Has. slun.r or Slammer 2 3 CoIS8

xxv) Resentful or aggressive when corrected 2 3 Col 59

xxvi) Bullies other children 2 3 Col 60

• 13

---------- .- .....

Yes, ,... (ef , ...... , fIgUre) 0fIty ...

Y-. .,.,. (Of IMICheI figuN) 0IIIr-._. V-.bGIh . ....,. 0.. .• know _ ...... __

~) w.. this .......... the inltiption ef die .,.,.n(I) or the _hoofl

...... (1)

SdIeof Don'tknow NOI appfiQble (no meetings)

... With ~ 10 the d!iId's education. do the father (or tather figure) and mocher (or mother figure) appear:

Ove, concemed aboullhe child's progress/expecling 100 high a standud Very in .... eSled To show some interest To show lime 01 no ..... Can', say Inapplicable (e.g. no fathef/f~her fIgUre or mothe,/ mocher ligure)

.. , At the ends of NCb line. on lhe sule befow .,e Mtectives which coutd describe a c:Md's personalily or bebawiout. Could you please ,.... the IIUdy child on each of these ~. For e.ampl., if you tfIinIt that the word on the leh dufty applies, please ring 1. " if is not compietely true. but roont appropriale than the ~ on the right. please ring 2. If the child is midway belwMn the two descriptions. ring 3; and 10 on.

cauftcMII 1 2 3 4 5 Impulsive Moody t 2 3 4 5 Even-tempered TIfRid 2 3 4 5 Fie .... 1 2 3 4 5 Soc:iebIe 2 3 4 5 lazy 2 3 4 5

42 8.low at. some further descriptions of children. Please ring the number appropriate to the study child against each one

AQg,e .. ive Rigid Wilhdlawn Hard-W9rking

N~:lat I Somewhat I Certainly I ~,:~ a) POOf~ 2 b) DiIfICUll to undentand because

01 poor speech 2 c) Bad eyesight 2 d) Clumsy 2 e) Poor control of hands (e.g. in

writing. drawing. handwork) 2 f} Poor physicaf co-ordinetion le.g.

in jumping. rvnning or throwing) 2 g) Obeseor~I 2

Q At. there a"Y OIher peiticuler comments you -*' like 10 add abou, the penc,,""'. behaviour. emotional .... eIopmenl or pe~1 bKtpound 01 this child 1

3 4

3 4 3 4 3 4

3 4

3 4 3 ..

~.nn.

Col 11

. ... 2 3 .. 5

Col 12 1

2 .3 .4

Col 63 Col 64 F.,he, Mot""

... .1.. ....... _.1 L .... 2 3 .. 5

.1

3 4

5

6

Col 65 CoIN Col 67 Col 68 Col 69 Col 70

Col 71

Col 72 Col 73 Col 74

Col 75

Col 76 Col 77

PARENTAL

• 15

Local Authority Code Number Child's Code Number

Cois. 1 2 3 5 6 7 8 9 10

NATIONAL CHILDREN'S BUREAU, S Wakley StiNt. Islington, London lCW 70E

Parental interview form

NATIONAL CHILD DEVELOPMENT STUDY (1958 Cohort)

s---: """' .. "', .. c ....... M.1Itt\. ~11'tV of l.oNIerI _ ....... _,-,-.........., ,."....~ "'l~~" '" E ... lend M'CI w .... .. ~--: SecioPtol'_OII-. _.'C-_ __ 01_.01( __ 1_. C_elC:-_ .. c_: .. _ O. Y. 0...- ••

0_., .. --, c __ : WOW"" ........ D

l.ecllt ... C ............. : ~1"'tIGI'H" ~ .. O.fIllC,..OCrt ,.,., ...... I' 0 .... 8A. P1l O. 01' E ~ ""eft Mr ...... Ite~rr .... ' ....... I'" hi C ;:I Sc

c •. .....-..n: M J " H .. !, IA ~. iii T ......... MO. D.Sc. 'AC'. f AC "'¥Ch W. D W ......... D

................. Otftce.r: 1.11.' ..........

Third follow-up of children born 3rd - 9th March, 1958

(a) Child'. name (.umame)

Fir.t name. (in full)

(b) Sex (ple6se ling 6ppropri6te number)

II Ca) Chllcl". Date of Birth

(b) Today'. Date I

III Ca) Child'. pr.sent addre ..

13/A 1197

(b) Child'. home addr ••• at time of birth

Boy Girl

Cc) Place of birth if different from above (ple.s. give addr ••• if pos.ibl.)

Cd) Child's address at the time of Second Follow-up (In 1969)

(.) If born abroad. please give approximate date chifd came to liv. in this country

IV Ca) Nam. of informant (surname) . (first names) .

(b) Relationship of informant to the study child

Mother

Other (pleas. specify

Col 11 1

..... 2

h • .,. ben/t

Col 12-1i

CDITJO Day Month Vear

Plt':.st': ring Col 17

1

2 3

Introductory Notes

First of ...... __ • this dIence 10 !hiInk you 'Of unyine euc .,.... inleMews on ben-" of th. Nltionll CN1d o....IDPi.1Iftt Study.

DvrinI IN .. lew IIIOMhI of IIIk Y'Nt IOf'iIe 18.000 weh ~ wII ... taking piau. During the AIM ............ people IhemMIves wtII be ••. ~~. nli.",_. re. ~ I ,_ In .. ..... .-c'.'PlI ........ 1 Ind they will be gi,,*n I ................. ti.R. w. ... ..., Ilk lhe¥ ........ _~.i. ·cMrI....... .,... .. IChciieI."M~ ~~ I. If you helped III wiIh -'* toIow-uIK of chese young people. you will know 1"-1 lhis is Ihi fourth lime Ihil intonnltion hu bean collected.

At birth. infOfmlCion wn obtained which cast light on such INn.,. .. ,.riNtlllYlOf1alify. IhI sigPlif~nCl of binhweiohc. !lie eHec:1 of mothers' smoking in PfegNftCY end -nv olher important dat.s wilh conSequenl improvement in che MIIlemity Services.

The findings 0' !fie lo6Iow·up when Ihe children _a ~ MYIft hive recently been published in F,om .iIth 10 5_ (Dayi •. BUllar & GoIdst.in. 1912). The OYWtWheJming co·operation received from hulth viIiIMs .... chera. medical offICers. parents and many ochers eMbied this report to present more findings which "- been recognised as having impottant impIic:ItionI for policy and planning decisions for future ~I. educational and social HIVic:es.

A similar follow-up was carried oul al 11 years of age and many of lhe IWSUI1s "om thit are now being published. A rul ... 0' all NCDS books. articlas and Plpera can ~ oIUined from tha Nltional Children', Bureau.

Now 1hIt Ihe young""'" in the ItUCty are 16 "aara of .... the ~ty ia being latan 10 axt.oo lhe study .. Chef MICh .chaol lee¥ing age.

The ........

IduIty the iM.w.w Ihould be with lhe child's mothal or mott. ........ by herself (apart from those faw ca ... where cheri is none). HoweYef. this cannot alwaya be possible and it is important 10 ayoid

embarrassmenl and IWkwlfdness thai mOgnl be caused by liking someone .... 10 ... v •.

IA our preperltOry -'t on lhe iMefview lann. _ ,.,. lried 10 IVOid qvnIions wflich wo'*' be ..... Ied by !he ....- being interviewed 'Of being too PIraonal. HowwIf. it is Ilweys pOAible IhIt people do not __ to .,... ..,.. ~ions tor ..-ons 01 .. kiM. ....... __ II 1M I1M1 of lhe •• rvIew tNt ,.... ...... to dediM 10 ane_ .... ClUMiiona IlI1tay cMoee and do not preu fOf __ ,. where thit is the UN.

__ rdl ... IItflHmltion

The form is designed so Ihat. IS far as possible. informl1ion can be recOfded wilh thl minimum of difficulty and the proceuinQ and analysis of lhe an,wars can be c¥ried out cOnYenienlly. You will find Ihal answers fall into Ihr .. callgOfies :

Fils"y. lhere are lhose !hilt requite a short. wrinen answer and space is proyided to write a faw words.

Secondly. there aFe ~ QUeIUons whlre a number 01 ahernatiye answers we offered. each with a number by il.ln this case. you should ring Ihe number co .... esponding to the ans_ you are given. You will also often find that IMra is a space proyided 10 be used when the answer does not fall into any of the calegories offered. For example:

Was the information oblained in this interview proyided by:

Mother ............ _ ... _ Father _ .. _ ..... _ .. _ ....... . Other (pluse specify .. _ ... _

.CD 2

.... ) 3

Fof the lhird kind of q.uestion !he answer is a number. FOf theM lhe IM.IIfIbar should be wrinen in lhe box Of bo ... ptOVidecI. fc:w eqmpe. '

How INny floors are lhefe in !he building in which tha familot lives 7 r--......... ~

Number of floors , 0 I 3 I If you fael-chal any ~r needs some qualificalion Of amplification. pluM ~ comments al lhal point on lhe form.

