Language and Adjustment Scales for the Thematic JLT CS HES | U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Vital and Health Statistics-Series 2-No.58 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 - Price $1.05 Series 2 DATA EVALUATION AND METHODS RESEARCH Number 58 Language and Adjustment Scales for the Thematic Apperception Test for Children 6-11 Years A report on the development and standardization of objective scoring procedures for five cards of the TAT used in the Health Examination Survey of children 6-11 years of age. DHEW Publication No. (HRA) 74-1332 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration National Center for Health Statistics Rockville, Md. December 1973 NATIONAL CENTER FOR HEALTH STATISTICS EDWARD B. PERRIN, Ph.D., Director PHILIP S. LAWRENCE, Sc.D., Deputy Director - GAIL F. FISHER, Assistant Director for Health Statistics Development WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development JOHN J. HANLON, M.D., Medical Advisor JAMES E. KELLY, D.D.S., Dental Advisor EDWARD E. MINTY, Executive Officer ALICE HAYWOOD, Information Officer DIVISION OF HEALTH EXAMINATION STATISTICS ARTHUR J. McDOWELL, Director GARRIE J. LOSEE, Deputy Director HENRY W. MILLER, Chief, Operations and Quality Control Branch JEAN ROBERTS, Chief, Medical Statistics Branch LINCOLN I. OLIVER, Chief, Psychological Statistics Branch HAROLD J. DUPUY, Ph.D., Psychological Advisor COOPERATION OF THE BUREAU OF THE CENSUS In accordance with specifications established by the National Health Survey, the Bureau of the Census, under a contractual agreement, participated in the design and selection of the sample, and carried out the first stage of the field interviewing and certain parts of the statistical processing for the Health Examination Survey. Vital and Health Statistics-Series 2-No. 58 DHEW Publication No. (HRA) 74-1332 Library of Congress Catalog Card Number 73-600035 FOREWORD This report summarizes research carried out under a research contract with the National Center for Health Statistics by the Institute of Behavioral Research, Texas Christian University, on the develop- ment of objectively scored cognitive and affective scales for the The- matic Apperception Test (TAT). The data for the study were obtained from story protocols given in response to the five-card, orally ad- ministered and tape-recorded version of the TAT used in the Health Examination Survey of children 6-11 years old completed in 1965, In keeping with the survey's focus on characteristics associated with growth and development, the TAT research was directed toward the construction of an objective scoring system and the formulation of scales useful in the assessment of psychological development and normal behavior. The objectives and procedures of the present study stand in sharp contrast to the usual clinical utilization of the TAT. In typical clinical assessment practice, the TAT is administered in order to confirm hypotheses about maladjustment and personality pathology which the clinician has inferred from his knowledge of an individual's life history and from the individual's responses to other instruments, both objective and projective. In that type of use, standard scoring procedures are of little interest, and protocols are usually recorded by the clinician him- self, Each clinician may use his own idiosyncratic set of notes and symbols, and his diagnosis or decision is largely a matter of subjective interpretation. With regard to the content of the TAT scales, the approach followed in this study was based on the Center's concern in the children's survey with a broad range of developmental aspects. The research was de- signed to explore various aspects of psychological development, cognitive as well as emotional, which the TAT protocols might illuminate, The TAT cognitive-verbal scales identified in the analysis were more highly correlated with the cognitive criterion measures used than were the TAT affective scales with the adjustment criteria. This may reflect in part on the adjustment criteria developed. However, the relationships between attitudes expressed in fantasy and overt behavior are always indirect; a more appropriate test of validity of these personality- affective scales might be based on other personality measures as criteria. In assessing the contribution of this TAT research, the criticism might be leveled that the objective scales are merely another measure of verbal ability, In actuality, the TAT language scales represent innovative measures of oral speech based on controlled samples of spontaneously produced speech and represent an important original contribution, That the TAT scales provide a basis for scoring verbal factors from actual samples of speech should be of considerable interest to linguistic scientists as well as to psychologists. Janice Neman of the Institute of Behavioral Research assisted in preparing the report on this study for publication, Arthur J, McDowell, Director Division of Health Examination Statistics National Center for Health Statistics SYMBOLS Data not available e-eeoeeemeeeeeeeeeeeeeen Category not applicable---------reememmemeeeeeeee QUANLitY ZErO------ersermrmmrmermrmmemeeme meneame een Quantity more than 0 but less than 0.05----- Figure does not meet standards of reliability or precision------------seeeeeeeeeeeee CONTENTS Page Foreword --=-----c-ommmmm meme meee iii Objectives and Background-------==--=-cmmmmmmmmm cme eee em 1 Research Design and Procedures for Study I----------oomomoommm—- 2 Results of Study I-==-=-m- momo mmm 5 Summary and Discussion of Study [--=----=-----mccmmmmmm mo 6 Plan of Study II-=-==-== common mmm mee eee 7 Criterion Data------=-==== cme 7 TAT Analysis and Scoring---------==----ccmommm meme emo 8 Development of Criterion Scales-------==ccmcmmmmmm meee 9 Criterion Factor I—School Adjustment-----=-------c-cmmmmmmmmm oo 9 Criterion Factor 1I——Poor Health---=-=-==commmmm meee eee 9 Criterion Factor IlI—Intellectual Development-------=------c-oocoooo-- 11 Criterion Factor IV—Social Adjustment------=--=--ccmmcmmmmomoomoo 11 Criterion Factor V—Emotional Disturbance----------=ccooccocono- 11 Relationships Among Criterion Factor Scores and Age, Sex, and Race---- 11 Relationships of Age With Items Used To Define Criterion Factors------- 12 Development of the TAT Sclaes--Structural and Thematic Data------------ 12 TAT Factor I-——Verbal Productivity-----==--ccccmmmmmm meme mmmo— 13 TAT Factor II—Dysphoric Mood--======mcccmmmmm meme 16 TAT Factor IlI—Conceptual Maturity-----=--=---ccommmmmome coe 16 TAT Factor IV—Narrative Fluency--------===-o-ccmmmmmmmmme ooo 16 TAT Factor V—Emotionality-----=-ccccmmmmmmm meme oo 16 TAT Factor VI—Verbal Fluency-----===-==-c-ommmmmmmmm memo 16 Validation of the TAT ScalesS----===--cccmmmmm mmm 17 Relationships Among Composite Scores on TAT Factors, Age, Sex, and RaCE-==m mmm mmm mmm mmm meee 18 Relationships Between TAT and Criterion Composites---==-==--=-=-=------ 18 Correlated and Uncorrelated TAT Factors----------==ccemeeocoomuooo- 18 Multiple Regression Analysis-------=--=-=cmommmmmmmmommo oncom 20 Development and Use of the National Norms=-------====c-o--cmoomoomoooo- 20 References = ======= === moomoo momen mmm mmm 24 vi CONTENTS—Con. List of Supplementary Tables-----=====m-mmmmm meme eee meme emo Appendix I, Description of the Samples--------=-=-omcmmmmm ao Cycle II of the Health Examination Survey------------eoocoomoomommooo- STRAY 1 BRITT wr tm mt 00 SENAY TT SOATTUDLE rere 0 2 282 0 0 0 0 0 0 0 00000 Appendix II, TAT Scoring Manualg-----=-cem comme Structural Scoring Manual--=----- comm. Thematic Scoring Manual---= === oo mm mmm Appendix Ill, Questions From Cycle II Health Examination Survey Forms Used in This Study-=-========= mmm mmm eee Appendix IV, Conversion Table and Percentile Equivalent Table----------- Appendix V. Weights for the 31 TAT Variables on the Six Uncorrelated Factors-----m-m momo mm mee 43 43 53 60 64 70 LANGUAGE AND ADJUSTMENT SCALES FOR THE THEMATIC APPERCEPTION TEST Ronald S. Neman, Thomas S. Brown, and S. B. Sells, Institute of Behavioval Research, Texas Christian University OBJECTIVES AND BACKGROUND This report summarizes research on the development of objectively scored language and emotionality scales for afive-card, orally admin- istered and tape-recorded version of the The- matic Apperception Test (TAT) used inthe Health Examination Survey (HES) of children conducted by the National Center for Health Statistics in 1963-65. National norms for children ages 6-11 are presented for these scales, Two studies were carried out to develop the scales and national norms. Study 12 involved the development of scoring manuals, criterion measures, and TAT scales, as well as validation studies in which the TAT scales were treated as independent variables and the criteria as depend- ent variables, In that study major emphasis was placed on creation of usable scales, The sample of 1,224 cases employed was chosen on the basis of completeness and quality of TAT protocol from among the children examined in the first 19 of the 40 locations or 'stands' in which ex- aminations took place in the national survey, Study II is the major focus of the present report, It was carried out on an enlarged sam- ple which incorporated a probability subsample of the total 7,119 children examined in the second program (Cycle II) of the Health Examination Survey (appendix I), Study II involved cross-vali- dation and refinement of the earlier study, as well as provision of national norms for the scales. The five-card version of the TAT was ad- ministered as part of the psychological test battery included in Cycle II, That program fo- cused on the population of noninstitutionalized children ages 6 through 11 in the United States, Since the prevalence of chronic disease in the target population of Cycle II is low, attention was directed to measurement of characteristics as- sociated with growth and development, The total examination of each child, administered in spe- cially designed mobile examination centers by a team of qualified professional examiners, in- cluded measures of visual and auditory acuity, anthropometric measures, dental examination, tests of respiratory function and exercise tol- erance, X-rays, and other physical examination tests and procedures, as well as the psycholog- ical test battery. Details regarding the plan and operation of the survey can be found in another report, ? The individually administered psychological test battery included the Vocabulary and Block Design subtests of the Wechsler Intelligence Scale for Children (WISC), the Reading and Arith- metic subtests of the Wide Range Achievement Test (WRAT), and the Draw-A-Person Test (DAP) scored on the Goodenough-Harris scales, in ad- dition to the TAT, The TAT was chosen mainly because of its potential for personality-emotion- ality measurement within the constraints of the survey and its requirements, while the other tests were selected primarily as intellectual- cognitive measures, The cards included in the specially adapted version of the TAT were: card 1 (boy contem- plating violin on table), card 2 (girl with books beside farm family scene), card 5 (woman at doorway looking into room), card 8 BM (boy with "operation scene' in background), and card 16 (blank card). The cards were individually pre- sented to each child, who was asked to imagine and relate a story. Responses were obtained orally, tape recorded, and later transcribed. All cards were shown to both boys and girls, even though card 8 BM is traditionally not shown to girls. The Cycle II battery was evaluated for the National Center for Health Statistics (NCHS) by Sells,* who noted with respect to the TAT: (1) that no single personality test for children known then (at the time the HES Cycle II was planned) could be recommended without qualification; (2) that because of its very general use in school and clinic, the TAT had widespread acceptance; and (3) that the planners of Cycle II believed that psychometrically acceptable scales for the TAT could be developed from the survey data, and they opted for technically sound measures in preference to the imperfect information that would be forthcoming from published self-reportmeas- ures, Although other projective procedures might have been similarly used, the TAT was the method preferred. Although inclusion of the TAT in the battery was determined mainly by interest in its rel- evance for measurement of affective functioning and personality, the experimental scoring man- uals were prepared to measure developmental aspects of oral language as well, This recom- mendation by the principal investigator was ac- cepted by the NCHS staff on the grounds that since language development data were avail- able, they should be examined, and that such examination was congruent with one goal of the survey—the investigation of the prevalence of pathology in psychological development of Amer - ican children ages 6 through 11. Within such a frame of reference, language developmentscales could be considered at least as relevant as personality-emotionality measures, and their in- clusion in the research in addition to the the- matic and structural indicators of emotionality was eminently appropriate. Research Design and Procedures for Study | Study 1! was mainly an exploratory effort with the following related goals: first, to de- velop procedures and scoring categories rel- evant to the survey goals; then, to identify meas- urable variables that would be sensitive to the range of responses to the TAT cards; next, to construct criterion measures of psychological development and adjustment from information available in the Cycle II survey; and finally, to determine how the TAT variables relate to the criterion scales once constructed. As noted ear- lier, major attention was focused on these goals, and the sample selected from the total file of transcribed records was chosen, within each age- sex group, mainly with regard to completeness of data and quality of protocols available, The general plan for this study involved the following steps: (1) development of experimental scoring manuals; (2) development of criterion measures of behaviors presumed to be meas- urable by analysis of the TAT protocols; (3) se- lection of experimental samples of children for the development and validation of the measure- ment scales; (4) scoring of the samples; and (5) validation of items, development of scales, and development of provisional norms based on the experimental samples. Scoring Manuals,—Two related scoring man- uals were developed; they are reproduced in ap- pendix II. These consisted of the Structural Scor- ing Manual, designed to analyze oral language usage and style, and the Thematic Scoring Man- ual, which stressed evaluation derived from story content, While both were believed to have de- velopmental as well as personality significance, the major emphasis was on language development in the Structural Manual and on aspects of emo- tionality and adjustment in the Thematic Manual, A review of the literature’ indicated that, although based on small samples, a number of previous efforts to analyze childrens' TAT pro- ductions quantitatively—in terms of length, parts of speech, and other formal characteristics— had produced developmental criteria of suf- ficient promise to encourage a large-scale ef- fort along these lines, The Structural Scoring Manual developed for this type of quantitative analysis included 67 items for scoring in the fol- lowing categories: time latency between instruc- tions and response; total time; count of total words; frequency counts of about 20 parts of speech, defined in accordance with a standard text; a number of stylistic speech characteristics, such as questions, interpolations, dialogue, and contradictions; queer verbalizations; mispercep- tions of card content; compliance with instruc- tions as to past, present, and future content; expressions of feeling and thinking; story out- comes; and the use of causally connected and purposefully connected statements, Previous studies have used many of these items; refer- ences to them are given in Sells’ review.! The 21 items to be scored in the Thematic Scoring Manual cover complexity of thematic elaboration; representation of manifest card con- tent in stories; misperceptions and coherence of character reference; indicators of morbid mood, bizarre quality, religious content, con- fusion, escape, egocentrism, fantasy, fear, wealth, poverty, and projection; expression of hostility and affection in characteristic interpersonal re- lations; assignment of selected traits or behav- iors to story characters (such as kind-loving, mean-rejecting, happy-glad, murder -killing); and analysis of goal orientations and story outcomes, The scoring of these items was categorical, in most cases, and areas of ambiguity were re- solved by the adoption of arbitrary rules, which are given in the instructions for scoring in ap- pendix II, Development of TAT Scoring Procedures,— In this review only brief attention can be given to the problems that arose in the series of steps leading from raw protocols to a set of tentative norms, Nevertheless, some of these steps de- serve mention because the quality of control ex- ercised at each step in the analysis was in part responsible for the successful outcome of the study. In order to remove irrelevant examiner var- iance from the protocols it was necessary to formulate strict rules to define both the begin- ning and the end of the scored protocol repre- senting each story response, These are given in the Structural Scoring Manual, appendix II, Ac- cording to these rules, a story is considered to begin at the point where the respondent starts to relate his response; this may be preceded by questions of the respondent or by efforts of the examiner to persuade the child to respond, Nor - mally a story is considered to end when the sub- ject stops or when he comments that the story is concluded. However, the rules provide gen- eral guidance to recognize leading questions or promptings by examiners which account for in- admissable content, Under these rules, post- story inquiries are excluded as well, Questions" by the examiner to clarify mumbled speech, or comments of a supportive nature, such as 'yes," "uh huh," which introduce no extraneous content, are not considered as bases for exclusion, The problem of determining story bound- aries is inseparable from that of defining the TAT response, Ideally, the examiner gives the in- structions and then presents the TAT cards to the subject, one by one, The subject, in turn, tells a story, and then turns over the card, in- dicating that the story is completed. In fact, however, it was found that the story related is often a product of sometimes subtle and some- times not so subtle interactions between the ex- aminer and subject, These interactions include reinforcements given to the subject, promptings by the examiner, and questions by the subject concerning the story form and adequacy, before, during, and following the telling of the story. Resolution of this problem is not an easy one, From the clinical viewpoint, the "extraneous," nonstandardized behaviors and the thematic pro- duction may be of equal value; story content given following a prompt may be considered a direct continuation of that given prior to the prompt. The problem is not unique with the TAT however; all measures employing unrestricted or open-ended responses are subject to wide variations in scores as a result of factors such as those mentioned above, The requirement for psychometric application is different, however, and the procedures accepted for the studies re- ported here have been to set up rather arbitrary standards for administration and responding and to accept only those responses or portions that fit within the predetermined standards. Failure to produce a scorable story in re- sponse to any card stimulus was scored as a re- jection for that card. Rejections were most easily scored when a child failed to respond at all, In some cases rejection was scored, despite a lengthy protocol, if application of the rules defining story boundaries rendered the response unscorable, In developing scores for sets of pro- tocols, particularly in the case of word counts and counts of other specific categories of re- sponse, it was determined that the results would be more meaningful if rejections were left un- scored than if scored as zero. When this was done, item scores were computed as averages across cards that could be scored. One aspect of reliability concerned the con- sistency with which a single scorer assigned the story content to scoring categories from story to story, as well as his accuracy for scor- ing each story and variable, In addition, since there were several scorers, it was necessary that all scorers respond in a similar manner to a single given protocol. A second aspect con- cerned the degree to which items could be scored reliably by different scorers (scorer agreement), Reliability was easily obtained with word count items, but greater training and experience were required to gain suitable levels of reliability for some structural items, such as situation com- plexity (item 53 in Structural Scoring Manual, appendix II). An extensive report on the reli- ability of variables and on scorer agreement in this study is available elsewhere.!»2 However, the essential findings of the reliability studies are briefly mentioned here. The median test- retest reliability coefficients of the five TAT cognitive scales that were developed (these scales are discussed under Results of Study I, below) were as follows: Verbal productivity 73 Maturity of language structure 37 Conceptual maturity 25 Maturity of language style .60 Thematic scale .43 The average interscorer agreement for eight scorers over all items in both scoring manuals was 94 percent, The outcome of the efforts to achieve op- timal "process control" in scoring was the se- lection of a set of variables for which acceptably reliable scoring could be obtained and the de- velopment of training procedures whereby such variables could be used reliably by nonprofes- sional personnel after 8 to 10 hours of super- vised training, Selection of Children, — Approximately 100 boys and 100 girls in each of the six age intervals 6 through 11 years were selected for the study. These children were selected from 17 locations or stands of the 40 stands® which constituted the entire Cyclé II national survey, A descrip- tion of both the HES Cycle II sample and the Study I sample is provided in appendix I. Criterion Measures,~—In order to have in- dependent criterion measures of development and adjustment with which to validate the TAT scales that were developed, major effort was devoted to the availability of relevant information from other parts of the HES. In addition to the other psychological tests administered, it was possible to obtain copies of interviews with mothers and teachers as well as reports from school authorities containing information on health, social adjustment, grades, scholastic performance, and other aspects of general life adjustment of the children in the sample. Ques- tionnaires used by the HES for gathering this in- formation are discussed and reproduced in an- other NCHS publication. ? The criterion measures, or scales, em- ployed in this study can be divided into two cat- egories: development and adjustment. The de- velopmental measures were chronologic age and an index of expected performance on cognitive functions, as measured by the Vocabulary and Block Design subtests of the WISC, Draw-A-Per- son, Reading and Arithmetic subtests of the WRAT, and by school reports of grade placement and scholastic performance. Adjustment is at best a vague concept, but the home and school reports were exploited as completely as possible to develop scales re- flecting aspects of personal and social adjust- ment defined in terms of the component items, Four criterion scales—reflecting social adjust- ment, health history (both as evaluated by the mother), and scholastic adjustment—were con- structed from items in the various HES forms: scale 1, intellectual adjustment (from school form HES-243, Supplemental Information from School); scale 2, school social adjustment (from the same school form); scale 3, social malad- justment (from parent form HEW-257, Child's Medical History-Interviewer); and scale 4, med- ical history (from parent form HES-256, Child's Medical History-Parent), The questions used to define the criterion measures are discussed in the report on Study I. Because of the exploratory nature of the study, it was decided not to use factor analysis in the preliminary analysis of the: criterion data, (The factor analytic approach was used in Study II.) Instead, items were chosen which reflected par- ticular aspects of (1) adequacy of performance in school; (2) social adjustment to the school situation and to peers; (3) mother's evaluation of conduct, emotionality, and peer adjustment; and (4) developmental medical history. The four scales were then constructed as follows: items considered by the investigators to be similar in content were summed, then, individual items were correlated with these content-defined sum scores, and finally, items showing marked in- tercorrelations were selected to comprise the criterion scales. In addition ‘to the foregoing, two derived scales were used—one, a linear combination of the last three scales, and the other, a weighted composite of the common fac- tor contributions of the four scales. Interpretation of the four original and two derived scales led to considerable speculation about the nature of the concept of adjustment, A noteworthy finding was the lack of substantial interrelation among the scales described above, The implication of these findings was either that the results reflected a series of independent, instrument-specific measures or that adjustment is a highly specific concept, tied closely to the background .u wnich it is considered and to the scale of values along which it is measured. The converse term, maladjustment, would necessar- ily be generally meaningless unless the refer- ence group and the norms of conformity for each source group were specified. The specificity of variance associated with each of these scales foreshadowed the results of the validation studies for the TAT thematic scale discussed below, These criterion findings have implications for those who would study delinquency from the point of view that its roots lie in maladjustment as judged in domains such as the school and home. The lack of correlation among measures of these different aspects of adjustment raises questions concerning the wisdom of attempting to predict delinquency on the basis of poor adjustment in the home or school. It is no wonder that parents are often shocked upon finding that ''Johnny, who has always been such a good boy," may also be a budding car thief, Item Validation of Developmental Scales, — For the items scored on the Structural Manual, item scores were computed across the five cards, with the exception that card rejection was not included as a score, Item scores were then averaged for five or fewer cards. Each item was analyzed first for discrimination of chronologic age, using a one-way analysis of variance design. Correlations with age and with intelligence, read- ing, and arithmetic tests in the HES battery were computed for the total sample, for all items that discriminated age significantly. Results of Study | Extensive factor analytic investigations by age and sex groups led to the identification of five age-related scales, or factors, These factors were as follows: I: Verbal productivity—This scale was de- fined in terms of numbers of verbs, nouns, pronouns, and other count items and measures of the quantity of sponta- neous verbiage produced. II: Maturity of language structure—This scale reflected differential use of parts of speech as a function of age and was defined chiefly in terms of adverbs, pronouns, and verbs, As such it indicated age-related changes in proportional use of various structural elements of language. III: Conceptual maturity—This scale was de- fined in terms of four variables: level of interpretation, situation complexity, out- come, and causally connected statements, It reflected the complexity of the con- ceptual content of the stories, independ- ently of vocabulary complexity. IV: Maturity of language style—This scale was defined by high loadings for proper nouns, first person pronouns, exclamations and comments, questions, dialogue, verbatim repetitions, and expletives, It was inter- preted as a measure of stylistic variations in the forms of the story narrative, V: Thematic—This scale was defined in terms of the following variables: escape, fantasy, fear, hostile antagonism, and the character attributes aggression, kind-loving, and happy-glad. The maturity of language structure, maturity of language style, and conceptual maturity scales appeared related to a common factor apart from verbal productivity, The maturity of language style scale was less well defined than the four other (primary) scales. Tentative analysis of the thematic items led to a scale which shared some common variance with the cognitive scales and which showed prom- ise as an adjustment predictor. Summary and Discussion of Study | This study was undertaken for the purposes of developing (1) standardized scoring procedures and (2) useful measurement scales for a psycho- logical test consisting of five TAT cards admin- istered individually to a national probability sam- ple of children in the United States in the age range 6 through 11 years, Criterion measures of development and adjustment were used to val- idate scoring items and measurement scales. Two scoring manuals were developed, a Structural Manual and a Thematic Manual (ap- pendix II), Acceptable levels of reliability were attained for the items in each manual, The items of the Structural Manual consisted of about 20 parts of speech, the number of words, a number of speech characteristics, and miscellaneous items, most of which were scored by quantitative counts, The items included in the Thematic Man- ual were based primarily on story content, such as complexity of theme, assignment of traits or behaviors to story characters, and expressions of hostility or affection in interpersonal relations, Five TAT scales were constructed which were significantly associated with development or adjustment as measured by age and scales de- veloped from questionnaire data. These scales are briefly described- as follows: (I) verbal pro- ductivity, a factor-analytically derived, age- related scale based on measures reflecting quan- tity of verbal output; (II) maturity of language structure, an age-related measure of the rel- ative frequency of use of certain language struc- tures in the spoken language of the child; (III) conceptual maturity, an age-related measure of level of conceptual complexity of spoken lan- guage; (IV) maturity of language style, a mod- erately age-related scale based on common stylistic and expressive characteristics of spoken language; and (V) thematic scale, the best single TAT predictor of a criterion of adjustment, which was only moderately correlated with age, While this exploratory study, in general, gave promise for the TAT mainly as an instru- ment to assess cognitive aspects of oral lan- guage development, there were some results which, while negative in tone, were informative as far as the process of behavioral prediction is concerned. These negative results were the approximately zero correlations among criterion clusters, and with a few exceptions, the relatively low intercorrelations between TAT scales and adjustment criterion measures. The crite- rion data tended to be composed of many unique clusters sharing little common variance. Con- sequently prediction of adjustment by the TAT scales was restricted, The lack of personality criterion data forestalled validating the TAT scales as personality measures, PLAN OF STUDY II Study II was in part a continuation of the ob- jective of scale development reported in Study I, but this phase used more sophisticated analytic techniques. A second important objective was to provide national norms for the scales developed by using a probability subsample of the 7,119 children examined in Cycle II of the Health Ex- amination Survey. In the developmental portion of the study, the total available sample of both studies was included in order to maximize the number of records on which the basic scales and statistical analyses were based and to increase reliability of the data. Only the probability sub- sample drawn from the entire Cycle II sample was used in computing the norms presented, The analysis of TAT protocols and develop- ment of standardized scales progressed through several stages. The basic research design in- volved the following separate phases: 1. Development of criterion measures for validation of the TAT scales; the criteria were derived from information available from HES records as source documents. 