Attachment 20.
Form
Approved OMB
No. 0923-XXXX Exp.
Date xx/xx/201x
xx/xx/20xxExDaxx/xx/20xx Exp.
Date xx/xx/20xx
ATSDR
estimates the average public reporting burden for this collection of
information as 90 minutes per child response and 15 minutes per
parent response, including the time for reviewing instructions,
searching existing data/information sources, gathering and
maintaining the data/information needed, and completing and
reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to a collection
of information unless it displays a currently valid OMB Control
Number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden to CDC/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:
PRA (0923-xxxx).
Proprietary Neurobehavioral Test Information
The following test forms are not found in the ATSDR Pease Study Protocol (Number XXXX). The data collection forms are copyrighted and may be reproduced only with written permission from the publishers. The SDQ allows paper versions of its forms to be reproduced and used provided ATSDR does not charge any fee to participants.
To review a copy of the test forms, write to the publishers at the addresses provided below:
Wechsler Abbreviated Scale of Intelligence – 2nd Edition (WASI - II) |
Pearson Education, Inc. (Clinical Assessment Ordering Department, P.O. Box 599700, San Antonio, TX 78259) Toll-free: 800-627-7271 |
A Developmental NEuroPSYchological Assessment – Second Edition (NEPSY-II) |
Pearson Education, Inc. (Clinical Assessment Ordering Department, P.O. Box 599700, San Antonio, TX 78259) Toll-free: 800-627-7271 |
Conners Kiddie Continuous Performance Test, 2nd Edition (Conners K-CPT 2) |
Multi-Health Systems Inc. (P.O. Box 950, North Tonawanda, NY, 14120-0950) Toll-free: 800-456-3003 |
Conners Continuous Performance Test 3rd Edition (CPT 3) |
Multi-Health Systems Inc. (P.O. Box 950, North Tonawanda, NY, 14120-0950) Toll-free: 800-456-3003 |
Strengths and Difficulties Questionnaire© (SDQ©) |
Development and Well-Being Assessment (DAWBA). Feedback and enquiries welcome at youthinmind@gmail.com The SDQ is part of the DAWBA family of mental health measures. COPYRIGHT NOTICE: Please note that Strengths and Difficulties Questionnaires, whether in English or in translation, are copyright documents that are not in the public domain. As such, they may not be modified in any way (e.g. changing the wording of questions, adding questions or administering only subsets of questions). This is to ensure that the SDQ is fully comparable across studies and settings. Similarly, to ensure high quality and consistency, unauthorized translations are not permitted. Paper versions may be downloaded and subsequently photocopied without charge by individuals or non-profit organizations provided they are not making any charge to families. Users are not permitted to create or distribute electronic versions for any purpose without prior authorization from youthinmind. If you are interested in making translations or creating electronic versions you MUST first contact youthinmind@gmail.com. |
Behavior Rating Inventory of Executive Function® (BRIEF®) |
Psychological Assessment Resources, Inc. (16204 North Florida Avenue, Lutz, FL 33549) Toll-free 800-331-8378 |
Behavior Rating Inventory of Executive Function® – Preschool Version (BRIEF®-P) |
Psychological Assessment Resources, Inc. (16204 North Florida Avenue, Lutz, FL 33549) Toll-free 800-331-8378 |
Pease Study Neurobehavioral Test Battery for Children
Neurobehavioral Test |
Domain |
Age |
Administration |
Time to Administer |
Wechsler Abbreviated Scale of Intelligence – 2nd Edition (WASI - II) |
Two Subtest Form (FSIQ-2) (Vocabulary and Matrix Reasoning) |
6 – 17* |
Child |
15 minutes |
A Developmental Neuropsychological Assessment – 2nd edition (NEPSY – II) subtests
* from Core Assessment |
Auditory Attention and Response Set* (reduced attention) |
5 – 16 |
Child |
7 – 11 minutes |
Inhibition* |
5 – 16 |
Child |
8 – 11 minutes |
|
Comprehension of Instructions* (receptive language, trouble following multi-step commands) |
4 – 16 |
Child |
6 – 8 minutes |
|
Speeded Naming* (expressive language, processing speed) |
4 – 16 |
Child |
2 – 7 minutes |
|
Word List Interference* (verbal memory) |
7 – 16 |