Thank you ...... fer 1M your help.

'3 t ........................ A ".,..'teM II.",...,,.,,,. who Ii" toptlt« .ntI •• t ..,...., .

... ...... ItJ .......... ~ ...... houNhokll ElIdIIde Mty _ who ;, onIr .t Ifome 1« .hott pMiods. (

•

,.. 4 If ItO. Miural or '-ga' edocMive mother, pIe~ .. It.te 11 pouib&e:

., Why child is not IiYin9 with his/her natural Of adoptlv. mother.

b) If child is living with. mother substitute, at what eo- did he/she rirIt come under hat care? Plea .. writ. age in ye.,. in bolles

I The Nlationship to the lIudy child of the person acting lIS the chileS'. tither is: (please ,ing applDPI~le lenv Of number)

Natural father F.-hat by legal adoption Step-father Foster-father Grandlather Elder brother Co-habit.e of moth.r Uncle Housefather. No regular father figure Other (please specify

, If not natural or legal adoptive father. please stale. il possible:

al Why child is not living with his/her natural 01 adoptive father

b) If child is living with a tather substitute. at what age did h./she first come under his care? Please write age in years in boxes

1 a) Has this child .ver been in the care of a Local Authority? Yes, in care now Yes, in C3fe only in the past No, hIlS never been in c¥e Don't know Other reply (give det~1s

If ".', what was the child's age at lhe time of admission to care (or at the lut time of admission if more than one) and the name of the Local Authority ?

Age Local Authorily

b) Has the child ever been in the care of a Voluntary Society? Yes. in care now Yes. in care only in the past No, has never been in care Don't know Other reply (give details

If y •• , what was the child's age at the time of admission to care (or II the last time of admission if more than one) and the name of the Voluntary Society?

Age Voluntary Society

Em., #fie Col 31-32

CIJ PI •• s. ,ing

Col 33 y

X o 1

2 3 4

5 6 7

8

Enter age Col 35-36

OJ PIllS. ring

Col 37 1

2 3 4

5

Col 38 1

2 3 4

.5

19

PS

• Ocr ....... ." .......... ,... ... father flvur. (i .•. preMnI ...... held 01 hewetIOId) If not wortURg. write 'Moe WOIting' below end fill in details of last OCCI..-.. ...., e) to .). If no ma .. head, wrile 'None' below and procMd 10 quHtioft 10 .

... _._ .... _---_ .... _ ..... -.......... . ......•........ ..... .- . (In COI1I9,.Iing" ~ _ much deuillS possible should be given 10 iIIdIaCe the euct type of WCNk done 10 thel we an dnIify !If ... quaIific:Mion III r~lity iIwotved. T ... IUCh • '~ worfIGI', .enginHt', 'civil MlVenf. 'clerk' ... ~It and need upa.ining.)

e) Ac:tuI job ..........

b) TrMe.......,., or ProfMaion

c) I. the f .. he, paid ~Iy, monthly or is he se"·employed?

d) If .. "-employed:

Weekly Monthly,

Self-employed Don't know. Other (please specify

How many people does he employ ? None ........... . 1-24 ........... . 25-;- .......... . Don', know

e) If not self-employed : (i) Does he supervise O1hers?

(e_o. foremen, manager, chafgehand)

Pluse ring 1 2 3 4

5

1

2 3 4

Yes ....... 1 No .. "............ 2 Don't know ... ... 3

(i) If yeI. ie. does sutJlMse other5, approximately how meny ~ does he supervise 7

1-24.... 1 25T .. 2 Don't know 3

, For how fNny weeks has the father (ie. male heed) been out of won: in the pat 12 months Ihfaugh illness or KCident or unemployment. Enter number of weeks in boxes. e.g. for 6

weeks put I 0 I 6 t for no _ks put I 0 I 0 ,. Where no male heed leave blenk.

Number of weeks 0" work thro~h :

10 Ooes the mother (or mother-ftgure) do paid work?

11 If mother does paid work, plene give fuN detai'.:

.} Illness or accident

b) Unemployment

Yes No

.) Actual job .nd nature of work (including whether fun or part-time)

b) Trade, industry or profession . c) Paid weekly, monthly or self-employed .. d) Supervisory .talus, if any, and how rNny supervised

e) It self-employed, how many peGple she employs

Col 39

o Col 40

o Col 41-42

OJ

Enter numb~r

Co, 43-44

OJ Co, 45-46

OJ Plnse ring

Col 47 .. 1

2

Le.ve bl.nlc Col 48

o Col 49-50

[JJ

, 20

11 At wNt eve did .. tiler or fllher fegur. Ie,ye fun-time edu-cationl _

" At whit Ige did mocher or mother figure INve full-lime edu-Cltlon 1

14 I) Is Enghh the languag. uSUlIIy spoken in Ih. chifer. home 1 Yes. EnQIish only ................... _._ Y n. belt other langulOlliso used

• No. Other ~ u~UMd.. ...

b) If InY other IIrIguIge is !POk.n in the home. whit i, it?

" How mlny Ciglfl"es each do the mother Ind flther smoIte ?

Does not smoke 11111 Smokes In occasionll cigarette. but less than 1 I day 1 -5 cigarettes I d.y &-10 11-20 21-30 31 or more Smokes. pipe or cigars. but not cigarettes

11 How ohen does lhe $Iudy child go out in the evenings 1 Never or rarely goes out Goes out in the evenings once or twice I we.k Goes out in the evenings three or four times a we.k Goes out in the evenings five or more limes a week Other Inswers (please specify

17 I) Remind the .,-rent that the study child's yelr group is the tim in which .. children have had to SlIY at school unlil the age of si.a1een. In the study child's Clse do thay wish tNt he/she had been able to leave school at fifteen?

Ves No Don't know/Cen-t Sly

b) Ask plrenlS who would hive liked the child to have Ilready lett school their reasons for this.

,. Which of Ih. following would the parents lik. the study child to do1 Lelve" minimum school leaving age (i.e. end of this school year) SIIY in full-lime education beyond minimum school leaving age, but not beyond 18 ..... Continue some form of lull-time educltion beyond age of 18 Uncenain _ ..

" Which of lhe following do the parents think the study child •• in tact likely to do 1 LHv •• 1 minimum school leaving age (i .•. end of this school ye.u) Sea.,. itt full-lime education beyond minimum school leaving age. but nol beyond lB .... Continu. some fann of full-time educltion beyond Ih' Ig. of 18 . Uncenain ..... .

L.,.,. ,.nk Col 51

o Col 52

o l'''eH ';"1/

Col 53 1

2 3

Moth., Flthe, Col 54 Col5S

1 2 3

.. 4.

5 .. 6. 7 .. 8 ...

Col 56 1

.2 3 4

5

CoIS7 1

2 3

leiII" bt.nk

Col5B

o P",se 'ing

Col 59 1 2

..3

.4

Col 60 ... 1

. ..... 2 . .......... 3

..4

1

2 3 .. 5 6 7

8

21

P7

• What ~ of WOftc would the pereMS" the I1Udychild 10 do ?

21 Whet type of WOfk do the ".ren .. think the IUtv eNId Is in feet"eIy to do? (If the .ns_ is .. ..,. _ to question 20 pie ... write ' .. above'),

2Z I. th. study child likely, .h., leaving IChooI. 10 be in need 01 any special PIOYition because of • hendiup which could restrict his/her employrTlflnt opportunities?

II yes, please specify type of h.ndicap

Yes No Uncertain/Don't know

23 Please .sk the parent to what extent they have been satisfied with the study child's education in his/her present school.

If any dissatisf.ction, please give reasons

Satisfied S.tisfled in some ways bul not in others Dissatisfied Uncert.in/Don', know

24 Ask the ".,.", how rNlny times during the past t_lve months he/she has discussed lhe study child's school progress with his/her le.chers (Writ. numbf!r;n box), If no such discussion write 0 in box.. If 9 or more, please write 9,

25 Have the ".rents .t .ny time in the past 12 nIOfIths found it necessary to keep the study child off school in order to help at home?