2. Development of measurement scales for the TAT using structural and thematic variables for which scoring manuals had been developed and standardized in Study I 3. Validation of measurement scales for the TAT by correlational analysis involving criterion measures, as well as age, sex, and race. 4, Development of norms based on the na- tional probability sample. The first three phases were conducted using a sample which combined cases from the Study I sample with those of the national probability sample. Inasmuch as the sample sizes varied in the several parts of this complex study, a detailed explanation of the Study II samples is presented in appendix I for the convenience of the reader. It is hoped that the presentation will avoid confusion and unnecessary cross-checking to account for variations, Criterion Data The Division of Health Examination Statistics of the National Center for Health Statistics fur- nished the following data on each child in both Study I and II: age at the time of testing; sex; race-ethnic status; family background; scores on WISC Vocabulary and Block Design tests; scores on the Draw-A-Person Test derived from the Goodenough-Harris scales; scores on the Wide Range Achievement Test, 1965 Revision, Reading and Arithmetic subtests; and forms containing information gathered from parents and school personnel relating to the child's health history, current behavior, adjustment, and school per- formance. (An earlier NCHS publication’ de- scribes the methods and shows the forms used for collecting these data, The specific questions and answers used in this study are shown in ap- pendix III.) These data were available on 2,012 children in the combined sample and were used in the development of the criterion measures described next. Four criterion scales, identicalinitem com- position to those described in Study I (reference 1, pp. 25-29, and reference 5), were computed for 2,012 cases of the total sample. (Six cases with missing criterion data were excluded from the criterion analysis.) In order to expand and possibly to improve on the criterion analysis reported in Study I, it was decided to factor analyze matrices of cri- terion variables for the total sample. Initially, a matrix of 68 items was generated including: 1. The four criterion scales developed in Study I (see pp. 4 and 5.) 2. Forty-nine behavior adjustment, medical history, and school performance items, used to develop the above four scales in Study I. 3. Five intellect-related scales: WISC Block Design, WISC Vocabulary, Draw-A-Per- son, WRAT Reading, and WRAT Arith- metic (also used in Study I). 4, The following five additional measures, not used in Study I: skipped a grade, re- peated a grade, rural versus not rural, family income, and foreign language in the home. 5. Five control variables: age in months, sex, race, sample I versus sample II in the replication design, and manually recorded versus transcribed stories. The four original criterion scales were in- cluded in the correlation matrix for the purpose of comparison with the earlier results as well as for assessment of the scales for internal con- sistency and validity. However, the four scales were excluded from the factor analysis because their spurious (part-whole) relationship with the items would have confounded the factor analytic results; afterwards, they were correlated with the factor analytically derived criterion scales. The WISC and WRAT subtests and the DAP as well as the five additional conceptually re- lated items (skipped a grade, repeated a grade, rural vs, not rural, family income, and foreign language in the home) were expected to cluster with the items comprising criterion scale 1 of Study I, intellectual adjustment. Three of the five control variables (age, sex, and race) were included in the factor analysis in order to assess their association with the derived factors. TAT Analysis and Scoring The analysis of the TAT data represented the largest and most demanding task in this study. Technical adequacy of the recordings of the tran- scribed protocols was an.important consideration in the selection of cases in Study I. In that study the emphasis was on scale development, and an effort was made to maximize the usefulness of records while less emphasis was placed on sam- pling adequacy. As a result, every child included in the first study had actually produced a scor- able protocol and had complete criterion data, In the present study some information was un- fortunately lost due to technical problems. A re- view of sample children for whom inadequate data necessitated omission is presented in ap- pendix I. The Structural and Thematic Manuals (ap- pendix II) described in the earlier study! were used to score all 2,018 cases, including the ad- ditional cases (n=1,022) selected for the present study for whom TAT protocols were available, Two teams of scorers scored the entire set of additional protocols; each team included a sen- ior and a junior scorer. The junior scorers were undergraduate college women with backgrounds in English grammar, and their duties were to score all "count" type items. The senior scorers were women with college degrees who had re- ceived training as scorers during Study I; their duties were to score the remaining items and to supervise the work of the junior scorers. Following is a brief resume of the extent of card rejection, which substantiates points made in the earlier study regarding the requirement for objective standards in delineating story bound- aries, Furthermore, as shown later, card re- jection was a key defining variable in one of the cognitive factors (factor III, conceptual maturity) developed for this version of the TAT. Card Rejections,—Story boundaries were defined as in Study [ (see pp. 3 and 4) and as outlined in the Structural Scoring Manual in ap- pendix II. Failure to produce a scorable story in response to any card stimulus was recorded as a rejection for that card. Rejections were also scored as in Study I (see page 4), with one exception: in the present study a variable denoting the number of card rejections was in- cluded in the analysis. Cases with rejections on all five cards were dropped from Study I as a result of a clerical error; four such cases were included in Study II. A tabulation of rejections, by TAT card, for age-race-sex groups in the total sample (n = 2,018) is shown in table 1 Tests for the significance of differences between independent proportions’ were com- puted to evaluate the relationship of sex and race’ to rejections for each of the TAT cards. These results, shown in table 2, indicate that: (1) there were no significant differences between boys and Tables 1-10 are supplementary tables that appear in a sepa- rate section, beginning on page 25. bThe numbers of children in the two racial groups—white and black—sampled in this study are given in appendix [. The white group included two oriental children. girls within the white group; (2) a significantly higher proportion of the 99 black girls than the 96 black boys rejected cards 5 and 8 BM; (3) no significant differences occurred between boys and girls for the total sample; (4) no significant differences occurred between the white and black samples of boys; and (5) a larger proportion of black girls than white girls rejected card 16 (the blank card), as did the total sample of blacks in comparison with the total sample of whites, Black children rejected only card 16 more frequently than did white children. The relationship between age and card re- jection was investigated for the samples of white boys and girls and for the total sample of boys and girls. The numbers of cases within age cat- egories for the black sample were too small to obtain stable relationships. Kendall's coefficient of concordance,” however, indicated that the proportions of card rejections were significantly related to age level for white boys (W=.59, p< .01), that is, there was a decreasing number of rejections with increasing age, but were not significant for all boys, white girls, or all girls. The five TAT cards differed in relation to the frequency of card rejections. For the total sample of boys and girls (n=2,018), thenumbers and proportions of rejections, by card, were: card 16, 137 rejections, 6.8 percent; card 1, 73 rejections, 3.6 percent; card 2, 57 rejections, 2.8 percent; card 8 BM, 47 rejections, 2.3 percent; card 5, 26 rejections, 1.3 percent, This pattern was extremely stable across the four sex-race subgroups, as indicated by Kendall's coefficient of concordance (W= .98, p< .0l). DEVELOPMENT OF CRITERION SCALES In the development of criterion scales, prod- uct-moment correlations were computed among the 68 criterion variables discussed on pp.” and 8 and enumerated in table 3, This intercorrelation matrix (excluding the variables representing the four criterion scales from Study I) was factor analyzed using the principal components solu- tion® followed by a varimax rotation? to or- thogonal simple structure. Results of this anal- ysis are shown in table 4 which presents the rotated factor matrix based on a five-factor so- lution. The five factors are defined as follows, using salient loadings as a basis for factor definition. Criterion Factor I-School Adjustment Five items were selected to define this fac- tor: grade repeated, special or remedial class attended, attentiveness to class work, intellectual ability, and academic performance (table A). (The information was obtained directly from the chil- dren's schools by use of questions from HES form 243, shown in appendix III.) The content of these marker variables suggested that some measure of ''school adjustment’ was being ob- tained. The factor loadings of the items ranged from .86 (academic performance) to .43 (grade repeated), With the exception of the item ''grade repeated" this scale is identical in composition to the intellectual adjustment scale of Study I. To obtain a score on this scale (factor) the un- weighted scores on each of the defining variables were summed. A similar composite score was obtained on each of the criterion scales discussed below. Criterion Factor |l-Poor Health Factor analysis of 26 health items derived from the HES Medical History form, No. 256, shown in appendix III (variables 18-43 in table 3), revealed that only eight items from the Medical History form were of salient importance as health criteria, Based on these marker items, this factor is designated here as "poor health'; the eight items composing it are summarized in table A, The information for the items on this factor was obtained primarily from interview reports contributed by the mothers of the children and may thus reflect some bias, Asagroup, the items do give a picture of illnesses which contribute to poor health of the children, Loadings indicate that the two ''present health items contributed the greatest amount of variance to the poor health factor, followed by history of measles, serious accident or injury, other allergies, hay fever, kidney trouble, and speech defects. Table A. Variables used to define the five criterion factors: scoring, means, standard deviations (SD), and factor loadings HES tore Factor Criterion factor and variable ques - Scoring Mean SD load - tion | ing number” | Factor I—School adjustment 6. Academic performance===-----amceooooooonan 243-#19 | O—above average 0.96 0.69 .86 1 —average 2 —below average 5. Intellectual ability===eeeccccmoococeaaaao 243-#18 | 0—above average 0.91 0.65 .85 1—average 2—below average 3. Class attended========ccmcemcmmccm cee 243-78 0—gifted 0.10 0.49 will l—normal classes 2=—slow learners 3—handicapped 4, Attentiveness=e====memmmm ccm omen 243-#12 | O—above average 1.00 0.66 .66 1 —average 2—~—below average 1. Grade repeated=========cm= com om cme 243-4 Jeno 0.10 0.30 43 —yes Factor II—Poor health ¥ 39. Present health problems-=-==--=-=comceomnonn 256-#21 Deri 0.19 0.39 .58 —yes 18. Present health statuS===----=e==ccecconanx 256-720 0—very good, good 0.06 0.23 .54 l=—fair, poor 33. Measles (severity)==-=---m=mcmcomcmcooacaaan 256-#33 0—not severe 0.06 0.24 48 l—severe 22. Serious accident or injury---------=------ 256-#28 | 0-—no 0,17 0.38 AA l—yes 35. Other allergies----=-=-cccomcmmmammnannaao 256-#35 | O0—no 0.11 0.31 .31 1 —yes 34, Hay fever-=----oeommmc mmm cm emma 256-#35 | 0-—no 0.06 0.23 .29 ’ l—yes 36. Kidney trouble-==--=-= = coccmmmmm cme mamee 256-#35 | O0—no 0.04 0.19 .28 l—yes 40. Speech defect ====-=mcmcmcmmmmmcm emma 256-#50 | 0=—no 0.05 0.21 .28 Factor III—Intellectual development 61. Age in months===-- ccm mcmmmm cee eeeee vee yi 107.73 20.52 «32 67. WISC Vocabulary raw score . actual score 25.49 9.78 .82 60. WRAT Arithmetic score=-=-==-=----- ’ actual score 27.28 8435 .80 59. WRAT Reading score--==--=------ vow actual score 51.47 19.61 +79 66. Goodenough-Harris score=--==--==-=-c-cecomo- NEw actual score 23.28 7.68 wl 3 68. WISC Block Design raw score==-====--=-=--= vos actual score 12.77 10.43 + 71 Factor IV—Social adjustment 53. Interchild relations---==--===co-omooeoono 257-#15 | O0—well liked 0.56 0.57 .60 1—average 2—has difficulty 52. New friends-===--cem ccm cmmm cee mcm meee 257-#14 O—very outgoing 0.72 0.75 +33 1 —above average 2=—shy 56. Tension level-=-m=cmcmcccom cece cece 257-#18 0=—calm, relaxed 0.16 0.36 «52 l1—tense, nervous 57. Temper =—===m=m cmc ame emma m 257-#19 | O—rare, occasionally 0.17 0.37 47 l—strong, easily lost 55. Traumas===-==== =m mmm mmm meme mmm n 257-#17 | O0—no 0.25 0.43 32 1—yes 51. Range of food tastes=--=-=-ceeecmooeaooaao 257-#5 | O-——eats most 0.23 0.42 .31 l—somewhat and very fussy Factor V—Emotional disturbance 11. Aggression=---=-me cme cme meee 243-#14 | O=——normal 0.27 0.77 oil 1-6 —number of aggressive behaviors checked 9. Overall adjustment=== ===ceececcomomoonann 243-711 0—very well adjusted 0.99 0.58 «34 l—no adjustment problem 2—adjustment problem 8. Emotionally disturbed===-=====cmeccmamaaax 243-#8 | O==no 0.04 0.21 .49 l—yes 10. Motor activity=-=--==ceccccm cmc ceeee 243-#13 | O-—normal 0.31 0.46 .36 l—restless or too quiet order for this grouping by factors. 2The questions from the appropriate HES forms are shown in appendix III. 10 IThe original numbers assigned to the variables have been retained, even though they appear out of numerical Criterion Factor Ill—Intellectuval Development The third factor was designated "intellectual development' (table A) in view of the high load- ings of the five intellectual measures. Age in months tied with the WISC Vocabulary raw score for the highest loading on this factor, empha- sizing the developmental significance of these intellectual scales. The WISC Block Design score contributed least to this intellectual development factor, while the WISC Vocabulary and the WRAT Reading and Arithmetic scores appeared to be of slightly greater importance in total contribution to factor variance. Age correlated .50 with the Block Design score in contrast to .79, .69, and .62 with the Arithmetic, Reading, and Vocabulary scores, respectively, Criterion Factor IV—Social Adjustment The six items (table A) representing factor IV were based on judgmental ratings (similar in this respect to those in the poor health scale), reported by the child's mother to the survey in- terviewer (HES form 257, appendix III). This factor was designated ''social adjustment" to re- flect the importance of the six defining items to the child's social development, Interchild (peer) relations and the ability to meet new friends contributed most to the Social Adjustment factor, Four other items included were tension level, experience of trauma, temper, and range of food tastes. Criterion Factor V—Emotional Disturbance Aggression, overall adjustment problems, emotional disturbance, and amount of motor activity defined this factor as shown in table A, These defining variables were derived from ques- tions in school form HES 243, shown in appendix III. Aggression was the dominant item in this factor and had the largest correlation with the criterion scale 2, school social adjustment, of Study I. The loadings of the items ranged from .71 to .36; motor activity contributed the least among the defining variables. Relationships Among Criterion Factor Scores and Age, Sex, and Race The correlations among the composite scores on the criterion factors are shown in table B. The school adjustment and emotional disturb- ance factors were most highly related with a Table B. Correlations among the composite scores on the criterion factors and age, sex, and race Variable Variable 1 2 3 4 5 6 7 8 1. Criterion factor I— school adjustment=------- 1.00 2. Criterion factor II-—poor health-=--cecccencancana- -0.05 1.00 3. Criterion factor III—in- tellectual development---| 0.28 | 0.02 1.00 4, Criterion factor IV— social adjustment-===--== 0.12 | -0.20 0.03 1.00 5. Criterion factor V-—emo=- tional disturbance------- -0.44 | 0.08 | -0.09 | -0.13 | 1.00 Age--memcmcc ccm ccc cen -0.03 | -0.05 0.77 | -0.02 0.03 1.00 7. SeX=mmceemcc emcee ccm eae 0.16 | -0.03 0.03 0.09 | -0.19 0.02 1.00 Race--==ccccccccccccccaan- 0.07 0.03 0.15 0.07 0.06 0.02 | -0.01 1.00 1 correlation of -.44, The negative sign here in- dicates that a high rating on school adjustment was associated with a low or poor ratingon emo- tional adjustment. Criterion factor III (intellec- tual development) was the only factor with a sub- stantial correlation with age (.77). Since age was one of the defining variables for criterion factor III, this relationship was spuriously inflated. Nevertheless, when age was partialed out of the factor, the correlation with age was reduced only to .64., The remaining four criterion measures were virtually uncorrelated with age. Sex (fe- male) was positively correlated with the school adjustment criterion factor (7 = .16) and nega- tively correlated (# = -.19) with emotional dis- turbance, (In this case, thenegative sign indicates that girls were not associated with being emo- tionally disturbed.) These correlations are as- sumed to give evidence for the position that culturally defined behavior roles for young girls coincide more readily with behavioral norms, also culturally decreed, for proper school con- duct than do those behavioral roles defined for young boys. Another cultural byproduct may be the basis for the positive correlation (7 = .15) between criterion factor III, intellectual development, and race (white). The relatively small percent of variance (2.25) in intellectual development is likely a cultural-developmental phenomenon, re- lated in part to differential exposure to the pre- dominant language community. Relationships of Age With Items Used To Define Criterion Factors Mean scores and standard deviations for the 68 criterion items, by factor, in 2-year age and sex groups are shown in table 5. Many of the criterion items showed consistent linear re- lationships across the three age groups, for each sex, However, there were a number of items which showed a curvilinear relationship with age. For example, item number 11 (aggression) rep- resents a curvilinear function across age groups: the aggression mean for boys, ages 6 and 7, is 0.34, followed by an increase to 0.49 for the mid- dle ages (8 and 9) and then a decrease to 0.38 for the older ages (10 and 11). The same re- lationship for this item is apparent among girls, 12 except that the marked decline was not obtained among older girls, DEVELOPMENT OF THE TAT SCALES- STRUCTURAL AND THEMATIC DATA Analysis of the structural and thematic data derived from the story protocols occurred in two phases. The first phase consisted of a correla- tional analysis of scores on most of the items from both the Structural and Thematic Manuals (appendix II). A factor analysis was performed to identify the dimensions relevant to the TAT responses. For phase one, 87 word count and thematic items were selected. Nineteen items included in the scoring manuals were eliminated, principally on the basis of infrequent occurrence. Phase two involved selection of those items defining the principal dimensions isolated in phase one (31 items in all) and refactoring of the cor- relation matrix of this reduced set of items. In terms of psychological meaning it was assumed that the list of 87 items actually represented only a few dimensions. The two-phase analysis was conducted on the basis of such an assumption and appears to have been justified by the results. Computation of these factors had the advantages of reducing the variables to a more manageable number and of simplifing the final steps in de- termination of the language and thematic scales. Several groups of variables were eliminated or combined in reducing the number of items from 87 to 31. First, it was decided to elim- inate those variables having negligible or zero loadings on the five factors accepted after the initial analysis of the 87 items as well as those having. low to zero intercorrelations with other variables, Second, it appeared appropriate to combine certain related items which had very low means. For example, four items measuring various aspects of hostile antagonism were com- bined into a single item, preserving the common aspects of their TAT responses and at the same time providing a more reliable measure of man- ifest hostility, Third, some items found in clus- ters with extremely high intercorrelations re- sulting from statistical interdependencies were excluded. An example is the elimination of num- ber of words, since this item was inevitably highly correlated with the other word count items. A second example involves the four items dealing with goal behavior. Since they had very high intercorrelations, three of the four were considered redundant and were therefore re- moved. Means and standard deviations for the 31 selected variables plus some additional variables of interest are reported in table 6. The large variances reflect the effect of aging over a 6- year age range which includes several develop- mental levels. Additionally, several variables listed in table 6 had zero as modal scores, giving rise to markedly skewed distributions. The intercorrelations among the scores on the 31 items selected in phase two are shown in table 7. (The items in this table are ordered to reflect clusters of variables defining each of the major factors resulting from the analysis dis- cussed below.) These intercorrelations were computed on a sample of 1,910 subjects (exclud- ing 102 subjects from combined sample I and II). The 31 by 31 correlation matrix was factor analyzed, using the principal component method, with unities in the principal diagonal. Factor ex- traction was halted when eigenvalues fell below 1.0 and seven factors were extracted, However, only the first six factors were readily inter- pretable, and these were rotated using the var- imax method. The rotated factor matrix is pre- sented in table 8. The six TAT factors retained accounted for 63.63 percent of the total variance. Factor I ac- counted for 34.86 percent of the variance, This was followed by a sharp decline to 7.96 percent in factor II. The six rotated factors were ac- cepted as the best representation of the variance in the matrix of intercorrelations. The variance accounted for by each of the rotated factors is indicated in table 8, The salient marker variables were used to interpret and define the factors, Table C shows the items for each of the six TAT factors and their respective loadings. In this - table, all loadings of .30 or greater are listed. For the purposes of computing composite scores, how- ever, only those with the highest loadings were used. This issue is discussed at length in a later section. TAT Factor I=Verbal Productivity Table C shows the variables whose factor loadings on factor I were at least ,30., The un- weighted standard scores on the first six var- iables listed were used to compute composite scores for this factor. The label "verbal pro- ductivity was chosen for at least two reasons. First, three of the six composite-forming var- iables—corrections, pauses, and repetitions— reflect what might be termed monitoring and mechanical functions associated with the pro- duction of the verbal protocol. Since these three variables were measured in terms of frequency of occurrence of the respective functions, it is not surprising that they show uniform and highly similar correlations with other productivity var- iables, This would also account for the loadings on this factor of pronouns, single verbs, common nouns, and possessive adjectives. Another reason for the designation of this factor as ''verbal productivity’ was that the items concern story construction and formation. They reflect attempts by the children to develop stories that emphasize proper organization of characters, places, and situations. The presence of both past and future reference is taken as an indication of efforts to give temporal boundaries to the stories; these variables reflect story content prior to and sub- sequent to the content manifested in the TAT cards. Among the grammatical classes of words, use of adverbs, in particular, gives the story ac- tion a fine-grained quality indicative of a high level of competence in manipulating the language. Finally factor I is believed to represent a fa- cility to use and produce language in a way that is culturally defined as competent and effective. In summarizing these data, it should be emphasized that factor I was of overwhelming importance relative to the other factors identified. The principal component solution indicated that a little over SO percent of the total variance ac- counted for was attributable to factor I. The vari- max rotation lent greater interpretability to the factors but, in the process, redistributed the variance among the factors. A great deal of the variance provided by factor I shifted to the other factors so that in the rotated solution its relative importance was reduced. Table C. Variables used to define the six TAT factors and their factor loadings TAT factor and variable! Item number in scoring manual” ) | Factor loading 4, wHENDUTOY 29, 28. 12. 27. 17. 24, WO 13, 10. 1. 12. 17. 14. 13. 15, 19. 20. 18. Factor I=-Verbal productivity COL EEE LL OTIS 0m 6 060 0 700 6 0 0 Future reference Past referencele-ememeeececcencnnnsnnnnnscananacecan POUSESS wmmmew neem oe ——— ww ewe we ee Adverbs’ meecenaaaaaa grmmmmmmemmss=sssmseemaneee- Verbatim repetitions PrONOUNS = memes masm ean as conan nam aan aan amnane——— Single verbs==emeaceccceccecaacccacacacccccccanann—" COMMON NOUNS == m= ee cs cn cece cman ana —-————————— Situation complexityee=eeececceceecccccacnnanan-—n Possessive adjectiveS===eeecccceccaccecncccacaan= OULCOME == emcee cccmccce ce ccc ccc cece crac a..--— Egocentrisme==-eeesaccacccccccccmcmcccccnancncean Factor II-—Dysphoric mood ET ——————— Murder-killing? Unhappy outcome? =-e-eacececacccacacmcacmcccamanca- Bizarre themee===cacacccccunccnccncnccccncncnnncnnn- Factor III-=—Conceptual maturity Present reference’ —— Rejection’ e=eeececccacccaccaccacecaccccccaccanananx Level of interpretation” Situation complexityl=e-eceecacccccccccmcncnnnaa- a. Factor IVe=Narrative fluency Outcome’ Happy outcome’ Causally connected statements’ Expression of feeling’ee-eecececesacccccacaccaanan Happy-glad (character attribute)’ Goal behavior’=eeececmccececcceccececcecccmccaaaa= Kind-loving (character attribute)? 