Document ID: EPA-HQ-ORD-2004-0016-0003
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2005-05-10T04:00Z

Application
of
Measures
of
Spontaneous
Motor
Activity
for
Behavioral
Assessment
in
Human
Infants
 
Pilot
Study
Section
1.

A.
Supporting
Statement
1.
Identification
of
the
Information
Collection
1(
a)
Title
Application
of
Measures
of
Spontaneous
Motor
Activity
for
Behavioral
Assessment
in
Human
Infants
 
Pilot
Study
EPA
ICR
Number
2166.01
1(
b)
Abstract
The
U.
S.
Environmental
Protection
Agency
(
EPA)
is
participating
in
the
planning
of
the
National
Children's
Study
(
NCS),
a
congressionally
mandated
study
to
examine
the
effects
of
environmental
influences
on
the
health
and
development
of
children
from
before
birth
until
age
21.
The
goal
of
the
NCS,
which
has
been
in
the
planning
stages
for
several
years,
is
to
improve
the
health
and
well­
being
of
children.
One
EPA
responsibility
is
to
identify
and
test
various
data
collection
methods
being
considered
for
the
NCS,
including
those
to
investigate
developmental
disorders
that
may
be
associated
with
exposure
to
environmental
agents.
Issues
associated
with
environmental
exposures
are
particularly
important
in
light
of
research
that
has
linked
prenatal
and
early
childhood
exposure
to
certain
neurotoxicants
(
including
lead,
mercury,
manganese,
and
polychlorinated
biphenyls
(
PCBs))
with
negative
behavioral
outcomes.
The
potential
association
between
the
large
increase
in
the
number
of
children
diagnosed
with
conditions
such
as
attention
deficit­
hyperactivity
disorder
(
ADHD)
and
environmental
exposures
is
of
particular
concern
to
the
EPA.
Early
detection
of
exposure
to
neurotoxicants
is
critical
because
infants'
and
toddlers'
neurologic
systems
are
in
the
beginning
stages
of
development
and
exposures
can
lead
to
long­
term
or
lifelong
defects.
The
EPA
proposes
this
information
collection
to
help
advance
the
ability
to
detect,
prevent
and
treat
such
negative
outcomes.
2.
Need
for
and
use
of
the
Collection
2(
a)
Need
/
Authority
for
the
Collection
The
goal
of
the
proposed
information
collection
is
to
test
a
method
to
collect
data
that
would
be
used
to
quantitatively
characterize
spontaneous
motor
activity
in
young
children
between
the
ages
of
6
and
24
months.
This
information
is
needed
to
help
plan
and
design
the
National
Children's
Study.
The
authority
for
this
Collection
derives
from
the
Children's
Health
Act
of
2000
(
PL
106­
310).
This
law
specifically
authorizes
the
conduct
of
a
national
longitudinal
study
of
environmental
influences
on
children's
health
and
development
and
directs
the
participation
of
EPA
in
this
effort.
2(
b)
Practical
Utility/
Users
of
the
Data
Data
from
the
study
will
be
used
to
1)
identify
sources
of
variance
in
infants'
and
toddlers'
daily
activity
levels,
2)
estimate
the
number
of
days
of
activity
measurement
that
would
be
necessary
to
reliably
quantify
these
activities,
and
3)
investigate
the
potential
association
between
activity
measures
averaged
over
long
periods
of
time
and
activity
measures
averaged
over
the
duration
of
a
specific
event.
Data
will
be
analyzed
and
used
to
help
EPA
determine
the
best
way
to
gather
reliable
data
to
further
examine
the
effects
of
exposure
to
environmental
contaminants
on
young
children's
development.
The
results
of
this
analysis
will
be
shared
with
the
NCS
planning
group
via
the
Interagency
Coordinating
Committee
(
ICC).
2
3.
Non
duplication,
Consultations
and
Other
Collection
Criteria
3(
a)
Non
duplication
To
ensure
that
no
other
sources
of
information
could
sufficiently
address
the
measurement
of
spontaneous
activity
among
infants
and
toddlers,
an
extensive
review
of
the
literature
was
conducted.
The
literature
revealed
that:
 
actigraphy
has
been
used
extensively
in
assessing
physical
activity
and
sleep
patterns
with
adults
and
adolescents,
but
not
young
children;
 
actigraphy
has
been
used
successfully
with
children
between
the
ages
of
3
and
6
years
in
efforts
to
understand
childhood
obesity;
and
 