Yes No Uncertain/Don', know

26 How many schools has the study child attended since his/her 11 th birthday? Please list the name and type 01 schools (secondary modern. comprehensive, etc,) below:

L_"",.nIc CoU,

o CoI1S2-63

CIJ Col~

o Col 65-66

CD

PleUtl ring Co/67

1 2 3

Leave blank

Col 68

o PJelstl ring

Col 69

2 3 4

Entef number Col7l

o Plelse ring

Col 72 1

2 3

PI 27 .) ....... .,.qaire Of IUIe from your own knowledge if .) IN

IlUdycNld,lnd b) IftVOlhefmembefofthe 'lfnilv, hal hid lIlY COfICICt with Iftv 01 the following MMe" linee the dIiId'l ~ bIr1hdrt. ( ....... ring "'Ih.t apply)

Social SeMceI or Social Work Department (including former ChilcSten's Department) Educational Welf.re Department earee,. DfflCtIf/Youth Employment Officer .. VoIuntlry Social Work Agency (pi .... slile which

PoI,ice or Probation Otrtce

b) If there hal been InY such conllCl, pIe.se SIIIe who ... ranged the contIC1 in the first instance

c) HII the study child 8VtIf been taken to coun (or. Children's Hearing in Scotland) 7

If yes, please give .s many details as you can

Ves No Don', know

ZI Does any child of the family receive Iree school meals at present 7

Yes No Don't know Other replies (please specify

)

Z9 Ask the parent whether they hive been seriously troubled by financial hardship in the past t 2 months.

For Office Use:

Ves. No .. Uncert.in ..... . Don'l know Other reply (please give details

Local Authority

PIe.s. ling

Study Other child p.'Son

Col 74 Col 75 t 1

2 2 3 3

4 4

5 5

Le .... e bl.nk Col76-77

OJ P~.u ring

Col 78 t 2 3

Col 79

1

2 3

4

Col SO . 1

2 3 4

5

~ N8O, Code No, Child's Code Number I Colt 2 3

30 What hive been the sources of income of Ihe household during the past 12 monlhs 7 (Ring .n re/e .... nt SOutces but exclude study child's e.rnings, if .ny).

Father/father figure's employment Mother/mother figure's employment Brothe,.'/sisters' employment

I 4 5

Other adult member(s) of household's employment Investments and/or private income , ..... Annuities and pensions (other than social security)

Supplementary benefit. Unemployment benefit. Widow's Pension/Widowed mother's allowances

Sickness benefit .. Retirement Pension Disability Pension Family Allowance Family Income Supplement Any other sources (please specify

I I 6 7

I I I 8 9 10

Please ring Col11

1 2 3 4

5 6

Col 12 Y X

0 1

2 3

.4

5

6

" 23

P9

" AM the iftforfNn4{.) to i~.. the range in which lhe Le .... blMk membeIs of the houIehoId's uswt M' inc:onw f.lI, (i .•. Mt., .. tlftNetioN ., 1OfIIf: •• "iz. inco_·ta1t. "'alth cont,ibutions. IHnsioM. He., ~"ion •. o"."i_ "..,. -'c. Include botttnu. cOfllflPinions. ov.rtim. "..,. .tc. if this is usually ,.e';"«I).

I"tMM show the intonnanl(s) lhe following section .nd uk them 10 indiute the ."."ollHNte r'Age in which the Mt income 0' II*nbers of the houMhoId f.,Is . ..... (i) the WMkty _ (ii) the monlhty income i. required whichew, the Infonunt(s) finds it most convenient to give.

(i) WMidy M' pey of f.ther or f.ther flgur. Plane ring the IPptoprill. number

C~ C~9 (1~" n ... ,. C2G-24 Cn-21 no-:w (35-39 (4~44 (4~9 (~59 (60·

I y X 0 1 2 3 4 5 6 7 8 9 Col 13 I WaaIdy _t ~y .f mother or mother flQur • ....... ring the IPpropriate number

[0-4 (~9 (1~I4 ('~I!t £20-24 (2~29 (30-:W C3~39 (40-

M I. ItIis KCommodalion :

P10

Owned by this household Of being boughl Renled 'rom Councilor New Town COtporation or Commission Of Sconish Special Housing Association Privalely rented-unfurnished .. Privalely rented-furnished Tied to occupalion " Olher (please specify

,. Ooes the accommodation have: (ask each item) (a) Bathroom

b) Indoor lallatory

c) Outdoor lallatory

d) Hot water supply

V _sole use 0' one Yes-sole use of IWO or more Yes-shared use only No balhroom, but permanent Ii xed bath wilh own Wiler supply in another room (e.g. kilchen) No bathroom or permanent lixed bllh Don't know

Yes-sole use 01 one Yes-sole use 01 two or more Yes-shared use only No ... Don'l know

Ves-sole use Ves-shared use only No. Don't know

Yes-sole use .. Ves-shlred use only No Don't know

,. a) How mMlY rooms doe. the accommodation have 1 Exclude all kitchens, sculleries and bathrooms. Include rooms used by lodgers and relltilles who are members 01 the household as defined in Question 1. Enler number of rooms in the boxes.

e.g. 6 rooms - I 0 I 6 I 11 rooms - I 1 I 1 I b) And now please describe the kitchen; which of the

following applies 1 Kitchen less Ihan 6 'eet wide and not used as a lilling room Kitchen less Ihan 6 leer wide and used as I living room Kitchen more Ihan 6 leel wide and not used as a lilling room Kitchen more than 6 leel wide and used as I living room .. No kitchen Don'l know

37 a) How many olher people sleep in the same room as the study child 1 Please lill in number in box. (If child has own room enter 0; if shares with 1 olher. enler 1. etc.)

b) How many other people sleep in the same bed as Ihe study child 1 Please lilt in number in box. (If child has own bed enter 0; if shares with 1 other. enter 1. elc.)

31 How many lloors are Ihere in Ihe building in which Ihe lamily live 1 Please enter number in boxes.

e.g. 6 floors ~ I 0 I 6 I 121100rs . I

PIUSII rin9 Col 21 ,

2 3 .-5 6

Col 22

, 2 3

4

5 6

Col 23 , 2 3 4

5

Col 24 , 2 3 4

Col 25 1

2 3

." 4

Enrer number Col 26-27

IT] Please ring

Col 28 1

2 3

.4

.5 .. 6

Cnref number Col 29

o Col 30

o

Col 31-32

, 25

P11

" On wNl floor is lhe fronl door of lhe home? aelow Slreel level .. AI SlrHt level/ground floor ht floor.. . .. 2nd floor ......... . ~thfloor

51h-eth floor 7th-9th floor

1 Oth-1 2th floor ... 13th floor upwards

41 Does the household have: (".R ring .11 th.t .pp/f) lV-bIad and white TV-

L

,.12

childten heM happens

.. hIow is I list 01 minor health problems which most haw It lOme time. f>tMselik how often elch 01 t with the study child. Anlwers should be given KCOfding 10 how the child has been during Ihe Pill 12 monl hs.

N."., Occ."o".lIr bUI

A.. Has S101NCh-KM or vomiling

8. Wets Pints or Ihe bed

C. Soils or loses control 01 bowels

D. Has lemper IIntruml (that is. complele loa 04 temper wirh"lhouting. Ingry moyements. etc.)

E. Has INrs on IrriYII It school or leluses 10 go inlO the building

F. Truanls from school

4S a) Does he/she Slammer 01 slutter ?

I I I I I I

no/ •• 011." •• o"n p.' .... ..t

1 2

1 2

1 2 .

1 2

1 2

1 2

No Yes. mildly Yes. sevelely

b) Has he/she Iny difficulty wilh speech olher I han slammer· ing or stunering ?

If yes. please describe lhe difficulty

c) Does he/she eyer sleal Ihings ?

" yes, pie ... giYe • few delails il possible

1) Is there Iny elling difficulty?

If yes, is it : Not ealing enough Eating 100 much Faddiness .... Olher (please describe

e) Does he/she haye Iny sleeping difficulty 7

If yes. is il :

....

No Yes. mild Yes. severe

No Yes. occasionally Yes. frequenlly

No Yes. mild Yes. severe

No. Yes. mild Yes. severe

Getting oil to sleep Waking during the nighl Waking early in Ihe mor ning Bad dreams _ .... Night lerrors Sleep walking Olher (specily

......

AI "U' one:.

p.,-3 Col 45 I 3 Col 46 I 3 Col 47 1 3 Col 48 J 3 Col 49 I 3 Col SO I

Plus~ ring

Col 51 1 2 3

Col 52 1

2 3

Col 53 1 2 3

Col54 1

2 ...... 3

Col 55 1

2 . .. 3

) ... -... 4

Col 56 1 2 3

Col 57 1

2 3 4

5 6

) 7

27

flU

Mown by uch one

oM Below are a serin 01 descriptions of beNviour often young people, Plene ask the informMtfa) about and ring the appropriate number to show the deg this description is true 01 the study child,

r .. to which

,) Very restleu, Has difficulty staying seated for long

b) Squirmy, fidgety child

c) Ohen destrovs own or others' property

d) Frequently fights or is extremely quarrelsome with other children

e) Not much liked by other children

f) Often worried, worries about many things

g) Tends to do things on own-i'ather solitary

h) Irritable. Is quick to 'fly off the handle'

iJ Often appears miserable, unhappy, tearful or distressed

I) Has twitches, mannerisms or tics of the face or body

k) Frequently sucks thumb or fingers

I) Frequently bites nails or lingers

m) Is ohen disobedient

n) Cannot sen Ie to anything for more than a few moments

0) Tends to be fearful or afraid of new things or new situations

p) Fussy or over-particular

q) Ohen tells lies

r) Bullies other children

41 a) Please enquire where the parents were born.