48 (SM) 60 (SM) 58 (SM) 46 (SM) 20 (SM) 47 (SM) 28 (SM) 32 (SM) 24 (SM) 53 (SM) 19(sM) 63 (SM) 11 (TM) 20h (TM) 201 (TM) 64 (2) (5M) 7(T™) 59 (SM) 1 (SM) 65 (SM) 53 (SM) 63 (SM) 64 (1) (SM) 66 (SM) 61 (SM) 20d (TM) 21 (TM) 20a (TM) .80 «73 .72 .69 .58 «31 C46 46 C41 .38 +37 .31 .86 +82 .61 33 .94 +93 «85 .60 "The original numbers assigned to the variables have appear out of numerical order for this grouping by fa formation on how the numbered items were scored, 28M = "Variable used to compute composite scores, been retained, even though they ctors., Structural Manual, TM = Thematic Manual; both manuals appear in appendix See appendix II for in- IL. Table C. Variables used to define the six TAT factors and their factor loadings-—Con. TAT factor and variable! ua? Factor loading Factor IV—Narrative fluency —Con. 11. Level of interpretation=ee=-eeececccaccmaccccaecea= 65 (SM) «37 12, Situation complexity==-=e-cecccecccmmcccccccncnnn= 53 (SM) «32 6. Future reference-e==e-mmecccccccccc ccc ceccnanan 60 (SM) 43 29, PronounS=--====seececcccecccccceemeccc mee —————— © 28(SM) .38 27. Possessive adjectives==-=e-mcacaccccccmnccc cna 19 (SM) «37 7. Unhappy outCOme====-mcecmom eae ccc cc ccm em mm 64(2) (SM) .36 30. Single verbS=meemmcmcccc mcm mce mcm m amen 32 (SM) .34 28. COMMON NOUNS=====-memmeccmccc emcee mc meee m—————— 24. (SM) «32 5. Past reference-=--eecocccmmcmc crc emam 58 (SM) .30 Factor V—Emotionality 25, Mean-rejecting (character attribute)” mmmmmmmm———— 20b (TM) .67 21. Antagonism’ meme e coco eoeeeeeeeeeeeee 18 (TM) .64 26. Aggression’? me=mem common eee 20e (TM) .59 23, Bizarre theme’ ====emm common 7 (TM) «37 24, Egocentrism’=mmeemem cme cme cece ema 11 (TM) Jab 22. Morbid mood quality’=-==e-emmecccemcemmeececee——— 6 (TM) .39 20, Goal behavior===--eecccmccc ccc 21 (TM) .49 18. Kind-loving (character attribute)=--=-------c--== 20a (TM) 35 Factor VI—Verbal fluency 28. Common nouns’ meme mc em mecmemcmmmm————— 24 (SM) «12 30. Single verbs? mmc mmcm momma 32 (SM) «72 29. Pronouns? =eememecmmemcmemcmcec ccm mmm ——————— 28 (SM) .68 27. Possessive adjectives’ meememmmm cme 19 (SM) +553 31. Dialogue’ =mmmmcm omen 49,50 (SM) .65 3. Verbatim repetitionS===-eeeccemcccc mcm eee 47 (SM) +43 15, Causally connected statementsS====--e--ececc-caeaa-= 66 (SM) 40 1. Adverbs=emceemmemcc emcee em mem 20(SM) .39 18. Kind-loving (character attribute)==--=ce-=mcaccce== 20a (TM) .36 19. Happy-glad (character attribute)=--=-c==mc-ccaac-oa- 20d (TM) «32 "The original numbers assigned to the variables have been retained, even though they See appendix II for in- appear out of numerical order for this grouping by factors. formation on how the numbered items were scored. 28M = Structural Manual, TM = Thematic Manual; both manuals appear in appendix II. %Variable used to compute composite scores. TAT Factor II—Dysphoric Mood Examination of the three variables defining factor II (shown in table C) and their loadings would suggest this factor to be a result of spu- rious dependency between death and murder- killing, However, this factor also emerged in a trial analysis when murder -killing was excluded from the variable list. Nevertheless, the paucity of variables defining factor II, plus the presence of a conceptually related factor (see factor V), led to the judgment that factor II was of relatively mi- nor importance, It seems a reasonable hypothesis that the factor was strongly a product of re- sponses to TAT card 8 BM. TAT Factor lll—Conceptual Maturity This factor was rather sharply defined by four variables, shown in table C. The designa- tion of this factor as ''conceptual maturity' re- flects two important aspects of this factor. One is that the factor measures the extent to which the children understood the instructions and re- quirements of the storymaking situation; the second is that it measures the qualitative grad- uations in the structure of the stories themselves, Level of interpretation, which indicates the ex- tent to which the behavior of the characters is given a meaningful basis, and situation com- plexity, which indicates finesse in depicting story plot through temporal and situational variation, were the two variables used to specify the quality of story structure. TAT Factor IV—Narrative Fluency In table C it can be seen by the nature of the large number of variables loading on factor IV that it is a complex dimension. The name for this dimension was chosen to reflect the interpre- tation that this factor represents those stories, particularly those positive in outlook, in which thematic elements make sharply defined appear - ances within the boundaries of well-conceived and well-developed stories, It may be noted that the two ''depth measures'' (level of interpreta- tion and situation complexity) loaded highly on factor IV; these variables were not included in the composite list, however, because of their inclusion in the composite for factor III, Never- theless, by the magnitude of their loadings on 16 this factor, they also contributed to the inter- pretation suggested for factor IV, TAT Factor V—Emotionality Two possible interpretations are suggested for factor V, as summarized in table C. One is that the factor to some degree stands as a neg- atively toned counterpart to factor IV, Thus, factor V would represent negatively conceived stories. However, noticeably absent from fac- tor V were any of the variables representing structural or conceptual organization. Thus an alternative, related interpretation is that this factor concerns chiefly the expression of ag- gressive, hostile ideas and, more generally, emotionality on the part of the subject, It will be noted that goal behavior was not included among the composite variables, Earlier analyses in which fewer factors were rotated suggested that it was more appropriate to include goal behavior as a composite variable for factor IV, TAT Factor VI—Verbal Fluency As shown in table C the chief defining var- iables for this factor were the count items for grammatical forms. In evaluating the results, it should be kept in mind that a large proportion of the variance reflected in the TAT measures is accounted for in terms of the amount of ver- biage produced in the stories. The more words that were produced, the greater the chance that expression of plot and character development would take place. While it is certainly possible to produce complex stories with relative brevity, the empirical findings of this study show con- sistent, high positive correlations between the production measures (count items) and items measuring other aspects of the responses. The first principal component resembled what would be the effect of combining into one factor the loadings of the marker variables on the rotated factors I, III, and VI. In its unrotated form the first principal component clearly represented verbal production. In addition the variables de- fining factor VI retained substantial loadings on the rotated factor I. Although the two factors are thus related, factor VI is interpreted as representing the verbal fluency component of the count items, whereas factor I is considered to reflect the component of verbal productivity. VALIDATION OF THE TAT SCALES The research reported in the preceding sections resulted in the construction of five criterion measures of development and adjust- ment and six TAT scales, or factors, derived from analysis of the story protocols. The five criterion measures representing intellectual de- velopment and adjustment were based on factor analysis of 64 variables derived from tests and background information collected in Cycle II of the HES, Four of the criterion scales reflected essentially uncorrelated facets of adjustment and were defined by the behavior adjustment, med- ical history, and school performance information made available from the Cycle II documents, The remaining criterion scale, the intellectual de- velopment criterion factor (factor III in table A), represented a composite of the WISC, WRAT, and Goodenough-Harris scales and age. The six TAT scales, representing aspects of language development and emotionality expressed in the story protocols, were constructed on the basis of a factor analysis of 31 structural and thematic scoring variables, The validity of the TAT scales as measures of psychological value was ana- lyzed on the basis of their relationships to the criterion factors and to age, sex, and race, Relationships were analyzed among the com- posite scores on the six TAT factors and among the scores on the five criterion measures, as well as between TAT and criterion factors. As stated previously, individual scores for the six TAT factors were formed by summing the un- weighted standard scores of the defining items for each factor. Ages were recorded in months, Intercorrelations among the 14 variables were then computed for the total sample of 1,910 chil- dren, The results are shown in table D, Table D. Correlations among TAT predictor composite scores, criterion composite scores, age, sex, and race Variable Variable 10 11 12 13 14 1. TAT factor I— verbal produc- tivity===-=c-e-un 2, 2. TAT factor II— dysphoric mood---| 0. 3. TAT factor III=— conceptual ma- turity--=--==--== 0. 4, TAT factor IV— narrative fluency====--c=o= 0. 5. TAT factor V— emotionality---=-= 0. 6. TAT factor VI— verbal fluency---| 0. 00 19 1.00 42 | 0.20 1.00 431 0.15 |. 0.37 1.00 26| 0.29 | 0.15| 0.26 | 1.00 54 | 0.23 | 0.31| 0.48 | 0.26 7. Criterion factor I—school ad- justment==-==-=== 0. Criterion factor II—poor health=-- 9. Criterion factor III—intellec~ tual development-| O. 12| 0.00} 0.09 O. .00 .01| -0.01 | 0.00 35| 0.03 | 0.24 .06 10. Criterion factor IV—social ad- justment=-=-=--==== 0.03 0.00 | oO. 02 .00 11. Criterion factor V—emotional disturbance------ -0.02 | 0.02 | -0.03 0.23 | 0.02 | 0.18 0.01 | -0.03 .02 0.01 | 0.02 -0.06 | 0. 0.29; 0. 0.06 | -0. -0.02 | -0. 01 06 06 01 12. 13. 14. o .00 o .00 «15 +35 .05 -0. 27 .07 .07 1.00 +00 0.12 | -0.20 | 0.03 1.00 0.03 -0.19 0.06 0.08 | -0.09 -0.05 | 0.77 -0.03 .03 0.03 | 0.15 -0.13 -0.02 0.09 0.07 05 | -0.44 -0.03 0.16 0.07 1.00 0.02 0.02 o 1.00 -0.01(1.00 17 Relationships Among Composite Scores on TAT Factors, Age, Sex, and Race It may be recalled that in forming the TAT predictor factors care was taken not to include any variable in more than one composite, This was done to eliminate spuriously high correlations between factors due to artifactual depend- encies. Even so, itis readily apparent through ob- servation of the intercorrelations among the com- posite scores on the TAT factors shown in table D that substantial correlations remain. The fac- tors may be thought of as representing two clus- ters, one pertaining to cognitive-verbal factors, and the other, to an emotional-hostile expres- sion factor. The average correlation among the TAT cognitive-verbal factors I, III, IV, and VI is .43; the correlations range from .31 between factors III and VI to .54 between factors I and VI. Scores on the dysphoric mood and emotion- ality factors correlated .29. Turning to the correlations with age, sex, and race, it can be observed that the four TAT ""cognitive'' factors show substantial correlations with age. Narrative fluency shows the highest correlation with age (7 = .29) among the four. Sex is not appreciably correlated with any of the TAT factors. On the other hand, there is a sub- stantial correlation between race and verbal productivity (# = .22). White children tended to obtain higher scores on this factor than did black children. Relationships Between TAT and Criterion Composites Validity of the TAT factors was assessed in terms of their relationships, as measured by product-moment correlation, with the five cri- terion factors and with age, sex, and race, As shown in table D, scores on all six of the TAT factors correlate near zero with the criterion factors labeled poor health, social adjustment, and emotional disturbance. The four cognitive TAT factors (I, III, IV, and VI) are relatively highly correlated with the intellectual develop- ment criterion factor (III) and are moderately correlated with the school adjustment factor (I). The correlations of the four cognitive TAT fac- tors with these two criterion factors are all 18 significant beyond the .0l level. The emotion- ality factor has essentially zero correlations with the school adjustment composite score and the intellectual development composite score. The low validity coefficients for the TAT emotionality factor were disappointing. The evi- dence indicates that it is not a measure of mal- adjustment, as reflected by the criteria avail- able. The appearance of this factor in the factor matrix is clear, and the consistency of the items loaded supports the interpretation that it is a substantive factor, even though the validation with external criteria has not been established. Apparently the factor represents an expression of hostility and destructiveness in fantasy which is not openly reflected in real-life situations. Pending further study of behavioral validity in relation to independent criteria, it must be con- sidered provisionally as fantasy construction. Correlated and Uncorrelated TAT Factors For purposes of the following discussion a distinction will be made between the terms TAT composite scores and TAT factor scores. In the preceding discussions all references to scores on TAT factors have been to composite scores based on unweighted sums of marker variables. There is an advantage, however, in the use of factor scores, which are orthogonal; that is, they are mutually uncorrelated. (There may be sub- stantial intercorrelations among simple compos- ite scores.) The disadvantage of factor scores is that they are laborious to compute while com- posite scores can be directly computed using the tables provided in appendix IV. For the purposes of interpretive clarity, the preceding analyses were supplemented by an analysis based on the use of orthogonal TAT factors. Computation of TAT Factor Scores. —The subject's z scores for the 31 TAT variables were converted into six factor scores by use of two matrix equations: W=R'F (1) pP=zZ'w (2) In equation (1) the weight matrix (W) was formed by multiplying the inverse of the cor- relation matrix (R') by the matrix of vari- Table E. Correlations of orthogonal TAT factor scores with TAT and criterion composite scores and with age, sex, and race TAT orthogonal factors Variable I II ITI Iv A Vi 1. TAT factor I—verbal productivity--e=-- .88 .07 .11 24 «12 +32 2. TAT factor II-——dysphoric mood==-=-====--- .12 .94 .06 .10 .16 .07 3. TAT factor III—conceptual maturity---- .28 +11 .63 .56 .11 +25 4, TAT factor IV—narrative fluency------- .21 -.02 .20 .81 .25 .37 5. TAT factor V—emotionality-==--=--ceau- .19 .20 .05 .09 .92 4 6. TAT factor VI—verbal fluency---------- 41 +12 .13 +35 .20 77 7. Criterion factor I-—school adjustment=-=- «12 -.03 .01 .22 .05 .06 8. Criterion factor II—poor health------- -.01 -.01 -.03 .02 .00 -.02 9. Criterion factor III=—intellectual development -====-=-ecccccccccmcccnnaan .33 -.06 13 45 .02 .10 10. Criterion factor IV—social adjustment- .02 .00 .00 .05 .01 .04 11. Criterion factor V—emotional disturbance----===-cccmccccccccccceaaa- -.01 .04 .00 -.10 .03 -.03 12. Age---=mceemmmc mccain .19 -.05 14 .38 .05 .09 13. SeX===-mmmmcccmm mcm eemm cmc ccemeem am -.02 -.02 -.06 14 14 .09 14. Race--=--cmmmccmccc ccc cce cme meee 37 | -.01 -.03 -.06 .06 -.07 max factor loadings (F). The weight matrix is presented in appendix V as table IX. In equation (2) the factor scores (P) were obtained by mul- tiplying the z scores (Z’) by the weight matrix. As the final step, correlations between these orthogonal factor scores and other variables were obtained, Correlations of Orthogonal Factor Scoves With Criterion Composite Scores, Age, Sex, and Race. —In the lower half of table E, the correla- tions between the TAT orthogonal factor scores and criterion composite scores, age, sex, and race, are shown. The intercorrelations among TAT factor scores are not reported, as they are equal to zero; the intercorrelations among cri- terion measures, age, sex, and race have already been given in tables B and D. Tables D and E should be compared carefully, In table D verbal productivity, narrative fluency, and verbal fluency correlated equally with criterion factor III, intellectual develop- ment (7 =.35). However, because these TAT corn- posite scores were themselves intercorrelated, it was desirable to obtain a clearer picture of their relationship with intellectual development, In table E it can be seen that the correlation of verbal productivity with intellectual development (.33) remains essentially unchanged, while that of verbal fluency with intellectual development (.10) is considerably reduced. On the other hand, there was a substantial increase (from .35 to .45) in the correlation between intellectual de- velopment and factor IV, narrative fluency. An explanation of the differences may be that all of the unweighted composites contained variance associated with productivity, With the factor scores, on the other hand, the productivity vari- ance was restricted to factor I, while the two fluency measures were restricted to factors IV and VI, Previous empirical evidence supports the view that verbal fluency does not tend to cor- relate with intellectual level measures. There is a marked increase in the corre- lation between race (white) and verbal produc- 19 tivity, in going from the TAT composite score in table D (.22) to the TAT factor score in table E (,37). The positive correlation between verbal productivity and race, white children rating higher on this factor, gives substance to the in- terpretation advanced earlier concerning race and intellectual development. The verbal pro- ductivity factor is seen in part as an indicator of the linguistic milieu with which children are most familiar. Black children, whose linguistic sur- roundings often differ from those of white chil- dren, have less contact with the prevailing pat- terns of English expression than do whites. Consequently, while the linguistic skills of blacks in their dialect may be comparable with those of whites, on verbal tests sensitive to the nondialect standard the verbal production of black children may be hampered. Multiple Regression Analysis The results of multiple regression analysis are similar whether TAT composite or factor scores are used as predictor variables. However, since computation of multiple correlations is facilitated by use of factor scores, only results based on such scores will be reviewed. In table 9, the multiple correlations between the six TAT factor scores and scores on the five criterion factors, age, sex, and race are presented. By comparing the multiple correlation with the highest single correlation between predictor set and criterion set, it can be seen that sub- stantial improvement was realized in predicting intellectual development, age, and sex, DEVELOPMENT AND USE OF THE NATIONAL NORMS The national probability sample was selected to represent a cross section of children ages 6- 11 in the United States and initially was com- posed of 1,268 cases. As explained in appendix I, this number was reduced to 1,201 as a result of the loss of 67 cases with missing data or un- scorable protocols. This national probability sam- ple, drawn from the total Cycle II sample, pro- vides a population base on which norms can be 20 370 360 350 340 330 320 310 300 COMPOSITE SCORE mm Boys sine Girls 290 280 270 260 _1SD 250 240 CT rTP TRY TT rv be AGE IN YEARS Figure |. TAT factor |, verbal productivity. Standard score means and scores at +| and -| standard devia- tion (SD) for boys and girls, by age. computed for the TAT scales and for projections to the total population from which the Cycle II sample was selected. Before the norms were computed, all valid- ity coefficients for TAT factors with criterion composites and with age and sex were recom- puted for the national probability sample. TAT composite scores were computed for all children in the national probability sample and then ex- pressed as deviation scores by age and sex groups. Since the TAT composite norms are orga- nized by age and sex groups, the relationships 180 [— 170 — « © 160 — OQ 17) w Pr Jin, f= STi Means 8 150 —~ hy (Im Ei. Q o 140 p— m Boys wine Girls 130: {~~ voy f® 1 SD _- m : ty, ot 120 [~~ ol Lo rrr 6 7 8 9 10 1 AGE IN YEARS Figure 2. TAT factor Il, dysphoric mood. Standard score means and scores at +| and -| standard devia- tion (SD) for boys and girls, by age. of these composites to age and sex in the na- tional probability sample need to be understood. All of the separate scoring manual items which define the six TAT factors (table C) were trans- formed to scores having a common scale (mean = 50; SD = 10) for the 1,201 subjects comprising the final sample. Composite scores were then obtained for each of the factors by summing the transformed unweighted standard scores of the items used to define each factor as listedin table C. Thus six algebraically summed scores were computed for each subject. It was decided tocom- pute norms for composite scores only, rather than for uncorrelated factor scores. This deci- sion reflects the fact that computation of the com- posites is far simpler than that for factor scores and that most applications of these scales would best be facilitated by norms based on unweighted sums. The subjects were divided into 12 age-sex groups, and means and standard deviations of each of the six TAT composite scores were computed for each group. Table 10 presents the means COMPOSITE SCORE 140 — ante, > &, ~4 4 130 — 120 [— 110 }— 100 |— 90 80 — 70 60 [— 0 unin Girls 40 30 — 2 10 ol + ory 6 AGE IN YEARS Figure 3. TAT factor Ill, conceptual maturity. Stand- ard score means and scores at +| and -lstandard de- viation (SD) for boys and girls, by age. and standard deviations at each age level for boys, for girls, and for boys and girls combined. The mean scores for each age group on the six TAT factors reported in table 10 are plotted in figures 1 through 6 for boys and for girls. In ad- dition, the scores that would be obtained by the members of each group falling one standard de- viation above or below the respective group means are shown for each TAT factor. These results provide a graphic description of the results and illustrate the growth function for each of the scales. With the exception of the slight dip of girls’ means on factors I and VI at age 11, the cognitive factors (I, III, IV, and VI) are positively and 21 oo 440 (— o 430 — +1SD 420 — 410— 400 — 390 & Co Means oO bee 3 370 w - J @ e 360|— = 8 — mmm Boys S50 ues wane Girls 340 — 330 i i ann 320— Le -1SD 310 f— 300 — 290 — 280 ce ol | | [ 1 1 | | 6 7 8 9 10 1 AGE IN YEARS Figure 4. TAT factor IV, narrative fluency. Standard score means and scores at +l and -| standard devia- tion (SD) for boys and girls, by age. linearly related to age for boys and girls, Emo- tionality (factor V) and dysphoric mood (factor II) are essentially unrelated to age. Although the slight positive trends shown for these factors in figures 2 and 5 undoubtedly reflect growth in ability to express hostility, it seems unjustified to regard them as age-related factors. Several fluctuations in the mean scores are found in both sex groups at succeeding age levels. Figures 1 through 6 also illustrate the over- lap in the scores across the age groups on some 22 360 350 340 — 330 " ee: c 320 — o 3 - W310 @ Lee: aT Means g 300 [— 8 a? 200 — mm Boys | wn Girls -18D AGE IN YEARS Figure 5. TAT factor V, emotionality. Standard score means and scores at +l and -| standard deviation (SD) for boys and girls, by age. of the factors. The plot of the score ranges rep- resenting one standard deviation above the mean on the verbal productivity composite (figure 1) indicates that some of the boys and girls at ages 6 and 7 have scores exceeding the means of boys at ages 9 and 10. This overlap at the upper end is also true for the narrative fluency factor (fig- ure 4) and the verbal fluency factor (figure 6). Similarly, on the low side of the distribution, on factors III and IV (figures 3 and 4) some older subjects (ages 9-10) scoring one standard deviation below the mean of their respective groups attained scores lower than the meanscore for younger age groups (ages 6-7). Norms for the national probability sample for each of the TAT scales are presented in ap- pendix IV, Table VII (appendix IV) contains the raw score and its standard score equivalent for each of the items from the TAT manual which are included in the six TAT factors. Total scores 3401— 330 [— 320— 310 300 [— 290— 280 270 260 [— COMPOSITE SCORE 250— ummm Boy's 240 |— y win Girls 230 — 220 — 210 200 — 190 [1 1 [1 | 6 7 8 9 10 1 AGE IN YEARS Figure 6. TAT factor VI, verbal fluency. Standard score means and scores at +l and -| standard devia- tion (SD) for boys and girls, by age. on each of the six factors for each of the sub- jects in the national probability sample were ob- tained by summing the unweighted standard score for each of the items comprising a factor, After obtaining the total scores, frequency, cumulative frequency percentage, and cumulative percentage distributions were computed for each of the six scales, Table VIII in appendix IV constitutes the normative table for the national probability sam- ple. The HES five-card version of the TAT can thus be administered to any child, his scores on the scales determined, and then these can be compared with the scores of anormative sam- ple of children of his own age and sex on each scale, For illustrative purposes, assume that a 6-year-old girl has been administered the TAT. Her performance on the verbal productivity fac- tor (I) is obtained as follows: First, her raw scores are determined on the six items making up this scale; then by referring to the appropriate age and sex group (age 6, female) in table VII of ap- pendix IV, the standard score equivalents for these raw scores are obtained and summed to arrive at the total composite score. Assuming that this 6-year-old girl obtains a total composite score of 300 on the verbal productivity factor, her percentile ranking in comparison to girls her age in the national probability sample is obtained from table VIII in appendix IV. In this case, the girl would have a percentile of 86. Percentile ranks in this report represent the percentage of children scoring below the raw score designated. The same procedures would be followed for all composites. 23 REFERENCES Sells, S. B., and Cox, S. H.: Normative studies of chil- dren’s performance on the Thematic Apperception Test. I. Standardized scoring and development of measurement scales. Fort Worth. Institute of Behavioral Research, Texas Christian University, for the National Center for Health Statistics, Public Health Service. Mimeographed. Mar. 1966. 2Gells, S. B., and Cox, S. H.: Normative studies of chil- dren’s performance on the Thematic Apperception Test. II. Test-retest reliabilities of items and scales. Fort Worth. Insti- tute of Behavioral Research, Texas Christian University, for the National Center for Health Statistics, Public Health Service. Mimeographed. Sept. 1966. 3National Center for Health Statistics: Plan, operation, and response results of a program of children’s examinations. Vital and Health Statistics. PHS Pub. No. 1000-Series 1-No. 5. Public Health Service. Washington. U.S. Government Printing Office, Oct. 1967. 4National Center for Health Statistics: Evaluation of psychological measures used in the Health Examination Survey of children ages 6-11. Vital and Health Statistics. PHS Pub. No. 1000-Series 2- No. 15. Public Health Service. Washington. U.S. Government Printing Office, Mar. 1966. 5 Sells, S. B., Cox, S. H., and Chatham, L. R.: Scales of language development for the TAT. Proceedings, 75th Annual Convention, American Psychological Association, 1967. 6McNemar, Q.: Psychological Statistics. New York. John Wiley and Sons, 1949. pp. 60-61. Siegel, S.: Nonparametric Statistics for the Behavioral Sciences. New York. McGraw-Hill Book Co., 1956. pp. 229-238. 8 Hotelling, H.: Analysis of a complex of statistical vari- ables into principal components. J. Educ. Psychol. 24:417-441, 498-520, 1933. 9Kaiser, H. F.: The varimax criterion for analytic rotation in factor analysis. Psychometrika 23:187-200, 1958. semi LC wanes 24 Table 1. 10. LIST OF SUPPLEMENTARY TABLES Number and percent of rejections of five TAT cards, by race, sex, and age for the total SAMPle (J) m2 1B) memes memos mum im mm mmm mo mm oh ot 0 ed tv Differences between proportions of rejections of five TAT cards by race and sex groups for the total sample (7=2,018)----cccecccccamccccccccccccccacaaa. —————— Correlations among the 68 criterion variables selected from HES CycleIl question- naires and tests (M=2,012) --==--c--ommcmmme eee emmmem emer mmmeee mao Varimax rotated loadings of 64 criterion variables selected from HES Cycle II questionnaires and tests on five principal components (2#=2,012)--c--cecccaaca-a- Means and standard deviations (SD) of 68 criterion. variables selected from HES Cycle II questionnaires and tests grouped by factors, by sex and age (7=2,012)- Means and standard deviations (SD) of selected variables used in analysis of the TAT structural and thematic data (2 =1,910) cco cmc ememmmemeeeee Correlations among the 31 TAT variables used in final analysis, five criterion factors, age, sex, and race (#=1,910)--mcccmm om cmmcmmm em eemeemmemeemme en Varimax rotated loadings of 31 TAT variables on six principal components (7 = 1,910) m--mmmmmmmmcm mm mme meee - Multiple regression analysis predicting criterion composites, age,sex, and race, using six TAT factor scores as predictors (#=1,910)-ccmccccc om cmcmccccecceeem Means Soa, Standard deviations (SD) of six TAT composite scores, by age and sex MN=1,20]l) cmcmcmcc cece cere rrr ccm cme c cc cecm cmc ccc meme ———— Page 26 27 28 31 32 33 34 36 37 38 25 Table 1. Number and percent of rejections of five TAT cards, by race, sex, and age, for the total sample (n=2,018) NEE Rejections of TAT cards of ay Ee shile Card 1 card 2 Card 5 Card 8 BM Card 16 in sample Number | Percent | Number | Percent | Number | Percent | Number | Percent | Number | Percent All boys 1,035 33 3.2 24 2.3 9 0.9 21 2.0 71 6.9 172 13 7.6 9 5.2 1 0.6 5 2.9 23 13.4 176 6 3.4 3 1.7 4 2.3 4 2.3 18 10.2 175 7 4,0 3 1.7 3 1.7 4 243 9 5.1 173 2 1,2 5 2.9 1 0.6 1 0.6 8 4.6 169 4 2.4 3 1.8 - - 5 3.0 9 5.3 170 1 0.6 1 0.6 - - 2 1.2 4 2,4 White boys! 6-11 years----- 939 30 3.2 23 2.5 9 1.0 2) 2,2 61 6.53 6 years==--=-=-=---= 155 10 6.3 9 6.0 1 0.7 5 3.3 20 13.3 7 years-==========- 160 6 3.4 2 1.2 4 2.5 4 2.5 14 8.8 8 years- -- 162 7 4,3 3 1.9 3 1.9 4 2:5 8 4,9 9 years- -- 158 2 1.3 5 3.2 1 0.6 1 0.6 8 5.1 10 years------=-=-- 154 4 2,6 3 1.9 - - 5 3.2 8 5.2 11 years~--=-===--- 150 1 0.7 1 0.7 - » 2 1.3 3 2.0 Black boys 6-11 years----- 96 3 3.1 1 1.0 - - - - 10 10.0 17 3 17.6 - - - - - - 3 17.6 16 - - 1 6,2 - - - - 4 25,0 13 - - - - - - - - 1 7.7 15 - - - - - - - - - - 15 - - - - - - - - 1 6.7 20 - - - - - - - - 1 5.0 983 40 4,1 33 3.4 17 1.7 26 2,6 66 6,7 131 17 13.0 13 9.9 8 6.1 9 6,9 19 14,6 164 13 7.9 6 Bel 4 2.4 1 0.6 18 11.0 187 3 1.6 2 1.) 