CHILDREN 3-12 YEARS OLD

Child Questionnaire

The University of Michigan

Survey Research Center SAMPLE LABEL
Institute for Social Research
Ann Arbor, MI 48106

INTERVIEWER LABEL

Date of IW: ___________

Length of IW: ___________

Length of Edit: ___________

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Woodcock-Johnson-Revised

A0. EXACT TIME NOW:________________

A1. INTERVIEWER CHECKPOINT

1. CHILD IS IN SCHOOL (KINDERGARTEN OR HIGHER) GO TO A2, AND

ATTEMPT ASSESSMENTS.

2. CHILD IS NOT SCHOOL-AGED

A1a. INTERVIEWER CHECKPOINT (ASK PRIMARY CAREGIVER)

1. CHILD SPEAKS ENGLISH GO TO A2, AND ATTEMPT ASSESSMENTS

2. CHILD DOES NOT SPEAK ENGLISH DO NOT ATTEMPT

ASSESSMENTS. GO TO SECTION E AND CODE “LANGUAGE PROBLEM”
AND CONTINUE WITH OTHER HOUSEHOLD QUESTIONNAIRES.

A2. INTERVIEWER CHECKPOINT (ASK CHILD OR PRIMARY CAREGIVER)

1. CHILD NEEDS GLASSES OR HEARING AID BE SURE CHILD HAS THEM ON

BEFORE CONTINUING.

2. CHILD DOES NOT NEED GLASSES OR HEARING AID

A3. (ASK IF CHILD IS 5 OR OLDER) What grade are you in?

_______________ GRADE

USE GRADE TO DETERMINE STARTING POINT FOR WOODCOCK-JOHNSON

ASSESSMENTS.

Copyright © 1989. By the Riverside Publishing Company. Reproduced from Woodcock-Johnson Test of
Achievement - Revised, by Richard W. Woodcock and M. Bonner Johnson, with permission of publisher.
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Test 22: LETTER-WORD IDENTIFICATION (3-12 YEAR OLDS)

Test 23: PASSAGE COMPREHENSION (6-12 YEAR OLDS)

Test 24: CALCULATION (6-12 YEAR OLD)

Test 25: APPLIED PROBLEMS (3-12 YEAR OLDS)

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(IF NEEDED, READ TO PRIMARY CAREGIVER)

This section gives us an idea of (CHILD)’s memory for number order. Each sequence of
numbers has more digits than the last. It is rare for anyone to remember all of the
sequences.

B0. EXACT TIME NOW: ______________

DIGIT SPAN SUBTEST OF THE WISC-R

WECHSLER INTELLIGENCE SCALE FOR CHILDREN-REVISED. Copyright © 1974 by the Psychological

Corporation. Reproduced by permission. All rights reserved. “Wechsler Intelligence Scale for Children” and
“WISC-R” are trademarks of The Psychological Corporation.
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SECTION C: TASK PERCEPTION

Ages: CHILDREN 8 YEARS AND OLDER

C0. INTERVIEWER CHECKPOINT

STEP ONE: CHECK LABEL ON FACESHEET. IS CHILD’S AGE 8 YRS OR OLDER?

1. YES 5. NO GO TO D1, P. 17

STEP TWO: READ THE FOLLOWING STATEMENTS:

Example 1:
(HAND R RESPONDENT BOOKLET) Now, I am going to ask you your opinion about some questions. I want
you to know that there are no right or wrong answers to them, I only want to know whatyou think. Here is a picture
to use in answering the question I will ask next. For example, if I asked:

(RB, P. 4) How hard is spelling for you?

1 2 3 4 5 6 7
VERY EASY NOT EASY VERY HARD
OR
HARD

If you think spelling is very easy, you would tell me the number 1.

If you think it is very hard, you would tell me the number 7.

What would you say if it’s not easy or hard?