studies
have
used
actigraphy
with
infants
and
toddlers
to
measure
sleep/
wake
cycles.
No
studies,
however,
have
been
conducted
that
provide
information
on
the
issues
EPA
needs
to
address
for
the
NCS.
3(
b)
Public
Notices
Required
Prior
to
ICR
Submission
to
OMB
The
announcement
of
a
public
comment
period
for
this
ICR
was
published
in
the
Federal
Register
on
November
2,
2004.
No
comments
were
received.
3(
c)
Consultations
The
following
individuals
were
consulted
about
the
overall
design
of
this
project:
Amy
Branum,
MSPH,
National
Center
for
Health
for
Health
Statistics,
CDC
Adolfo
Correa,
MD,
PhD,
National
Center
on
Birth
Defects
and
Developmental
Disabilities,
CDC
Sarah
Keim,
MA,
National
Institute
of
Child
Health
and
Human
Development,
NIH
Woodie
Kessel,
MD,
MPH,
Office
of
the
Secretary,
Department
of
Health
and
Human
Services
Carole
A.
Kimmel,
PhD,
National
Center
for
Environmental
Assessment,
EPA
Mark
Klebanoff,
MD,
MPH,
National
Institute
of
Child
Health
and
Human
Development,
NIH
Pauline
Mendola,
PhD,
National
Health
and
Environmental
Effects
Research
Laboratory,
EPA
Sheila
A.
Newton,
MS,
PhD,
National
Institute
of
Environmental
Health
Sciences,
NIH
James
J.
Quakenboss,
MS,
National
Exposure
Research
Laboratory,
EPA
Peter
C.
Scheidt,
MD,
MPH,
National
Institute
of
Child
Health
and
Human
Development,
NIH
Kenneth
Schoendorf,
MD,
MPH,
National
Center
for
Health
Statistics,
CDC
Sherry
G.
Selevan,
PhD,
National
Center
for
Environmental
Assessment,
EPA
Marshalyn
Yeargin­
Allsopp,
MD,
National
Center
on
Birth
Defects
and
Developmental
Disabilities,
CDC
The
following
individual
was
consulted
about
the
statistical
portions
of
this
project:
Abhik
Das,
Ph.
D.,
Statistics
Research
Division,
RTI
International
3(
d)
Effects
of
Less
Frequent
Collection
This
is
a
one
time
collection.
3(
e)
General
Guidelines
There
are
no
special
circumstances
that
require
this
collection
to
be
conducted
in
a
manner
inconsistent
with
OMB's
general
guidelines.
3(
f)
Confidentiality
All
staff
involved
with
data
collection
will
be
trained
on
confidentiality
and
be
required
to
sign
confidentiality
pledges.
Identification
numbers
will
be
assigned
to
each
child
participating
in
the
study.
Names
and
other
identifying
information
will
not
be
included
in
or
with
the
data
collected
from
the
accelerometer.
All
data
will
be
stored
in
secure
computers
and
storage
facilities.
3(
g)
Sensitive
Questions
3
No
sensitive
questions
will
be
asked.
4.
The
Respondents
and
the
Information
Requested
4(
a)
Respondents/
SIC
Codes
This
study
will
be
conducted
using
110
parent­
child
pairs.
The
children
will
be
recruited
in
two
groups
of
54­
56,
each
with
approximately
equal
numbers
of
boys
and
girls.
One
group
will
be
comprised
of
infants
6
 
12
months
of
age.
The
other
will
be
comprised
of
toddlers
19­
24
months
of
age.
4(
b)
Information
Requested
(
i)
Data
items,
including
record
keeping
requirements
Data
will
be
collected
in
the
following
way.
Parent­
child
dyads
will
be
invited
to
a
laboratory
for
an
initial
visit,
where
the
study
examiner
will
obtain
consent
and
place
a
small,
lightweight
device
called
an
accelerometer
on
the
child's
waist.
Children
will
wear
the
accelerometer,
which
produces
activity
measures,
for
a
7­
day
monitoring
period
(
day
and
night).
After
the
accelerometer
has
been
placed,
the
parent
will
complete
either
the
Infant
Behavioral
Questionnaire
(
IBQ)
(
for
children
12
months
of
age
and
younger)
or
the
Infant
Toddler
Social
and
Emotional
Assessment
(
ITSEA)
(
for
children
over
the
age
of
12
months).
Results
will
be
used
to
assess
the
child's
temperament.
During
the
lab
visit,
the
study
examiner
will
administer
the
Peabody
Developmental
Motor
Scale,
2nd
Edition
(
PDMS­
2)
to
the
child;
any
child
not
falling
into
the
normal
range
of
development
will
not
be
asked
to
continue
in
the
study.
(
Attachment
2
has
information
on
the
IBQ,
ITSEA,
and
PDMS­
2.)
Children
continuing
in
the
study
will
participate
in
a
brief
unstructured
play
activity
before
leaving
the
lab.
(
ii)
Respondent
Activities
If
a
child
is
in
the
normal
range
of
development,
the
parent
will
be
provided
with
a
7­
day
Time
Activity
Diary
(
see
Attachment
1),
on
which
the
parent
will
record
the
beginning
and
ending
time
of
each
activity,
using
a
list
of
coded
responses.
At
48­
hour
intervals,
the
study
examiner
will
visit
the
child's
home
to
retrieve
accelerometer
data.
At
the
end
of
the
7­
day
data
collection
period,
the
study
examiner
will
visit
the
home
of
each
dyad
to
collect
the
accelerometer
and
time
activity
diary
5.
The
Information
Collected
 