1 0.5 2 3.7 9 4,8 164 4 2.4 7 4,3 3 1.8 6 3.7 14 8.5 169 3 1.8 5 3.0 1 1.8 3 3.0 3 3.0 168 - - - - - - - - 3 1.8 884 35 4,0 28 3.2 13 1.5 22 2.5 52 5.9 120 15 12.5 10 8.3 6 5.0 7 5.8 17 14,2 145 11 7.6 6 4,1 4 2.6 1 0.7 14 9.7 163 3 1.8 2 1.2 1 0.6 6 3.7 7 4,3 146 3 2.1 5 3.4 1 0.7 5 3.4 10 6.8 157 3 1.9 5 3.2 1 0.6 3 1.9 3 1.9 153 - - - - - - - - 1 0.7 99 5 5.1 5 5.1 4 4,0 4 4,0 14 14,1 11 2 18.1 3 27.3 2 18.1 2 18.1 2 18,1 19 2 10.5 - - - - - - 4 21.1 24 - - - - - - 1 4,2 2 8.3 As 1 5.6 2 11.1 2 1.1 1 5.6 4 22.2 1 - - - - = - ~ 15 - - - - - - - - 2 13.3 Includes one oriental ll-year-old boy. “Includes one oriental 6-year-old girl. 26 Table 2. Differences between proportions of rejections of five TAT cards by race and sex groups for the total sample (#=2,018) TAT card Comparison groups! and variables 1 2 5 8 BM 16 All boys-all girls: Difference in proportionseece-cccece-- -0.0088 | -0.0104 | -0.0086 | -0.0063 0.0015 Standard error of difference---------- 0.0081 | 0.0072| 0.0049 | 0.0066 0.0109 Critical ratio=---ccceccccccncccccanas 1.10 1.44 1.76 0.95 0.14 White boys=-white girls: Difference in proportions=---=-ececce--- -0.0077 | -0.0072 | -0.0051 | -0.0024 0.0062 Standard error of difference---------- 0.0084 | 0.0075| 0.0050 | 0.0069 0.0110 Critical ratio------c-ccccccccacccnaas 0.92 0.96 1.02 0.35 0.56 Black boys-black girls: Difference in proportions=------=---c-- -0.0193 | -0.0401 | -0.0401 | -0.0401 | -0.0373 Standard error of difference------=--- 0.0283 0.0246 | 0.0203 | 0.0203 0.0470 Critical ratio-----ccececcccccncccana- -0.68 1.63 21.99 21.99 0.79 All white-all black: Difference in proportions=--=-=-cecec=- -0.0053 | -0.0028 | -0.0085 | -0.0031 -0.0611 Standard error of difference---------- 0.0141 | 0.0125 0.0085 | 0.0114 0.0190 Critical ratio====-==cec-cocmcocccnnee 0.38 0.22 1.00 0.27 23.22 White boys-black boys: Difference in proportiong-----cccccea- 0.0007 | 0.0141| 0.0096 | 0.0224| -0.0393 Standard error of difference-----==e-- 0.0188 | 0.0161| 0.0099 | 0.0151 0.0270 Critical ratio-----ccceccccccccccnana- 0.04 0.88 0.97 1.48 1.46 White girls-black girls: Difference in proportions=-----ceccec--- -0.0109 | -0.0188 | -0.0257 | -0.0155 -0.0826 Standard error of difference----=-==--- 0.0209 | 0.0190 0.0138 | 0.0170 0.0264 Critical ratio------ccc-cccccccccncaa- 0.52 0.99 1.86 0.91 33.13 lyhite includes one oriental 1ll-year-old boy and one oriental 6-year-old girl. 2Significant at .05 level. Significant at .0l1 level. 27 Variable Correlations among the 68 criterion variables 19 22 29 Grade repeated- Grade skipped-- Gifted child/slow learner Pays attentioneeeeeea-- - Intellectual ability--=----- Da GN Academic performance-- -— Intellectual adjustment scale- - Emotionally disturbed-- — Overall adjustmente=-- - Motor activity- cw N® — 11 Aggression==-mmmmccccmccec cc —————— 12 Frequency of being chosen leade 13 Rank order when choosing sides- 14 Frequency of disciplinary action= 15 Social maladjustment scale-==m-m=a-- 16 Nursery school attendance------ ———— 17 Special resources for physical disabilities-=mecaaaa 18 Present health status- 19 Wets bed-=--=- - - 20 Permanent scars. -— 21 Serious hospitalization----- 22 Serious accident or injury- 23 24 25 POliommmmmmmmannn 26 Meningitis or sleeping sickness - 27 Tuberculosis-- 28 Diabetes--= 29 Epilepsy--- 30 Whooping cough=== 31 Measles (yes, NnO)=mmmmmmmm= 32 Asthmleeeeececomcmeaaa-—. 33 Measles (severity)- - 34 Hay fever--eeme-=- - 35 Other allergies--==emee--. 36 Kidney trouble=-=-- 37 Heart trouble-= 38 Convulsions, fits=- 39 Present health problems: 40 Speech defect-= 41 Hearing difficulty=e--==-. 42 Suck thumb, fingers-=e-=-- - 43 Prevented from strenuous exercise 44 Unpleasant dreams-- - 45 Sleepwalking===e=-- 46 Fear of darke-==- Sp 47 Medical history scale-. - 48 Residence location= - 49 Income level==w==w. - 50 Foreign language- — 51 Range of food tastes 52 New friendge=eeme=- - 53 Interchild relations 54 Run away from home====-=-. S55 56 Tension leve 57 Temper-==--e=== 58 School social adjustment scale--- 59 WRAT Reading score===-=- 60 WRAT Arithmetic score--- 61 62 63 Race-==mw=== 64 Sample numbere-m==- - 65 Manually recorded protocol= 66 Goodenough-Harris score. 67 WISC Vocabulary raw SCOTe==m=-. 68 WISC Block Design raw score-=s-=em-- 40) 55 53 71 24 12 09 33 33 06 08 -01 -01 -01 =01 03 -13 -02 06 04 04 -01 -05 05 -01 -22 -26 -20 89 2333 AR38 RBI -02 03] -01f 01] -04 01 11 -01 =07 -18 05 -02 04 10 0S 04 o7 10 11 -33 -08 02 -11 10 -01 -24 -33 -29 91 14| 17 42| a7 16] 17 171 22 18| 23 37| 43 44| 48 48| 55 =01|=03 ol -04]-03 03| 03 11 12 -|-o1 -05|-08 -03(-03 03 02] o1 05( o7 05 ol 03( 03 -02]=-01 Olf-01 lof 10 09| 08 12] 12 -31|-36 =-11(-11 o3| - =13( 75 o8| 09 -02]-01 -23|-27 -28(-33 -29[-31 21 34 23 33 39 70 06 01 04 03 -0l ol 02 03 -01 lo 11 o7 -04 13 13 11 18 o? -12 -10 -17 538 20 ol Al 13 -13 -11 -01 328% BR. BRRABR. 10 46 05 -03 -03 ol -03 o7 10 10 10 -01 -04 -05 -01 -04 -01 -02 -03 -01 -01 -01 1pecimal points have been omitted because 28 of space limitation. selected from HES Cycle II questionnaires and tests (n= 2,012) Variable—=Con. 30 | 31) 32] 33] 34] 35] 36 37) 38 39] 40] 41] 42] 43] 44| at | 46] 47] 48] 49] S051 52| 53) 54) S55] 56] 57 58] S59 ]|en]|61]62| 63 |ca| 65 66] 67 1 2 3 4 5 6 7 8 8 lo 11 12 13 14 15 16 17 : 18 1g on 21 22 23 24 25 26 27 28 29 30 03 31 o8| 09 32 02) of 02 33 -07|=-02 [-02( 25 34 =-07] 02| 01] 16( 17 35 02 02] 08] 06| 03] 10 36 -04|=05( O1[-04| = |-02|=03 37 =0l|-02]| 02| 07 o1| 04 olf 09 38 05 09] 05] 21 11 15( 07] 01} 11 39 -02| 06| 02| 04 02 |-0L| 11| 04-02 19, 40 02 03] 02] OLl|-03|-01( =[-04][ 03] lof 0° 41 -03| 01] =| =| OlL|-05( 08] 03] 02] 04 01] 02 42 -1 05 =f 21] 11] 12] 11| 03| 10[ 21] 03( lof 06 43 06] 02] 05| 04] 04 o1f o2[-02|-02]=01| 06] =| O2( OL 44 -1 02 03f 02] 04] 06] 06] 03] 06 03] 15| 06 02| 04] 27 45 08 =~] 03 o5| -|o08] 03] 02] =| l0| 02| 09(-0S| OS| 06] O1 46 21| 27] 23] 38 24| 30( 30[ 08] 23| S4( 28] 30| 18] 40 13| 28 37 47 =03| 02|-03|-02| Ol [~03(=-06] OL| 03|=03 (-02 - - = |=05| =11f «04 =04. 48 =17|=01 [-04| 02| 05 | 03|=-09| 02(=03|=10|=07 [«=06| O04 [-01| O4|=01|=08|=12| 15 49 01[-07 | 06 02 [-0L (-04|=05( =| OLf 0S| 05|-03(-03| 01-04] =| 02|=01f O4|-12 50 -01|=01| 02] OL] O1| 06|=04| =f 02| 06|-02| 0S|=-04 | OL| 06] 04 12[ 08] OL] 06 02 51 -01f = -| 01] o1| 02f-02| 03| O1|=01|-02| 06] 04 | 02]|-04| Ol|-04| 02] =| 03] 04( 01 52 -01| 03| 05-02] 01] 07| 04| 04 05| 06|-05| 04|-01| 04[-01|-04[ 07 lo] OL|-04| 02 03] 18 53 03| 06| 03| 04] 04 |-03| 04|-02| 07| O01] 09 |-02(-01| 08] 04 06] 03| 09] 07 01l[-03[-02(-02| 02 54 -02| 03| 01] 09| 02| 10 08] oL| 09| 12| 07 04| 02 | 1lo0[-01| o4|-01| 17] O1l| =~[-06|-02] ~| 06 OS 55 -| 06 02] 01] 04] 05| 09|-02| 03| 12] 02| 04| 01 | 0S| =~| 04 07| 19] 01|-03|-04| O07] 02] 15| 06] 17 56 06 02 09-05-04 [03] 04 02| 03] 06 03] =|-OL -| 11] 02] o5| 12 -|-10| 06] 04] -| 16] o7| 02] 29 57 -| o4|o6f 02 -] 09] 05] =-| 08] 12] 01] 09| or 08 02] 03 07] 21] o2|-02| 02] 33] 60f 60 14] 37| 48] 42 58 -04| 07 [03] 04] 09 | 05(-05| 02| OL|=04 |-04 [-16]|-06 [ 02|-06| 03[-00|-08] 03| 22|-04| 02]-04]-07|-03| 03] 01 [-06 [-05 S59 -02| 02-03] 03| 06 |-02|=-01|=03| 01|=02 |-02[-10|=07 [-0S| 01|=-02|=03[=-07| 03] 09|-02[-03|-03]-06] =|=02]-02(-02 [-07| 86 60 07( 15 f-02| o7| 06] 01|-01f =~ 04] 03[|-02(-13]|-11| 06|-02| 06|-07| O1 - -|-02[-02|-03]|-04 -| 03] 02] o5|-01| 69] 79 61 -02(-03] 03|-04| o1}-01| 02 -|-07]|-03}|-06(-05| 09 }-01]|-05|~05| o1|-06]-03| 03|-01] 03| 02|-03|-10]|-03|-04|-12|-05]| 15] 08] 03 62 14| 04 [-02| = |-04}-05| 03|-02|-02] 09| 03| 07] 03 | 01(-04|-04| 0S| 0°| 08|-26(-08]| 02|-02]|=02]|=03|=05 |-0S [ 04 [03 |-18 |-15| 01] OL 63 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 64 04] 03| 05| ol f-02] 01 =-]|-02| ~-]|-04(|-03[-02] O1| o1} 09| 0S|{-03| 02[-08| 06|-03| 04| 04]|-01| 02| OL|-03| O01 03] =-[-04|-02] =-[-05 | - 65 -05| 05| olf =-| 0S] 02|-03|-05|-02|-04 |-03|-11[-06 |-02|-03| 05]|-08|=10[=04| 10[~01|-05|-05|=12|=04|=04 |-07 [06 |-14| 63 | 64] S56] 17 |-14 | - [02 66 -08| 06-02] olf 09 | 09|-04| 03 -|-04]-04|-14|-08 | 01| =-| 09]|-09|-07| 02] 24|-11| ~-]|-07|-07| O01] O3| Ol|-06f-07| 77| 75] 62 -|-26 | - - | 59 67 -07| 03] oL| 03] 05 | 02|-03|~-02]|-03 =~] 03]-11}-06| 02] 01] 03|-11|-08]-05| 21| =|}-02| =|-09|=03]|=02[-05|-06|-08| S57] 61] S0(-02]-22 | - [02 | 57 | 61|68 29 Table 4. Varimax rotated loadings of 64 criterion variables selected from HES Cycle II questionnaires and tests on five principal components (m=2,012)! Rotated factor Variable I Iz i Iv Vv 1. Grade repeated==----=-=cmmemccm cme mmeemeceeeee 43 -.08 .08 - -.12 2. Grade skipped===-eoo cocci n .06 -.02 -.04 .02 -.22 3. Gifted child/slow learner 71 -.01 12 .02 .02 4. Pays attention=-------ccmmcemmccmmeema remem —————— -- .66 .04 .13 .03 -.37 5. Intellectual ability=--====-c-cmccccecoccaccnann ————————— .85 -.05 +13 .05 -.02 6. Academic performance---------ee-cemcmmmomoneoan -—- .86 -.04 «12 .04 -.11 8. Emotionally disturbed--=---=-cmcmemmeccocmcannen -—— .09 -.05 .03 .04 -.49 9. Overall adjustment=-----=-=cemeccemcmmoe ce cemm em -- 43 +03 .05 .07 -.54 10. Motor activity===---mccmmmme emer eeeemeee .15 -.04 - -.07 -.36 11. Aggression=---=--cm comme meee .10 .03 - -.02 -.71 12. Frequency of being chosen leader----------c-cocmeanan -—- .50 -.10 -.09 .02 +13 13. Rank order when choosing sides=----=--ccccccmmmacanann -— «31 - - .05 -.30 14. Frequency of disciplinary action--------c-emceceencax - .56 - - .06 -.28 16. Nursery school or kindergarten attendance-------=-- -— .01 -.05 -.10 -.12 -.02 17. Special resources for physical disabilities---- -—- .03 -.20 22 .01 -.05 18. Present health statuS=---==--ccmemcmcccmaonaou - .10 -.54 .08 01 -.06 19. Wets bed==---m-emcomcm meme cee eeeem -- .04 -.23 +19 .16 -.13 20. Permanent SCArS========= == mmc me ome mmmm— oo -.02 -.08 .09 .08 -.10 21. Serious hospitalization=--=---cmcmooomm omc cmmeecmee -.05 -.14 .01 14 -.18 22. Serious accident or injury---------emecccmcoccmcnono- -.02 -.44 03 .08 14 23, Scarlet fever-=------memmmcccm cence eee +02 -.13 -.08 - - 24, Rheumatic fever--=--seeemccmmmccm ccm meee .10 -.17 -.06 -.02 -.03 25. POliO==mcmmm mmm meee meee .05 .01 -.11 .06 .05 26. Meningitis or sleeping sickness- -.03 -.01 - «02 -.02 27. TuberculoSig=-==--cceecmcecnaanan - - - - - 28. Diabetes ====comcmm mmm emcee meee mmo - - - - - 29, Epilepsy=-=--ceemmcc meme eme meee .04 -.07 -.03 -.05 -.02 30. Whooping cough=---sme cme imme cee eo 14 -.18 07 -.04 .09 31. Measles (yeS, NO) =====-smmcmmccmcem cece memcme—————— +20 -.23 -.15 01 - 32, Asthmas---eccmoc mom cme mmm .01 -.19 .03 .07 - 33. Measles (severity) --=s=-s--cemccecmcmmmcccanaoun +01 -.48 -.04 -.06 .06 34, Hay fever=--s-eeeccmmccm ccc cm cme cen eo -.07 -.29 -.09 -.02 .06 35. Other allergies===---mcmmmem meee -.06 -.31 -.05 .08 -.03 36. Kidney trouble==---esccmmc cece ccccm cee e -.05 -.28 .07 .02 -.15 37. Heart trouble--=----cmcmmc cmc e em -.01 -.02 .02 - -.06 38. Convulsions, fits-----cecmemomcmm mca .04 -.20 -.02 .08 -.09 39. Present health problems .03 -.58 .05 .06 -.02 40. Speech defect =---omm mcm mm cme eee eee meme meee -.01 -.28 .07 -.04 -.02 41. Hearing difficulty==-----mcmccm meme cmmmcemcme cee eam -.01 -.23 .26 .06 - 42, Suck thumb, fingers=------ccemmmoccmmcc cee -.07 -.08 +15 .01 -.04 43. Prevented from strenuous exercise, health defects- «15 -.17 .08 -.06 «19 44, Unpleasant dreams ===-----==c=cccmcmmem mcm cm———— .01 -.17 .03 -.17 -.02 45, Sleepwalking? -=-mmmm mmm cm omc cee -.40 -.13 .09 -.07 -.62 46. Fear of dark=----c-ceccmmm mmc ee ee «11 -.28 13 «05 .03 48, Residence locationd=--eemmeccmcccccmccccacaen -.40 .61 -.16 .61 -.85 49. Income level=---ecccmomome ccc ee emcee em -.23 17 -.21 .06 -.07 50. Foreign language=-======--cmemcmcemmm eee cme mmm ——————— .06 .01 .05 .03 .07 51. Range of food tastes =-=--cmecmmcmcm emcee cmeee en -.05 -.06 .02 «31 +07 52. New friends----cececmcmm cmc cece eee .08 .04 +02 +53 .18 53. Interchild relationS--=----cecmmcmmmceoonoo «11 - .04 .60 -.08 54. Run away from home--=---cecmcmcmmcm ccc eeeen .02 -.07 - 14 -.08 55. Trauma=---=---oeemm emcee ecm mem mean +01 -.19 -.03 +32 -.06 56. Tension level----mcecccmomcc mmm .02 -.13 -.01 «52 -.19 57. Temper -=====mmmcecm cece cece eee —————————— .07 -.03 .02 47 -.18 59. WRAT Reading ScOre-=--=--eeccmmmcmcmacccceeen -.24 -.02 -.79 - 04 60. WRAT Arithmetic score -.04 - 80 -.07 - 61. Age in months =---=-emcccmccme emcee cece oe -—- .16 -.13 -.82 -.01 .05 62, SeX=-=--emmemmmm eee meme mee—e—————— -—- -.05 .01 .04 -.01 «31 63. RACE====mm mmm mm momo memmee on -——- +13 -.11 24 -.09 .06 64. Sample nNuUmMber=----ce-cccmccm meme ecmeeeeen -— - - - - - 65. Handwritten protocol=--=---=ceccccmocna- --- -.03 - - .05 +03 66. Goodenough-Harris score=--=----ecececeaao -—- -.13 -.01 -.73 -.11 .08 67. WISC Vocabulary raw SCOre@====---==e--cmemcmaaan -- -.24 -.02 -.82 -.01 -.05 68. WISC Block Design raw scoOre=-=------cecomcmomomcmcmcoonann -.21 .02 -.71 «07 .05 IThe variables used to define each factor are listed in table A and are discussed on pp. 9-11. 2This variable was dropped due to insufficient variance. 3This variable was dropped due to error in definition. NOTE: Four criterion scales from Study I-—variables 7, 15, 47, and 58—were omitted from this analysis, 31 Table 5. Means and standard deviations (SD) of 68 criterion variables selected from HES Cycle II questionnaires and tests grouped by factors, by sex and age (M = 2,012) Criterion factor and variable! Boys Girls 6 and 7 years 8 and 9 years 10 and 11 years 6 and 7 years 8 and 9 years 10 and 11 years Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD Factor I—School adjustment 1 Grade repeated-==========- 0,065 | 0,240 0,170 | 0,380 0.175| 0.375 | 0.070] 0.250 0,105| 0,300 0,070 0,260 3 Gifted child/slow learmer-| 1,080 | 0,395 1.125| 0,480 1,085| 0,535 | 1,030| 0.470 1.035 «450 1.015 0.445 4 Pays attention-------e-o-n-- 1,080 | 0,630 1,165| 0,655 1.095 | 0.630 | 0.890| 0.610 0.855| 0.630 0.850 0.645 5 Intellectual ability-- 0,950 | 0,615 0.965| 0.655 0.995| 0,685 | 0.825| 0.645 0.,815| 0.635 0.865 0.625 6 Academic performance------ 1.010 | 0.665 1.055| 0.695 1.080 | 0,685 | 0.865| 0,665 0.830 | 0.675 0.890 0,650 Factor II—Poor health 18 Present health status----- 0.035°| 0,185 0.055| 0,230 0,055 | 0,230 ( 0,050 | 0,220 0,055 | 0.220 0.040 0,195 22 Serious accident or injury-----=s=cceeaua- ==={ 0,190 { 0.390 0,220 | 0,415 0,195 | 0.395 ( 0.135| 0.340 0.155 0.365 0.170 0,375 33 Measles (severity)- -( 0.030 | 0,195 0,070 | 0.245 0.070 | 0.245 | 0,050 | 0,230 0,035 | 0,190 0.075 0.270 34 Hay fever----=--=--- -| 0.050 | 0,215 0,055| 0,225 0,075 | 0,260 | 0,040 | 0,190 04 «19 0.060 0.240 35 Other allergies--=-==-===== 0.135 | 0.340 0.145| 0,355 0.090 | 0.285) 0,085| 0,275 0.,125| 0.325 0.130 0.340 36 Kidney trouble----=======n- 0.030 | 0,170 0,025| 0.155 0.025 | 0.165] 0,040 | 0,195 0,050 | 0,220 0.060 0.230 39 Present health problems---| 0,170 | 0,380 0,180 | 0.390 0.200 | 0,400 | 0.165| 0,375 0,155 | 0,360 0,190 0.395 40 Speech defect--=====eemn=- 0,045 | 0,205 0.045| 0,210 0.035 | 0,190 | 0,030 | 0,160 0.020 | 0.150 0.040 0,190 Factor III—Intellectual development . 59 WRAT Reading score--=--=---- 63,290 | 15,485 | 36,090 | 13,930 | 57,690 | 13,010 | 67.780 | 13,315 60 WRAT Arithmetic score- 34,180 | 6.800 [19,880 | 4,690 | 27,770 | 4,440 | 35,510 6,310 61 Age in months---=-=-=---- 131.850 | 7,210 [(84,835| 6,510 106,950 | 6.680 [131,660 7.220 66 Goodenough-Harris score--- 27,010 7.530 [19,310 5.670 25,090 | 6.860 28,875 6.180 67 WISC Vocabulary raw score- | 18,160 | 6.085 | 26,390 | 8,110 | 32,405 | 9,095 [18,100 | 5.645| 25,335| 8,935 | 32,500 8.520 68 WISC Block Design raw SCOre-====mrmmnmmnnmnnnm—n 7.250 | 6,030 | 12,110 7,930 | 19.860 | 12,360 | 6.860 | 4.745| 11,700 | 8,790 | 18,900 | 12,210 Factor IV—Social adjustment 51 Range of food tastes=---=--- 0.245 | 0,430 0.230 | 0.420 0.215 | 0,410 | 0.265 | 0.440 0.,195| 0.395 0.220 0,410 52 New friends---======ece=u- 0,795 | 0,770 0,705 | 0.735 0.680 | 0,730 | 0,785 | 0,800 0.735| 0,775 0,790 0.750 53 Interchild relations------ 0,615 | 0,565 0,620 | 0,575 0,605 | 0,570 | 0.535| 0,560 0,520 | 0.570 0.520 0.570 55 Trauma-======mm====== -| 0.255 | 0.435 0,250 | 0,430 0.285 | 0,450 | 0,180 | 0,385 0.265 | 0,440 0.260 0.440 56 Tension level-- -{ 0.135 | 0.345 0,205 | 0,400 0,195 | 0,395 | 0,130 | 0,335 0,140 | 0.345 0,150 0.335 57 Temper===--======cececoaann 0,175 | 0,385 0,225 | 0.420 0.195 | 0,400 | 0.115| 0.320 0.100 | 0.300 0.150 0.360 Factor V—Emotional disturbance 8 Emotionally disturbed----- 0,030 | 0,165 0,090 | 0.280 0.040 | 0,200 | 0,030 | 0,170 0,030 | 0.170 0.050 0.215 9 Overall adjustment--- 1.025 | 0,570 1.135 | 0.550 1.070 | 0,575 | 0.890 | 0.475 0.880 | 0.520 0.870 0,560 10 Motor activity-==----- 0.285 | 0.455 0.355 | 0,480 0.325 | 0,470 | 0.250 | 0.475 0.295 | 0,455 0.285 0,455 11 Aggression-========ccecau- 0.340 | 0.860 0.490 | 1,045 0,380 | 0,915 | 0,065 | 0.290 0,140 | 0.490 0.130 0.440 Miscellaneous variables 2 Grade skipped----====mmn=- 0.010 | 0.110 0.020 | 0.140 0.020 | 0,150 | 0,005 | 0.040 0.015 | 0.130 0,010 0.095 7 Intellectual adjustment scale---===mmmmmmmee————— 4.115 | 1.855 4,310 | 2,090 4,250 | 2,115 | 3.620 | 2,020 3.530 | 2.015 3.630 1.935 12 Frequency of being chosen leader--=====ccemeconannn 0.630 | 0,485 0,695 | 0.465 0.645 | 0,475 | 0.465 | 0,505 0,390 | 0.490 0.410 0.490 13 Rank order when choosing sides~=====mmmmmmmmnnn——— 0.865 | 0.555 0.885 | 0,580 0.830 | 0.575 | 0.795 | 0.570 0.820 | 0.625 0.820 0.590 14 Frequency of disciplinary Sctisn ae -- 1,090 | 0,515 1.055| 0,615 1.110 | 0.615 | 1,040 | 0,510 1.050 | 0.610 1.060 0,600 15 Social maladjustment scale------ d mmemmemmee—ee 4,270 | 2.215 4.700 | 2.485 4,415 2.370 | 3.535| 1.705 3.600 | 1.895 3.635 1.845 16 Nursery school or kinder- ey attendance-======= 0.070 | 0.250 0.085| 0.280 0.105 | 0.300 | 0.070 | 0.255 0.095| 0.295 0.115 0.315 17 Special resources for areas disabilities----| 0,095 | 0,290 0,080 | 0.270 0.060 | 0,240 | 0,090 | 0,280 0.055| 0,230 0,035 0,185 19 Vets bed--~=====m=mmmunun- 0,180 | 0.385 0,200 | 0,400 0,130 | 0.340 | 0,150| 0,360 0,090 | 0,285 0.085 0,280 20 Permanent scars-----------= 0,050 | 0.215 0,040 | 0,180 0,035| 0,190 | 0,045| 0,205 0,040 | 0,195 0,045 0,210 21 Serious hospitalization---| 0,035 | 0,190 0.055| 0.225 0.,035| 0,190 | 0,040| 0.195 0.,045| 0,205 0,040 0.200 23 Scarlet fever-------====-=- 0,020 | 0,130 0.,025| 0,155 0.040 ( 0,195 | 0,020 | 0,140 0.,045| 0,200 0.045 0.200 24 Rheumatic fever- - - - - -| 0,080 | 0,005| 0,080 0.005| 0,040 0,005 0,040 25 Polio-=-==-- mmmmmmm—————— - - - - 0,010 0,090 ( 0,005| 0,040 -| 0.040 0,005 0.040 ningitis or sleepin 2 NI tLs or lee PIE en - | 0.060 -| 0.060 - - a -| 0.010] 0.095 | 0.005 | 0.040 2 Suberauilopis-~- ———— - - =| 0.040 “l siote - » = - 28 Diabetes---===mrm=mmmm————— - - - - = . - = = . 29 Epilepsy-==============n== - | 0,040 - - -| 0,040 - - -| 0.040 0.010 0.095 30 Whoo ing cough-=-======-=u=- 0,075 | 0.255 0,080| 0,270 0,100 | 0,300 ( 0,040| 0,190 0.070 | 0,255 0,090 0,285 31 Measles (yes, no)========-= 0.765 | 0,425 0,890 | 0.305 0,905| 0.290 ( 0,750 | 0,430 0.,865| 0,340 0.910 0.285 32 Asthma---=====mem=emeeenn- 0,030 | 0.175 0,035| 0,175 0,040 | 0,200 [ 0,055| 0,225 0,065 | 0,240 0.050 0.220 37 Heart trouble-----======-= 0,030 | 0,170 0,025| 0,155 0,020 | 0,130 | 0,010 0,095 0,015| 0,120 0,015 0,115 38 Convulsions, fits--------- 0,040 | 0,200 0,050 | 0,220 0.050 | 0,215 0,030| 0,160 0,025| 0,155 0,040 0,190 41 Hearing difficulty-------- 0,145 | 0,355 0,080| 0,270 0,070 | 0,245 | 0,090| 0,285 0,055| 0,225 0,055 0,225 42 Suck thumb, fingers------- 0,080 | 0.275 0.,060| 0.230 0.060 | 0.245 | 0,190 0.390 0.120 0.325 0.070 0.255 43 Prevented from strenuous exercise, health defects-| 0,055 | 0,230 0,040 0,195 0,075| 0,270 | 0,050 | 0,220 0,050 | 0,220 0,070 0.260 44 Unpleasant dreams--------- 0,030 | 0,165 0,025 0,150 0,010 0,105 0,015 0,130 0,015 0,085 0,010 0,105 45 Sleepwalking---==========- 0,070 | 0.260 0,105| 0,300 0,130| 0.335] 0.,075| 0.255 0,075| 0,270 0,110 0,310 46 Fear of dark------ 0,270 | 0,445 0,235| 0.420 0.135] 0.340-| 0,250| 0,430 0.250 | 0,430 0,205 0.400 47 Medical history scale 2,685 | 1.875 2,835 1,930 2,695 1,900 ( 2,510 1,790 2,540 | 1.645 2.675 1,845 48 Residence location- 1,710 | 0,450 1.680 0,465 1,705| 0,455 | 1.635| 0,485 1,700| 0,460 1.680 0.475 49 Income level--==-===m=m--- 5.520 | 2,420 5,380 | 2,485 5,515 2,390 | 5.545| 2.285 5.490 | 2,265 5.720 2,325 50 Foreign language---=-==-==-=--= 0,115 | 0,320 0.,095| 0.290 0,085| 0,275 0,080| 0,275 0,090 | 0,280 0,095 0.290 54 Run away from home-------- 0,025 | 0,155 0,040 0,195 0,025| 0,150 0,015 0,110 0,015 0,130 0,020 0.130 58 School social adjustment ] 2,250 | 1,440 2,280 1.470 2,200 | 1,510 | 2.,025| 1,410 1,975| 1.410 2,115 1.580 1.000 - 1,000 - 1,000 -| 2,000 - 2,000 - 2,000 1,095 | 0,295 1,080| 0,270 1.100 0.305 1.100 0.300 1.120 0,325 1.080 0,270 64 Sample number 1,500 - 1,500 - 1. - . = . - . - 65 Be ot protocol--==-=-= 0,020 | 0,150 0,030| 0,165 0,020 0,130 0,025) 0,150 W015] 0,130 0.035 0,180 The original numbers assigned to grouping by factors. the variables have been retained, even though they appear out of numerical order for this Table 6. Means and standard deviations (SD) of selected variables used in analysis of the TAT structural and thematic data (7 = 1,910) Variable! Mean SD Lo AQUETIIS mw mmm mim ww mim mm on on mm mm tm mm a mm 2,958 4,687 2, PauseS----=rremmecmee mms m sees em — ee ———————————————— 15,251 17.416 3, Verbatim repetitions=---=-===-ccccmccmomcmanncaanaa 5.765 8.174 4, Corrections--==--=-m-cemmccccccccc cmc ccc ———————— 3.487 5.899 5. Past reference--------==-c-eceeomccmmmccceec ecm 1.264 1.561 6. Future reference-------=----emeccmcmcmcccccm cee ——a- 1,586 1,700 7. Unhappy outcome--=====mmmmmeemcmce cm — cc ——————————— 0.414 0.755 8, Death=-==--ccmcmmmmmmm ecm me emcee meee 0.441 0.732 9, Murder-killing--=-=-====-=e-cemcccccccccncccc eee 0.271 0.555 10, Rejection--=-=--==cmememccmce ccm meme me meen mee 0.164 0.549 11, Level of interpretation------------mcmcccocmcccaan- 11,442 2,307 12, Situation complexity----====---c-emeccemcec ee ee———— 11.429 2,444 13, Present reference---======-mc-ememcccoacccceacaa——- 4,781 0.646 14, Happy OuUtCOME====-====m-- meee - mec cec—ecec—cc—————— 1,054 1,356 15, Causally connected statements----=-===-===cce--c---- 1,239 1.395 16, Expression of feeling----=---==--=-c-cmccoceocoana- 2,228 1.557 17. Outcome--===mmemmemmcem mcm —ce eee —————————————— 1,915 1.760 18. Kind-loving-=-==»=wrremmommo mmc cen mn 0.280 0.643 19, Happy-glad----====mmeee=-meeem cece era ec mem —— emma 0.370 0.759 20, GOBL DENAVI OL wm mmm mm mmm om a im mo wm a a s/t 00 2,659 1,840 21, Antagonism----==-=m--mecceecce eee meee ————————————— 0,119 0.437 22, Morbid mood quality--===-==----cecccecmmc mecca an 0.134 0.504 23, Bizarre theme-----====--mccemocccece ccc mce—a an 0.059 0.273 24, Egocentrism-===w==mm=oemee remem rm mem — 0.256 0.549 25, Mean-rejecting--=====mm====reemmemmee— mem ———————— 0.311 0.644 26, Aggression----=-==m--cecccccccccecccccccce ema 0.506 0.732 27. Possessive adjectives-----=--ememmmcmme mma —— 7.967 9.040 28, Common NOUNS=========m=-=cc--eeececcea—e—c————o—o=o 49,748 39.390 29, PronounS----=-=-=me-emmcmcmmeeeeeeeeeeeeee—ee—e——— 40,808 38.611 30. Single verbs---====rmmemmmemmme meee ————————————— 51.047 42,729 SLs DABLOGUG mm gm mmm mor mio stim ss ests sm 0 mr ee ms 2,874 6.761 320 ADE (JOBE) mmm mm mmo sm ct item tt 8.517 1,681 33, SexZmmmmmmm mmm m mmm eee 1,481 0.499 340 RACE Prime mnimm nn wg ion rm om mm 0 0 1 0.726 0.784 35+ Critetion PACEOL I mews mmission wus 301.275 46,879 36, Criterion factor Il =-==-=--c-e-ccmccme mcmama 449,953 45,251 37. Criterion factor IIL”-------ccememooomcmmocmeooo- 300.893 45,708 38, Criterion factor IVZ------cccmcmmomomm emcee 349,828 39.090 39, Criterion factor VZ------eemmooocmmmcmmm mcm 250,123 34,892 Purposefully connected statements? --------eccccccoaona- 0.588 0,943 Interpolations? =memme mmc 0.334 1,311 Reaction time latency?d-==--mmeeeccccmcccm cc cmcc cece 60,345 62,595 Total timedeme-memmccceccc cece ccc ——————— 509,349 215,108 Number of WOrdsd=sm--eeeeececcccmecmcccmccmm ccc m meme 370.722 319,960 Thinking d--==-eooommm mmm cmc e eee 1.183 1.312 ESCAPES mum mmm mm mmm mem mt mt mt tn tn en 0.091 0.322 Fear3=-eemmmmceccmce cmc cm ——————————————————————— 0.101 0.319 Illness -injuryd==-me m-mec oe cece emcee cme 0,700 0.686 Number interpolated words3d=----=cemeecmcmme mcm ence 8.128 12,103 see pages 12-16 for discussion of these variables. Variable used in validation analyses. 3Variable not included in second phase of analysis. These are reported for possible use as resource information. 33 Table 7. Correlations among the 31 TAT variables used in final Variable Variable i 2 3 4 5 6 7 8 gj10111 (12 [15 14 |156 {18 | 17 | 18 1 Adverbs===--cm commen meee X 2 Pauses-------c-cooon - 47 3 Verbatim repetitions- ——————— 35| 54 4 Corrections=--=---ccocmcmmmomca aan 51) 58] 82 5S Past reference-----c--cecccmocmooaan 48 | 44| 35| 60 6 Future reference--------ccceccmaaono 51 51, 37; S6| 64 7 Unhappy outcome--- -— iz 15| 13] 20) 19 23 8 Death---------- --| 13] 15] 19} 21 15( 18| 38 9 Murder-killing--------ccccmmommaeoon o8| 11 134 15 08| O7| 28] 176 10 Rejection=-----momommmcmmme een -15| -19| -15| -14 | -17| -21| -12| -11| -06 11 Level of interpretation----------e-= 34| 34| 35| 30| 36| 39| 30| 18| 09 | -66 12 Situation complexity-------=ccceoae- 42 | 44| 42) 40 53| 62| 29 22| 12| -64| 80 13 Present reference--- -- 15| 20 17| 15) 17| 22 12 10| 0O5|-87| 68| 66 14 Happy outcome==------meceaeaax -- 35 30! 31] 28 34 50 - 03| -04 | -19 54 59 20 15 Causally connected statements------- 34 27 33 26 29 30 28| 20 10 | -20 72 52 22 50 16 Expression of feeling ==s=ememeee-—-_ 40 27] 27| 31 | 41| 41| 21| 12| O4|-30| Se S52| 32 | 43 | SO 17 Outcome----=mcmmmcmm meee -| 41| 38| 36 | 38] 45| 64 | 44| 22| 10|-25| 63 | 71| 27| 78 | S6| 47 18 Kind-loving----=-----commmceomn - 16| 19( 20| 11| 15| 19 o02| 02 -|=-11| 31} 31| 12 | 34 | 32| 28] 29 19 Happy-glad-- -- | 30| 21{ 26 20, 29 31 -| 05(-02|-12| 28 33| 13 | 45 | 27 | 43| 34 27 20 Goal behavior-=------ceceeecmcmmmaaano 24| 23| 28| 18 | 25| 30| 15| 10| O06 |=-29| SO | 48| 32 | 39 | 41] 41| 42 39 21 Antagonisme=----c-commmmmmme mo 15) 14 18| 16 | 15! 17| 14| 10| 10|-06| 19| 20| 06 | 16 | 23| 21| 19 25 22 Morbid mood quality- : l2| 13 23| 20, 13 15| 04| 09| 10|-05| 10| 15| 06 | 10| 10] 10| 11 12 23 Bizarre theme---------cmeemmemmoo 07| 07| O07| O7| 10| O5| 13| 32| 30(-04| O06 | 10| O04 -| o7( O07 O08 13 24 Egocentrism--- 21 22| 19 | 24 | 24 27 16| 12| 14 (-11| 24 | 28| 12 | 16 | 22| 22| 29 12 25 Mean-rejecting-=----eommmoc coc nn 21 17| 20| 21| 18 18 21| 19| 19|-10| 23 | 24| 08 | 13 | 28| 29| 24 22 26 Aggression----------e-o O4| 13 15| 10| O6| O7| 16| 26 33|-11| 13| 16| 11 | O01 10| oO8| 09 11 27 Possessive adjectives— S2| 46 | 43 | 49 | SO| 48 22| 22| 14 |-20| S1| 59 | 22 | 46 | S4| 47| sS4 36 28 Common nouns----------- 57| 54 | 53 | 51 | 48 | 49| 20| 27 19 |-27| 56 | 65| 28 | S50 | S57| 45| S57 35 29 61| 54 | S6| S6| S1| S53 | 23| 27| 19|-24| S8| 66| 26 | S2 | 60| S2| 60 36 30 63] S5| 55 56 | S51 S53 | 22| 26 17|-26| S57 | 66 | 28 | 51 | 58 S1| S9 35 31 33| 24 | 30| 27 | 27 28| 12 14| 13|-09| 27 | 34| 10] 27 | 30| 26| 32 22 ze 30| 20 14 | 15| 30| 28 | 11 -|-05|-16( 36| 36| 18 | 34 | 32| 36| 36 17 33 03 | -01 | -04 -| O04 02 01(-03|-06| O3|-05| 02|-03| 06 | 13| 11| OS 02 34 58| 20| ov) 25 26) 32| 01 - - -]=-05] 11| 01 - |-09 -| 06 | -06 35 Criterion factor I--------ccmomeaooo 14 09) O5| 09 | 17| 18 06|-01|-05[-03| 15| 17| os | 20 | 17 | 14| 20 07 36 Criterion factor IT------e--eoeomoan -|-03]|-02 |-01 - - -]=-01|-01| 02 |=-02|-01|-01| O02 |-03|-01( O1 02 37 Criterion factor III---------ce-e-an 42 | 31| 18 | 24 | 45 44 | 13 -|-06|-18| 42 | 48 | 23 | 42 | 36 | 42 | 45 21 38 Criterion factor IV------ceo-cccmaoou 03 | 05 | 02 -| 03 | 05 |=-02 - - - 03 | 05 -| 07] 02] 02 05 04 39 Criterion factor V-----ccccecmcaaaan -02 | -03 | -01 -|-02 | -02 -| 02] 04 -|=-06 |-05|-01]|-10 |-08 |-02 | -08 | -05 34 Decimal points have been omitted because of space limitation. 