Child |
6 – 8 minutes |
|
Narrative Memory* (comprehension, verbal memory) |
4 – 16 |
Child |
6 – 11 minutes |
|
Design Copying* (visuospatial processing) |
4 – 16 |
Child |
7 – 10 minutes |
|
Theory of Mind (social perception) |
4 – 16 |
Child |
10 – 13 minutes |
|
Sentence Repetition (verbal memory) |
4 – 6 |
Child |
4 minutes |
|
Statue (inhibitory control) |
4 – 6 |
Child |
3 minutes |
|
Word Generation (expressive language, executive control) |
4 - 16 |
Child |
4 – 6 minutes |
|
Conners Kiddie Continuous Performance Test, 2nd Edition (Conners K-CPT 2) |
Inattentiveness, Impulsivity, Sustained Attention, Vigilance |
4-7 |
Child |
8 minutes |
Conners Continuous Performance Test 3rd edition (CPT 3) |
Inattentiveness, Impulsivity, Sustained Attention, Vigilance |
8-17 |
Child |
14 minutes |
Strengths and Difficulties Questionnaire© (SDQ©) |
Double-sided form with impact supplement (behavioral problems) |
4 – 17 |
Parent about Child |
5 minutes |
Behavior Rating Inventory of Executive Function® (BRIEF®) |
Executive Function |
6-17 |
Parent about Child |
10 minutes |
Behavior Rating Inventory of Executive Function® – Preschool Version (BRIEF®-P) |
Executive Function - Preschool |
4-5 |
Parent about Child |
10 minutes |
Neuropsychological Test Battery, Children aged 4-17 years |
||
Age Range, years |
Test |
Domains |
6-17 years |
Wechsler Abbreviated Scale of Intelligence® - Second Edition (WASI® - II) |
https://www.pearsonclinical.com/psychology/products/100000037/wechsler-abbreviated-scale-of-intelligence--second-edition-wasi-ii.htmlAuthor: David WechslerQualification Level: C Age Range: Individuals 6:0–90:11 Completion Time: Two-subtest form (Vocabulary and Matrix Reasoning), 15 minutes Scores/Interpretation: FSIQ–2 score: Estimate of general cognitive ability Scoring Options: Manual scoring Publication Date: 2011 |
4-16 years |
A Developmental NEuroPSYchological Assessment – 2nd Edition (NEPSY-II) |
https://www.pearsonclinical.com/psychology/products/100000584/nepsy-second-edition-nepsy-ii.html https://images.pearsonclinical.com/images/Products/NEPSY-II/Clin_Chp_2.pdf
Author(s): Marit Korkman, Ursula Kirk, Sally Kemp Qualification Code: CL1 Age Range: 3 years to 4 years; 5 years to 16 years Administration: Core Assessment 45 minutes for preschool ages, 1 hour for school ages; Comprehensive Assessment - 90 minutes for preschool ages, 2-3 hours for school ages Publication Year: 2007
This NEPSY-II battery covers Five of Six DomainsExecutive Functioning/Attention, Language, Memory and Learning, Visuospatial Processing, Social Perception. Sensorimotor Functioning will not be tested. |
4-7 years |
Connors Kiddie Continuous Performance Test Second Edition™ (Conners K-CPT 2™) |
https://www.mhs.com/MHS-Assessment?prodname=kcpt2
OverviewThe Conners Kiddie Continuous Performance Test 2nd Edition™ (Conners K-CPT 2™) assesses attention deficits in children ages 4 to 7 years old. Based on the well-established Conners CPT paradigm, the Conners K–CPT 2 takes only half the time (7.5 minutes) to complete, making it more appropriate for younger children. Results from the measure can be used for clinical assessment, early identification, and educational classification. The assessment can be also be used to evaluate treatment effectiveness by administering the test before treatment and during treatment to monitor change.
Author(s): Keith Conners, Ph.D Key Areas Measured:
Age: 4 to 7Administration Type: SelfAdministration Time: 7.5 MinutesQualification Level: B
|
8-17 years |
Connors Continuous Performance Test Third Edition™ (CPT 3™) |
https://www.mhs.com/MHS-Assessment?prodname=cpt3
OverviewThe Conners Continuous Performance Test Third Edition™ (Conners CPT 3™) measures attention-related problems in individuals aged eight years and older. By indexing the respondent’s performance in areas of inattentiveness, impulsivity, sustained attention, and vigilance, the Conners CPT 3 can aid in the assessment of Attention-Deficit/Hyperactive Disorder (ADHD) and other neurological conditions related to attention. The Conners CPT 3 provides objective information about an individual’s performance in attention tasks, complementing information obtained from rating scales such as the Conners 3®.