Agency
Activities,
Collection
Methodology,
and
Information
Management
5(
a)
Agency
Activities
EPA's
Human
Studies
Division,
Epidemiology
and
Biomarkers
Branch
will
be
responsible
for
subject
recruitment,
eligibility
screening
and
enrollment,
accelerometer
instruction
and
placement,
data
analysis
and
review.
5(
b)
Collection
Methodology
and
Management
This
project
will
use
multiple
methods
of
data
collection:
lab
assessments,
actigraphy
data
(
collected
from
the
accelerometer),
and
activity
diaries.
Data
on
each
child's
temperament
(
IBQ
or
BITSEA)
and
motor
development
(
PDMS­
2)
will
be
collected
in
the
laboratory
by
trained
technicians
on
day
one
of
the
study.
Motor
activity
data
will
be
collected
by
an
accelerometer
device
(
Actiwatch
AW
64,
Mini
Mitter
Co.,
Inc,
Bend,
Oregon)
worn
by
the
child
for
the
7
day
monitoring
period.
Time­
activity
data
will
be
collected
by
parent
completion
of
a
time­
activity
diary
for
the
seven
day
monitoring
period.
Accelerometer
data
will
be
downloaded
directly
to
a
computer
file
via
a
docking
station.
IBQ/
BITSEA
and
PDMS­
2
data
will
be
converted
to
electronic
files
and
entered
into
a
data
base.
Time­
activity
data
will
be
converted
to
electronic
format
and
entered
into
a
data
base.
4
Because
of
the
exploratory
nature
of
this
study,
most
analyses
of
the
actigraphy­
produced
data
will
be
descriptive,
including
mean
counts
of
activity
in
various
categories
(
e.
g.,
per
minute,
per
minute
while
awake,
per
minute
while
asleep,
and
per
minute
for
specific
activities).
Summary
measures
will
be
calculated
for
various
age
cohorts,
for
the
entire
data
collection
period
and
for
each
day
within
the
period.
Summaries
of
activity
for
other
periods
of
time
(
e.
g.,
hourly)
and
gender­
specific
analyses
also
will
be
prepared.
All
measures
of
activity
will
be
categorized
according
to
events
recorded
in
diaries
that
will
be
classified
as
sedentary,
light,
moderate,
and
vigorous.
Access
to
all
data
will
be
controlled
in
accordance
with
Federal
privacy
regulations
and
OMB
Circular
A­
110.
5(
c)
Small
Entity
Flexibility
No
small
entities
will
be
affected
by
this
collection.
5(
d)
Collection
Schedule
Task
Date
IRB
Approval
February
2005
OMB
approval
June
2005
Participant
recruitment
June
2005
 
September
2005
Field
staff
training
May
2005
Data
collection
June
2005
 
October
2005
Data
analysis
November
2005
 
January
2006
Interim
Report
December
2005
Final
Report
March
2006
6.
Estimating
the
Burden
and
Cost
of
the
Collection
6(
a)
Estimating
Respondent
Burden
Anticipating
10%
attrition,
the
study
will
enroll
110
respondents
to
get
100
complete
accelerometer
readings
and
time
activity
diaries.
The
annualized
hour
burden
reported
in
Table
1
was
computed
as
follows:
 
According
to
the
developer,
conducting
the
PDMS­
2
motor
assessment
for
one
child
takes,
on
average,
45
minutes.
 
Conducting
the
IBQ
or
ITSEA
temperament
assessments
for
one
child
takes,
on
average,
30
minutes.
 