2See pages 12-16 for discussion of the 31 TAT variables and pages 9-11 for discussion of the five criterion factors. analysis, five criterion factors, age, sex, and race? (n = 1,910) Variable—Con. 19 20 21 22 23 24 25 26 21 28 29 30 31 32 33 34 35 36 37 38 24 il 29 09 19 22 04 19 19 10 09 22 21 13 23 12 32 42 10 34 30 0l 28 20 15 33 17 31 35 35 30 21 14 30 32 11 37 39 28 21 17 3) 34 19 84 38 44 29 23 In 34 37 7 80 89 39 42 28 23 16 33 35 I 82 93 96 24 21 21 09 12 17 23 11 52 53 54 56 14 31 13 - ol 12 09 - 30 32 32 32 06 08 -08 -05 -07 -06 -04 -| =13 11 04 07 06 04 02 04 -07 -01 - - 02| =-01| -03 09 09 06 08 - 01 - 12 11 - - -03 04 02 -03 x7 16 17 18 05 -03 16 06 - - 01 -01 - -02 - - - - -0l1 -01 -02 04 -03 03 -04 22 35 iz - 02 14 09 -02 38 40 41 42 09 77 02 14 27 02 03 02 -03 -02 04 03 - - 05 05 05 05 ol | -01 08 06 11| -20 03 -03 -03 - 01 02 -01 - 05 | =05 | =04 | «06 | =05 - 02 | =19 06 | =43 08 | =09 =12 Ae Bo OW®NO» = 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 35 Table 8. Varimax rotated loadings of 31 TAT variables on six principal components (n=1,910) Rotated factor Variable I II III Iv Vv VI 1. Adverbs---c-cccccccccmccccnc cece remem —— +37 .01 .03 .22 | -.03 +38 2, PauseS=-==--csccemcmcccnnnncn cmc —————— .69 .03 14 .05 | -.10 +28 3. Verbatim repetitions=---ececcccccccccnnaa- .50 .04 .13 04 | -,16 42 4, CorrectionS=---e=eccccccncmcccmnncccnannn" .80 .10 .05 .04 | -.09 «22 5. Past reference--====cccccccmccncnncncccan- «72 .05 .06 .29 | -.08 .08 6. Future reference-===-e-cccccmcraccccccnan-= .73 +05 .08 43 | -.07 .03 7. Unhappy outcome=-====-ememecccn ccc meneecen= all .60 .03 +35 | =.10 -.16 8. Death--=--ccccccccccc ccc cccecc ccm .08 «85 .05 -| =-.11 «17 9. Murder-killing---=cc-ecccrccrmcccncncncccnax .02 «32 .03 -.12 | -.18 +16 10. Rejection---=ccceccmcmcmmccnmccncccncnnean= -.08 | -.03 | -.93 -.10 .04 -.04 11. Level of interpretation------ccceccccenaa- «15 «11 .65 .57 | -.09 +25 12. Situation complexity---=-ceccmccmcncncnna" +39 +11 «59 .51 | -.11 +23 13. Present reference===-=-eececccccccccnnananx .09 .02 +33 12 | -.04 .04 14, Happy outCOme==-===scceccccccmccecmmcnnanx 21 | -.11 .09 + 13 - +25 15. Causally connected statements===--==ece-=- .05 .16 «15 64 | -.11 +39 16. Expression of feeling--------cccmccccccua- “23 .01 +22 «57 | -.15 +20 17. Outcome=-=---scccemcmcmmcn cnc cmc eee ———— .37 19 13 .78 | -.06 +12 18. Kind-loving=-===-ecccccccmccnmnccccccnnann -.08 | -.17 .05 .38 | -.35 «35 19. Happy-glad---=---cccccmcccmmcc ccc ccna .15 | -.13 .01 43] -.03 .31 20. Goal behavior---=--cececcecccccnce cece cencnnn .06 | -.05 +29 43 | -.49 .15 21. Antagonism=-=--=-cececcmcmccnnccnn cece .06 | -.04 | -.04 .18 | -.63 12 22, Morbid mood quality==-=-ccccemccmecceccnna" .23 | -.07 .05 -.09 | -.39 14 23. Bizarre theme--=--cceccmccccccncccceanana- - 32 - -.05]| -.57 .05 24, EgocentriSme----ccecmcemccmcmcccncnncnnnnx .30 .08 .03 18 | -.44 -.01 25. Mean-rejecting=--===-c-ccecccmmcmcccnnnana- .07 .13 | -.01 .19 | -.66 14 26. Aggression----s-eecccccmecceccnn nena .01 .28 14 | -.09| -.58 .04 27. Possessive adjectives----ccccccccccnnncan- .38 .09 .09 .36 | -.17 «65 28. COMMON NOUNS ========smecceceeccem nm ——————— JA4l 12 .17 +31 =. 19 ZL 29. PronounS==-=--=cececceccmcecmmmcm ec ————— 45 wk 14 +37 | =e21 .67 30. Single verbgs==---scccccccccmmmccmmccnnan WA45 +11 .16 341 -.19 sdk 31. Dialogue=-===-=cccmcmmmccmm ccc mee .13 .09 - .16 | -.10 +65 Principal component solution: Eigenvalues =-===c-ccmccmccmcmncmmcc ccc ceaen 10.80 | 2.47 | 2.24 1.74 | 1.33 1.17 Proportion of variance----=--ceccccccccnaaax 34.86 | 7.96 | 7.23 | 5.52 | 4.28 3.76 Varimax rotation solution: EigenvalueS-==memcemc cmc cccccmcccccccccce em 4,12 12.19 | 2.84 | 4.08 2.53 3.52 Proportion of variance------ceccecccccnnaaa- 13.29 | 7.05 | 9.17 [13.17 | 8.16 11.36 IThe variables used to define each factor are listed in table C and are discussed on pages 12-16. 36° Table 9. Multiple regression analysis predicting criterion composites, age, sex, and race, using six TAT factor scores as predictors (#=1,910) Highest Proportion Criterion variable Teor © single variance relation for 1. Criterion factor I-—school adjustment--------c-cc--- .26 «22 .06 2. Criterion factor II —poor health------c-cccccecaa-o .04 .03 - 3. Criterion factor III—intellectual development-=---- +39 JA45 «34 4, Criterion factor IV-—~social adjustment------------- .07 .05 - 5. Criterion factor V-—emotional disturbance--=-==------ ou -.10 .01 6. Age=-=-cemmmcmmc cee eee 46 .38 21 7. SeX=-omecmcmemmc ccc ccm ccm cm eee em emcee cee +22 14 +05 8. RaC@===mcmmccccccccc ccc ccc ccccc ccc .39 .37 «15 37 Table 10. Means and standard deviations (SD) of six TAT composite scores,by age and sex (7 = 1,201) 6 years 7 years 8 years 9 years 10 years 11 years TAT factor and sex Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD actor I—Verbal productivity Both sexes---- | 281.,5( 29.3 | 288,5| 36.4 | 297.0 | 44.7 | 306.4 | 46,3 | 311.0 | 43,1 | 316.0| 50.9 BOyS=====ceemcanan 278.8 | 26.,5| 287,9| 38,5 | 295.5 | 41,1 | 300.2 | 36.5 | 305.0 | 41,1 | 320.1 | 54.4 Girlse=-ceeccecan- 284.8 | 32,1 | 289.3 | 33.8 | 298,3 | 47.3 | 312.7 | 53,7 | 317.1 | 44,2 | 311.9| 46.7 Factor I1I—Dys- phoric a Both sexes----| 149.8 | 25,5| 147,5| 22,5 | 150.3 | 23,2 | 148,1 | 22,6 | 152.8 | 25,9 | 151.8 | 24.2 BOyS======ccacanan 150.5 | 26,9 | 145.8 | 20,4 | 151.3 | 23,6 | 148,2 | 20,5 | 151,5| 25,9 | 151.8 | 23,1 Girls--~=-==neumn- 148,9 | 23,6 | 149.5 | 24.6 | 149,5| 22,9 | 148.0 | 24,4 | 154,1 | 26,0 | 151.8 | 25,3 Factor III—Con= ceptual maturity Both sexes----| 80,5| 48,7| 93.,3| 31.8 | 97.9 | 40.1 | 103.1 | 34,0 | 111.0 | 24,1 | 114,3| 19.1 BOyS======cecmecax 84,6 | 39,1 | 90,0 33,9 | 95.7 | 40,9 | 104,7 | 29,6 | 107,3 | 26.6 | 112,5| 19.6 Girls -=mmmmmmmmnm 75,2 | 58.1| 97.0| 28,9 | 99.6 | 39.4 | 101.5 | 39.7 | 114.7 | 20,7 | 116.1 | 18.3 Factor IV—Nar=- rative fluency Both sexes----| 317,9| 36.,2| 329,9| 40.3 | 344,2 | 50,3 | 360.4 | 50,8 | 371.2 | 53,0 | 377.2 | 51.5 BOyS=========c==== 309.4 | 25,3 | 329,3| 41,7 | 338,5 | 46,5 | 352,8 | 45,3 | 360,0 | 50,4 | 368.3 | 43,5 Girls-------===n=-- 328,7 | 44,1 | 330.6 | 38,7 | 348.8 | 52,8 | 368,2 | 54,7 | 382,6 | 53,1 | 386.4 | 57.1 Factor V—Emo- tionality Both sexes----| 294,0| 31,3| 295,1| 30,0 | 300.1 | 35,0 | 300.2 | 33,0 | 304,7 | 41,2 | 306.2 | 42,5 BOyS--======mmmn== 295,0 | 31.5 294.9 27.8 | 299.7 | 36,7 | 301.4 | 36.5| 303.3 | 43.4 | 307.2 | 34.4 Girls-=---ecnceaux 294,0| 31,1| 295.3 | 32,3 | 300.3 | 33,6 | 299.0 | 29.0 | 306.1 | 38,8 | 305.1 | 49.5 Factor VI—Verbal uency Both sexes----| 228,8 | 25,7 | 237.1 27,5 | 250,4 | 51.1 | 253.9 | 41.0 | 263.3 | 49.7 | 266.6 | 52.8 BOyS~==mmmmmmm———— 224,8 | 17.8 | 237.4 | 29,7 | 246,3 | 45,3 | 250.2 | 38,9 | 254.1 | 41.4 | 263.1 | 45.9 Girls---»=n=n= w===1233,7| 32,3 | 236.8 | 24,6 | 253,7 | 55.2 | 257.7 | 42,3 | 272.6 | 55.2 | 270.3 | 58.9 38 APPENDIX | DESCRIPTION OF THE SAMPLES Cycle II of the Health Examination Survey The samples of children for the two studies de- scribed in this report are subsets of the national prob- ability sample of children aged 6-11 years examined during the second program (Cycle II) of the Health Ex- amination Survey. The sample design for that survey was a multistage probability sample of persons in ge- ographically defined segments of the U.S. population. Successive elements dealt with in the stages of selec- tion of the sample are primary sampling units (PSU's), census enumeration districts, small clusters of house- holds, individual households, and finally, the sample children, At the first stage, the nearly 2,000 PSU's into which the United States has been divided were grouped into 40 strata, One PSU was then selected from each of the 40 strata, Later stages of selection resulted in the selection of nearly 200 children aged 6-11 years from each of the 40 sample PSU's. Examination of the sample children began in the first of the survey's 40 geographic locations (stands) in July 1963. The survey was completed in December 1965. Of the 7,417 children selected, the 7,119 who were examined—a response rate of 96 percent—gave evidence that they were a highly representative sam- ple of children in the noninstitutionalized population of the United States (table I), Study | Sample To meet the primary objective of Study I (scale development) within requirements of budget and re- liability, it was decided that the sample should consist of about 100 white boys and 100 white girls in each of the 6 single years of age in the 6-11 year age group for whom the Thematic Apperception Test (TAT) pro- tocols were scorable and criterion data were complete. Since national representativeness was not an important factor in meeting the objectives of the pilot study, it was possible to begin the study as soon as data had been collected and processed for the required number of white children, The data for white sample children in 17 of the first 19 stands completed in Cycle II were reviewed for completeness and quality of TAT proto- cols. Sample children tested in the first two locations were eliminated from consideration because the TAT protocols for these two stands were manually recorded, whereas the TAT protocols were recorded on tape for all other stands. Of the 1,760 white children examined in Stands 3 through 19, 1,224 met the standards of com- pleteness and quality of TAT protocol. Most of thé elements of Study I were based on the sample of 1,224 children. However, for some elements of Study I it was additionally necessary to have complete criterion data for each child, From the 1,224 children in the Study I sample, 996 children were identified for whom complete Table I. Health Examination Survey Cycle II sample, by sex, race, and age Both sexes Boys Girls fge Oth hi : Other : ther Other Total || White | Black Feces Total White |Black conn Total || White |Black Paces All ages--| 7,119 6,100 987 32 3,632 3,153 464 15 (3,487 2,947 523 17 6 years=----=-=- 1,111 950 156 5 575 489 84 2 536 461 72 3 7 years==-==-== 1,241 1,063 172 6 632 551 79 2 609 512 93 4 8 years---==--= 1,231 1,035 192 4 618 537 79 2 613 498 113 2 9 years=-----=- 1,184 1,019 158 7 603 525 74 4 581 494 84 3 10 years-=-=--=-- 1,160 1,014 142 4 576 509 65 2 584 505 77 2 11 years===-=-=-=- 1,192 1,019 167 6 628 542 83 3 564 477 84 3 39 Table II, Study I sample (m= 996) of white children, by sex and age Age posh Boys Girls All ages----- 996 505 491 132 69 63 158 81 77 183 94 89 160 78 82 188 94 94 175 89 86 criterion data were available, It is that smaller sam- ple of 996 white children which was combined with an- other sample and used in some elements of Study II, The distribution of the Study I sample of 996 white children by age and sex is shown in table II. Study Il Samples The research design of Study II consisted of four separate phases. To carry out these four phases, three samples of different size and composition were used in the Study II research: (1) from the total combined sample of 2,018 children, a reduced combined sample of 2,012; (2) a further reduced combined sample of 1,910 children; and (3) the national probability sample of 1,201 children selected to be representa- tive of the larger HES national probability sample. The four phases and their corresponding sample sizes are: e® Development of criterion measures for validation of the TAT scales (n= 2,012) ®Development of measurement scales for the TAT using structural and thematic variables (n =1,910) OTAT scale validation (n = 1,910) ®Development of national norms (n=1,201) The national probability sample ( n = 1,201) and the combined samples n=2,018, n=2,012, and n=1,910 are described below. National Probability Sample (n= 1,201),—The ini- tial objectives of Study II—the development of TAT scales from a national sample of children and the es- timation of norms on a national basis for the scales developed—required the study to be conducted on a nationwide probability sample of children. Due to budg- eting limitations it was decided to conduct the study on only a subsample of the HES national probability sample of 7,119 children aged 6-11 years examined in Cycle II. Specifications for selecting the subsample included the following points: the subsample should consist of approximately 1,200 children equally distributed by sex and single year of age (6-11 years) and approxi- mately 200 of the 1,200 children should be black (Ne- gro). The subsample was selected by a random system- atic sampling technique. A total of 1,268 children were selected from the children examined in Cycle II of the Health Examination Survey, Of this total, 211 were black children, The distribution of the probability sub- sample for Study II by age, sex, and race is shown in table III, The national probability sample (n= 1,201) is the probability subsample from Cycle II of the Health Ex- amination Survey described above reduced from 1,268 to 1,201 children as a result of the loss of 67 TAT pro- tocols, Specifically, 67 sample children were dropped because the TAT data were either inadequate or miss- ing for the following reasons: Table III. Total national probability sample (2% = 1,268), by sex, race, and age (Study II) Both sexes Boys Girls Age Total white! [Black || Total white! | Black | Total || white! | Black All ages--=-==--==---- 1,268 1,056 21.2 643 542 101 625 514 111 6 years------=--=c----oenn 203 171 32 111 94 17 92 77 15 7 years--=--e=m--cmeceeeoa- 222 185 37 115 98 17 107 87 20 8 years--=--=---c-eeooeonn 227 182 45 101 85 16 126 97 29 9 years---=------c-cooonoa- 207 174 33 106 91 15 101 83 18 10 years=--===--=ccceean--- 203 175 28 104 87 17 99 88 11 11 years=-==-=-=ce-coeeeon- 206 169 37 106 87 19 100 82 18 lIncluded with white children are one oriental ll-year-old boy and one oriental 40 6-year-old girl, Table IV. The corrected stratified national probability sample (% = 1,201), by sex, race, and age (Study II) Both sexes Boys Girls Age Total || White | Black || Total || White | Black [Total || White |Black All ages--======-==-= 1,20) 1,006 195 610 515 95 591 491 100 6 years----=-----=c=------ 188 162 26 105 89 16 83 73 10 7 years--=-=-=---mm--om-n- 207 173 34 11 94 17 96 79 17 8 years------=----c---e-on- 218 176 42 97 83 14 121 93 28 9 yearg--=--==-----c---nan- 200 168 32 101 87 14 99 81 18 10 years-------=---=---uuo= 191 166 25 96 81 X5 95 85 10 11 years-----==--==--=---= 197 161 36 100 81 19 97 80 17 Number scales and statistical analyses were based so as to Reason for loss of cases increase reliability of the data. Tnadenuste tenting: time aliowsd 5 The total number in the combined sample is 2,018. 7 £ That figure represents the sum of the 996 children of Examiner error 3 the Study I sample plus the 1,201 of the national prob- Atypical behavior of child (upset, refused to cooperate, etc.) 10 Retarded, deaf, blind, or special problems > Non-English speaking 4 Not recorded for other reasons (tape recorder not turned on, one or more cards omitted, etc.) 26 Tape recording technically inadequate for transcription 10 The distribution of the national probability sample of 1,201 children, the sample used in the final com- putation of normative information for the developed scales (phase four), by age, sex, and race, is shown in table IV, Although the age-sex-race composition of the probability subsample of 1,268 children (table III) seems not to have been seriously affected, the absence of the 67 TAT protocols cannot be completely ignored, par- ticularly inasmuch as 10 cases were lost as a result of atypical behavior and seven for sensorimotor im- pairment or mental subnormality, However, the poten- tial biasing effect of these omissions on the normative data is considered to be tolerable since they comprise such a small percentage of the total sample of 1,268 children. Total Combined Sample (n= 2,018) and Reduced Combined Sample ( n= 2,012), —For the developmental portion of Study II, the Study I sample and the national probability sample were combined to maximize the number of TAT protocol records on which the basic ability sample with the exception of 179 children who were common to both samples, Furthermore, six chil- dren with incomplete criterion data were deleted in those phases of the study in which the criterion meas- ures were developed and validated, reducing the sample to 2,012. The distribution of the total combined sam- ple of 2,018 by age and sex is shown in table V. A note identifying age, sex, and color of the six deleted children is also included. Further Reduced Combined Sample (n=1,910),— In computing correlations among TAT variables and be- tween TAT and criterion composites, phases two and three, a further reduction was necessary, This reduced combined sample consisted of 1,910 children after the exclusion of 49 children with manually recorded TAT protocols and 53 other children with incomplete data, The TAT protocols for 49 children in the national probability sample selected from the first two stands of Cycle II had been manually recorded by the field examining psychologists. The 49 manually recorded protocols were compared with the tape-recorded pro- tocols of Study I. An examination of the manually re- corded protocols indicated two probable sources of bias which tended to reduce the length of stories for these children: (1) examiners asked questions which may have influenced the end of the story as defined in the scoring manual, and (2) at least one examiner did not record verbatim responses of the children; instead notations were made such as 'describes room." A comparison of number of words per story between the Study I sample (mean=88, SD =70, n=996) and the group of 49 manually recorded cases (mean = 54,SD = 38) indicated that the distributions differed signif- icantly. In order to retain these 49 cases in the study, it would have been necessary to transform scores on 41 Table V. The combined Study I and II sample (# = 2,018), by sex, race, and age Both sexes Boys Girls Age Total White | Black Total White | Black | Total White | Black All ages---===c==co-=-o- 2,018 1,823 195 1,035 939 96 983 884 99 6 years---------==o-o-m-ouuo- 303 275 28 172 33 17 131 120 11 7 years-------cemmccccoccceoan 340 305 35 176 160 16 164 145 19 8 years-------mmmecemmmcceaaan 362 325 37 175 162 13 187 163 24 9 years-----==---cccemacaooao-o 337 304 33 173 158 15 164 146 18 10 years----=--=-ceccmccmanoa- 338 311 27 169 154 15 169 1157 12 11 years--=--=-c--mmmceooaooo 338 303 35 170 150 20 168 153 15 lsample was reduced to 2,012 children for development and deletion of one child in each of these six categories. "count" type items, such as number of words, to dis- validation of criterion measures by Table VI. TAT scale validation sample (7M = tributions with means and variances equivalent to those 1,910), by sex and age of the respective age-sex-race subgroups of children me with tape-recorded stories. Unfortunately, other var- Both iables, such as dichotomous items, could not be adjusted Age sexes Boys Girls by any rational scheme. It was finally decided to drop these 49 cases in the development and validation of the TAT scales. All ages----- 1,910 990 920 Since the analysis of results in phases two and three involved correlational studies of composite ET — 291 162 129 scores, it was necessary to exclude 53 children in the 7 years------------ 324 175 149 national probability sample whose scores on one or 8 years------------ 348 165 183 more of the composite defining variables were lacking. 2 REE mn oy 169 1% The distribution of the reduced combined sample 11 ets JE 314 160 154 of 1,910 children by age and sex is shown in table VI. —0O000—ro 42 APPENDIX II TAT SCORING MANUALS STRUCTURAL SCORING MANUAL INTRODUCTION Determining Story Length Many of the items to be scored in accordance with this manual involve counting words, parts of speech, and other features of the story protocols in which ac- curacy and reliability of scoring are highly dependent on the precise identification of the story boundaries (beginning and end). The scorer should make this de- termination as the first step in the scoring of each story. Instructions for Determining Story Boundaries Beginning, —Ordinarily, the beginning of a story may be recognized by application of the following rules: (a) Respondent (R) narrates a story or comments about the card after examiner (E) has asked him to "make up a story." The beginning of the story may be preceded by conversation between E and R. (b) The story is not a specific reply to a specific question, such as "What do you see here?" followed by "I see a boy." (c) If E asks R to tell a different story, score the first story only; disregard the second story. (d) If R makes a spontaneous remark, such as "That boy is sad," and no further story is produced, either because of inability of R to elaborate or the in- tervention of questions by E, accept the remark as the story. In the event that no story at all is given, even if R answers specific questions by E, score the response as a rejection, item 1, In all cases of rejection of a card, no further scoring of that card for the partic- ular R will be made under this manual. Mark the story beginning on the protocol with a capital letter B or score rejection, End.—Use the following rules to establish the end of a story: (a) R indicates that the story is ended by a re- mark such as "That is all," "That is all I can think of," and the like. Such remarks establish the end of a story and are included as part of the story. (b) R stops and E accepts the story as completed. (c) E asks a question calling for interpretation which would thereby introduce content not spontane- ously contributed by R, thus ending the spontaneous story. Questions such as "How does he feel?" and the like are in this category. Reflective statements by E do not constitute the end of the story. (d) The following types of questions and comments by E encountered during a story are considered as ac- ceptable questions or promptings and do not terminate a story: (i) "Uh huh," "Go on," "Yes." (ii) Repetition of a statement by R (frequently done when R's speech is inaudible or un- clear, but also for encouragement), (iii) "Tell me about it," "Tell me more." (Such statements reflect judgment by E in the ex- amining situation and, while they may intro- duce extraneous variance in the story, are not arbitrarily condemned.) (iv) The questions, '"What happens then?" or '"What is going on in your story?'' are questionable, but are acceptable. (v) E asks R to repeat a statement of his story. (Delete the portion of the repeated statement that paraphrases the original statement.) Mark the story ending on the protocol with a cap- ital letter E. Inguiry.—The remainder of the protocol, follow- ing E, will be referred to as the "inquiry." Unless other- wise specifically stated in instructions for particular items, always score items in this manual only on the story content, defined by the boundaries B and E, Ref- erence is made to other parts of the protocol for cer- tain items, and in those cases the specific item in- structions should be followed. 43 SCORING INSTRUCTIONS 1. CARD REJECTION, Score 1 for failure or refusal of R to produce a story in response to a card. Score 0 if not rejected. No further scoring is required if a card is scored 1 on this item, (2.-4. IDENTIFICATION OF CHARACTERS.) The characters referred to in each story are classified in these items according to the following nomenclature. The first (two-digit) number in the double classification refers to Type of character; the second number refers to Age status. A character is defined as an animated being capable of communicating or feeling. Information in the inquiry may be used to establish role identity of characters. t Classifications should be written in three digits, combining the type of character (first two digits) and the age status (third digit) as stated in story or inferred by scorer from information given, A. Type of character (01) Self. Refers to narrator and applies only when story is in first person. (02) Father, Refers to character in role of a father in the story. (03) Mother. Refers to character in role of a mother in the story. (04) Son. Refers to character inrole of sonin the story, (05) Daughter. Refers to character in role of daughter in the story. (06) Brother. Refers to character in role of a brother of another character in the story. (07) Sister. Refers to character in role of a sister of another character in the story. (08) Husband, Refers to character in role of husband. (09) Wife. Refers to character in role of wife, (10) Other male relative. Refers to character in role of grandfather, uncle, male cousin, or other male relative of another character in the story, includ- ing in-laws. (11) Other female relative, Refers to character inrole of grandmother, aunt, female cousin, or other female relative of another character in the story, including in-laws, (12) Family. Collective reference to persons in the story as a family and not in any other way. (13) Occupation, Refers specifically to persons such as teacher, doctor, burglar, policeman, or farmer having an occupational role in the story. The oc- cupational title must be stated in the story. "A 44 man plowing a field" would be scored as a man, not as a farmer; ''a man operating' is scored as a man, but "a doctor operating' is scored as a doctor. (14) Man. Adult male character, not a relative of an- other character, (15) Woman. Adult female character, not a relative of another character. (16) Boy. Young male character, not a relative of an- other character. (17) Girl. Young female character, notarelative of an- other character. (18) People. Collective reference to people, not other - wise specified, (19) Animal, An animal as a character having a role in the story. (20) Animals, Collective reference toanimals as char- acters having roles in the story, not otherwise specified. (21) Supernatural being. Refers to a ghost, spirit, elt, fairy, or other supernatural being as a character in the story. (22) Supernatural beings, Collective reference to ghosts, spirits, elves, fairies, or other super- natural beings or characters in the story, not otherwise specified, (23) Inanimate object(s). Includes dolls, manikins, robots, toys, etc., as characters having role(s) in the story. (24) None. (25) Character, Sex not identified, not related to other characters. When there are conflicting roles, follow these rules: (a) If a character has two roles, selecttheone re- lated to the "main character' identified in items 2, 3, and 4, For instance, if the main character is a child, a woman who is both the child's mother and a wife would be scored as a mother. (b) If the main character has multiple roles, se- lect the role more closely related to the theme of the story. If no character as defined by the character code is mentioned, score 240. An example of such scoring is as follows: Card 1. "The ribbon unrolled," (240) The ribbon is not a character, capable of communication or feeling, as defined in this manual, If the story were to suggest that the ribbon acted in this way for some purpose, such as 'to torment the boy's mother," then it would be a character, and the ribbon would be scored under category 23. In that case, the scoring would be 230, B. Age status Classify as accurately as possible from informa- tion given, (0) Not applicable (used for character codes 12 and 19 through 25) (1) Aged person (2) Older adult, middle-aged person (3) Younger adult, 20-30 year age range (4) Youth, teenager, high school and junior high school age (5) Boy or girl, 6-12 year age range (6) Preschool child (7) Infant Character category (18) will be scored age O unless specified as children, then it will be (18), (4), (5), (6), or (7). When age status of characters in the story is not specified or suggested, use the following guides: Card 1: a boy (5) Card 2: girl (4), woman (2), man (foreground) (2) Card 5: woman (2) Card 8 BM: man (with lantern) (2), man (with knife) (2), man (on table) (2), boy (foreground) (4) If there is changing age status, score that age which corresponds to the dominant (i.e., principal) action of the story, or to the picture, if this is not sufficient, There may be multiple ages, corresponding to mul- tiple dominant actions. If so, indicate only in character list, For example: (04) (4) (3). This would represent a son who ap- pears first as a youth and later as a young adult, with equally important actions at both age levels. 2. FIRST CHARACTER MENTIONED. Identify the first character mentioned in the story, using the three-digit code outlined above. The first reference to a charac- ter, although not completely identified, governs the scoring of this item, Thus reference by a pronoun (he, she, they) may establish precedence, even if identity is disclosed later, in the story or inquiry context. The following examples illustrate typical scoring decisions: Card 5. "This lady's son was playing in the library." The score would be 032, The first character is this lady, Since the context identifies her as a mother, she will be scored as (03) Mother. Since no specific information is given about her age status, follow the cues in the picture and score (2) Older adult, Card 8 BM. "He has been shot in the stomach, We are trying to take it out, This boy is his grand- child," Score 102. The first character mentioned (He) is identified from the following context as the boy's grandfather. Score (10) Other male relative and (2) Older adult, Do not score age status as (1) Aged person, unless specifically indicated. 3. MOST DISCUSSED CHARACTER. Identify the char- acter discussed most in the story, using the three-digit code outlined above. In most cases this should be an obvious decision, If it is necessary to compare the at- tention given to two or more characters, count the num- ber of sentences in which each is mentioned. In the event of a tie, count the number of Main Character Modifiers, items 5-7, below, and score for the char- acter having the largest number, 4, CENTRAL CHARACTER. Identify the central char- acter and use the three-digit code outlined above, The central character is defined as the character to whom the point of the story is anchored and without whom the story would be incomplete. The following guidelines are suggested for identifying the central character, (a) The central character is associated with the principal event in the story, For example, the figure popularly described as being operated on (card 8 BM) may appear to be the central character. However, in many stories, the person being operated on dies and the boy becomes grieved, The scorer must decide in such instances, whether the ''patient' or the boy is to be scored as the central character, according to his judgment of the focus of the story. (b) Other characters are usually identified in the story by their. relation to the central character, For example, a teacher, mother, or father is frequently introduced in card 1 as "his teacher," ''the boy's mother," or "the father of this boy." (c) The character to whom affective reactions are attributed is usually the central character. For ex- ample, in card 1, "This little boy had been taking violin lessons and he feels sad because he doesn't want to take them anymore," (d) The main character is usually involved in the outcome of the story. For example, incard 1, "He might be thinking that he is going to run away from home, He didn't." In cases of extreme doubt in scoring item 4, score the character already most prominent in items 2 and 3. If there is a group of characters defined separa- tely, but as a group are the most discussed and are 45 the central character, code as 180 but do not include on list of characters, (5.