DOl/In', .,.fIIy

I 1

I 1 1 1

I 1 I ,

I 1 I 1 I , I 1

1

1

1

1

I ,

I 1

I 1

I 1 I ,

Applle. 10m. wit.,

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

Place of birth ( lown, county and country)

Mother

Father ..

b) If not born in Britain, in which year did pare nlS come to live in this country 1

Vear 0' arrival: Mother Father

Lun bI.nlt

Cel'~

'''pM'

3 Col 58 J 3 Col 59 J 3 Col 60 J 3 Col 61 I 3 Col 62 I 3 Col 63

3 Col 64 I 3 Col 65 I 3 Col 66 I 3 Col 67 I 3 Col 68 J 3 Col 69 J 3 Cof 70 J 3 Col 71 I 3 Col 72 I 3 Col 73 I 3 Col 74 I 3 Col 75

LtI.". bI.nk Col 76

0 Col 77

0 Col 78

0 Col 79

0 ColBO

0

• 28

, I L

PHI

~o. OHice Use:

tiJ local Authority

No. Code No.

9 I Col 1 2 3

... MMicaI c.u ... of School AbMnCe a) How much time 1I1e>ge,her has ,he Sludy child missed hom

school in the IMst 12 fItOnths for reasons of ifI-heahh or emotional disturblnce 1

None. o. less than one week in .11

I 4

Over one week and up to one month in all

Over one month and up to three months in all

Over three months in all

Missed school. but don't know for how long Don't know whether missed school

Does not allend school (pleue state why

b) If absent tor more ttYn _ WMk in all during the past 12 months. please indicate reason (5). If not applicable. leave blank; otherwise please ring all appropriate leners or numbers.

I 5

Colds. catarrh. sora throats. ear infections or influenza Bronchitis or chest infections, including pneumonia

Asthm. or wheeziness

49 Gener81 H_.th

Heldaches Emotion.1 or nervous problems (specify

Bilious _ullcks or diarrhO!a

Dysmenorrhc2a Abdomin.1 pain

Infectious diseasas (specify Accident or injury (specify Convulsions, fits or turns Other causes (specify

Has the study child suHared in the .,..t 12 month. from any of the .ollowing 7 Please ring all appropriate leners or numbers.

Hay faver 01 _Hergic rhinitis Recurrent vomiting or bilious anacks Dysmenorrhoea T.aval sickness

Recurrent abdominal pains Recurrent mouth ulcers

Recurrent throat and/or ear infections requiring treatment by a doctor Acne (other than trivial)

Eczematous rashes

Psoriasis None of the above

Child', Code Numbe.

I I 6 7

I I 8 9

Pluse Tlng Col 11

1

2 3 4

5 6

7

Col12 y

X o 1

2 3 4

5 6 7

8 9

Col 13 y

X o 1

2 3

4

5 6 7

8

10

• 29

• PIS

;"g burns. scalds. poisoning. ".ar· 10 Acct'I .. " (inclutl drow~) r~1ring depMment anenda

~pital admission or Iccident/casualtv nee.

I' HIS VIe l1udy child ever had any accident necessitlting IdmiSlion to ho depanment7

spital or Ittendance al an Iccident/cisullty

Ves.on. Ves. two Ves. thr ..

Pleas. ring

Col '4 . ,

2 .. 3

Ves. four ...... I" ........ 4

Ves. fIVe Ves. six Ves. seven or more No. Don't know

If No or Don If V •• , plel.

't know, please proceed to Queslion 49 complete b) to f) below.

cident occurred e the following table bv ringing the appro-

b) P/~ce where ac Pieisl complet priate numbeR whether the s Inended In ICC Against (i) to (i _at recent I the most recent If the studv chi enter details of

to show where each accident occurred and tudy child WIS admined to hospital or ident/casualty department onlv. v) please enter this information for the four ccidents which have occurred. starting with

lei has had more than four accidenlS please all earlier accidents in section (I).

Accident reSUlting in :

Hospilal admission or Accident/casualty overnight or longer department anendance only

Qn the At At Else· On the At At road home school where raid

(i) Most recent Bccide

(ii) Next most rec.nt

nt , 2 3 4 5

(iii) Next most recent

(iv) Next most recent

C) Ty". 01 injury For each ICcide type of injury number against

, 2 3 4 S 1 2 3 4 S

1 2 3 4 5

nt recorded in b) above. please show the which resulted. Ring more thin one

eech Iccident. if necessary.

T_ .. No -. F.act",. 't'K1ur. E't"t 'urn

home school

6 7

6 7

6 7

6 7

f ..... Poelon,,,,

EIse-where

a

a

a

a

I. -.. Ioj..., ........ ~.~ • r .r 'ntyry .. -...... .. ........ iAi .. '" - ... - - MU. -. ICIld ,~ 1U1QIK1K1 at - bon. 10· poisontr.e"'~ (i) Mort IKenl

eccidenl

(ii) N .. I mosl "eeen.

(iii) NeJl'l "-I ree.".

(iv) NeJl'l_ recenl

y X

Y X

y X

Y X

0 1 2

0 1 2

0 1 2

0 1 2

ttitchel

3 c 5 6 7

3 c 5 6 7

3 c 5 e 7

3 c 5 6 7

h accident(s) occurred d) Age(s) at whic Please enter in which IIch ace

the boxes in the margin the age in veaTS at ident occurred. (Iflge less than '. enler 00).

(i) Mosl recent accident

(ii) Ne.1 most recenl

(iii) Nex! mOSI recenl

(iv) Nexl most reccn!

8

8

II

II

. --.... ---

.. .5 6

.... .. 7 . 8

9

Leave blank

Col'S

Col 16

CoI'7

Colla

LUlie blank

Col 19

Col 20

Col 21

Col 22

Enter age in years

Col 23-24

CD Co12S-26

CD Col 27-28

OJ Col 29-30

OJ ,

30

P16

e) Below. for ..en KcidenI. plea .. give any further known delaill. e.g. clrcunm.nces. type of injury. lite of fracture, nelure of poisoning, etc.

(i) Most recent ICCident

ii) Next most recent

(ii) Next most recent

(iv) Next most recent

f) foeleila of III earlier Kcidenu (including bums. SCI Ids or poisoning) if child hes had more thin four. i.e. where lCCidenl(s) occurred. Ntule of injury. whether Idmitted 10 hospitll ovemight Ind child's age.

51 Admission to hospital overnight or longer

a) HIS the study child lIVer been admitted to hospital over-night?

Yes, as I result of In Iccidenl(s) only Yes. for other relSones} only Yes, as I result of an acci-dentes) Ind for other reasones) No ............. . oon't know

If No. or Don't know, or V ... accidentes) only, please proceed to Question SO. Otherwise, pi elSe comp/ete b) to f) below.

b) Opt"ations Plelse complete the following table by ringing the Ippropriate number or lener in each line to show whether the study child has had any of these operations and II what Ige.

.... Don', 'now Ya. but I ______ y_-_·_w_'-' ...... ....:-=._. ____ _

... · •• no. ~ 3. 501' 7. tOf 11 ... 1... • • • ,0

Ii) TonsilleclOmy y X 0 t 2 3 4

(ii) Appendicectomy y X .) t 2 3 4

(iii) CQtfKtion o' y X 0 1 2 J 4 ~uint

(iv) Circumcision y X 0 1 2 3 4

(v) Hernia rep.i, y X 0 1 2 J 4

(vi) Oper.'ion on un- Y X 0 1 2 J 4 d .. unded 'Hlio(H)

c) Other operation(s) HIS the study child ever been admitted to hospital overnight for Iny operation other thin the above (please ring as appropriate and give diagnosis).

Operllfion Age Diagnosis

ei) Thoracic ............ - . eii) Upper respiratory or E.N.T.

(other thin tons illectomy and/or adenoidec tomy) .. ......

(iii) Orthopledic ..

(iv) Any other opera tion(s) .... ... .......... --d) PI .... give nlme Ind address of hospital anended for

operation(s) mentioned in c) above.

....

5

5

5

5

5

5

'2 13 u·

, 7 8 9 6 7 8 9

6 7 8 9

6 7 8 9

6 7 8 9

6 7 8 9

..... .. -.. -.