An
adult
will
spend
about
45
minutes
per
day,
for
each
of
7
days,
to
enter
information
into
the
activity
diary.
 
The
adult
will
spend
30
minutes,
on
average,
when
a
staff
member
visits
the
home
to
collect
study
materials
and
equipment.
 
The
most
recent
average
national
wage
provided
by
the
Bureau
of
Labor
Statistics
is
$
17
per
hour
(
U.
S.
Department
of
Labor,
2003).
5
Table
1.
Estimated
Annualized
Respondent
Burden
Form
Number
of
Participants
Number
of
Responses
per
Participant
Hours
per
Response
Total
Response
Burden
(
Hours)
Average
Hourly
Wage
in
Dollars
Total
Average
Wage
Burden
in
Dollars
Laboratory
Assessment
Motor
Assessment
Temperament
Assessment
Accelerometer
Training
110
1
1
0.75
0.50
0.75
82.5
55.0
82.5
$
17
$
17
$
17
$
1,402.50
$
935.00
$
1,402.50
Time
Activity
Diary
110
1
5.25
577.5
$
17
$
9,817.50
Follow­
up
Home
Visits
110
3
0.50
99.0
$
17
$
1,683.00
TOTAL
110
­­
7.55
962.5
­­
$
16,362.50
6(
b)
Estimating
Respondent
Cost
There
are
no
direct
costs
to
participants
other
than
their
time
to
participate
in
the
study.
6(
c)
Estimating
Agency
Burden
and
Cost
Burden
Hours
Cost
($)
Agency
Activities
Contractor
EPA
Freq
Total
Hours
Contractor
$
90/
hour
EPA
$
95/
hour
Administer
labbased
Evaluations
220
50
1
270
19,800
4,750
Instruct
Parents
on
Accelerometer
Use
110
0
1
110
9,900
0
Collect
In­
home
Data
110
0
3
330
29,700
0
Data
Handling
220
0
1
220
19,800
0
Statistical
Analysis
120
40
1
160
10,800
3,800
TOTAL
1,090
$
90,000
$
8,550
AGENCY
TOTAL
ANNUAL
BURDEN:
1,090
hours
AGENCY
TOTAL
ANNUAL
COST:
$
98,550
These
Agency
burden
estimates
are
based
on
our
prior
experience
in
developing
and
gathering
information
for
research
purposes.
The
Agency
costs
are
based
on
a
GS15
(
8)
for
the
Principal
Investigator
and
include
benefits.
The
contractor
costs
are
based
on
a
composite
cost
of
projected
study
personnel.
Estimated
annualized
hours
and
costs
could
be
over
estimated
by
20%
6(
d)
Estimating
the
Respondent
Universe
and
Total
Burden
and
Costs
The
respondent
universe
is
the
110
parent­
child
dyads
which
will
be
enrolled
in
this
study.
The
total
estimated
respondent
burden
and
costs
are
962.5
hours
and
$
16,362
6(
e)
Bottom
Line
Burden
and
Costs
The
estimated
respondent
burden
for
this
study
is
962.5
hours
and
$
16,362.
The
estimated
Agency
cost
for
conducting
the
study
is
1,090
hours
and
$
98,550.
6(
f)
Reasons
for
Change
in
Burden
Not
applicable
 
this
is
a
new
request.
6(
g)
Burden
Statement
6
The
annual
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
8
hours
per
response.
Burden
means
the
total
time,
effort,
or
financial
resources
expended
by
persons
to
generate,
maintain,
retain,
or
disclose
or
provide
information
to
or
for
a
Federal
agency.
This
includes
the
time
needed
to
review
instructions;
develop,
acquire,
install,
and
utilize
technology
and
systems
for
the
purposes
of
collecting,
validating,
and
verifying
information,
processing
and
maintaining
information,
and
disclosing
and
providing
information;
adjust
the
existing
ways
to
comply
with
any
previously
applicable
instructions
and
requirements;
train
personnel
to
be
able
to
respond
to
a
collection
of
information;
search
data
sources;
complete
and
review
the
collection
of
information;
and
transmit
or
otherwise
disclose
the
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.
The
OMB
control
numbers
for
EPA's
regulations
are
listed
in
40
CFR
part
9
and
48
CFR
chapter
15.