-7. MAIN CHARACTER MODIFIERS,) The following instructions apply to the "main character'' identified in items 2, 3, and 4. Follow them separately for each item, Count the number of words, including nouns, proper nouns, names, pronouns, and possessive ad- jectives in relation to the "main character" in the particular item, 5. MAIN CHARACTER MODIFIERS, ITEM 2, Count and record as instructed above, 6. MAIN CHARACTER MODIFIERS, ITEM 3. Count and record as instructed above, 7. MAIN CHARACTER MODIFIERS, ITEM 4, Count and record as instructed above. 8. LIST OF CHARACTERS. List all characters, in order of mention in the story, using the three-digit code outlined above, After each code number, write in on the scoring form any further characterization or detail mentioned in the story, such as name, age, role, etc., for each character, 9. OBJECTS MENTIONED. An object is something that can be manipulated—e,g., tool, toy, door, door knob, window (as in ''She looked through the window''), mod- ern conveniences, bullet, The central object is an ob- ject which is an integral part of the main action, and often indispensable. Multiple objects may be used as the central object. A face, music lessons, sky, and scenery are not objects, Score an object even though it is only mentioned as not being there (for example, "It is not a guitar, but a violin."). List all objects mentioned in the story inthe space designated on the scoring form. Animals referred to in the story which are not identified as characters should be recorded as objects. First, identify the central ob- ject, which is involved in the principal action of the story (for example, card 1, "is staring at his violin, wishing he were out playing baseball''). Record this on the first line, designated central object. If no central object is mentioned, write none, Second, record all other objects, including animals not identified as char- acters, in the order mentioned in the story. When ob- jects are referred to by pronouns (it, this) or indef- inite nouns (something) and the identity is suggested by the context, write the suggested identity after the object word, in parenthesis. If no objects are men- tioned, write none on the second line, designated other objects, as well as on the first line. Do not include place names, such as house, farm, field, etc., as ob- jects, 10. PLACES MENTIONED, List all place words and names in the story in the space provided on the scor- ing form, Places are distinguished from objects by the 46 fact that they are loci of action and indicate where action takes place, but are not manipulated, as are ob- jects, Examples of places are house, room, farm, field, roof, garage, garden, church, ranch, behind the door, under the bed, etc, Indefinite references to a place are not scored, for example: "There is a woman," "Here is a man," 11, ACTION OR ACTIVITY. Write, in the space pro- vided, a word, phrase, or sentence identifying the main action or activity in the story. For example, card 1, looking at the violin, wishing he were outside; card 2, plowing the field; card 5, looking in the room; card 8 BM, watching an operation, operating on a man, re- moving a bullet, The main action is usually associated with the central theme of the story and is most often performed by the central character. The following ex- amples illustrate the recording of more than one main action, Card 1. Boy wishes he were out playing; mother insists that he practice violin. Card 5. Woman looks in bedroom; burglar goes out window, 12, REACTION TIME (RT) LATENCY (time latency be- tween presentation of card and response). Record in seconds, as reported by E at end of story, 13. TOTAL TIME (length of story). Record in seconds, as reported by E at end of story. 14, NUMBER OF WORDS. Count number of words in story from point identified as beginning (B) to point identified as end (E). Do not count E's questions, in- terruptions, interpolated comments, or repetitions of words or phrases. Count auxiliary words separately (was playing is counted as two words), contractions as separate words (isn't is counted as though it were is not); titles or names are counted as words (Miss Mary Smith is counted as three words) and hyphenated words are counted as two words. Do not count statements re- ported by R in response to E's questions because of. inability to understand. 15. POLYSYLLABIC WORDS. Count the number of different words (excluding variants) with three or more syllables that appear within the story, not including in- terpolated comments, Hyphenated words are not nec- essarily polysyllabic words, unless they have three or more syllables, Examples are the following: operation, operated or operating (variants, scored once), instrument, wondering, remembering, some- body, everybody, violin (16.-39. PARTS OF SPEECH.) Parts of speech are defined in this manual in accordance with J. N. Hook and E. G. Mathews, Modern American Grammar and Usage. New York: The Ronald Press Company, 1956. These definitions must be applied to the words as they appear in the story context. Count only words included in the word count in item 14. (References to the Hook and Mathews text are identified below by letters HM, followed by a page number.) 16. DESCRIPTIVE ADJECTIVES. Count the number of single or two-word (hyphenated) descriptive adjectives, which suggest physical or other characteristics of a noun, or express a judgment or opinion related to the noun, These include words of identification (e.g., moun- tain lion, Harvard student) and verbals (infinitives, gerunds, or participles) used as adjectives, which are always descriptive (e.g., living room, running water, dying soldier). Count hyphenated descriptive adjectives as one adjective, Do not include articles, demonstra- tives, possessives, relatives, interrogatives, indefi- nites, numbers, exclamatory words, or words of loca- tion, (HM 115) 17. COMPARATIVE ADJECTIVES. Count the number of comparative adjectives, whether used correctly or not. One-syllable adjectives normally form the com- parative by the addition of -er or less (taller, less tall). Two-syllable adjectives are erratic in forming the comparative; those formed either by adding -er or employing more should be counted (e.g., happier, more happy, funnier, more funny, famouser, more famous), 18. SUPERLATIVE ADJECTIVES. Count the number of superlative adjectives, whether used correctly or not. These are formed by adding the suffix -est or by using most (e.g., most beautiful, prettiest, happiest, most funny). 19. POSSESSIVE ADJECTIVES, Count the number of possessive adjectives. Possessive adjectives are formed from nouns and pronouns which are adjectival in function and denote possession. Their primary pur- pose is to limit the application of the noun or pronoun (e.g., his mother, my book, boy's violin, father's gun). (HM 266) 20. ADVERBS. Count the number of one-word ad- verbs (not adverbial phrases) ending in -ly or their equivalents (e.g., beautifully, vigorously, thickly, justly, etc.). Equivalent adverbs include those which can have two forms, with or without the -ly (cheap, real, close, fair, late, loud, slow, thick, wrong), and those given by the child which may be grammatically incorrect. Ad- verbs often answer the question '""How?'. An adverb functions as a modifier of verbs, adjectives, adverbs, prepositional phrases, adjective clauses, or sentences. An example of each follows. (HM 289-293) Modifier of verb: "The boy ran swiftly down the street." (Score only swiftly: do not score the ad- verbial phrase down the street.) Modifier of adjective: "They lived in a real big house." (Real is considered to be an -ly equivalent.) Modifier of adverb: "He ran very slow." (Score one one-word adverb, very modifies the adverb slow but is not scored.) Modifier of phrase: "Early in the morning he went to school." Modifier of clause: "The result is nearly what was expected." Modifier of a sentence: "Obviously, the boy wanted to play the violin," Do not score adverbs which do not take an -ly end- ing (down, far, how, long, much, never, not, once, out, since, soon, then, too, up, well, where, shy, fast, or very). (HM 295) Do not score any of the following special functions of adverbs (HM 293) in this category: interrogative adverbs (how, when, why, where), exclamatory adverbs, transitional adverbs, relative adverbs, correlative ad- verbs, the expletive there, or independent adverbs (yes, no, and a few other words which stand alone as answers to questions). A test for an adverb. Insert a form of be, seem, or become in place of the verb used. If these words make sense, the word used should be counted as an adjective; otherwise an adverb. 21. DIFFERENT ADVERBS. Count the number of dif- ferent adverbs, as defined in item 20 in the story. 22, COMPARATIVE ADVERBS. Count the number of comparative adverbs, whether used correctly or not. A few adverbs cannot be compared, but most are com- pared by either adding -er or by employing more (quicker, faster, more slowly). Only adverbs defined in item 20 will be scored as comparative adverbs. 23. SUPERLATIVE ADVERBS. Count the number of superlative adverbs, whether used correctly or not. These are formed by adding the suffix -est or using most (e.g., quickest, most quickly, most slowly, fastest). Only adverbs defined in item 20 will be scored as su- perlative adverbs. 24, COMMON NOUNS, Count the number of common nouns. A common noun may refer either to something material or to an abstraction (e.g., class, path, man, star, pity, kindness, love). Include in this category other parts of speech such as gerunds used as nouns, but not pronouns. (Compare with items 25 and 26.) 47 25. PROPER NAMES, Count the number of different proper names given to characters, either animal or human, Count the whole name (given and surname, e.g., John Smith) as one name, Count only instances where a given or surname is used, Donot count titles (Mother, Father) used as specific reference, 26. OTHER PROPER NOUNS, Count all other proper nouns, referring to specific persons or places, not in- cluded in item 25, Proper nouns composed of more than one word (e.g., Christmas Eve) will be counted as a single proper noun, In the following examples, only (a), (c), and (e) are proper nouns, scored in this category. Include titles, names of days, months, or- ganizations, holidays, seasons. (a) ''Mother came into the room," (proper noun) (b) "Her mother came into the room." (common noun) (c) "If Winter comes, can Spring be far behind?" (proper noun) (d) "Nights are long in winter." (common noun) (e) "Where is the Sergeant?" (proper noun) (f) "One sergeant was killed." (common noun) 27. INDEFINITE NOUNS. Indefinite nouns can apply to people or to objects. In the former case they refer to people who have no role in the story, i.e., are not char- acters. For example, "People say he plays the violin well," Indefinite objects are those which have no referent in the story, that is, they have no clear identity, For example, "Something wonderful happened." Only the following are scored as indefinite nouns: people, folks, something, thing, nothing, when used as defined herein, Count the number of indefinite nouns in the story. Indefinite nouns, such as folks, people, may be iden- tified from the story context as having no clear ref- erents, For example, folks, referring to folks in gen- eral, is indefinite, while folks, referring to my folks, has a referent, 28. PRONOUNS. Count only the following personal pronouns: 1, you, he, she, we, they, me, him, her, us, them, himself, myself, except when used as a posses- sive pronoun or adjective (her book). (See items 19 and 30.) } 29. USE OF THE FIRST PERSON, Count the number of first person singular pronouns (I, me, my, mine, myself) referring to the narrator or to a character in the story. "I" statements may appear either in inter- polated comments or in the story. The following are examples of scorable personal references: "I said, 'Give me that book," (two words) 48 "I told the story to my daddy how we were hunt- ing." (two words, do not count we) "This happened to me once," (one word) "My mother is the same way." (one word) "I don't know." (not as direct answer to E) (one word) "That's all I can think of," (one word) "I am playing the violin." (one word) 30. POSSESSIVE PRONOUNS, Count the number of pos- sessive pronouns. The words, mine, yours, hers, his, theirs, and its, when used as pronouns, are defined as possessive pronouns (e.g., ''His is the blue one." "The book is mine."). (HM 173) Score only the pronouns mentioned. 31. INDEFINITE PRONOUNS, Count the number of indefinite pronouns in the story. Indefinite pronouns, such as it, they, are pronouns used ina context in which the referent of the pronoun is indefinite. For example: "They say it is wrong to do that," "He played it." In both cases, the underlined pronoun would be scored as indefinite only if the context fails to disclose a clear referent, (32.-36, VERBS.) A verb is a word or group of words that expresses action, being, or state of being, Verbs are scored in this manual as: 32, single verbs; 33, com- plex verbs; 34, multiple verbs; 35, transitive verbs; and 36, intransitive verbs. Count each category as de- fined below. Items 32, 33, and 34 will overlap 35 and 36. If a verb is a multiple verb and one element of that multiple verb is complex, score both 33, complex verb, and 34, multiple verb. Verbals (infinitives, participles, and gerunds) are scored as verbs when used as such. The participle is a verbal used as an adjective (see item 16). Gerunds are verbals used as nouns (see item 24), Generally, infinitives are scored as verbs depending on their func- tion in the sentence. For example, in '"To win is not easy," the phrase to win is used as a noun and the subject of the sentence, Therefore it is not scored as a verb, but as a noun. However, in "He likes to win," although used as a noun, the infinitive to win is the ob- ject of the verb likes and, the phrase ''likes to win' is therefore counted as a complex verb. 32. SINGLE VERBS. Score as a single verb any verb, with or without auxiliary words, that is the only verb involved with a particular subject, Single verbs may have modifiers expressing tense or mood, such as is eating, is going to play, was supposed to play, had been studying, is about to leave, didn't like. Sometimes the word going is used as part of a single verb, as in the second example above to express developing (future) action. However, this usage must be distinguished from that in which going is a verb in its own right, as in "going to school." In the latter sense, going may also be coupled with an infinitive ("going to school to play") and would then be a complex verb, item 33. Other examples of single verbs are: "He wants him to win." The subject he involves only the verb wants; him is the subject of the in- finitive to win, This sentence is therefore scored as including two single verbs. "The boy ran and the girl walked." Score as two single verbs. "There's somebody playing a violin," The word there is classed as an expletive and has no func- tion except to start the sentence, The subject some- body involves the contracted verb is and the pred- ‘icate nominative playing. Score as a single verb. Additional single verbs are: "She keeps harping at him to play the violin." (two single verbs) "He ended up being one." (one single verb) "He grew up to be Jack Benny." (one single verb) 33. COMPLEX VERBS. Score verbs coupled with in- finitives ("He wants to play') and verbs coupled with verbal phrases (''He is thinking about playing'') as com- plex verbs, Disregard the number of couplings. Thus, "He wants to go to play," and '"He wants to go," would both be scored as complex verbs. 34, MULTIPLE VERBS. Score two or more verbs re- lated in a sentence to a subject as multiple verbs, as in the following example: "He went to his music lesson, played the violin for his teacher, and rode the bus home.'' The sub- ject he takes the verbs went, played, and rode. 35. TRANSITIVE VERBS, Score as transitive all verbs that express ''someone doing something to somebody or something." Transitive verbs must have an actor and a receiver of the action. They may also be in either active or passive voice, as in the following ex- amples: "The boy played the violin." (active voice) ""The violin was played by the boy." (passive voice) In the following sentence the first verb is transi- tive, while the second is intransitive: "The girl took a pill and felt better," This sentence should also be scored as a mul- tiple verb (item 34). 36. INTRANSITIVE VERBS. Score all remaining verbs as intransitive verbs. The distinguishing feature of in- transitivity is the absence of a receiver of the action, An intransitive verb can have no passive voice form (HM 224), Examples of intransitive verbs are: "The boy plays well." "Children are playing." The following linking verbs are usually intran- sitive except when used as auxiliary verbs (included in single verbs in this manual): am, is, was, were, seem, become, appear, prove, look, remain, feel, taste, smell, sound, turn, and grow. (37.-38. SIMPLE EXCLAMATIONS.) Count the number of simple exclamations by R (Wow! , Geel , Wheel, Hot diggety!, Oh! , Oh, thank goodness! ). The word well is frequently used to fill pauses and is not scored as an exclamation. Exclamations which precede the story proper and occur while R and E are discussing the task should be scored here. Do not count simple exclamations accompanied by comments such as "My goodness, that man is being operated on," "Oh boy, this is a hard one." These are scored under item 38, 38. EXCLAMATIONS ACCOMPANIED BY COMMENTS. Exclamations such as the last two examples initem 37, whether in or preceding the story, should be scored in this category. Count the number of such exclamations given, 39. EXPLETIVES. Expletives are words having only the function of introducing a sentence or statement, They are used as a sign, without special meaning. For the purpose of this manual, count there, here, now, it (usually followed by "is," an indefinite), well, as ex- pletives. Record the number of expletives in the story. 40, QUESTIONS. Record the number of direct or in- direct questions asked by any story character. A di- rect question is in dialogue while an indirect question is in narrative, For examples, "The boy said, 'Can you play the violin?'" is a direct question, but "The boy asked the girl if she could play the violin," is an in- direct question, (41.-45. INTERPOLATIONS,) These items refer to in- terpolated remarks, which may be asides or digres- sions from the continuity of the story narrative made by R. Interpolations need not be complete sentences, They should be scored only within the story proper (between points identified as beginning and end of story) and only when made spontaneously by R., Remarks made in response to questions or comments by E are not to be counted as interpolations. 49 41. NUMBER OF INTERPOLATIONS. Count the num- ber of separate interpolated statements (not the number of words). One word interpolations, such as "Gee!'' may also be scored an exclamation, item 37. Examples of interpolations are given under item 42, 42, NUMBER OF INTERPOLATION WORDS. Count the total number of words in the interpolated statement identified for item 41. The following are examples of scorable interpolations: "That's all, I guess." (five words; that's is scored as two words) "The boy was walking along, you know, andhe . ..." (two words) "I can't think of anything else.' (six words; can't is equivalent to cannot, one word) 43, INTERPOLATIONS REFERRING TO R. Count the number of interpolations involving self-references by R in which he relates himself to the story content, or to a story character. For example, on card 1, R may say, 'He feels the same as I do about practicing the violin." Do not include interruptions, as defined in item 45. 44, INTERPOLATIONS REFERRING TO E. Count the number of interpolations in which R makes a refer- ence to E, such as, "He looks like you." Such com- ments as ''you see, you know' or simply, "See ...." are not scored here but are scored under items 41 and 42, 45, INTERRUPTIONS, Count the number of interpo- lations which represent interruptions of the testing situation by R, such as, "I have to go to the bathroom." 46. PAUSES. A pause is indicated by the typist by a dash, statement, or periods (e.g., "um," PAUSE---), Count pauses only within the story boundaries. 47. VERBATIM REPETITIONS, Count all occurrences within the story of immediate reuse of the same word or group of words. Do not count repetitions within in- terpolated comments, Examples of repetitions are the following: "He took his horse out there with a—with a plow." (one repetition) "Once there was a—Qnce there was a man who lived in a—lived in a house." (two repetitions) 48, CORRECTIONS. Count the number of instances in which corrections occur in the story, not including interpolated comments. Corrections may be regarded as a form of self-monitoring of speech, Whenever R corrects or changes a statement to make it clearer, more exact, or to alter the meaning, count the change as 50 a correction. Do not count repetitions as corrections. The following are examples of corrections that should be scored: "It was a — to him it was a — .," "She had a cat, I mean a dog." "The woman was going to move into the house, Well, no. She didn't want to move in the house." (49.-50, DIALOGUE.) Score dialogue when the form of narration involves statements by characters that should be placed in quotations. Dialogue may involve occasional quotable statements (item 49) or conversa- tions between two or more characters (item 50). In some cases, the second character may be inferred and does not participate in the conversation. Such instances should usually be scored under item 49. 49, DIALOGUE, QUOTES. Score this item for any statements that should be in quotations for any char- acter in the story, but do not count two-way conver - sations for this item. A whole story in the first per- son should be scored. Also score instances such as "The sign read 'Wanted — Someone to do cleaning." 50. DIALOGUE, CONVERSATION. Score as present if conversations occur between two or more charac- ters. 51. SPEECH IMPAIRMENT, The responsibility for detecting speech impairment of R has been assigned to the transcription reviewer (auditor). Such defects are noted by the typist and include: STAMMER, STUT- TER, CLEFT PALATE. Score if any such indication appears on the transcript. If an excessive number of "uh's'" or the like appear in the transcript, the tape should be checked for speech impairment even if not noted by the auditor. 52. SPEECH INCOHERENCE OR UNINTELLIGIBIL- ITY. Detection of incoherence or unintelligibility of the narrated story has also been assigned to the tran- scription reviewer (auditor). The word MUMBLES is used to indicate speech incoherence. Score if this ap- pears on the transcript. 53. SITUATION COMPLEXITY. The complexity of the situation developed in the story should be scored ac- cording to the following classification: (1) No situation, Use this category when there is no discernible action situation. This occurs when R enumerates persons or objects in the picture (boy, horse, tree) or describes a scene (in present or his- torical perspective without any action, '"That is a farm scene," "This is a man," "These people just came from Boston . ..."). (2) Simple action situation, For the purpose of this manual, a simple action situation involves a single action in progress, Dramatically, it is a simple scene in a play. The action, occurrence, or event transpires as the scene unfolds and does not involve reference to antecedent or consequent events or explanation of a plot beyond the action taking place. (3) Complex action situation, A situation is con- sidered complex if the scene of action shifts during the story in time or place, or if the plot involves ac- tivity of greater complexity than the limited action situation described in (2). 54, CONTRADICTION, Contradiction is scored if the story contains statements of mutually incompatible ideas. If a contradiction is found which R has cor- rected, whether in the same sentence or later in the story, do not score it as a contradiction (it should be scored as a correction), Contradictions therefore ap- pear to be made without awareness on the part of R. Contradictions between meanings expressed, about the same persons, objects, or events in different parts of the story should be noted and scored. Sev- eral types of contradiction are illustrated in the fol- lowing examples, "People for miles would walk to buy books be- cause their children didn't have any books to lis- ten to." (contradictory sense words) "One day there was this man and she wanted to buy a store." (contradictory sex role) ""She said, 'Do you want to go to the store?' and he said 'yes.' So we went to the store," (projects self as story character previously identified as not- self) "They told her to work, and then they said that he could quit," (contradictory sex role) "They were playing on the baseball diamond and he made a touchdown." 55. QUEER VERBALIZATIONS, Note any unusual or deviant expressions, whether considered pathological or not. The following examples illustrate types of ex- pressions that should be noted under this item. Record all expressions noted in the space provided on the rec- ord sheet, ",..his father will give it for him on the whole ". . . up in the sky God thinks like they ain't going to ruin theirs because there's going tobe a thunder storm. . .." "They need all the equipment they can do to get the bullet out," ""And there were branches of trees and bunches of felled down trees and a forest fire." "They order a hole, but there wasn't very much water there," "They turned upside down some lamps and some panicking." "This is church time... there was plows of rows to everybody that's staying." "He asked his mother if he could go to violin mu- sic and learn how...." 56. MISPERCEPTIONS. Note all instances in which R misidentifies elements of the picture. Include in this category age misrepresentations to an extreme de- gree, This item is not scored on card 16. The follow- ing are some examples: Card 1. boy referred to as a man; violin referred to as a beartrap, machine gun, train, etc. (violin referred to as fiddle, guitar, or banjo is accept- able) Card 5. figure of woman identified as a man or boy Card 8 BM, identification of the figure in the fore- ground as a woman or girl 57. STORY (OR PICTURE) TITLE. Score if R gives the story a title, List title on scoring sheet, (58.-62., COMPLIANCE WITH INSTRUCTIONS.) Items 58 through 62 are designed to measure compliance with the examiner's instructions. 58. PAST REFERENCE, Credit any reference to things, events, or situations which have taken place in the past and may be considered as antecedent to the present action of the story. The reference may be to either the immediate or remote past, but should be acceptable as antecedent to the present action. 59. + wuSENT REFERENCE. Credit if the story in- cludes any activity or behavior that is in the process of occurring within the story, For example: "He's thinking about his violin that he got for his birthday." "He wants to become a violinist," 60. FUTURE REFERENCE, Future reference iscred- ited if any reference is made to things, events, or situations which take place in the future, i.e,, after the time of the scene pictured on the card as described in the story. References may be to immediate or re- mote future but must be to definite things, events, or situations. In some instances, outcome, item 63, and this item will both be scored alike for the same ma- terial. However, a future event may occur when there 51 is no outcome to the story and vice versa, For ex- ample: "His mother wants him to play the violin, He hates it so much that one day he will break all the string on his violin and throw it out the window." "He will grow up to be a violinist." 61. EXPRESSION OF FEELING. Any indication of an expression of feeling or emotion on the part of any of the characters in the story is credited. "Wishing" and "wanting'' may be considered as "feeling" for the scoring of this item. For example: "...he doesn't know how to play it and he's sad." "He wants to learn to play it." 62. REFERENCE TO "THINKING," Creditany expres- sion of thinking, recalling, or related cognitive behav- ior such as deciding, believing, realizing, wondering, and the like. For example: "He is thinking about becoming a famous musi- cian," 63. OUTCOME. Credit any reference to an ending or outcome to the events or situations which take place in the story, whether or not as a consequence of the ac- tivity or behavior that is in the process of occurring. 