Please ring

Col 31

1

2

3 4

5

Leave blank

CO! 32

Col 33

Col 34

Col3S

Coll6

Col 37

Plene ring

Col 38 .... 1

................. 2 3 4

• 31

• P17

e) All ho¥iIal MlmiUion6 (ot'- than 'Of accidents Of ope,.,· tions). PtNse indiate any condition. (not included in b) Of c) llbove) .tOf which the study child has ever been admined 10 hospitlll overn~ht by ringing the lIpp'opri.te number(., below:

No other admission .....

.\sIhma/WhMzy bronchitis lJ9per ,..ratory tract infection(s, (including E.N.T.) ...... . eMst infections ................ ... ..." Urinary tr.cl infections/investigation

Olher infections

Convulsion. '''' .... , .......... . Heart investigalion/treatment Abdominal conditions not requiring operation

Disorders of bones and joints

8100d disorders including leukaemia/anaemia Tumours, neoplasms and other malignam conditions ........ . Endocrine disorders (diabetes, thyroid. etc.)

Skin conditions

Eye conditions

Problems of nutrition (e.g. over or under weight) Emotional conditions

Any other conditions .

Age If first .dmission Di.gnosis

f) Please give name and address of hospital atlended for any condilion(s) ringed in e) above:

52 Ho.pital outpatient ettend.nces a) Apart from any accident recorded in Question 48, has the

study child ever Inended a hospitll outpatient depiJrtment fOf specialist opinion or investigalion 1

Yes

No Don't know.

If No. or Don't know. please proceed to Queslion 51. It V ••• pluse complete b) below.

b) Please show, by ringing the appropriale number(s), the condition(s) for which investigation(s) was carried out and enter any known details of diagnosis (e.clude con· ditions IIlrudy entered in Question 49 above) :

No ou~tient anendana apart from conditions included in Ouestion 49

Asth~/Whe.zy bronchitis Upper respiratory trlct infections (including E.N.T.) .. Chest infections Urinary tract infections/investigations

Other in'ections .......... "

Convulsions ." "" Heart investigation/treatment .. Abdominal conditions not requiring operation

Disorders of bones ilnd joints ....

Blood disorders including leukaemia/ln •• miil

T~rs. neopl.lsms ilnd other malignant conchtlons __ ........ _ ...... __ ... ____ ....... __ .

Endocrine diSOfders (diabetes, thyroid. etc.) Skin conditions Eye conditions ...

Problems of nutrition (e.g. over or under weight) EmotioNI conditions. All other conditions

Age It fi,st IJttendlnce Dl6gnos/s

Col 39 1

2

3 4

5 6 7

8 9

Col 40 y

X

o 1

2 3 4 5

.6

Col 41

. 1

2 3

Col 42 . 1

2

'3 4

5 6 7 8 9

Col 43 Y X

.0 1

2 3 4

5 6

• 32

~---------------------------------------------------P18

53 Vi.ion

Pleu. ring the number(s) against all of the following which apply:

54 H •• ring

Study child wears glasses now (or they have been prescribed recently)

He/she has seen an oculist or eye specialist in the past 1 2 months

He/she has had a squint in the past but not present now He/she has a squint now None of the above applies

Has the study child ever worn a hearing aid 7 Ves, and still wears it

Ves, but no longer wears it No Don't know

If Ve •• please give reason

55 Speechth.rapy

Has the study child attended for speech therapy in the past 12 months?

Ves No Don't know

If V ••• please give reason

56 Convul.ion.

a) Has the study child ever had any form of fit or other turn in which consciousness was lost. or any part of the body made abnormal movements (do not include emotional faints) ?

Ves No Don't know

If No. or Don't know, please proceed to Question 55, If V •• , please complete b)-i1) below,

b) Did the first episode OCCur:

Be fore first birt hday

Between 1st and 2nd birthdays Between 2nd and 5th birthdays Between 5th and 7th birthdays Between 7th and 11 th birthdays Since 11th birthday Don't know

c) Did the most recent episode occur:

Before 1st birthday

Between 15t and 2nd birthdays Between 2nd and 5th birthdays Between 5th and 7th birthdays Between 7th and 11th birthdays

Since 11th birthday but not in the past 12 months In past 12 months Don't know age

d) II episodes have taken place since the age of 11. please enter details below: Description Frequency

Name and address of any hospital attended

Col 44 1

2 3 4 5

Col 45 1 2 3 4

Col 46 1

2 3

Col 47 ... 1

2 .. 3

Col 48 1

2

3 4

5 6 7

Col 49 1

2 3 4

5 6 7

8

33

P19

57 A.thme/Wheeay bronchltl.

I) HII the study child ever hid an IttlCk of Isthml or wheezy bronchitis 7

Ves No Don't know

II No. or D_'t know, pi .. ,. proceed to Question 56. II V ... plel,. complete b)-e) balow,

b) Hive the Ittacks ever necessitltad investigation/treatment 7 (Pie.,. ,ing .,Ith.t.pply)

No. Don', know Ves, admined to ho~ital Ves, by a ~ecillist in a hospitll outpatient departmentl clinic. Ves, by a G.P ...

c) Did the first anack occur: Belore lirst birthdlY . Between 1 st Ind 2nd birthdlYs Between 2nd and 5th birthdays Between 5th Ind 7tl') birthdays. Between 7th and 11 th birthdays Since 11th birthday Don't know Ige .

d) Did the most recent anlck occur: Before first birthday . Between 1st and 2nd birthdIYS ... Between 2nd and 5th birthdlYs Between 5th ilnd 7th birthdays .. ' . Between 7th and 11th birthdays .. Since 11th birthday but not in past 12 months In past 12 months ... . Don't know Ige ........ _._ ..

e) If the child has had Isthml Of wheezy bronchitis In the .,.et '2 monthe did this occur:

sa Mig,..ln.

At IelSt once I week._. Usuilly less than once I week but It least once I month Less thin once I month Frequency unknown ..

Has the study child had Ittacks of migraine or recurrent sick headaches in the past 12 months 7

No_ ..

Don't know .. Ves. but none in the p~st month ..... . Ves. one in the past month Ves, more than one in the past month .. Yes, but Irequency unknown

II V •• , please specify exact nature of anacks:

Pie.,. ring

Col SO 1

2 3

Col 51 1 2 3

4

5

Col 52 1

2 3 4

5 6 7

Col 53 1 2 3 4 5 6 7 8

Col 54 1

2 3 4

Col 55 1

....... 2 3 4

.. 5 6

34

P20

II aledcler centrel .) Has the ~udy child wet 1M bed II night (more Ihln

occasioNly) lince 1M Ige 0' 5 ? Yes No Don'l know

\I Mo, or DOII't know, ptoceed 10 Queslion 58. " V." please complete b) 10 d) below.

b) Has he/she _ received treltment/invesligation lor Ihis condilion (p/lise ring III that apply) ?

No. Don't know whether received treltmenl Yes, idminecS to hospil.I ..... Yes, 1$ In oulpatienl, but no longer allending Yes, IS .n outplltient and 51ill allending Yes, al • clinic bul no longer attending Yes, 81 a clinic and still attending Yes, by a G.P. but no longer attending Yes, by a G.P. and still attending Yes, but don't know where received treatment/investigation

c) AI what age did he/she most recently wet the bed? Not known when _. eefore 11th birthday. Aged 11 Aged 12 Aged 13 Aged 14 or more but not in past 12 months. During past 1 2 months but not in the past month During the past month

d) If the 5tudy child has wet the bed during the pa.t month was it:

60 P.ychiatric and behaviour problem.

Frequency not known 1-3 nights 4-10 nights 11 or more nights

Has the study child ever been seen by I specialist for In emolional or behavioural problem 1 (Ring III thlt IPPIy)

No Don't know Yes. as an inpatient in hospital Yes. in a hospital outpatient department Yes, at a child guidlnce clinic Ves. elsewhere (specify

II V." plelse give year of anendance. diagnosis and name and address of hospitll/clinic attended

Diagnosis Name and address of hospital/clinic attended

Col 56 1

2 3

Col 57 V X

o 1

2 3 4

5 6 7

Col 58 , 2 3 4

5 6 7

8

Col 59 1

2 3 4

Col 60 , 2 3

4

5

6

, 35

P21

., D_t.I car.

.) Haslhe study child been ...., by. achool dentl., during the pest 12 months 1 (Ring all that apply)

No Don't know

Y •• , but don't know reilson Yes, for inspection ..

Yes, for fillings ilnd/or extrKtioos Yes, for strilightening teeth

Yes, other reason (specify

b) HilS he/.he been teen by any other dentin during the pest 12 months 1 (Ring a" that apply)

No. Don't know.