To
comment
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
the
use
of
automated
collection
techniques,
EPA
has
established
a
public
docket
for
this
ICR
under
Docket
ID
No.
ORD­
2004­
0016,
which
is
available
for
public
viewing
at
the
Office
of
Research
and
Development
(
ORD)
Docket
in
the
EPA
Docket
Center
(
EPA/
DC),
EPA
West,
Room
B102,
1301
Constitution
Ave.,
NW,
Washington,
DC.
The
EPA
Docket
Center
Public
Reading
Room
is
open
from
8:
30
a.
m.
to
4:
30
p.
m.,
Monday
through
Friday,
excluding
legal
holidays.
The
telephone
number
for
the
Reading
Room
is
(
202)
566­
1744,
and
the
telephone
number
for
the
Office
of
Research
and
Development
Docket
is
(
202)
566­
1752.
An
electronic
version
of
the
public
docket
is
available
through
EPA
Dockets
(
EDOCKET)
at
http://
www.
epa.
gov/
edocket.
Use
EDOCKET
to
submit
or
view
public
comments,
access
the
index
listing
of
the
contents
of
the
public
docket,
and
to
access
those
documents
in
the
public
docket
that
are
available
electronically.
Once
in
the
system,
select
"
search,"
then
key
in
the
docket
ID
number
identified
above.
Also,
you
can
send
comments
to
the
Office
of
Information
and
Regulatory
Affairs,
Office
of
Management
and
Budget,
725
17th
Street,
NW,
Washington,
DC
20503,
Attention:
Desk
Office
for
EPA.
Please
include
the
EPA
Docket
ID
No.
(
ORD­
2004­
0016)
in
any
correspondence.

B.
COLLECTIONS
OF
INFORMATION
EMPLOYING
STATISTICAL
METHODS
1.
Survey
Objectives,
Key
Variables
and
other
Preliminaries
1(
a)
Survey
Objectives
This
project
is
a
pilot
study
to
determine
feasibility
and
reliability
of
collected
data.
Data
collection
procedures
were
determined
based
on
a
thorough
literature
review
of
similar
studies.
1(
b)
Key
Variables
This
study
will
classify
young
children
into
two
age
groups:
6­
12
months
and
18­
24
months.
Because
some
studies
have
noted
a
difference
in
activity
levels
between
boys
and
girls
at
older
ages
(
Jackson
et
al.,
2003),
the
study
will
involve
approximately
equal
numbers
of
boys
and
girls.
1(
c)
Statistical
Approach
To
determine
the
number
of
subjects
to
be
included
in
the
study,
we
calculated
the
number
of
subjects
that
would
be
necessary
to
estimate
mean
movements
per
minute
for
a
range
of
confidence
interval
widths.
If
the
population
mean
is
215
movements
per
minute
while
awake
and
the
population
standard
deviation
is
15,
a
sample
size
of
22
subjects
is
needed
to
estimate
the
mean
to
within
7.5
movements
per
minute
(
one­
half
of
a
standard
deviation)
(
Table
1).
This
corresponds
to
being
able
to
7
detect
a
difference
of
15
movements
per
minute
in
the
value
of
two
means
(
the
mean
number
of
movements
per
minute
for
boys
and
the
mean
number
of
movements
per
minute
for
girls,
for
example)
with
a
power
of
89%.
Comparable
results
are
obtained
if
sample
size
estimates
are
based
on
movements
per
minute
while
sleeping.
These
standard
deviation
estimates
are
consistent
with
statistics
reported
in
the
literature.

Table
1.
Determining
Number
of
Subjects
Movements
per
Minute
While
Awake
Movements
per
Minutes
While
Asleep
Number
of
Subjects
Mean
=
215
(
SD
=
15)
Mean
=
21
(
SD
=
5)

Distance
from
mean
to
limit
10
7.5
5
3
2.5
2
Number
of
children
14
22
44
17
22
32
*
Based
on
a
2­
sided
confidence
interval
with
confidence
level
95%.

Attrition
must
be
considered
when
determining
the
number
of
subjects
required.
Subjects
may
become
ill
or
decide
to
discontinue
participation
during
data
collection.
Some
subjects
may
produce
unusable
data
because
of
extreme
(
and
irresolvable)
discrepancies
between
the
activity
diary
and
accelerometer.
Anticipating
attrition
of
10%
means
that
a
total
of
110
dyads
will
be
recruited
(
resulting
in
100
parentchild
dyads).
The
110
will
be
divided
into
the
four
age
groups
of
interest.
2.
Survey
Design
2(
a)
Target
Population
The
target
population
for
this
study
is
infants
and
toddlers
age
6
 