64. TONE OF OUTCOME. This item will be scored Zero (0) if no outcome is given, If an outcome is given, score (1) happy, (2) unhappy, or (3) neutral, (1) Score 1 for happy ending or optimistic out- come. For example: Card 8 BM: "The boxer was hurt and had to stay in the hospital, Then this thing healed up and he got to box again....He won the fight, He won the second fight. And then he was champ again." Card 1: "...the boy learned how to play the violin when he grew up to become a great musician." (2) Score 2 for unhappy ending or pessimistic out- come, For example: Card 1: "...he broke all the strings on his vio- lin and threw it out the window," Card 8 BM: '"',..it was something in his stomach and they had to operate and cut it open. The boy was worried. Finally, his father died." (3) Score 3 for neutral ending or outcome, For example: Card 1: '"Then she just found it, and she wondered who owned it," 52 Card 2: "He's plowing a garden. He will spend much time thinking whether he should make it bigger or just leave it like it was," 65. LEVEL OF INTERPRETATION. Classify each story as to level of interpretation according to the fol- lowing criteria: (1) Enumeration, Score 1 if R enumerates the stimuli on the card (boy, table, thing). (2) Description, Score 2 if R describes the scene on the card but provides no interpretations as defined below, "There is a young boy sitting at a table with a vio- lin, The boy is sad." (3) Interpretation, Score 3 if R interprets the char- acter's feelings, behavior, etc., in terms of a causal or purposeful relationship. However, the causal or pur- poseful relationship may be implied and is not nec- essarily scored as items 66 or 67. "He feels sad because his mother died." "He wants to learn to play so he can become a great musician," 66. CAUSALLY CONNECTED STATEMENTS. This item is intended as an elaboration of item 65, Level of Interpretation, Causally connected statements involve a related action (feeling, behavior, etc.) which occurs in the same or adjacent sentences. The reason for such action should be given or inferred, and the conse- quence of the action should be expressed. For example: "Her father brought home a birthday cake. That is why the mother wanted her to come home." "The woman promised to pay him fifty cents an hour because he needed the money so bad." "The horse broke his leg so the man shot him." "He feels sad because his mother died." 67. PURPOSEFULLY CONNECTED STATEMENTS. This item is also intended as an elaboration of item 65, Level of Interpretation. Purposefully connected statements involve a related action (feeling, behavior, etc.) which occurs in the same or adjacent sentences, The reason for such action should be given or in- ferred: the consequence of the action is on the actor, and a goal-oriented activity is implied or occurs. Some examples follow: "This lady was getting ready for bed. She heard a noise in the next room. So she looked out the door to see what it was." "The boy was hungry so he ate an apple." THEMATIC SCORING MANUAL INTRODUCTION The rules for determining story boundaries and the definitions of terms given in the Structural Scor- ing Manual also apply to this manual. Following is a set of procedures for scoring the TAT for thematic content. SCORING INSTRUCTIONS Enter the sample number, age, and sex of respond- ent (R) on the Thematic Scoring Sheet in the spaces provided. 1. CARD REJECTION, Code each card 1 (rejected) or 0 (not rejected) in accordance with the instructions in the Structural Scoring Manual. No further thematic scoring is required if a card is scored 1 on this item, 2. THEMATIC RESPONSE. A theme is defined as part or whole of the story proper which involves some expressed interaction between one or more characters (persons or animals) and an environmental press. Use definition of characters as in the Structural Scoring Manual. As in that manual, animated objects (e.g., a dancing doll) may be treated as characters. Three levels of thematic response are distinguished as fol- lows: Score Q—No theme, For example: Card 1: B [Beginning]. "There's a boy." E [End]. Card 2: B. "It's a house. It's a lady with Bibles, It's a other lady. It's a man..It's a horse, It's a wheats or something, and it's some rocks." E. (Lacks minimal interaction between character and environmental press.) Card 5: B. "There are some flowers with a lamp. The lamp's over there, There's a table. There's a door." E. Score 1—Thematic content (not elaborated), A story in which the essential elements of interaction of a char- acter and an environmental press are present but not developed into a coherent story. Themes which lack one or more of the criteria which define thematic elaboration in 2, below, are scored here, For example: Card 1: B., "He has his hands in his ears, He's looking at an instrument. There's a piece of paper like on bottom." E. (Satisfied criterion minimal interaction between character and environmental press.) Card 1: B. "The boy feels sad. It looks like he's getting ready to play his gui... violin, It looks like he's worried about something too." E. Card 2: B. "Lady's walking home, I guess from school—Like they're planting vegetables, Lady's going in the house—and she sees some barns back there. There's a lady lay-—up—Ileaning—up against a tree. Looks like—the lady with the books looks like she's walking to school." E. (This is an example of an item which borders on the ''no theme'' response, but the minimal criterion was judged to be satisfied by the underlined elements.) Card 2: B. "It looks like a man is planting food. It looks like that girl's going to school, or she's worried about something. The man and the lady are looking at something." E, Card 5: B. "It looks like the lady's surprised." E. (Environmental press is implied.) Score 2-—Thematic elaboration, A response in which a theme is presented in a coherent story. This ''coher- ent story'' should contain: (a) One or more indications of "feeling' or ''think- ing" by a character (b) Goal behavior (c) An outcome A coherent story is defined as one which has the essential elements integrated and organized. The story should be something more than a series of relatively unrelated statements, and there should be an apparent effort to present a story which has a plot. This definition excludes stories which are primarily descriptive of the situation or action. 3. REPRESENTATION OF MANIFEST CONTENT OF CARD. The question here concerns whether or not R included in the story the persons, animals, objects, and locales depicted in cards 1, 2, 5, and 8 BM, For each card, score each item listed on the scoring sheet as 1 (present) or O (absent). The underlined items below are arbitrarily designated as major. . The card content items listed below are intended to provide a means of anchoring objects and characters in the story to the stimuli on the card. Synonyms or generic terms should be scored as manifest content of the related items. The objects scored must be spec- ified in the story, but if mentioned, the objects are scored regardless of their significance to the story. Misidentification or misperceptions are not scored on this item but are scored on item 4, Card 1. boy, violin, bow, table, chair, sheetmusic Card 2. girl, young woman; older woman, mother; man, adult_male person (in foreground); books; farm scene, country scene; horse, white horse; horse, black (dark) horse (in background); fur- rows, plowed field, row; barn(s), house(s); lake, 53 river, water; hill(s); sky; tree(s) (NOTE: rocks are not scored) Card 5. woman, middle-aged woman; half-opened door, doorway; room; lamp, light; table; flowers, vase, flowers in vase; sideboard (or equivalent); bookends, books; bookcase (on wall) Card 8 BM. boy, youth; man, father (on operating table); man, doctor (with knife); knife; rifle, gun, barrel of rifle; operation scene (reverie); other man Scoring rules: The object listed must be specified in the story. A synonym or generic term is accepted as equivalent to the object listed. Content representation is scored as follows, if not otherwise specified: Card 1: Any mention of a single character (he, him, person, etc.) is scored as boy. The following are acceptable names for the violin: fiddle, viola, instrument, Card 2: If only a single character is included in the story, score as girl unless otherwise spec- fied, An indefinite reference to a group of char- acters (i.e., family) will be scored as girl, woman, man (foreground), unless otherwise indicated by the story content, If, in addition to the girl (lady, person with books), another indefinite character is given, score older woman, If, in addition to the girl, a plural pronoun is used to describe char- acters, score older woman and man, unless other - wise specified. Card 5: Mention of a single character is scored as woman, Card 8 BM: Mention of a single character is scored as boy unless specified in the story. Indefinite reference to characters (they) will be scored as doctor and other man, e.g., "They're cutting on him" would be scored as father, doctor, and other man, In cases where the operation scene is''imag- ined" or dream content and the boy is thinking of himself as being on the operating table, score both boy and father. 4, MISPERCEPTION, Score each of the card content items listed above in item 3 for cards 1, 2, 5, 8 BM for accuracy of perception of objects and characters presented. Score each item 0 if identified accurately and 1 if incorrectly identified. Incorrect identification is defined as gross error in age (man for boy), sex, species (cow for horse), role (father for boy), or other significant attribute, Scoring rules: Misidentification is sufficient to score this item, 54 Card 1: "picture," score sheet music; ''belt," score bow; "it," ""whatcha-ma call it," "bear trap," "tank," "guitar," "piano," score violin Card 2: ''guy," score girl (provided reference is to the central character in the story) Card 5: "he," score woman Card 8 BM: '"woman'' or "mother" on the operat- ing table, score father; '"'woman'' or '"'mother' in the role of the "doctor," score doctor 5. CHARACTER REFERENCE INCOHERENCE. Inco- herence of character reference is defined as disagree- ment between nouns or pronouns of reference and the antecedents to which they refer. Grammatical errors of tense or number are not included. If no incoherence is found in the story, score 0; indicate a number (1 or higher) to record the number of instances of incoher- ence in the story, The incoherent reference must be to a character: Card 1: "The boy in this picture is looking at a violin, She — he wonders whether he will play it." Card 5: "He was thinking where she could be so he—she— he went back home." Card 5: "So I went back to sleep ....when she got up her face was all different." The following example is not scored here (but should be scored under item 4 as a misidentification). "I was supposed to be practicing piano before I ate. So I finally practiced violin and then I ate my lunch," 6. MORBID MOOD QUALITY. A story theme is con- sidered morbid if it expresses ideas of a depressed, extremely gloomy, gruesome nature, or preoccupation with disease, or death, Statements involving cutting out someone's heart, internal organs falling out, and gruesome accidental death or murder are examples of morbid quality. Score morbid quality present 1; not present 0. A theme may be bizarre but not morbid, mqrbid but not bizarre, both, or neither, These two examples should be scored as morbid mood quality: Card 5: "The girl fell all the way down and she was dead. The mother cried, and the father cried. They buried her, Then there wasn't any girl for her mother, and her mother was sad and started bawling all night and all day." Card 16: "The car smashed him, He didn't wake up the next morning. He's dead. He didn't have enough time to disintegrate. When he disintegrated, he looked awful bad. He didn't like to pass on, but he did." Preoccupation with death refers to death abstractly or to one's own death, Preoccupation withkilling some- one else is not scored here, but is scored under item 20e, if threatening to kill, and 20h and i if death occurs through violence. 7. BIZARRE THEME. A theme may be morbid, but not bizarre, bizarre but not morbid, both, or neither. Bizarre themes lack orientation to reality, suggest distorted, nonlogical thought processes, or represent socially deviant behavior (e.g., cannibalism) to an ex- treme degree, Crimes of murder or robbery are not bizarre in and of themselves, nor are humanlike be- havior of animals (e.g., Mickey Mouse) or "fairy tale" content, Science fiction content (e.g., man from outer space) in and of itself is not scored as bizarre. Score bizarre thematic content 1, and absence of bizarre content 0, The following excerpts from stories are given to illustrate scoring of this item: Card 5: "Well, her face was real pretty. Then when she looked out it turned to bricks. Turned into bricks. She couldn't move her eyes or mouth," Card 8 BM: "He's cutting him up to eat him—to eat him for dinner." Card 16: "They would cut him up and eat him and then would save the rest for the other eating din- ner,” Card 16: "The alligators will climb up in your hair and you'll have alligator hair forever." 8. RELIGIOUS EMPHASIS, Religious emphasis is re- flected in the following themes: (a) those devoted to religious topics, (b) those in which significant story characters have roles as priests or ministers, or have Biblical names such as Baby Jesus, Joseph, Mary, or God, or (c) those in which the Bible, Noah's Ark, or other references to religion are essential aspects, If religious emphasis is present, score 1; if not, score 0. Excerpts from stories which illustrate the scoring of this item follow: Card 2: "A girl's going to church." Card 2: '",..the missionary's bringing all this food to them." Card 2: "She was trustful for God and she always liked God... ." Card 8 BM: "They thought God was a piece of junk," Card 16: "Well, this is a picture of God, and he is up in heaven." 9. CONFUSION OF R. Score 1 if R makes a remark indicating that he feels confused, such as, "I'm all mixed-up," "I'm crazy," or "I'm confused." If con- fusion is absent, record 0. 10. ESCAPE. Escape is defined as any action in a story in which any character expresses thought or ac- tion which has the effect of avoiding persons or sit- uations by running away or otherwise escaping, includ- ing going to sleep. Only overt acts of escaping or attempting to escape are scored. Score positive in- stances of escape 1, absence of escape (. Scoring rule; The idea of escaping must be im- plicit in the story; the fact that an unpleasant or aver- sive situation exists is not justification for scoring this item. Illustrations of story excerpts properly scored here: Card 2: "Then she's going to go and run away." Card 8 BM: "At the ending, he escaped from the enemies and he went home safely." Card 8 BM: "Tom started to watch but then he couldn't stand it any longer." (This represents a borderline case which may be scored here.) Card 16: "The fox beat him to his hole and chased the rabbit into the forest," (NOTE: the rabbit es- caped.) 11. EGOCENTRISM. Egocentrism is considered pres- ent if the theme is focused on the feelings, thoughts, or actions of a single character without evidence of any awareness of the reactions or feelings of other persons. Score presence of egocentrism 1, absence 9. Illustrations of story content properly scored here follow: Card 1: The theme is concerned only with the boy and his feelings or actions. Card 2: The girl with the books is usually the focal character. This card is scored here if the other characters are ignored or handled at a very superficial level of description and the focal char- acter is given dynamic attributes (not merely de- scribed). Card 5: The theme is concerned only with the woman and her feelings or actions. A burglar may appear as a threat to the focal character but is treated as an object of fear rather than a person. Card 8 BM: The boy in the foreground is dream- ing or fantasizing and the story is focused on his thoughts or dreams; or the story is focused on the boy to the exclusion of the operation scene char- acters, 55 12, FANTASY. Fantasy is considered involved if the theme is set totally or partly ina framework of dreams or daydreams, or if any character expresses dreams or daydreams in the story. Score presence of fantasy 1, absence of fantasy 0. The inference concerning dreaming or daydream- ing must be explicit in the story. Indications of rev- erie in thought are not scored here (''thinking'' was scored as item 62, Structural Manual), Examples properly scorable here: Card 8 BM: "In his sleep he was dreaming this." Card 8 BM: "He's dreaming that these two men are getting ready to cut him open." Examples of reverie not scorable here: Card 8 BM: 'He was, thinking about that he had to go to hospital and they were going to cut him open," Card 2: "She's thinking what she would do when she grows up." 13. FEAR. Look for any expression of fear, dread, or phobia; mild states of worry or anxiety are excluded from this definition. Indications of fear include re- actions to threat involving screaming, being scared, shaking with fear, or being terrorized. Phobic indica- tions include overt or implied fears or excessive con- cern with specific objects, such as snakes, alligators, rats, ghosts, the dark, storms, etc. Score presence of fear 1, absence of fear 0. Excerpts of stories which are properly scored here follow: "It was chillers from science fiction and she was scared." "He starts wiggling around and screaming." "The dog started barking at her, She was almost ready to scream. She went out of the house, shak- ing." 14. WEALTH POSSESSED OR ACQUIRED. This cat- egory focuses on themes involving wealth or riches, indicated by the possession or acquisition of wealth, including symbols of wealth such as valuable (not cos- tume) jewelry, mink coat, inheritance, riches, etc. Score mention of wealth possessed or acquired 1, ab- sence 0. Illustrations of story excerpts properly scored here follow: Card 5: "The man received a big reward for cap- turing a bandit," Card 8 BM: '"...Then he became a famous doc- tor, and he got a lot of money and was very wealthy," 56 NOTE: The mere saving of money through one's labor or stealing money should not be scoredhere, The intent is to score the subject's values con- cerning wealth, not his industriousness or honesty. If he saved a million dollars, that should be scored here. 15. WEALTH LOST. Score 1 for any mention of the loss of wealth, including theft of valuables or changing status from rich to poor; absence of wealth lost is scored 0. The loss must be extreme. The burning down of one's house would not be scored unless the context indicated the house was a very valuable one, The temporary loss of an item of wealth is not scored, i.e., "The maid stole a sum of money from a man but the police caught her." The value of the item should be substantial. The following would not be scored here: "Her favorite vase and some money on the table were stolen," 16. POVERTY. Score 1 for any mention of poverty or serious economic deprivation, such as being poor, not having enough food or clothing, or having to beg. If poverty is not mentioned or suggested, score 0. The following illustrations are properly scored here: Card 2: "This family with very many children— they lived in the city and found out it was much too expensive for them to live," Card 8 BM: "...in the past, he and his father, they were very poor and the father needed an op- eration." 17. PROJECTION, Score 1 if R, either directly or by an apparent slip of the tongue, includes himself (or herself) in the story. Do not score as projection first- person: dialogue quotations ("I'm going to play," said Pete). If projection is absent, score 0. The following are illustrations of items properly scored here: Card 1: "Once upon a time my little boy was play- ing a violin," Card 5: "Once.upon a time a burglar came in my house, and I was sleeping." Card 16: "When I got home I was happy that I had a fun time at the beach," 18. HOSTILE ANTAGONISM, Antagonism is defined as intense conflict or negative affective relations be- tween story characters, Instances of resentment, re- jection, willful disobedience, expressions of an adverse emotional relationship, unprovoked aggressive acts, and intense rivalry for the affections of another person are included in this definition. Each of the four inter- personal patterns listed below should be scored sep- arately. Score 1 for the presence of hostile antago- nism, and 0 for the absence. There should be no doubt in the scorer's mind that the interpersonal relationship is antagonistic. Dis- agreement with respect to what one likes or dislikes or difference of opinion is not sufficient indication of antagonism to score here. The element of hostility should be present in order to score items (a) through (d). If antagonism is evidenced between the child and the parents, score both (a) and (b) for this item, (a) Mother-child Card 5: "There were these little children and her mother —their grandmother —this their mother couldn't put up with them." Card 5: "And afterwards I didn't feel so good be- cause she hit me," (b) Father-child Card 2: ''She was mad because her father was just standing there working and paying no attention to her,” Card 16: "His father had heard that he went so his father went up there and got him and brought him home. One night his father killed him." (c) Mother-father Card 8 BM: "So one time his father got married. One time the wife didn't like him—her husband. She didn't like him so that she cut him." (d) Child-sibling Card 5: "So their mother came in and they started fighting," 19. AFFECTION. The interpersonal relationship must be spelled out in the story to be definitely one of loving affection, Affection is defined as a positive, pleasant, emotional relationship between story characters, In- stances of justifiable discipline do not preclude scor- ing this item, Each of the same four patterns listed above in item 18 should be scored separately, Score 1 for the presence of affection, and Q for absence, If affection is evidenced between the child and the parents, score both (a) and (b) for this item, 20. ATTRIBUTES OF CHARACTERS. Each card is to be scored separately for the presence or absence of each of the traits, states, or conditions of char- acters, as defined below, Score 1 if the characteris- tic is present; otherwise score 0. The traits or characteristics specified in (a) through (d) must be attributable to a character and must be spelled out, The manifestation of behavior which merely suggests that the person may possess such traits is not sufficient evidence to score these items. (a) Kind, loving, rewarding. A character helps, teaches, loves, rewards, shows kindness, or other positive affect toward another character, For example: Card 5: "He must be at Joey's house. If he is there, 1 will give him an apple when he comes home." Card 8 BM: 'He always dreamed of being a doc- tor and wanted to help people a lot." (b) Mean, rejecting, punishing, A character re- fuses to help or teach, neglects, rejects, hurts, pun- ishes, or shows negative affect toward another char- acter, If a child merits disciplinary action by the parent and is punished for a misdeed, do not score as punishing. Examples to be scored follow: Card 2: "Her mother makes this man work real hard, because he hurt his—her mother's feelings." Card 16: "This boy was always mean to other boys." (c) Unhappy, sad. The story states that any char- acter is sad, unhappy, discouraged, grief-stricken, depressed, crying, or weeping. For example: Card 1: "Feels bad because he can't play." Card 8 BM: "The boy is sad because the mother might die, and he doesn't want her to die." Card 8BM: "That little boy and he looks sad." (d) Happy, glad. The story states that any char- acter is happy, glad, cheerful, thankful, laughing, and smiling. For example: Card 1: "He took them and learned how to play. Then he was happy." Card 8 BM: "Tom felt real good and thanked his father and the other man," Card 16: "When I got home, I was happy that I had a fun time at the beach." (e) Aggression, Hostile or threatening action by any character that causes fear or flight or brings the other person into forceful contact, Include acts of dis- placed aggression (e.g., the boy breaking the violin be- cause he does not want to practice), For example: Card 8 BM: '"Then two crooks got him tied up," Card 16: '"...some bad man he tells him, 'Come on and have some candy." Then the little boy go to ...and the guy grabs him and he is strangles him," (f) Dishonesty. Instances of stealing, robbing, ly- ing, cheating, or deception by any character. Abandon- ment of children should not be scored here, Examples for this item are: Card 5: "She opens the door very quietly and she goes in to steal the money." Card 8 BM: "He had no more friends because that he didn't have a hunting license. He had been hunting for so long and nobody noticed it." Card 16: "So he said, 'If you help me, I'll pay you," and the men said, "All right." Then when they were finished, he didn't pay them... ." (g) Illness, injury. Score instances in which any character is crippled, ill, sick, injured, in hospital, undergoing an operation, in poor health, or in an ac- cident without reference to condition. For example: Card 2: "She thought that her mother had a sick- ness that was going around and she was very pain- ful looking." Card 5: "So the others had a piece and they were poisoned." Card 8 BM: '",..this boy by the name of Tom was watching his tather and another man—operate on—his friend." Card 16: "She steps up to the side and tries to get the dog out of a fight, She gets hurt." (h) Death, Score if any character dies, or may be presumed to be dying whether the cause of death is violent or nonviolent, If murder or killing is scored, death will also be scored. Examples follow: Card 2: '"...the letter had said that her mother had died. so her father came out to live with her, ow... Card 16: "He didn't wake up the next morning. He's dead." (i) Murder, killing, Score if any character mur- ders or is murdered, kills or is killed, either inten- tionally or accidentally, or is in danger of dying as a result of violence. Do not score unless a death occurs or is occurring. (Unsuccessful attempts are scored under item 20e, Aggression.) Examples follow: Card & BM: "He was asleep, and they cut him and killed him," Card 8 BM: "Two men always took after him, and started killing everybody," (j) Parental protection, Any indication of exces- sive parental protectiveness or overconcern for the child. Attributes include: trying to keep the child out 58 of situations that might be unpleasant or embarrass- ing; is concerned about the possibility of the child getting hurt or becoming ill; protects from other chil- dren. (k) Parental casualness. Attributes include: does not object to the child's loafing .or daydreaming; lets the child do pretty much as he wants to; expects the child to have everyday disappointments; lets the child off easy when he does something wrong. 21. GOAL-ORIENTED BEHAVIOR. Goal-oriented be- havior is defined as involving some expressed plan, intention, or action of one or more characters to at- tain a goal. It may generally be observed when the reaction of the character(s) to the environmental press determining the story theme takes the form of goal-oriented plans, intentions, or overt behavior. Such reactions are scored separately in respect to temporal aspects of goals accepted, whether the di- rection is toward or away from something, and status of outcome, in the subitems below, The minimal type of action between the character and the environmental press is not scored as goal- oriented behavior. For example: "The boy is looking at the violin" does not evi- dence such behavior. However, "The boy is looking at the violin and thinking if he can play" is goal-oriented behavior since it involves a plan, intention, desire, or action, Another example: "The girl has books in her arms' is not scored, but "The girl wants to go to school" should be scored. (I) Number indicated Where the elements of the theme are knit into a coherent major or principal theme, score 1. Do not attempt to break down such a theme into el- ements, Where the story contains two or more different themes, as in the case where E interrupts and R elaborates a different theme, score 2. In the case where R seems to change his mind and tells another theme, score 2. (I) Thematic goal behavior To determine the thematic goal behavior, for which temporal aspect, direction, and outcome are scored, first select the principal theme, which can be identified as: (A) The theme involving the central character and the perceived environmental press. (B) The interaction with the central character which seems to be most important to that char- acter, Then, score the principal theme for temporal aspect, direction, and status of outcome as follows: (1) Temporal aspect, For each card, score 0 if no goal-oriented behavior as defined is present; score 1 if the goal is short range (today, this week, soon); score 2 if the goal is long range (years, "When I grow up"). (2) Direction, Consider the initial situation of the character in relation to the terminal situation: (a) Score the following as ''approach': 1 (i) The terminal situation is positive (save from drowning, prevents from being hurt, avoids pain). (ii) The initial situation is positive with no threat of change to a negative situation. (iii) The initial situation is negative and the ter- minal situation is positive. (b) Score the following as ''avoidance'': 2 (1) The terminal situation is negative (the hero dies, is sent to jail, is spanked). (ii) The initial situation is negative with no ac- tion taken to change it, (iil) The initial situation changes from positive to a negative one, (3) Status of outcome, Score Q if the goal be- havior has no outcome as defined by item 63 in the Structural Scoring Manual, A barrier is defined as a definite interference by another character or a nat- ural catastrophe, Otherwise score as follows: 1, if the ending or outcome indicates that the pur- pose of goal behavior is satisfied and no bar- rier or obstacle prevented the attainment of the goal, if the purpose of the goal behavior is satisfied despite a barrier or difficulty, if goal attainment was prevented by an insu- perable barrier or difficulty; failure. 