Yes, but don't know reason Yes, ilt a surgery for inspection

Yes. ilt iI surgery for fillings and/or extractions Yes, ilt a surgery for straightening teeth Yes. at a surgery for other reason (specify

Yes. ilt a dental hospital for fillings and/or extractions Yes. at a dental hospital for straightening teeth Yes. at a dental hospital for other reason (specify

c) HilS the study child lost any second teeth 1 (Ring.1I that apply)

No Doo't know Yes, through decay Yes, through accident

Yes. as a procedure for straightening teeth Yes, for other reason (specify .. ..... ) Yes, reason not known"

d) Does the study child have any false teeth? (Ring one number only)

No ..... Don't know Yes, to replace teeth lost through decay Yes, to replace teeth lost through accident Yes, to replace teeth lost in both above ways ... Yes. but reason not known

.) Has the study child ever wo'" it brace for straightening his/her teeth?

No. Oon'\ know Yes, and wears it now ........ .. Yes, but does not wear it now

PI • .,e ring Col 61

1

2 3 4

5 6

7

Col 62 Y

X o , 2 3

4

5 6

7

Col 63 1

2 3 4

5 6 7

Col 64 1

2

3

4

5 6

Col 65 1

2 3 4

36

-----------------------------------------------P22

IZ ~"'y~t

a' Gills: At what age did she have her first rnenstNal period 1 aefore 11th birthday

When aged 11

Aged 12

Aged 13 .... .

Aged 14 ........ . Aged 1 5 or more . Not yet commenced

Commenced, but don't know age

Don't know whether commenced

b) Boy,: At what 101 did his voice break? 8efore 11th birthday ..

When aged 1 1. Aged 12 Aged 13

Aged 14 .. Aged 15 Of more

Not yet broken

Voice broken but don't know when

Don't know whether voice broken ..

13 Chronic III-h .. lth or di .... Ulty In the hou .... old

In Inswering this question:

(i) include conditions which have been present since the study child's 11 th birthday, irrespective 01 when they commenced

(ii) include only the most severe condition il more than one is .Heeting the same parson

(iii) include parent substitute under 'mother' or 'father'

a) Has the study child since his/her 11th birthday lived in the same household IS anyone suHering from chronic physical or mentll ill-health or disability 1

No Don't know

Ves, but not now

Ves, and still continuing If No. or Don't k_. please proceed to Question 62. If V", please complete b) to d) below.

b) Indicate, by ringing the appropriate number(s), the member(s) of the household IHeeted

c) Please give the following details:

Mother.

Father..... , Other adult (specify .. Other child

...... )

Ye., of Oi.gnosis onset

Ou,.tion of iI/ness

P'IISllnt stllte of condition

Mother

Flther

Other adult ......... ..

Other child

Pleas. ling

Col 66 .. 1

2 3

.4

5 6 7 8 9

Col 67 1

2 3 4

5 6 7

8

9

Col 68 ... 1

2 3

.4

Col 69 . ... 1

...... 2 3 4

LII.YII bl.nk

Col 70-71

CD Col 72-73

CD Col 74-75

CD Col 76-77

IT]

37

P23

... Nlme Ind .ctdrHl of the .tudy chile,.. G_II Prlctitione,

•• PlelM ISk for the .tudy chile,.. Nitional HNlth Service Number

PI_.. ....nk the ... rent for .... /h... • •• I.tance In completing thl. form.

II Summary (to b. campl.ted ehtu the ifltervi_l

I) Tlking into account the informltion you hive obtlined during the interview Ind any other relevlnt informltion. do you consider the child h .. Iny hlndapping condition or diSibility 7

Yes No Don't know

b) If V •• , what is the nature of the child's handicap or dis-ability 7 (Plttas. ring all that apply)

Congenitll malformation Visual defect . Hearing defect Mentll retlrdltion Muscular dystrophy Other general motor handi~p (e.g. cerebral palsy) Epilepsy Psychiatric problem Speech defect

Asthml Other che.1 condition Alimentary condition Chronic bone or joint disorder Heart condition Disorder of kidney or urinary trlct Malignancy (including leukaemia) Diabetes Skin disorder Any other handicap or diSibility

Pie ... give brief description.

.7 Are there any remarks or other notes you would wish to add 7

Th.nk you

PI • .,. ring Col7a ,

2 3

Col 79 , 2 3 4 5

6 .7

... a .... 9

Colao ....... Y ..... x

o , 2

3

4

5 .. 6

.... 7

If you wish to ~d 11'1'1' commel'llS on Inything in thil Question· naire. pt .... u .. the s~c. below. Lih ev.lVIhing eI.8 in this questionnaire this will be strict'y confident;".

Thank you. Now pl •••• pl.ce this form in the epecie' _velope provided and ••• 1 it. Th.n pi_e. writ. your __ on ~ back of the _".Iope.

MEDICAL

• 40

'~'ri·:~?:..,:.t~· ,J-n"

ItftotIy .... fid .......

~~

No.

1

Local Authority Code Number Chikrl Code Number

CoIs. 2 3 4 5 & 7 8 9

NATIONAL CHILDREN'S BUREAU, , .,..,. ~~ 1 Fibroy SQu.re, ~~'~W1'1AA .

"~I pam'n,tIon form NATIONAL CHILD DeVELOPMENT STUDY

(1958 Cohort)

"C".'I .• II ..... t ~ .. ~-__ elc-Mr_ ............... ~ .. I--I~

___.efC_ "Ir.~:. • ......... 0.11._ ....

~ ......... c_ ... : •.•. _ ........ 0

.--..,c;.....-.: _ •. It. _ MD. ,.c~. DC" 11.0 ........ ",-6. _.ID .. ... _ .... _ .............. o.osc

c. ...... .-.nt ... J.II ......... .... J. Y. , ....... MD. 0 Sc., '''Cft. 'fie '..-c." ..0 ........ "'0

10

Third follow-up of children born 3rd - 9th March. 1958

I Ca) Chitd's surn .....

Christian names (in full)

Cb) h. Col 11 ,

"

"

"

'.'

(pI •• se ring .pp'opri.,e number) Boy

OJrl 2 I------~.~

.. (a) Data.f birth

tb} Teder's tlata

IIIHomelKklraaa

March 1958

/

IV Name 8ftCI addre .. of Gan..-al Practitioner

y t. the child accompanied by: (p'~~ (;"gone~)

Mother/mother substitute

Fathar/fat"ar substitute

80tit parents.

Other adult

110 adult. but •• amined

Child not e •• mined. form completed

from records

Pi .... turn over dHt. page and read the introctuottKy notes

Col l2 . 16

.. "

.~ fj

"

I ~--.J III 0' I O.y Month V •• :. I I

Plene ling

Col 17

2

3

4

s

6

Notes on the completion of this form

It is rKovniHd th.c Ihe lxamtc.e is no tonver I 'chiId" 10 evert effon hn bHr! rude 10 IricIeate our ___ that IN tt58eGbon" flit lnaining eduIc .aponlialilly. ~ .. weld "·cftId· ~ In OCCetMlRI'" but It .. not intan4ad it IhouId be used to lither "., ... or puJlil.

It is known that r.w motherl attend IChooI"l~ medical lxaminations but. nevwthatals. _ hope for I higf1er lnendanca on this occasion.

The E __ lnati_

Neoativl at\SwerI Ire II vetuabIe II poeitiw 0.- - pIea.e t;y 10 obtain I definite ensw. to .. QUeStions .nd ring the appropriMa coc;. Oft -r queltion. The 0fIfY QUISlions tNt do fIOt *IV;" an I~ ... foI.Am(ItI. thole r ..... to the 0CII!I0IiCe .... ftORI ... of the .eudy child.

It at any point you '"' tNt an I~ fequira clarificltion or ~iCllion please .... f,. to write COinmeNl on Ihe form It shis potnt.

Return of C ...... ted Medical E_-'_tien F __ and Au4ioeraml

PMase 'Itum the completed Form to your Cent'll Off"iCI OJ in ICCOfcIance with IocII inslnKtions. Iftar cMdI;"g thai .. QUestieN hive beeft _-.ct. and for complet_ of .ach._.

The audiogram. if completed It I different time from the Medtal hlminltion. lhould be checked later against the resul1 of the Clinical H_ino TlSt.

For thOle children who cannot be examined.

The Mac:fiClllu"*,-lion consilts basically of I pel10Nl Ind detaiIad Ihort medical history (Sections' & 2). infOl"lMtion for which will be needed from pupil • .,.,.,.t when present and from all ~ ~ wfIich •• .."...,.. 10 ~ (1OM.eu:).~""~1 ~l.il"~~be nGIId!hat Qqllt'[ -1(1t) .net Jt> aN 11(.) !MY

"..... til Wi .. IftUCA .. possible ot the l'MIdicll exaIIIinIfioft tor.. ~0I'It ...... ,ecords .net "om your trio...,g. ci die itMrd, t;l"1Ud\ calli. Sections 1. i If 4 IhouId be COItopit-' frocn ~ 8ftd. ... ,...... ."-IIiI" r.om ... ~

ThIN II ............ luminICicIn if .... ~ deulIi 01 My .~(s) arried out In 1M PAST 12 MONTHS ... ItIUCh .. pOIIibte of Section 3 should be completed.