IF R CHOOSES 4, SAY “Four means not easy or hard.”
IF R DOES NOT CHOOSE 4, SAY “Actually, four means not easy or hard .”

What number would you say if you think it’s a little hard?
IF R CHOOSES 5 OR 6, SAY “(5/6) means a little hard.”
IF R DOES NOT CHOOSE 5 OR 6, SAY “Actually, you would choose 5 or 6 because 4 is not easy or hard, and
7 is very hard, and a little hard is somewhere in between those.”
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Let’s try another one,

Example 2:
(RB, P. 5) If you were to list all the students in your class from the worst to the best in spelling, where would you
put yourself?

1 2 3 4 5 6 7
ONE OF THE IN THE THE BEST
WORST MIDDLE

Imagine how well all the kids in your class do in spelling. If you think you are one of the worst, you would choose
the number 1, the smallest or shortest bar.

If you think you are the best, you would choose the number 7, the largest or highest bar.

What would you circle if you think you are in the middle?
IF R CHOOSES 4, SAY “Four means not one of the worst or one of the best.”
IF R DOES NOT CHOOSE 4, SAY “Actually, you would choose 4.”

How about if you’re between the middle and the best?

IF R CHOOSES 5 OR 6, SAY “(5/6) means between the middle and the best.”
IF R DOES NOT CHOOSE 5 OR 6, SAY “Actually, you would choose 5 or 6.”

Now, I’m going to ask you some questions and you just let me know which number describes how you think or feel.
Remember any answer is fine as long as it’s the way you think or feel!
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IWER INSTRUCTION: IF R HAS DIFFICULTY READING THE RESPONSE CATEGORIES IN

THE RB, READ THEM TO R BEFORE READING EACH QUESTION.

IF CHILD GIVES THE CATEGORY AS AN ANSWER, ASK FOR NUMBER.

MATH

C1. (RB, P. 6) How good at math are you? (not at all good, ok, very good, or somewhere in between?)
________ (ENTER #)

C2. (RB, P. 7) If you were to list all the students in your class from the worst to the best in math, where would
you put yourself? (one of the worst, in the middle, the best, or somewhere in between?)
________ (ENTER #)

C3. (RB, P. 8) Some kids are better in one subject than another. For example, you might be better in math than
in reading. Compared to most of your other school subjects, how good are you at math? (a lot worse in
math than in other subjects, about the same, a lot better in math than in other subjects, or somewhere in
between?)
________ (ENTER #)

C4. (RB, P. 9) How well do you expect to do in math this year? (not at all well, ok, very well, or somewhere
in between?) ________ (ENTER #)

C5. (RB, P. 10) How good would you be at learning something new in math? (not at all good, ok, very good,
or somewhere in between?) ________ (ENTER #)

C6. (RB, P. 11) How hard is math for you? (not at all hard, somewhat hard, very hard, or somewhere in
between?) ________ (ENTER #)

C7. (RB, P. 12) Some things that you learn in school help you to do things better outside of class, that is, they
are useful. For example, learning about plants might help you grow a garden. In general, how useful is what
you learn in math? (not at all useful, somewhat useful, very useful, or somewhere in between?)
________ (ENTER #)
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C8. (RB, P. 13) For you, being good in math is: (READ OPTIONS IF NECESSARY: not important, somewhat
important, very important, or somewhere in between?) ________ (ENTER #)

C9. (RB, P. 14) Do you find working on math assignments: (very boring, somewhat interesting, very interesting,
or somewhere in between?) ________ (ENTER #)

C10. (RB, P. 15) How much do you like doing math? (not at all, somewhat, very much, or somewhere in
between?) ________ (ENTER #)

READING

C11. (RB, P. 16) How good at reading are you? (not at all good, ok, very good, or somewhere in between?)
________ (ENTER #)

C12. (RB, P. 17) If you were to list all the students in your class from the worst to the best in reading, where
would you put yourself? (one of the worst, in the middle, the best, or somewhere in between?)
________ (ENTER #)