New Scores and Score Dimensions of Attention Measured:
Key Areas Measured:
Age: 8+ Administration Type: Self Administration Time: 14 Minutes Qualification Level: B |
Parent (4-17 years) |
Strengths and Difficulties Questionnaire (SDQ) |
http://www.cebc4cw.org/assessment-tool/strengths-and-difficulties-questionnaire/
The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire about 3-16 year olds. It exists in several versions to meet the needs of researchers, clinicians and educationalists. Each version includes between one and three of the following components: 25 items on psychological attributes. All versions of the SDQ ask about 25 attributes, some positive and others negative. These 25 items are divided between 5 scales: 1) emotional symptoms (5 items) 2) conduct problems (5 items) 3) hyperactivity/inattention (5 items) 4) peer relationship problems (5 items) 5) prosocial behaviour (5 items)
[1) to 4) added together generate a total difficulties score (based on 20 items)]
A two-sided version of the SDQ has the 25 items on strengths and difficulties on the front of the page and an impact supplement on the back. These extended versions of the SDQ ask whether the respondent thinks the young person has a problem, and if so, enquire further about chronicity, distress, social impairment, and burden to others. This provides useful additional information for clinicians and researchers with an interest in psychiatric caseness and the determinants of service use (Goodman, 1999).
Target Population: Children between the ages of 2 to 17 Time to Administer: One sided version with 25 items, administration time approximately 5 minutes Completed By: Parents and teachers
NOTE: As of June 2014 the authors have relabelled all SDQ questionnaires to be consistent in giving '4-17 years' as the age range of the standard SDQ (e.g. 4-17 years not 4-16 years) and giving '2-4 years' as the age range of the early-years SDQ (i.e. 2-4 years not 3/4 years). The content of the SDQs themselves is unchanged. They have relabelled the SDQs following evidence that the SDQ has good psychometric properties in 2-year-olds, and that the performance of the SDQ in 17-year-olds is similar to that in 15- and 16-year olds. |
Parent (4-5 years) |
Behavior Rating Inventory of Executive Function® – Preschool Version (BRIEF®-P) |
https://www.parinc.com/Products/Pkey/26
BRIEF®-PBehavior Rating Inventory of Executive Function®—Preschool VersionGerard A. Gioia, PhD, Kimberly Andrews Espy, PhD, and Peter K. Isquith, PhDPurpose: Assesses executive functioning in preschool-aged children Format: Paper and pencil, Online administration and scoring via PARiConnect, Software Age range: 2 years to 5 years, 11 months Time: Approximately 10-15 minutes to administer; 15-20 minutes to score Qualification level: B
The BRIEF-P is the first standardized rating scale designed to specifically measure the range of executive function in preschool-aged children. Features and benefits
Test structure
Technical information
|
Parent (6-17 years) |
Behavior Rating Inventory of Executive Function® (BRIEF®) |
https://www.parinc.com/Products/Pkey/23
BRIEF®Behavior Rating Inventory of Executive Function®Gerard A. Gioia, PhD, Peter K. Isquith, PhD, Steven C. Guy, PhD, and Lauren Kenworthy, PhDPurpose: Assesses impairment of executive function Format: Paper and pencil, Online administration and scoring via PARiConnect Age range: 5 years to 18 years Time: 10-15 minutes to administer; 15-20 minutes to score Qualification level: B
Assess executive function behaviors in the school and home environments with the BRIEF, a questionnaire developed for parents and teachers of school-age children. Designed to assess the abilities of a broad range of children and adolescents, the BRIEF is useful when working with children who have learning disabilities and attention disorders, traumatic brain injuries, lead exposure, pervasive developmental disorders, depression, and other developmental, neurological, psychiatric, and medical conditions. Features and benefits
Test structure
Technical information
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Stephanie Davis |
File Modified | 0000-00-00 |
File Created | 2021-10-07 |