(Sec1ioR 3~ ...... of thIt IQUiprnent wit be naadad .. below.

hoc:edura

Height

Weight

Dis..". VISion

NurVlSion

Clinical HaIring T 1St

Motor Co-ordination Tntl

Publrtll Assessment

Audiogram

Equipment N_ ... ry

Steel or wooden measuring rod. or if no! Ivailable. steel llpe measure

lam balance. or other weighing lPPIfalUS

SlIndartf Snellen Ch.n

N_-Vision Card of Sheridln·GIfdInar type. provided by us

Primed on back of Heir-VISion Catd. II wei as on Medfcat EuminltiOn Form

No equipment but quiet room ~

Tennis ball. white chait. ~ch with lICond hand

No speci. equipment needed and can be carried out at lime time as Damin.tion of chest and Ibdomen

Audiometer. The ludiogram lorm is on !he back page 01 the Medical baminllion F~m. so that it can be detached 10' completion II a ~rlle Illendance. if more convenient.

.. 42

Section 1 Recorded History

1 hoenh Which lKOfdI,tonN •• ~ Ie you _ you COIIIpWI ....... 1 .. -,.--' -_ .. ,.,.. .......... .

,. IBM or $dMMII MediCIf CIfd 0Iher,...(~ ... ---_._----- -)

2 a) H_ a decision been ruched II\' the Loc.I Eduation Authority ahat ... dIiId is i(I need of S~ EduadoNI r .... n.tt (do not &,dude 'remediaI" ~ In an ordinary KheoI unteu ..... has been clusUied as ISH) 1

No, and noc IiUIV &0 be r.quired _. No, but decision pending .. Y .. , but wafting few a pIaQ ... Yes, receiving SET _ Yes, received SET ill put. but no longer required Don', know .. ....... _ .. _ ..

If you ha_ rhtgM " I or I pIeue p..-..i to MCtIon Z

If _y of Z, 3 or 4 ..,. .. I .............. b) IneliUl. into which category or calegories he/she falls:

(ring all relevant codes)

·In Scot .. nd, pIeese ring 5 tor menially hanclicapped (~}, , lor INfMI\y handicapped (tr ....... ) aM 7 tor ment"V haftdiclPtItd (untie fer education or tfaining in a IChoor or apedallChooI)

Blind ....... Partially lighted . Deal ....................... ..

~'-ing-ESN· ....... _ ... _ ........ .

ESM· (ror-t SSN callogOfy)

c) In the CGUrM of assessmenc _ an to assessed and recorded?

If , •• , what WiIS the reslllt

Tes1 usad .

d) Does the child live:

Yes .. . No ................... _ .... . Don't know

10 below 50 1050-75 107&-100. 1010'-'25 10_125 Result not recorded

At '-nit and aRends ordiMry schoot At home and attends spec;.! unit attached to ordinary schoof .. At '-'- and a".nels day spec;.1 school In a residential special school In a hoslel and .nends day special school In a hospil.1 for the subnormal In any ocher hos.,.lal Other (pr.ue specify)

Don"lknow

,.,...,.., Celt'

1 .2 3

Coil! 1 2 3 .. S 6

Col 20 ........... y

X 0 1

2 3 .. 5 II 7 8 9

Col 2. 1

2 3

Col 22 1

2 3 .. 5 6

Cell3

2 3 4

S 6 7 8 9

, 43

Section 2 Persona I History

AT THIS I'OINT TH£ CHILD AND HIS/HER PARENT. IF MESENI. ~ III INVITED TO ANSWER A ~'It (N 0fJIS't~

I In', F' .... f~ ... I .. ~~n HM .. ,. ..... ~ .pn.t ,,,-... , Ping (,..... ring appop_ -.ber in _h CNe) 1 .

Yes No Oon', know

Tuberculosis (BCG)

Rubetbl ~--.----:----~------~-~--::-----~ 3 Colle Smallpox 4 "--'1 .....

• ) Hospiul Admiuion Has he/lM been Idmitted &0 ho&piIal tOl ., least one nigh, ill tIM ~t 12 monthal

Yes ....................... . No ..... __ .... __ . __ ... __ .... .

Don', know .. __ ....... ..

If yM. give presumed diagnosis(es) 101 uch adl1'lisaion and.- .nd address of hospiqitl(s)

b) HtMPiUI auident/uswIty depMInWnl nOf nwlfing in HospiUI AtIIrtiaion Has he;stIe .aended an accident/casualty ~mllfl' in tIM pe8t 12 _dial

Ves ...................... .

No .... __ .................. . Don', kMW ............. ..

If ,... giw presumed ~(es) .nd name and ~ of hospit.'(s)

c) H".;uI OtIIp.,;"" .uetNhnce nDt ,.sulting in HtlspiUl A..-..",

Has MI .... attended • hospttal QU'lN,ient depenmen, lor consullatioft. investlga,ion 01' 'r •• tmenl ii, the p .. ' 12 ~""1

Yes •... ____ .............. __ .. __

He ......................... .. Deft·, know .... : .............. ..

If Y_. give presumed ~nosis(es) and name .nd address of hospit.'(s)

. 1

.2 3

LUlie IIINik CoI2B-29

ITJ

. ... 1 __ ...... __ .2

. ........... 3

OJ

Please ring Col 33

-- \ .. ... 2

. .... __ ..... 3

LUlie bl.nlc Col 34-35

, 44

., """~'''.lW ~

.)

H • ..,. ....... G.P. Su"",/HMIth Centre Of been 'IiIiIM It '-.. IM..-t '2 ...... '

No ................................................ , V .. _ ....................................... 2 V..,lWice .......................... . V ............................ . V .............................. . V .. lWeor .................... . VII, don't know frequency ..... . Don't kMw whether anended

" ,... tor wIIidt ., 1M folio nlnl leMOnS (,.... ring .. .... ..,..,,: .

............ 3

.......... . .

......... .. 5

............ 6

............ 7

............ . CotdI, ION thfOe1& or Nf infeaJonl (inctudtng influenza) " .......... y BlOnChkiI Of CMIt Infections .. .. .. .. . .. .. .. .. . ... .. . .. .. . .. ..... " .. , ....... X AsttwnI or whe.zi~ ............................................. . ........... 0 Infectioul feverl ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ......... " 1 GHlroenteritis ...................................................... . ......... '. 2 Other infections (specify................ ......................... ) .......... '. 3 Abdominfi pain . . .. .. .. . . .. . .. .. ................................. .. ....... '" • HeMJaChel ..................................................... .-... .. ........ " 5 ElAOtlonal problems ................................................ .. .. , ....... 6 ~Ic conditions ............................................... , ............ 7 ACM .............................................................................. 8 Other sIIin condilions (specify ................................. ) ............ 9

Col 38 Eye conditions ........................... .......................... .. ....... '" V Accident or in;urY .. . .. .. .. .. ... . .. .. .... . .. .. .. ... .............. . ........... X Dysmenorrhea ...................................................... . ........... 0 Immunilition/VacciNtion .... . . ...... .... . .. ..... .. . .... ........ . ........... 1 Other feasons (specify .......................................... ) ............ 2 Oon'l know ......................................................... .. .......... 3

Hu he/she _ baM seen br a ~psychofooist: Yes No

a) At • Child Guid.nce 2 CIifIic: b} At a HoIpMI (outpatient 2

or Inpatient)

c) Other place t 2

If YH. lor .), b) Of c) pluM giw reason, ega .. flllt attanct.nce and nama and address 01 clinic/hospilaf anended

Don', know

3 Cot 39

3 Col

Section 3 Medical Examination

• .,.,. ~ ". _ction ~ ... )'OW tliM:r«ion /16 to wIwlheI lite ptMf/ethM ............ lie lhMked I« .nentIing .,-.irI,. heM".. ~ ., .... ~ .

• vw.. I) S".." II there any evldenc:e of I squint"

No.............................. .. ........... 1 Yes. alter",ting eyel ............... .. .......... 2 Yes. right eye ....................... '" ..... 3 Yes. left eye .. .. .. .. .. . ...... .. .. .... ... 4 Unable to 'est .... ...... ...... . ...... 5

b) GIa_ wom Have vI- been prescribed for U .. It Col 46 .he preMn' lime .,

No ............................................... 1 Yes, .nd .vailabfe for test .... .... .. .... ... 2 Yes, bu. not av.ilable fof IHt ... . ... 3 Don't know ................................... 4

c) If gt.U'6 ",.n,ib.d .re they for: Continuous use .... .. .... .. ... Reading .nd/or lelevision only .. . NOl known why prescribed ..... .

d) DISTANT VISION TEST ............... t vision ...... ~ chait .. 20 fee •. HIAg GfIeft in • ~ ...... 1iMIt ....... ~~ eyes lAd he ,......... Occlude .... __ .. ~Jy without

.' on ... ..,.,.. ~::."'ring the number ~ to ahe lowest 11M ~rNd.

