Table 5 Developmental history questionnaire description.
From: A longitudinal neuroimaging dataset on arithmetic processing in school children
Item | Response options | |
---|---|---|
Child’s difficulties | Does your child have speech delays/problems? (i.e.: stutters, difficult to understand) | Yes/No If yes: Please explain |
Was speech/language therapy ever necessary? | Yes/No | |
Does your child struggle with reading? | Yes/No. If yes: Please explain | |
Has your child ever been tested for a Reading Disability? | Yes/No. If yes, please list diagnosis | |
Is or has your child received remediation/tutoring for reading issues? | Yes/No | |
Does your child struggle with math? | Yes/No | |
Has your child ever been tested for a Math Disability? | Yes/No. If yes, please list diagnosis | |
Is or has your child received remediation/tutoring for math issues? | Yes/No | |
School-related information | What type of school does your child attend? | [Free answer] |
Is your child in a regular classroom? | Yes/No If no, please specify | |
Has your child repeated or skipped any grades? | Yes/No If yes, please specify | |
Does your child have an Individualized Education Plan or a 504 Plan? | Yes/No | |
Child’s learning preferences | How does your child prefer to learn? | Listening in class to teacher; Viewing visual information provided in class; Watching demonstrations; Interaction with peers Participating in discussions; Other |
Child’s home | Primary language spoken at home: | [Free answer] |
Child lives with: | [Free answer] | |
Mother’s specific history | Mother’s age: | [Free answer] |
Mother’s occupation: | [Free answer] | |
Mother’s highest grade/degree completed: | No High School; High School; Some College; Bachelor’s Degree; Graduate Degree | |
Mother: Any history of learning problems: | Yes/No | |
Mother: Any history of speech problems: | Yes/No | |
Mother: Any history of behavioral problems: | Yes/No | |
Mother: Any history of medical problems: | Yes/No | |
Mother: Any history of emotional problems: | Yes/No | |
Mother: Any history of drug or alcohol abuse: | Yes/No | |
Father’s specific history | Father’s age: | [Free answer] |
Father’s occupation: | [Free answer] | |
Father’s highest grade/degree completed: | No High School; High School; Some College; Bachelor’s Degree; Graduate Degree | |
Father: Any history of learning problems: | Yes/No | |
Father: Any history of speech problems: | Yes/No | |
Father: Any history of behavioral problems: | Yes/No | |
Father: Any history of medical problems: | Yes/No | |
Father: Any history of emotional problems: | Yes/No | |
Father: Any history of drug or alcohol abuse: | Yes/No | |
Family: Any history of learning problems: | Yes/No | |
Family: Any history of attention deficit disorder: | Yes/No | |
Family: Any history of behavioral problems: | Yes/No | |
Family: Any history of neurological problems: | Yes/No |