24
months
residing
in
the
Research
Triangle
Park,
NC
vicinity.
2
(
b)
Sample
Design
Because
data
collected
for
this
study
will
not
be
used
to
make
estimates
representative
of
children
ages
6
to
24
months,
but
will
instead
be
used
to
determine
the
most
effective
and
efficient
procedure
for
collecting
spontaneous
motor
activity
data,
this
study
will
not
utilize
random
sampling
procedures.
A
convenience
sample
will
be
drawn.
Participants
will
be
recruited
in
two
ways:
1)
parents
and
children
will
be
recruited
from
child
care/
day
care
settings
by
having
day
care
staff
distribute
a
letter
to
parents
of
children
4
months
and
older,
and
2)
community
flyers
will
provide
information
about
the
study
and
invite
interested
adults
to
call
a
toll­
free
number.
To
maximize
response
rates,
the
information
collection
will
1)
recruit
as
participants
only
those
who
express
interest
in
the
study,
2)
compensate
participants
for
travel
costs
and
time
and
3)
ask
simplified
items
in
the
checklist
participants
will
complete
as
their
diaries,
thus
decreasing
prospects
of
noncompliance.
4.
Pretests
and
Pilot
Studies
This
project
is
a
pilot
study
to
determine
feasibility
and
reliability
of
collected
data.
Data
collection
procedures
were
determined
based
on
a
thorough
literature
review
of
similar
studies.
8
Attachment
1
OMB
Control
No.
2080­
XXXX
Approval
expires
XX/
XX/
XX
The
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
8
hours
per
response.
Send
comments
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
through
the
use
of
automated
collection
techniques
to
the
Director,
Collection
Strategies
Division,
U.
S.
Environmental
Protection
Agency
(
2822T),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20460.
Include
the
OMB
control
number
in
any
correspondence.
Do
not
send
the
completed
form
to
this
address.

TIME
ACTIVITY
DIARY
AND
QUESTIONNAIRE
APPLICATION
OF
MEASURES
OF
SPONTANEOUS
MOTOR
ACTIVITY
FOR
BEHAVIORAL
ASSESSMENT
IN
HUMAN
INFANTS
CHILD
ID
NUMBER:

BIRTHDAY:
Month
Day
Year
AGE:
Months
WEIGHT:
Pounds
Ounces
HEIGHT:
Feet
Inches
TODAY'S
DATE:
Month
Day
Year
EPA
Form
#
5310­
8
9
TIME
ACTIVITY
DIARY
AND
QUESTIONNAIRE
During
the
day,
please
record
the
time
your
child
participates
in
the
activities
listed
below.
In
order
to
provide
the
most
accurate
information,
when
you
can
please
record
the
activities
as
they
happen
instead
of
waiting
until
the
end
of
the
day
and
recording
information
based
on
memory.

There
is
one
activity
chart
for
each
day
of
the
study.
Each
day,
please
enter
the
date,
day
of
the
week,
activity
code
for
each
activity,
the
time
the
activity
started
and
ended,
and
any
comments
about
the
activity
you
think
are
important.
If
you
are
unsure
of
how
to
code
the
activity,
please
write
the
activity
in
the
comments
box
and
we
will
code
it
for
you.
Please
record
all
activities
for
a
24­
hour
period.
The
time
activity
diaries
begin
on
the
next
page.
The
following
is
an
example
of
a
time
activity
diary
for
a
5­
month­
old
boy.

Example:

Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
01
6
:
30
A.
M.
P.
M.
6:
45
A.
M.
P.
M.
05
6
:
45
A.
M.
P.
M.
7:
30
A.
M.
P.
M.
06
7
:
30
A.
M.
P.
M.
8:
30
A.
M.
P.
M.
02
8
:
30
A.
M.
P.
M.
9:
45
A.
M.
P.
M.
01
9
:
45
A.
M.
P.
M.
10:
00
A.
M.
P.
M.
07
10:
00
A.
M.
P.
M.
11:
00
A.
M.
P.
M.
03
11:
00
A.
M.
P.
M.
11:
15
A.
M.
P.
M.
02
11:
15
A.
M.
P.
M.
12:
30
A.
M.
P.
M.
01
12:
30
A.
M.
P.
M.
1:
00
A.
M.
P.
M.
06
1
:
00
A.
M.
P.
M.
2:
30
A.
M.
P.
M.
02
2
:
30
A.
M.
P.
M.
4:
00
A.
M.
P.
M.
01
4
:
00
A.
M.
P.
M.
4:
30
A.
M.
P.
M.
09
4
:
30
A.
M.
P.
M.
4:
45
A.
M.
P.
M.
10
4
:
45
A.
M.
P.
M.
5
:
30
A.
M.
P.
M.
Grocery
store
09
5
:
30
A.
M.
P.
M.
5:
45
A.
M.
P.
M.
07
5
:
45
A.
M.
P.
M.
6:
30
A.
M.
P.
M.
03
6
:
30
A.
M.
P.
M.
6:
45
A.
M.
P.
M.
07
6
:
45
A.
M.
P.
M.
7:
30
A.
M.
P.
M.
04
7
:
30
A.
M.
P.
M.
8:
00
A.
M.
P.
M.
01
8
:
00
A.
M.
P.
M.
8:
30
A.
M.
P.
M.
_
06__/_
28_/_
2004_
Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
02
8
:
30__
A.
M.
P.
M.
12:
01_
A.
M.
P.
M.
Bed
time
Code:
Activity:
Examples:
Code:
Activity:
Examples:
01
Meals
Breakfast,
lunch,
dinner,
snacks,
bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,
but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,
bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
You
will
also
be
required
to
complete
daily
questions
regarding
your
child's
activities,
general
health,
and
routine.
The
daily
questions
begin
on
page
10.
On
the
last
day
of
the
study,
please
complete
the
questions
on
page
11.
10
Day
1
(
First
day
of
the
study)

Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
11
Day
2
Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
12
Day
3
Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
13
Day
4
Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
14
Day
5
Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
15
Day
6
Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
16
Day
7
(
Last
day
of
the
study)

Date
Day
of
Week
Activity
Code
Time
Started
Time
Ended
Comments
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

______/_____/_____

Month
Day
Year
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
____:___
A.
M.
P.
M.
____:___
A.
M.
P.
M.

Activity
Codes
Code:
Activity:
Examples:
Code:
Activity:
Examples:

01
Meals
Breakfast,
lunch,
dinner,
snacks,

bottle
feedings
07
Interactive
Play
Playing
with
another
persons,
such
as
a
sibling
or
parent
02
Sleeping
Night
time
and
nap
time
08
Watching
TV/
Video
Watching
television,
including
videos
or
DVDs
03
Crying
Any
crying,
including
tantrums
09
Travel
Time
Riding
in
a
car,
bus,
or
other
type
of
transportation
04
Bath
Time
Bathing
10
Shopping
Going
to
a
grocery
or
department
store
05
Quiet
Alert
Child
is
not
interacting
with
toys,

but
is
observing
surroundings
11
Preschool/
Daycare
Attending
a
daycare
or
preschool
06
Solitary
Play
Sitting
in
an
excersaucer,
swing,

bouncy
seat,
or
on
a
blanket
and
entertaining
them
selves
12
Outdoor
Play
Playing
on
a
swing
set,
swimming,
running
outside,
and
other
activities
that
cannot
take
place
indoors
17
Daily
Questions
Question
Day
1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
Date:
Date:
Date:
Date:
Date:
Date:
Date:

Was
the
child's
(
the
child
participating
in
this
study)
routine
or
activities
today
normal
for
a
typical
day?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Did
the
child
take
any
prescription
or
over
the
counter
medicines
today?
If
so,
what?

___________________________
___________________________
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Was
the
child
sick
or
ill
today?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Was
the
actigraphy
monitor
removed
or
did
it
accidentally
fall
off
today
at
any
time?
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________
Yes
No
If
yes,
what
time
did
this
occur:
__________

Approximately
how
much
time
did
the
child
spend
with
his
or
her
mother
or
primary
female
caregiver
today?
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
Approximately
how
much
time
did
the
child
spend
with
his
or
her
father
or
primary
male
caregiver
today?
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
<
1
hour
1­
2
hours
3­
4
hours
5­
6
hours
7­
8
hours
>
8
hours
18
Additional
Questions
to
be
Completed
on
the
Last
Day
of
the
Study
Question
Responses
Mark
all
that
apply.

Has
a
doctor
or
health
professional
ever
told
you
that
the
child
had
attention
deficit
disorder,

mental
retardation,
or
any
other
development
delay?
No
Attention
deficit
disorder
Mental
retardation
Other
developmental
delay
Please
specify:
___________________________

Does
the
child
have
any
impairment
or
health
problem
that
limits
his
or
her
movement
or
ability
to
crawl,
walk,
run,
or
play?
No
Yes
Was
the
child
born
prematurely?
No
Yes:
If
yes:
What
week
of
gestation
was
the
child
born?