C13. (RB, P. 18) Compared to most of your other school subjects, how good are you at reading? (a lot worse in
reading than in other subjects, about the same, a lot better in reading than in other subjects, or somewhere
in between?) ________ (ENTER #)

C14. (RB, P. 19) How well do you expect to do in reading this year? (not at all well, ok, very well, or somewhere
in between?) ________ (ENTER #)

C15. (RB, P. 20) How good would you be at learning something new in reading? (not at all good, ok, very good,
or somewhere in between?) ________ (ENTER #)

C16. (RB, P. 21) How hard is reading for you? (not at all hard, somewhat hard, very hard, or somewhere in
between?) ________ (ENTER #)
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C17. (RB, P. 22) How useful is what you learn in reading? (not at all useful, somewhat useful, very useful, or
somewhere in between?) ________ (ENTER #)

C18. (RB, P. 23) For you, being good in reading is: (READ OPTIONS IF NECESSARY: not at all important,
somewhat important, very important, or somewhat in between) ________ (ENTER #)

C19. (RB, P. 24) Do you find working on reading assignments: (very boring, somewhat interesting, very
interesting, or somewhere in between?) ________ (ENTER #)

C20. (RB, P. 25) How much do you like doing reading? (not at all, somewhat, very much, or somewhere in
between?) ________ (ENTER #)

GENERAL

(RB, P. 26) Now I am going to read some statements. For each, think about whether the statement never applies
to you, sometimes applies to you, always applies to you, or is somewhere in between. Then give me the number from
the booklet after I read each sentence.

C21. I do lots of important things. (never, sometimes, always, or somewhere in between?)

________ (ENTER #)

C22. I like being the way I am. ________ (ENTER #)

C23. Overall, I have a lot to be proud of. ________ (ENTER #)

C24. I can do things as well as most people. ________ (ENTER #)

C25. A lot of things about me are good. ________ (ENTER #)

C26. I’m as good as most other people. ________ (ENTER #)

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C27. Other people think I am a good person. ________ (ENTER #)

C28. When I do something, I do it well. ________ (ENTER #)

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SECTION D

D1. Do you have one main teacher and classroom, or do you have different classrooms and teachers for each
period during the day in school?

1. ONE CLASSROOM 2. DIFFERENT CLASSROOMS AND TEACHERS

THANK R AND
RECORD END TIME AT
P. 24, D14

D2. Now I want to ask you a few questions about your day at school. Were you in school on (WEEKDAY
DIARY DAY ON LABEL)?

1. YES GO TO D3 5. NO

D2a. IWER: CHOOSE THE DAY AS CLOSE AS POSSIBLE TO THE DIARY DAY THAT R WAS
IN SCHOOL, AND CONTINUE WITH D3.

D3. Please think about __________________________________________________ in school. I am going to

RECORD DAY/DATE FOR MIDDLE SCHOOL DIARY
ask you to walk through that school day with me. I will ask you what subjectsyou had each period, and what
you did that day in each class. Use P. 28 of your booklet for answer choices.
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D4. D5. D6. D7. D8.
(ASK IF
NECESSARY:) What time did
What was your What subject was that activity What time did it Where were you?
(first/next) activity? that in? begin? end? (use RB, column A)
#1

____:____ ____:_____

#2

____:____ ____:_____

#3

____:____ ____:_____

#4

____:____ ____:_____

#5

____:____ ____:_____

GO TO P. 20 FOR ACTIVITIES 6-10 OR P. 24, D14 TO RECORD END TIME

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D9. D10. D11. D12. D13.
Who was doing What format was What materials did What was your
Who was teaching this activity with used for this you use for this behavior like
the class? you? activity? activity? during this activity?
(use RB, (use RB, (use RB, (use RB, (use RB,
column B) column C) column D) column E) column F)
#1

#2

#3

#4

#5
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D4. D5. D6. D7. D8.
(ASK IF
NECESSARY:) What time did
What was your What subject was that activity What time did it Where were you?
(first/next) activity? that in? begin? end? (use RB, column A)
#6

____:____ ____:_____

#7

____:____ ____:_____

#8

____:____ ____:_____

#9

____:____ ____:_____

#10

____:____ ____:_____

GO TO P. 22 FOR ACTIVITIES 11-15, OR P. 24, D14 TO RECORD END TIME.