(I) Wllhout (IMuu. If ..... Ie lest rin9 'g'

U",,'*I. lUI

Col 47 .. .......... 1

........... 2

.......... 3

Left eye I' 234567 8 9 Col 48 I '-----------------------------------------------------+------------__ --'

Wet ... the" 11110 .,. '" f/'Z .". f/Z4 ,,36 "flO ., lIIind

UIYI*,. -R~M~ 1~' ____ 2 ____ 3 ____ 4 ____ 5 ____ 6 ____ 7 _________ 8 __________ ! __ _+-----CoI---49----.--1

(ii) Ret.u wdh 9'"U.6. (If worn fof dislan' vision .nd IIvailab/e; olherwise INvebl.nk) W_._I/6D

1/' ", '''2 ./1. 1/14 1/36 "110 0I1IIttHI UIYI*,. "~I l~l'~ 1~_' ____ 2 ____ 3 ____ 4 ____ 5_. ____ 6 ____ 7 ________ 8 ___________ 9 __ ~~----CoI--50-------1

....... _.,6D '" ." '"2 ",. "24 '136 6/60 01 Mnd

2 3 .. 5 6 7 I u,..,.,. ,..,

9 Col 51 Right eye I 1 ~--------------------------------------------------~,---------------

" 46

~ NIAIf WSIQIt u. .... ·ViIIon T_ CMI ~ IMwI tNt .... ... ...... ... UIIIt no """* III'IIay fIIOM 1M eye INn 10 .. ~ ............ eye ....... ..., . ....... ring 1M fIUIMIers WoP'OpM,e 10 1M IowMI ... cOIMCIfy ..... tI) ~~ .. If UNbIe 10 ......... rino "t.

......... 10 I • ,~ ,. 1. • .. ., ,.,.

l ... ..,. I 1 2 3 4 5 I 7 8 ..,..,..,.eo

• • '1 ,. 14 • 10 ., .... ~eye r , 2 3 4 5 8 7 8

(ii) Refut with ,/Mus. (if worn; otherwise Ie..,. blank) W., •• lINn f()

6 9 '2 ,. 2. J6 60 or.-wt

left eye I 1 2 3 4 S , 7 8 WOI,._AI()

I • t2 ,. 14 36 MI .. .-wt Right eye I 1 2 3 4 5 6 7 8

r} Eye Condition,. Does he/~ have any of the following eye conditions (please ling ... thaI ~}:

u...t.It .. -, ~ .. -, ~/O

lal

9

UAHIo I_ . ., 9

Col 52 I

CoIS3 I

Col 54 I

Col 55 I PlHsering

Col 56

CAt.act ....................................... 1

GlaUCOlna ....................................... 2 Coloboma ........................... .. .. .. .. .... 3 Microphthalmos.. .. . . .. . .. .. .. . . .. .. . . .. . .. . .... 4 N.,.u.glftus ....................................... 5 Abaent eye.. .. .. . . .. . . . . . ... . .. .. .. .. . .......... 6 Ptosis................................. ..._ ....... 1 Any GUIer eye condilion (specitv ............................... -....... ) ............ . HOM .,. the mow . . . ...... .. .. .. ... . ....... 9 Don', know ............ 0

• HMring

a) Hearing Aid. Has. hearing aid .".. been presaibed 1 Col 57 No ............... ............. ...... '" .. 1 Ves ............................................. 2 Don'r know ........................ .. .......... 3

b) CUNICAL HEARING TEST

PIKa ,he child exaaly 10 "'1 _.., "om the euminel sitting IidewrtI with the untested _ occ:luded and funher away from tt. eQminer. Remove ~ aid, if worn. Ask lhe child to repeal after you NCh word separately. malr.ino ..... fIlM he/the unnoIlip INd. St;lNk in • quiet. medium pitched converNtionai voic •. Test and ~ reeutts below by ~ ... all incerrec:t r •• pons-and NCOnfine 'otal.

TEST WORDS Lefr . .,

look Kind Train ust Pot Does Field HMf Poor B.u Moede Hair a. Room Can Slick Good When Wash One Three Give Saw Float Said

Enter total number 01 incorrect WOlds in the boxes in the

margin (e.O. for 5 enler

enter ~ rn ). If unable to lest

Entn numlH, in bOlles

ColS8-59

47

IUfItf •• Good Room U. One ICMd Iig Tnin Wah Wet ...., Boot Give Field Stick Itoor Does .... HN c.n Three

f,., ..... IUnber of inc:ofNc:l words in the bolles. If

~IO""""" ~ c) Hunttg A ... ......,

1ft .. 1igN." 'fOUr ......... ion would you c:OMider mat

It. MouIe When Saw Floot

::-~::~-=-=~~"'not. . NOnriII tlell'ing. no inllrte,lnce .. ,

7 Speech

~.Iots. but no ,nIiIIf.ence ............ .

Haring loss, Ind some interlerence

Don't know

a) SpflKh T.~t. (He back of near vision card)

Itosilion the child close to you and fKino you. Ask himl her 10 tud aloud the MIItenCe5 on the e.G. ThIs is I t_ of wice Ind ~ and NOT a test of ,e8ding 10 that if the child sI-.Id stumble in Iny wr, or is unable to rMCI the sentences, the eUnMner should re.cf the WOfdI or ptw_ and .. the child 10 repelt them. This should rlrely be necessary.

PIe_ underflne any miapr_ncM worda on your cepy .f the te.t _~ below (ignore local accents' Ind r_reI the totaL

TEST SENTENCES

Number 23 hiS been correctly described as the shabbiest hoUM in Churchyard Square. The ~ _ cracUd end all_ grounds I wilcMmelS of ..ngIid ~1Ion. Manhew dIfnbed • flight of llippery marble Sleps to the ffoMctoor. The window cwtainI ~ drawn but he distinctly heard young voic:ea end IMaghW within. A lamp iR the porch wu switched oft abruptly when he IIn1eci the Iettefboll.

Enter toUlt nurnbef of mispronounced words in the boll" in

the marvin. If unable to test enter ~

b) Slam",.,. Does he/. st_ or stvller

c) As~essmflnt of Intelligibility 01 Speich

No ............ . Yes. slightly Yes, moder;tlely. Yes, severely Don't know

Speech is fully intelligible... ... . ... Almost all WOfds are inteUigibie .. Many ~ iIIe unintelligible ......... . AM Of almost ... WOlds are uninlelltgtble Don't know, or unable to test ........ ,.

E"'II numl»f Col 10-61

co

............ 1

. I····

I·

I··

.2

... 3

... 4

Enkr INII1IbeI in bollfl~

Col 83-64

PI.I" ling Col 65

.... 1

.2 3

... 4

.... 5

Col 66 .. 1

.2

.3 .. 4

. .... 5

• 48

I ,

......... 0 .... ....,

Poaidon die chid ....... lac wei., • cIe8f. lAng a ~·bouM ... ., piece of ..... 4Iown en 1M c:hIIcf". ...... Medl ........ of ........... witfI. pendt .............................. poundwilh aweodor ..... nIIMIUM. ..... ebMnc:. of a IMIsurino 106 or ..... &ape .,...... tMlIINIUring ~ Oft 1M tieck of a Wlighlfit IMChiM NY ....... ~ II poaIIIIe. 1ft cell....... .... _...., In tMt ... Inc:hee 10 .... ..... lln.

Col 17-11

I I I I ....................................... cm

.................. ft .................. in

• w-...c (iR 1H .... '.1Iws only) P1Hae check the:t 1M beIence • _14 ftfO before weighing. Record. II poaibIe. In kIogrems to twO decimal pllces. e.g. 70 Kg 424 gm -70·42 Kg

Col 70-73

70 Kg 42 om -70·04 Kg ! I ...................................... Kg

............... Sl .................. lb.

,leaN rMd * ......... _X1 eerie_ of .. _tio .... theft C8rry out yo.- ....... n ..... _ ....... you to .... _ .... fthem.

10 Does he/she h.w eny of the fol\owint skin di80rders 1 (Pt.e,e ring .n "'., ."pIy)

PMue ring Col 74

11 Has he/she a hernia 1

12 Has he undescended/ectopic tNlida 1

P.oriesis .......................... , .......... " 1 Eczema .......................................... 2 Acne--matked .. .. . ... . . . . .. . .. .. .. .. ..... 3

-mild ........................ .. ..... " Wans-upper limbs ................. ....... 5

~limbs ........................... II DiIflguring scan . .. .. .. ... .. .. . ... . ......... " 7 Birthmarks. (.pecify ............... ) ........... . om. condition (specify ........... . ....................................... ) .......... 9 No skin diIorders ............ 0

Plee,e