_______________________

How
many
brothers
or
sisters
does
the
child
have?
0
1
2
3
or
more
Where
do
you
live?
In
a
city
In
a
suburb
In
the
country
(
rural
area)

On
a
farm
What
is
the
highest
level
of
school
the
child's
mother
has
completed?
Less
than
high
school
High
school
diploma
Technical
or
trade
school
Some
college,
no
degree
2
or
4
year
degree
Graduate
degree
What
is
the
highest
level
of
school
the
child's
father
has
completed?
Less
than
high
school
High
school
diploma
Technical
or
trade
school
Some
college
2
or
4
year
degree
Graduate
degree
19
Attachment
2
Description
and
Domains
of
ITSEA,
IBQ
and
PDMS­
2
ITSEA
and
IBQ
Personality
characteristics
such
as
temperament
affect
a
person's
movement
or
activity
level.
Researchers
have
noted
that
one
of
the
consistent
dimensions
of
temperament
across
time
is
that
of
activity
level
(
Thomas
&
Chess,
1977).
The
ITSEA
is
suitable
for
use
in
6­
12
month
old
infants.
The
following
chart
summarizes
the
domains
of
temperament
and
sample
question
items
the
ITSEA
uses
to
measure
these
domains.

ITSEA
Behavior
Domain/
Scales
Sample
Items
from
ITSEA
Externalizing
Scales
Activity/
Impulsivity
Is
restless
and
can't
sit
still
Aggression/
Defiance
Has
temper
tantrums
Peer
Aggression
Hits,
shoves,
kicks,
or
bites
other
children
Internalizing
Scales
Depression/
Withdrawal
Looks
unhappy
or
sad
without
any
reason
General
Anxiety
Worries
a
lot
or
is
very
serious
Separation
Distress
Hangs
on
you
or
wants
to
be
in
your
lap
when
with
other
people
Inhibition
to
Novelty
Is
quiet
or
less
active
in
new
situations
Dysregulation
Scales
Sleep
Must
be
held
to
go
to
sleep
Negative
Emotionality
Has
trouble
calming
down
when
upset
Eating
Refuses
to
eat
foods
that
require
chewing
Sensory
Sensitivity
Won't
touch
some
objects
because
of
how
they
feel
Competence
Scales
Compliance
Tries
to
do
as
you
ask
Attention
Sits
for
5
minutes
while
you
read
a
story
Imitation/
Pretend
Play
Hugs
or
feeds
dolls
or
stuffed
animals
Mastery
Motivation
Enjoys
challenging
activities
Empathy
Is
worried
or
upset
when
someone
is
hurt
Prosocial
Peer
Relations
Takes
turns
when
playing
with
others
20
Attachment
2
(
continued)

IBQ
The
IBQ
is
applicable
for
assessment
of
temperament
in
the
18­
24
month
old
infants.
It
includes
a
total
of
94
items
on
six
scales;
Activity
Level,
Smiling
and
Laughter,
Fear,
Soothability,
Distress
to
Limitations,
Duration
to
Orienting.
There
are
seven
response
options,
ranging
from
"
never"
to
"
always"
as
well
as
a
"
does
not
apply"
option.

PDMS­
1
Gross
and
fine
motor
development
follows
a
consistent
trajectory
throughout
development.
The
PDMS­
2
measures
this
development
in
six
specific
domains.
These
domains
are
listed
in
the
chart
below
with
a
more
complete
description
of
each
domain.

PDMS­
2
Scale
Domains
Description
of
Measure
Gross
Motor
Reflexes
Child's
ability
to
automatically
react
to
environmental
events.

Gross
Motor
Stationary
Child's
ability
to
sustain
control
of
his
or
her
body
within
its
center
of
gravity
and
retain
equilibrium.

Gross
Motor
Locomotion
Child's
ability
to
move
from
one
place
to
another
by
crawling,
walking,
running,
hopping,
and
jumping
forward.

Gross
Motor
Object
manipulation
Child's
ability
to
manipulate
balls
by
catching,
throwing,
and
kicking
(
because
these
skills
are
not
apparent
until
a
child
has
reached
the
age
of
11
months,
this
subtest
is
only
given
to
children
ages
12
months
and
older).

Fine
Motor
Grasping
Child's
ability
to
use
his
or
her
hands.
It
begins
with
the
ability
to
hold
an
object
with
one
hand
and
progresses
to
actions
involving
the
controlled
use
of
the
fingers
of
both
hands.

Fine
Motor
Visual
motor
integration
Child's
ability
to
use
his
or
her
visual­
perceptual
skills
to
perform
complex
eye­
hand
coordination
tasks
such
as
reaching
and
grasping
for
an
object,
building
with
blocks,
and
copying
designs.