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D9. D10. D11. D12. D13.
Who was doing What format was
Who was teaching this activity with used for this What materials did What was your
the class? you? activity? you use for this behavior like during
(use RB, (use RB, (use RB, activity? this activity?
column B) column C) column D) (use RB, column E) (use RB, column F)
#6

#7

#8

#9

#10
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D4. D5. D6. D7. D8.
(ASK IF
NECESSARY:) What time did
What was your What subject was that activity What time did it Where were you?
(first/next) activity? that in? begin? end? (use RB, column A)
#11

____:____ ____:_____

#12

____:____ ____:_____

#13

____:____ ____:_____

#14

____:____ ____:_____

#15

____:____ ____:_____

GO TO P. 24, D14 TO RECORD END TIME.

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D9. D10. D11. D12. D13.
What format was What materials did
Who was teaching Who was doing this used for this you use for this What was your
the class? activity with you? activity? activity? behavior like during
(use RB, (use RB, (use RB, (use RB, this activity?
column B) column C) column D) column E) (use RB, column F)
#11

#12

#13

#14

#15
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D14. EXACT TIME NOW:
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SECTION E: INTERVIEWER INFORMATION AND OBSERVATIONS

PLEASE FILL OUT THIS INFORMATION AFTER YOU HAVE COMPLETED ALL OF THE CHILD
ASSESSMENT PACKAGE

E1. Was anyone else present in the room at any time during the administration of the assessments?

1. YES 5. NO GO TO E2

E1a. How much did the presence of this person distract the child or interfere with the assessments?

1. A GREAT DEAL 2. SOMEWHAT 3. NOT AT ALL

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E2. Were all the appropriate Woodcock-Johnson assessments completed?

1. YES GO TO E3 5. NO

E2a. What were the reasons for not completing them? (Check all that apply.)

A. PARENT/PRIMARY CAREGIVER TERMINATED/REFUSED

B. CHILD WOULD NOT RESPOND

C. MAJOR INTERRUPTION CAUSED TERMINATION

D. CHILD COULD NOT UNDERSTAND TASK

E. CHILD HAD LANGUAGE PROBLEM

F. CHILD’S EMOTIONAL CONDITION

G. CHILD’S PHYSICAL CONDITION

H. CHILD TIRED

I. OTHER (SPECIFY)_____________________________________
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E3. Was the Digit Span assessment completed?

1. YES GO TO E4 5. NO

E3a. What were the reasons for not completing them? (Check all that apply.)

A. PARENT/PRIMARY CAREGIVER TERMINATED/REFUSED

B. CHILD WOULD NOT RESPOND

C. MAJOR INTERRUPTION CAUSED TERMINATION

D. CHILD COULD NOT UNDERSTAND TASK

E. CHILD HAD LANGUAGE PROBLEM

F. CHILD’S EMOTIONAL CONDITION

G. CHILD’S PHYSICAL CONDITION

H. CHILD TIRED

I. OTHER (SPECIFY)_____________________________________
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E4. Please provide a few words about this interview which might help editors and coders understand any
potentially confusing situations.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

E5. Elaborate on any ambiguous or conflicting information in this interview that you want editors and
coders to know about.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

E6. How would you describe the interview situation? Please add any other clarifying remarks that will be
helpful to editors or coders when this interview is processed. If this R should be recontacted for
missing information from Ann Arbor, is there something else we should be aware of?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________
P. 167/457563
1997