QUESTIONNAIRES FOR STUDY

NOTE: Questionnaires are in PDF format.
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Screening

• Core Consent Forms (Version 10)
• Parent/Guardian Interview: PreRandomization Eligibility Review
• Participant Referral Sheet
• Pre-Randomization Eligibility Review
• Residence Information: Pre-Randomization Visit 1

First Visit

• Participant Tracking Form
• Review of Eligitility Lab Results: Pre-Randomization Visit 1
• Pre-Randomization Visit 1
• Repeat Eligibility Lab Work: Pre-Randomization Visit 1A

Diaries

• Medicine Diary
• Vitamin Diary

Home Assessment, Inspection & Cleanup

• Home Characteristics
• Home Assessment Log
• Home Visual Inspection
• Home Floor Plans
• Dustwipe Collection
• Home Cleanup
• Environmental Eligibility Review

Second Visit

• Family Characteristics Interview
• Report of Ineligibility: Visit Non-Compliance
• Report of Non-Enrollment
• Pre-Randomization Visit 2 or 2A

Initial Psychometric Assessment

• Psychometric Assessment for Younger Children
• Review of Tapes of Psychometric Assessment for Younger Children
• Wechsler Adult Intelligence Scale for Parents

Randomization and Treatment

• Randomization
• Local Lab Review
• Initiation of Treatment
• Review of Medications and Physical Exam: Treatment Day 7
• Review of Medications and Physical Exam: Treatment Day 28
• Treatment Day 42
• Retreatment
• Adverse Drug Experience Case Report Form

Followup

• Medical Followup
  • Annual Followup Visit
  • Midyear Followup Visit
• Psychometric Assessment Followup Visits
  • Psychometric Assessment for Older Children
  • Review of Tapes of Psychometric Assessment for Older Children
  • NEPSY Session Data for TLC Children