4, if failure was the result of lack of capacity of the individual (physical, mental, social, finan- cial, or other inability to cope). if failure represents loss of interest, cessa- tion of effort, or changed motive, 6, if the outcome depends upon conditions ex- plicit in the story, i.e., "If he goes to school, he will become a doctor." —QO0O0—— 59 60 APPENDIX ll QUESTIONS FROM CYCLE Il HEALTH EXAMINATION SURVEY FORMS USED IN THIS STUDY CONFIDENTIAL — The National Health Survey is authorized by Public Law 652 of | Form apPROVED the 84th Congress (70 Stat. 489; 42 U.S.C. 242c). All information which would BUSeeTIelmERO WD: Sainepoiess permit identification of the individual will be held strictly confidential, will be used only by persons engaged in and for the purposes of the survey and will not be disclosed or released to others for any other purposes (22 FR 1687). DEPARTMENT OF HES-256 HEALTH, EDUCATION, AND WEL FARE PUBLIC HEALTH SERVICE NATIONAL HEALTH SURVEY CHILD’S MEDICAL HISTORY - Parent (1-8) NAME OF CHILD (Last, First, Middle) SEGMENT (8-11) SERIAL |e NO. NOTE: Please complete this form by checking the correct boxes and/or filling in the blanks where applicable. When you have completed it, keep it until the representative of the Health Examination Survey calls on you within a few days. If there are some questions you do not understand, please complete the others and the person who comes for the form will help you with the ones that were unclear. 20. NOW TURNING TO THE PRESENT TIME. HOW WOULD YOU DESCRIBE THE CHILD'S HEALTH NOW? 1 [J Very good 2 [] Good s [J Fair 4 [] Poor IF FAIR or POOR, what is the trouble? 21, IS THERE ANYTHING ABOUT HIS(HER) HEALTH THAT BOTHERS YOU OR WORRIES YOU NOW? 1 O Yes 2 [1] No IF YES, what is the trouble? 28. HAS HE(SHE) EVER HAD ANY OTHER ACCIDENT OR INJURY THAT TROUBLED HIM QUITE A BIT? 1 [J Yes 2 [J No 3 [J] Don’t know 33. HAS THIS CHILD EVER HAD MEASLES? 1 3 Yes 2 [J No 3 [] Don’t know IF YES: A. At what age? B. Was he(she) sick longer than usual? 1 [OO Yes 2 [J No 3s [] Don’t know C. Did he(she) have to go to the hospital? 1 (3) Yes 2 [J No 3 [] Don’t know D. Did he(she) have a high fever for more than one week? 1 [J Yes 2 [J] No a [J Don't know E. Did he(she) seem to be unusually drowsy (sleepy) after the illness? 1+ [J Yes 2 [J No 3 [] Don’t know 35. HERE ARE SOME OTHER KINDS OF ILLNESSES OR CONDITIONS SOME CHILDREN HAVE. HAS YOUR CHILD EVER HAD: A. Asthma? 1 [J Yes 2 [J No 3s [J Don’t know R Hay fever? 1 [1] Yes 2 [J No 3 (] Don’t know C. Any other kinds of ' [3] Yes 2 [No 3 []) Don’t know: allergies? D. Any trouble with his v [O Yes 2 [J No 3 [7] Don't know (her) kidneys? E. A heart murmur? 1 [0 Yes 2 [J No s (J Don’t know F. Anything wrong with + [1 Yes 2 [J No 3 [_) Don't know his(her) heart? G. A convulsion? 1 [1 Yes 2 [1] No 3 [_] Don’t know H. A fie? ' [1 Yes 2 [] No 3 [] Don’t know 50. IS THERE ANY PROBLEM WITH THE WAY HE(SHE) TALKS? 1 [0] Yes 2 [J No 3 [] Don’t know IF YES, what is the problem? 1 [] Stammering or stuttering? 2 [) Lisping? 3 [] Hard to understand? 4 [] Something else? What is that? PHS-T217-6 Form Approved 7/64 Budget Dureau Io. 68-R620-Sh.6 CONFIDENTIAL - The National Health Survey is authorized by Public law 652 of the 84th Congress (70 Stat. 489; 42 U.S.C. 242c). All information which would permit identification of the individual will be held strictly confidential, will be used only by persons engaged in and for the purposes of the survey and will not be disclosed or released to others for any other purposes (22 FR 1687). iS = 257 DEPARTMENT OF (1-5) HEALTH, EDUCATION, AND WELFARE Public Health Service National Health Survey Child's Medical History - Interviewer 5. Which one of the statements in each of these sets best discribes ? a. (1) [TJ Eats too much (2) /_/ Usually eats enough (3) // Doesn't eat enough b. (1) [7 Eats nearly all kinds of food (2) [7 Bats most kinds of foods, dislikes a few kinds (3) [J somewhat fussy ebout kinds of food he (she) eats (4) 7 Very fussy about food; won't eat many things. 14. When it comes to meeting new children and making new friends is [ Je. Somewhat shy [ Jb. About aversge willingness [Je. Very outgoing - mekes friends easily 15. How well would you say he gets along with other children? [Ja. No difficulty; is well liked [Jb. As well as most children [Jec. Has difficulty with many children 17. Has anything ever happened that seemed to seriously upset or disturb your child? [J Yes [J wo 18. With respect to how relaxed or how tense or nervous your child is, would you rate him (her) a. [J Rather high strung, tense and nervous. b. [J Moderately tense. Ce J Moderately relaxed. d. [7 Unusually calm end relaxed. 19. With respect to your child's temper or his (her) getting angry, would you rate him (her) a. £7 Has a very strong temper, loses it easily. b. [J Occasionally shows a fairly strong temper. Cs LJ Gets angry once in a while but does not have a particularly strong temper. d. J Hardly ever gets angry or shows any temper. 62 CONFIDENTIAL - The National Health Survey is authorized by Public Law 652 of | Form apeRovED the 84th Congress (70 Stat, 489; 42 U.S.C. 242C). All information which would BUDGET GUREAU NO, 80:R020:94.8 permit identification of the individual will be held strictly confidential, will be used only by persons engaged in and for the purposes of the survey and will not be disclosed or released to others for any other purposes (22 FR 1687). DEPARTMENT OF HES-243 HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE National Center for Health Statisties ' Health Examination Survey SUPPLEMENTAL INFORMATION FROM SCHOOL The child whose name appears below is one of the sample of children Rate studied in the Health mination Survey. Please complete this form on the basis of school records and/or information the child's teacher or other school official may have. Please return it in the enclosed franked envelope. This child's parent or guardian has given us written authorization to obtain information from the school. School Number / 7 Sample Child Number / 7 Name of child: (Last Name) (Pirst Name) (Mlddle Name) Home address (for identification) 4. Have any grades been repeated for any reason? [J Yes [7] No 8. If the following special resources were available, check those you would recommend for this child: a. [J Special provision for hard of hearing. b. {7 Special provision for "sight saving". c. [J Speech therapy. d. LZ Special provision for orthopedically handicapped. e. [7 Special provision for gifted children. [7 Special provision for "slow learaers". g [J Class for mentally retarded. v4 Special provision for emotionally disturbed. i. [J] Other (specify) . J+ [J None of above. 11. Which one of these statements most accurately describes this child? [7 A. His adjustment is at times a concern. You think of him 2s a problem or future problem. [7 B. Unusual in his ability to cope with normal situations. At least occasionally have thought of him as "unusually well adjusted." [J C. You rarely think of him in terms of his behavior. He is not described by A or B. 12. As you know, the ability to pay attention to a task and to sustain attention (concentrate) changes with age, although children of the same age differ. Check the item which best describes the child in the classroom situation. vj A. Pays attention as well as most children his age. [7 B. Characteristically is more attentive than others his age. [7 C. Characteristically is less attentive than others his age. [7 D. No basis for judging which of above fits this child. 13. In the classroom situation which one of these statements most nearly describes this child? {7 A. Almost constantly moving, inappropriately talks out loud, drops things, leaves his seat when he should not, finds reasons to be "on-the-move". ZZ B. Slightly more restless than most children his age. But usually is not a problem in the classroom. [7 C. Shows average amount of restlessness if fatigued, bored, etc. Motor activity level is as expected for nis age. / / D. Remains quiet long after the average child has become restless. Sometimes seems too controlled for his age. [7 E. No basis for judging which of above fits this child. 14. Below are a list of statemen“s which may or may not describe this child. If the statement is descriptive of him/her, place a check mark (v”) in front of the statement. If it does not describe this child, leave the space blank. (You may check several items). [7 A. Other children frequently accuse him of fighting. [J B. "Accidentally" trips, shoves or hits other children. Is too "rough" with other children. [J C. Frequently comes to your attention because he has been injured. [7 D. Agressive behavior frequently makes disciplinary action necessary. [7 E. Children, frequently complain that he uses bad words. J F. Parents of other children call to complain about his behavior. id Ge No method of discipline seems to work with him. [J BH. No basis for judging about this child in these areas. [7 I. Non= of above statements describe this child. 18. With respect to intellectual ability, would you judge this child to be: [7 A. About average for his age (neither in the top - about one-fourth, nor the bottom - about one-fourth) [J] B. Clearly above average for his/her age (In about the top fourth). [7 C. Clearly below average for his/her age (In about the bottom fourth). [J] D. No basis for judging this child. 19. With respect to academic performance, would you judge this child to be: [TJ A. About average for his/her age (neither in the top - about one-fourth, nor the bottom - about one-fourth). [J B. Clearly above average for his/her age (In about the top fourth). Lk C. Clearly below average for his/her age (In about the bottom fourth). [/ D. No basis for judging this child. sen 3 CO Sm 63 64 APPENDIX \% CONVERSION TABLE AND PERCENTILE EQUIVALENT TABLE Table VII. Conversions of raw scores on the 31 TAT variables to standard scores (! scores) EN: mm Raw t Raw t Raw t Raw t Raw t Raw t score score score score score score score score score score score score Item 1: Adverbs Item 2: Item 4: Cor- Item 10: Item 15: Caus- Item 22: Morbid Pauses —Con. rections —Con. Rejection ally connected mood —Con 0 45 statements—Con. 1 47 57-58 74 18 94 0 47 2 87 2 49 59-60 75 19 96 1 64 3 61 3 108 3 52 61-62 76 20 99 2 81 4 68 4 128 4 54 63-64 77 21 102 3 98 5 75 5 149 5 57 65-66 79 22 105 4 116 6 169 6 59 67-68 80 23 107 5 133| Item 16: Expres- 7 61 69-70 81 24 110 sion of feeling Item 23: Bizarre 8 64 71-72 82 25 113 Item 11: Level theme 9 66 73-74 83 26 115 of interpre- 0 36 10 69 27 118 tation 1 42 0 39 11 71 |Item 3: Verbatim 28 121 2 49 1 45 12 73 repetitions 29 124 0 3 3 55 2 51 13 76 30 126 1 7 4 61 3 57 14 78 0 42 3 129 2 un 5 68 4 63 15 81 1 44 32 132 3 15 5 69 16 83 2 45 33 134 4 19 | Item 17: Outcome 17 85 3 46 34 137 5 23 Item 24: Egocen- 18 88 4 47 35 140 6 27 0 39 trism 19 90 5 49 36 143 7 31 1 44 20 93 6 50 37 145 8 35 2 50 of, 45 21 95 7 51 38 148 9 39 3 56 1 64 22 97 8 52 39 151 10 43 4 61 2 83 23 100 9 53 40 153 1 47 5 67 3 103 24 102 10 55 41 156 12 52 4 122 25 105 11 56 42 159 13 56| Item 18: Kind- 26 107 12 57 43 162 14 60 loving Item 25: Mean, 27 109 13 58 44 164 15 64 rejecting 28 112 14 60 45 167 0 45 29 114 15 61 46 170 Item 12: 1 61 0 45 30 117 16 62 Situation com=- 2 76 1 59 31 119 I? 63 Item 5: Past plexity 3 92 2 74 32 121 18 64 reference 4 107 3 88 33 124 19 66 0 4 5 123 4 103 34 126 20 67 0 44 3 8 5 117 35 129 21 68 1 52 2 13| Item 19: Happy- 36 131 22 69 2 60 3 17 glad Item 26: 37 | 133 23 71 3 69 4 21 Aggression 38 136 24 72 4 77 5 25 0 42 39 138 25 73 5 85 6 29 1 49 0] 42 40 141 26 74 7 33 2 57 1] 56 41 143 27 75| Item 6: Future 8 37 3 64 2| 69 42 145 28 77 reference 9 41 4 71 3 83 43 148 29 78 10 45 5 79 4 | 96 30 79 0 43 11 49 Item 2: Pauses 31 80 1 50 12 53| Item 20: Goal=- Item 27: Posses- 32 82 2 57 13 57| oriented be- sive adjectives 0 41 33 83 3 65 14 62 havior 1-2 42 34 84 4 72 15 66 0 42 3-4 43 35 85 5 80 0 34 1! 43 5-6 44 36 86 Item 13: Present 1 39 2 44 7-8 45 37 88 [Item 7: Unhappy reference 2 45 3 45 9-10 46 38 89 outcome 3 50 4 46 11-12 48 39 90 0 -18 4 56 5 47 13-14 49 0 44 1 -3 5 61 6 48 15-16 50 Item 4: Cor- 1 58 2 10 6 66 7 50 17-18 51 rections 2 71 3 24 1 72 8 51 19-20 52 3 84 4 39 8 77 9 52 21-22 53 0 45 4 98 5 53 9 82 10 53 23-24 55 1 48 5 111 10 88 11 54 25-26 56 2 50 Item 14: Happy 12 55 27-28 57 3 53 | Item 8: Death outcome Item 21: Hostile 13 57 29-30 58 4 56 antagonism 14 58 31-32 59 5 59 0 43 0 45 15 59 33-34 60 6 61 1 57 1 59 0 47 16 60 35-36 61 7 64 2 71 2 73 1 70 17 61 37-38 63 8 67 3 86 3 87 2 93 18 62 3-40 64 4 69 4 100 4 101 3 115 19 63 41-42 65 72 . © { 138 20 65 43-44 66 un 73 [Teen 3) Murder Item 15: Caus- 5 161 21 66 45-46 67 12 78 g ally connected 22 67 47-48 68 13 80 0 45 statments Item 22: Morbid 23 68 49-50 69 14 83 1 63 mood 24 69 51-52 71 15 86 2 81 0 41 25 70 53-54 72 16 88 3 99 1 47 0 47 26 72 55-56 73 17 91 4 117 2 54 1 67 27 73 Table VII. Conversions of raw scores on the 31 TAT variables to standard scores ( £ scores) —Con. Raw t Raw t Raw t Raw t Raw t score score score score score score score score score score Item 27: Possessive Item 28: Common Item 29: Pro- Item 29: Pro- Item 30: Single adjectives —Con. nouns —Con. nouns —Con. nouns—~Con. verbs —Con. 28 74 87-90 60 18- 21 45 305-308 118 238-241 95 29 75 91-94 61 22-25 46 309-312 119 242-245 96 30 76 95-98 62 26- 29 47 313-315 120 246-250 97 31 77 99-102 63 30- 33 48 316-319 121 251-254 98 32 78 103-106 64 34- 37 49 320-323 122 255-258 99 33 80 107-110 65 38- 41 50 324-327 123 259-262 100 34 81 111-114 66 42-45 51 328-331 124 263-267 101 35 82 115-118 67 46 - 49 52 332-335 125 268-271 102 36 83 119-122 68 50- 53 53 336-339 126 272-275 103 37 84 123-126 69 54- 56 54 340-343 127 276-279 104 38 85 127-130 70 57- 60 35 344-347 128 280-284 105 39 86 131-134 71 61- 64 56 348-351 129 285-288 106 40 88 135-138 72 65- 68 57 352-355 130 289-292 | 107 41 89 139-142 73 69- 72 58 356-359 13 293-296 108 42 90 143-146 74 73-76 59 297-301 109 43 91 147-150 75 77- 80 60| Item 30: Single verbs 302-305 110 44 92 151-154 76 81- 84 61 306-309 111 45 | 93 155-158 17 85- 88 62 0- 3 39 310-313 112 46 | 95 159-162 78 89-92 63 4-7 40 314-318 113 47 | 96 163-166 79 93- 96 64 8-12 41 319-322 | 114 48 | 97 167-170 80 97-100 65 13- 16 42 323-326 115 49 98 171-174 81 101-104 66 17- 20 43 327-330 116 50 99 175-178 82 105-107 67 21- 24 44 331-335 117 51 100 179-182 83 108-111 68 25- 29 45 336-339 118 52 101 183-186 84 112-115 69 30- 33 46 340-343 119 53 103 187-190 85 116-119 70 34- 37 47 344-347 120 54 104 191-194 86 120-123 71 38- 41 48 348-352 121 55 105 195-198 87 124-127 72 42- 46 49 353-356 122 56 106 199-202 88 128-131 73 47- 50 50 357-360 123 57 107 203-206 89 132-135 74 51- 54 51 361-364 124 58 108 207-210 90 136 -139 75 55- 58 52 365-369 125 59 109 211-214 91 140-143 76 59- 63 53 60 111 215-218 92 144-147 77 64- 67 54 | Item 31: Dialogue 61 112 219-222 93 148-151 78 68- 71 55 62 113 223-226 94 152-155 79 72-75 56 0 45 63 114 227-230 95 156-158 80 76 - 80 57 1 47 64 115 231-234 96 159-162 81 81- 84 58 2 48 65 116 235-238 97 163-166 82 85- 88 59 3 50 66 118 239-242 98 167-170 | 83 89- 92 60 4 51 67 119 243-246 99 171-174 84 93- 97 61 5 533 68 120 247-250 100 175-178 85 98-101 62 6 54 69 121 251-254 101 179-182 86 102-105 63 7 56 70 122 255-258 102 183-186 87 106-109 64 8 57 71 123 259-262 103 187-190 88 110-114 65 9 59 72 124 263-266 104 191-194 89 115-118 | 66 10 60 73 126 267-270 105 195-198 90 119-122 67 11 62 74 127 271-274 106 199-202 91 123-126 68 12 63 75 128 275-278 107 203-206 92 127-131 69 13 64 279-282 108 207-209 23 132-135 70 14 66 Item 28: Common nouns 283-286 109 210-213 94 136-139 71 15 67 287-280 110 214-217 95 140-143 72 16 69 0-2 38 291-294 11) 218-221 96 144-148 73 17 70 3-6 39 295-298 112 222-225 97 149-152 74 18 72 7-10 40 299-302 113 226-229 98 153-156 5 19 73 11-14 41 303-306 114 230-233 99 157-160 76 20 75 15-18 42 307-310 115 234-237 100 161-165 77 19-22 43 311-314 116 238-241 101 166-169 78 23-26 44 315-318 117 242-245 102 170-173 79 27-30 45 319-321 118 246-249 103 174-177 80 31-34 46 322-325 119 250-253 104 178-182 81 35-38 47 326-329 120 254-257 105 183-186 82 39-42 48 330-333 121 258-260 106 187-190 83 43-46 49 334-337 122 261-264 107 191-194 84 47-50 50 338-341 123 265-268 108 195-199 85 51-54 51 342 124 269-272 109 200-203 86 55-58 52 273-276 110 204-207 87 59-62 53 Item 29: Pronouns 277-280 111 208-211 88 63-66 54 281-284 112 212-216 89 67-70 55 0-2 40 285-288 113 217-220 90 71-74 56 3-5 41 289-292 114 221-224 91 75-78 57 6-9 42 293-296 115 225-228 92 79-82 58 10-13 43 297-300 116 229-233 93 83-86 59 14-17 44 301-304 117 234-237 94 65 Table VIII. Percentile equivalents for TAT composite scores, by sex, age, and TAT factor Boys Girls TAT factor and SoTpoFiLe score 6 7 8 9 10 11 6 7 8 9 10 un years [years |years |years |years | years | years | years | years | years | years |years Factor I: Verbal Percentile productivity 245-255 cm mmm meen 0 0 0 0 0 0 0 0 0 0 0 0 256-260-===-=meeun 18 11 12 3 4 2 21 14 10 7 1 4 261-265=-==--====== 44 31 26 16 16 10 43 34 21 17 5 11 266-270-=---=-nnom= 65 48 39 28 23 17 52 51 36 24 15 15 271-275=-===-====== 72 59 47 37 31 25 65 60 41 33 22 23 276-280=----omomun 83 68 56 44 40 30 71 66 53 46 32 28 281-285-===-=-=---- 88 73 58 52 46 36 74 70 61 49 37 38 286-290--===-m-m-- 89 77 66 55 56 43 79 74 65 54 42 41 291-295-==-nmcuenn 92 80 68 61 60 46 83 79 69 53 46 45 296-300==-=-=-==---=- 93 84 73 67 64 51 86 80 72 60 51 59 301-305--====-c-m- 93 87 79 70 67 54 88 80 78 63 55 63 306-310--=-----num= 95 88 80 74 70 58 88 82 80 66 58 68 311-315==-=-=mmnuu= 96 89 81 80 74 61 88 83 80 67 62 73 316-320=-====nmu== 96 90 84 83 79 68 93 84 84 71 63 77 321-325---=---=--~ 96 93 88 85 82 70 93 86 86 72 64 80 326-330----=-=-==- 96 93 88 85 84 74 93 89 88 77 68 82 331-335--====numu=- 97 95 91 88 85 75 94 90 91 79 71 84 336-340----=mcumm- 97 95 93 91 85 76 95 91 91 82 78 85 341-345 == cmcmmmmmn 97 95 93 gL 87 77 95 92 92 83 81 85 346-350===-mememnn 97 95 94 91 90 78 98 92 92 83 83 87 351=355----==mnumn 97 96 94 94 91 82 98 94 94 83 84 88 356-360--=---couu- 97 96 95 94 91 82 98 95 94 85 85 90 361-365=-===nmmm-= 97 96 95 95 91 84 98 95 94 86 86 91 366-370=-==-=nu--== 97 97 97 95 92 87 98 97 94 89 86 91 371-375======meum= 97 97 97 95 93 88 98 97 95 89 88 01 376-380=--=-=-mmo-n 97 97 97 96 94 89 98 97 95 90 88 93 381-385-===--mm=-- 98 97 97 96 95 91 98 97 95 91 92 93 386-390=-----==--=- 98 98 97 98 95 92 98 97 95 91 94 93 391-395-----o-om-=- 98 98 97 98 96 22 98 98 95 91 95 96 396-400-----===u== 98 98 97 98 96 92 99 99 95 92 96 96 401-405-==--~==-== 98 98 97 98 96 93 99 100 96 92 97 97 406-410====cmmemun 98 98 97 99 96 93 99 100 96 93 97 97 411-415-=-=----==-- 99 98 97 99 96 93 99 100 97 93 98 97 416-420--------==~ 99 99 98 99 97 95 99 100 97 23 98 97 421-425 -==cmmemmmm 99 99 99 99 98 95 99 100 97 94 98 97 426-430---=--==-=-- 100 99 99 99 98 96 99 100 98 95 99 97 431 -435-=-mmmmaann 100 99 99 99 98 96 99 100 98 95 99 97 436-440 -=-cmmmmmnn 100 99 99 99 98 98 99 100 98 97 99 97 L441 =445 meme mmm 100 99 99 99 100 98 99 100 98 97 99 97 446-450 === =mmauum 100 99 99 99 100 98 99 100 98 97 99 97 451-455 ===cmmauun 100 99 99 99 100 98 99 100 98 98 99 97 456 -460--=--=----= 100 99 99 99 100 98 100 100 98 99 99 97 461-465---=----=== 100 29 99 99 100 98 100 100 99 99 99 97 466-470 mmcmmmem 100 100 100 100 100 100 100 100 100 100 100 100 Factor II: Dys- phoric So 125-=-ccmmcmmmm em 0 0 0 0 0 0 0 0 0 0 0 0 126-130-=----=----- 58 63 53 54 52 47 54 55 52 59 45 47 131-135---==ccun=- 58 63 53 54 52 47 54 55 52 59 45 47 136-140----=---=-= 58 63 53 54 52 47 54 55 52 59 45 47 141-145-=--ceccmumm 67 77 63 68 64 63 73 68 67 75 62 67 146-150---------==~ 68 77 64 68 65 63 73 68 67 75 62 67 151-155---=-====== 69 78 64 70 69 64 73 72 68 75 64 70 156-160--==---=-== 70 79 65 76 12 74 73 76 73 77 72 74 161-165------===-~ 86 86 82 85 83 80 86 86 86 85 75 79 166-170--==-=====- 87 86 85 87 83 83 86 89 87 87 78 84 171-175-===--====- 90 92 88 94 90 90 93 92 92 93 84 88 176-180=--=---=--- 90 92 88 94 90 90 93 92 92 93 84 88 181-185-=-----=-m-o=- 90 94 90 95 91 91 95 93 93 93 86 90 186-190=-=-=======~ 91 96 94 96 93 93 98 95 96 95 93 94 191-195--=-=-==umo- 93 96 95 97 95 93 98 95 97 95 94 97 196-200 ---====---=- 93 96 95 97 95 94 98 95 97 95 95 97 201-205======-===- 93 99 98 97 96 96 98 95 97 98 98 98 206-210-=====nome= 95 100 99 99 97 99 98 97 98 98 98 98 211-215=====mcmuun 96 100 99 100 97 99 98 97 98 98 98 98 216-220=--===mmuu= 98 100 99 100 98 100 99 97 98 98 99 99 66 Table VIII. Percentile equivalents for TAT composite scores, by sex, age, and TAT factor —Con. TAT factor and Boys Girls composite score 6 7 8 9 10 11 6 7 8 9 10 11 years |years |years |years |years | years |years | years | years | years | years | years Factor II: Dys- Percentile phoric mood —Con. 221=225----mmmmmmn 98 100 99 100 99 100 99 97 98 98 99 99 226-230=-=-=cmmmun 98 100 100 100 99 100 99 97 99 98 99 99 231=235=c-mmmmmmun 98 100 100 100 99 100 99 99 99 99 99 99 236-240===--mmomn- 99 100 100 100 99 100 99 100 99 99 99 99 241-245 cm mmm meme 99 100 100 100 99 100 99 100 99 99 99 99 246-250 mmm mmm mmm 99 100 100 100 99 100 99 100 99 99 99 99 251=255=====mmmemn 99 100 100 100 99 100 99 100 99 99 100 99 256-260=--==----=-=- 100 100 100 100 99 100 99 100 100 99 100 99 261-265===-=-nmuen 100 100 100 100 100 100 100 100 100 99 100 99 266-270==-==--==-- 100 100 100 100 100 100 100 100 100 100 100 99 271-350===-=mmuum= 100 100 100 100 100 100 100 100 100 100 100 100 Factor 111: Con- ceptual maturity 75mm mmm mmm mmm - 1 0 1 1 0 0 4 0 2 1 0 0 -74 to -70-=-===-- 1 0 1 1 0 0 4 0 2 1 0 0 -69 to -65-----=-=- 1 0 1 1 0 0 4 0 2 1 0 0 -64 to -60=-=--=--= 1 0 1 1 0 0 5 0 2 1 0 0 -59 to =55----=--- 1 0 1 x 0 0 5 0 2 L 0 0 =54 to -50--==-=-- 3 L 2 1 0 0 6 0 2 1 0 0 49 to =45---==--- 4 1 2 1 0 0 Z 0 2 1 0 0 44 to =40---=---- 4 2 3 L 0 0 7 0 2 1 0 0 -39 to =35-==-===- 4 2 3 1 0 0 7 0 2 1 0 0 -34 to -30=--===-=- 4 2 3 1 0 0 7 0 2 1 0 0 =29 to =25---===-- 4 2 3 1 0 0 7 0 2 1 0 0 -24 to =20---===-- 4 2 3 x 0 0 10 1 2 1 0 0 -19 to =15--=-=--- 4 2 3 1 0 0 10 1 2 2 0 0 -14 to -10-------- 4 2 3 1 0 0 10 1 2 3 0 0 -9 to =5--====om-- 4 2 3 1 0 0 10 1 2 3 0 0 “4 to O=--mmemmeen 5 5 4 2 2 L 14 3 4 3 0 0 1=5=cmccmm mcmama 5 5 5 2 2 1 14 4 4 4 0 0 6-10=-mcmmmm mame 8 5 5 2 2 1 14 4 4 4 0 0 11-15-=mccmemmmann 3 5 5 2 2 1 14 4 4 4 0 0 16-20 -mmccm cman 5 5 9 2 3 1 14 4 4 5 0 0 21=25=c=m mcm emmme em 7 6 7 2 3 1 14 5 5 6 1 0 26-30=--mmmmmmemmn 7 6 7 2 3 1 14 6 5 7 1 0 31-35--=mcmmmmmmmn 7 6 7 2 3 1 14 6 5 7 1 0 36 -40=-cmmmmmmmman 10 10 7 2 4 1 15 6 5 9 1 0 41-45 mmm cm mmeem 16 16 9 7 8 1 21 8 7 11 1 2 46-50=--mcmmmmmmmn 17 19 11 7 8 2 25 9 8 12 2 2 51=55=mcmmm mmm eee 19 20 12 Z 8 4 27 11 9 13 4 2 20 21 12 8 8 4 30 11 Il 13 5 3 21 21 13 8 8 4 30 12 11 13 5 4 22 23 14 8 8 4 31 14 il 13 5 4 24 23 15 10 8 4 35 14 11 13 3 6 24 24 18 10 9 4 35 15 12 13 6 6 28 26 19 11 11 6 36 17 15 14 6 6 29 28 20 14 11 6 39 18 17 16 7 6 62 42 33 21 23 10 52 36 30 25 14 10 83 68 59 41 37 30 69 62 52 38 31 25 90 76 64 55 45 41 79 76 61 42 36 32 96 86 72 62 55 51 85 79 67 60 45 38 97 89 76 69 67 60 87 83 72 68 54 45 99 95 90 85 78 78 94 94 87 84 64 66 100 97 92 92 87 87 95 97 88 92 73 77 100 99 96 97 92 91 98 98 97 94 84 87 100 100 100 100 100 100 100 100 100 100 100 100 Factor IV: Nar- rative fluency 275-280 0 0 0 0 0 0 0 0 0 0 0 0 281-285 20 10 5 1 4 2 15 8 6 5 0 0 286-290 31 21 14 8 9 2 25 18 9 8 0 1 291-295 43 26 24 13 11 4 36 23 13 11 1 4 296-300 55 32 32 19 14 7 40 29 21 13 3 7 301-305 63 35 36 21 16 9 48 36 26 15 7 7 306-310 69 40 43 24 18 10 54 42 30 19 9 8 67 Table VIII. Percentile equivalents for TAT composite scores, by sex, age, and TAT factor —Con. Boys Girls TAT factor and composite score 6 7 8 9 10 11 6 7 8 9 10 11 years | years | years | years | years [years | years | years | years | years | years | years Factor IV: Narrative Percentile fluency—Con. 311-315-==cmeumann 72 48 47 28 23 14 58 48 35 21 14 11 316-320---===-==== 80 57 53 30 32 19 61 59 39 28 18 13 321-325---=-=-==-= 85 62 55 33 35 23 63 64 47 30 20 21 326-330-=cmcmnmunn 87 68 57 40 36 28 67 67 52 31 22 23 331-335-===-cmeeun 90 74 59 43 41 29 68 69 57 34 28 26 336-340=-=-ncmmumn 92 77 63 46 44 30 69 69 58 37 28 26 341 -345---mcnmmmnn 93 80 67 52 47 35 73 73 61 42 35 28 346-350=-==-cmeum= 94 81 68 58 49 41 76 76 66 45 35 35 351-355=mmmmmmcomn= 97 83 69 64 54 45 77 80 68 49 38 36 356=360=---c-mcem-n 97 85 74 66 60 50 81 81 71 S1 39 39 361-365---=-=cmu-= 97 86 74 70 61 54 87 82 73 54 43 45 366-370=--==----=- 98 88 47 72 65 58 87 85 77 58 47 47 371-375=======o=== 98 90 86 74 68 63 87 86 79 63 51 51 376-380=---cmmoaum 98 92 87 77 7L 69 88 89 80 65 54 56 381-385-=--===----=- 98 93 88 79 72 69 88 91 82 68 57 58 386-390-=------m--- 98 93 89 83 15 70 90 94 82 69 58 60 391-395 ~===ccmmmnn 98 93 91 84 78 76 90 96 84 71 63 63 396 -400----=---mu- 98 94 91 86 79 80 92 96 84 17 69 64 401 -405-====mmmumn 98 95 91 87 80 81 92 96 86 81 72 65 406-410==-=-m mmm 98 95 92 88 83 84 92 96 87 82 75 69 411-415---==--m=o- 99 95 93 88 86 88 92 96 88 82 77 70 416-420-=--=m=mum= 100 95 94 89 90 89 94 96 89 83 78 75 421-425 mmm meme em 100 96 94 93 91 91 95 97 89 83 79 76 426-430 -=-mcmmmunn 100 97 95 94 93 91 96 97 90 83 81 80 431 -435-=-==oomoo= 100 98 97 94 94 92 99 99 90 84 82 84 436-440=-==mmcmmn- 100 98 97 95 95 95 99 99 92 87 85 84 441 445 = mmm mmm mem 100 98 97 96 96 97 99 99 93 91 86 86 446-450 =---mmmmmun 100 98 97 98 97 99 100 99 95 93 89 88 451-455 === mm mma 100 98 98 98 98 99 100 100 95 93 91 89 456-460 =--mcmamnam 100 98 98 99 98 99 100 100 96 93 92 89 461 -465-=-=-cmmum- 100 98 98 100 98 99 100 100 97 94 92 91 466-470-==-==-mmon 100 98 98 100 98 99 100 100 97 96 93 92 471-475 ccmmmm am 100 98 98 100 98 99 100 100 97 98 94 93 476-480 -==-memunan 100 98 98 100 98 99 100 100 97 99 98 93 481 -485-=-==-=-=== 100 99 100 100 99 99 100 100 97 99 99 95 486-490 ---mmmmunan 100 99 100 100 99 100 100 100 98 99 99 96 491-495 === == =mou= 100 99 100 100 99 100 100 100 98 100 99 97 496-500-=---m=nem=- 100 100 100 100 100 100 100 100 100 100 100 100 Factor V: Emo- tionality tt 0 0 0 0 0 0 0 0 0 0 0 0 266-270=-==mcemunmn 44 42 39 35 36 25 50 45 35 30 35 44 271-275=-==c=nmmum 44 42 39 35 36 25 50 45 35 30 35 44 276-280=-=mcmmmun 44 42 39 35 36 25 50 45 35 30 35 44 281-285--===cmemu= 67 66 59 60 56 47 69 66 55 58 51 59 286-290=- mcm mmmmmm 71 68 63 66 61 55 70 70 57 62 53 64 291-295---mcmmmmmn 73 70 67 67 64 58 73 71 62 68 56 65 296-300--===-mmmun 85 74 13 70 70 64 79 76 66 74 62 70 301-305=-====-cuun 86 19 82 76 73 67 87 82 27 79 69 75 306-310==--m=mumum 86 82 85 78 74 68 87 83 77 80 73 76 311-315=-=-==eucmm- 87 83 86 81 76 69 87 83 19 82 74 76 316-320=cmmmmmmemm 90 88 88 86 80 73 90 85 87 85 78 81 321-325--=ccemanuan 90 90 88 86 83 74 90 91 89 86 79 84 326-330==cmccmeman 91 92 88 86 85 77 90 92 91 88 83 84 331-335-==-=-mom-- 91 95 89 87 ol 85 92 93 92 89 86 85 336-340=-cmcemmann 92 95 90 88 93 87 83 95 92 92 87 85 341-345 ----mmcennmn 94 95 91 88 94 88 93 96 93 93 87 89 346-350-c=mmcmmenn 95 95 21 88 94 89 93 96 95 95 88 90 351-355-mccmmmmann 96 96 93 88 96 90 93 96 95 96 91 90 356=360-=c-memuaan 98 96 93 90 96 91 95 97 96 97 93 91 361=365====cmcmmnan 98 97 93 92 96 92 95 97 97 97 93 92 366-370=-===nmmm-= 99 98 93 95 96 93 96 98 97 97 93 93 371-375--===c-muu= 99 98 93 95 96 95 98 99 97 97 94 93 376-380-----c-mum= 99 98 94 97 96 95 98 99 97 98 94 93 381-385---cmmmamnmn 99 99 95 98 96 97 99 99 97 98 94 93 68 Table VIII. Percentile equivalents for TAT composite scores, by sex, age, and TAT factor —Con. Boys Girls TAT factor and composite score 6 7 8 9 10 11 6 7 8 9 10 11 years | years | years [years | years |years |years | years | years | years | years | years Factor V: Emo- : tionality—Con, Percentile 386-390----mmmmmun 99 99 95 98 96 98 99 99 97 98 94 94 391-395---mcmcnmnn 99 99 96 98 96 98 99 99 97 98 96 94 396-400-==ccmmm-m- 99 99 97 98 96 98 99 99 97 98 97 94 401 -405====cmmaeaa-= 99 99 97 98 96 99 99 29 97 99 97 94 406-410-=-meemee-= 99 99 97 98 96 99 99 99 98 99 97 95 411 -415===cmmmmnnan 99 99 97 99 96 100 99 99 98 99 97 g5 416-420 =-==mmmcmmmn 99 99 97 99 97 100 99 99 98 100 97 95 421-425 === am mmmem = 99 99 98 99 97 100 99 99 98 100 99 96 426-430 -=cmmmmmaan 99 99 99 99 97 100 99 929 99 100 99 98 431-435 cmmamman 99 99 99 99 97 100 9g 99 99 100 99 98 436-440 --mmmcmnnnan 99 99 100 99 97 100 99 99 99 100 99 98 441 445 cm mmm mmm 99 100 100 99 98 100 99 99 99 100 99 98 446-450 mm mm mmm me 99 100 100 99 98 100 100 99 99 100 99 98 451-455 = =m cm mma 99 100 100 99 98 100 100 99 99 100 100 98 456-460 -==-m-mmmem 99 100 100 99 98 100 100 99 99 100 100 98 461-465 mmm mmmmm em 99 100 100 99 98 100 100 99 99 100 100 98 466-470-=mmmmmmnn 99 100 100 99 98 100 100 99 99 100 100 98 471-475 mmm mmm em 99 100 100 99 98 100 100 99 99 100 100 98 476-480===m mm mmmem 99 100 100 100 99 100 100 99 100 100 100 98 481-485 =m mmmmm = 99 100 100 100 99 100 100 99 100 100 100 98 486-490 =m mn mmm mmm 100 100 100 100 100 100 100 100 100 100 100 100 Factor VI: Verbal fluency 0 0 0 0 0 0 0 0 0 0 0 0 8 1 3 2 1 1 13 3 4 2 0 0 26 13 14 27 5 1 26 10 9 8 1 2 44 32 30 12 16 11 46 23 15 12 3 6 64 42 39 25 28 16 57 37 25 20 11 8 78 57 46 35 32 22 65 51 41 29 20 18 88 65 55 45 39 30 74 58 48 37 27 24 90 74 59 52 45 37 79 70 56 39 33 33 93 25 65 61 53 47 82 75 67 49 40 39 95 79 71 65 64 54 83 80 70 53 46 45 95 82 13 69 67 57 85 84 75 59 51 52 96 85 79 74 71 59 86 89 77 64 55 57 97 86 81 75 73 63 86 90 80 68 59 62 97 87 84 80 76 67 87 90 82 74 63 66 97 90 85 82 77 70 87 93 83 13 66 72 97 91 88 86 80 76 87 93 83 76 69 77 97 91 89 89 83 79 87 93 84 80 71 80 97 93 89 89 85 81 89 94 85 84 74 82 98 95 90 90 86 82 93 95 85 87 76 84 99 95 92 91 86 82 94 97 87 87 77 85 99 95 92 91 90 85 94 97 87 87 80 86 99 95 92 94 91 88 95 98 89 88 81 86 99 97 92 94 92 88 95 99 90 90 83 86 99 97 94 94 92 90 95 99 gL 92 84 86 99 97 94 94 93 91 98 99 92 92 85 87 99 97 95 94 95 92 98 99 92 94 86 88 100 97 95 94 95 93 98 99 92 94 87 90 100 97 96 94 96 95 99 99 94 94 88 91 100 98 97 94 96 95 99 100 94 95 89 92 100 98 97 96 96 95 99 100 95 95 9L 92 100 99 97 98 97 95 100 100 95 96 91 92 100 99 98 98 97 95 100 100 96 96 92 93 100 100 98 98 98 95 100 100 96 97 95 93 100 100 98 98 98 95 100 100 96 98 95 94 100 100 98 98 98 95 100 100 96 99 96 95 100 100 98 98 98 96 100 100 96 99 96 95 100 100 98 98 98 96 100 100 96 99 96 95 100 100 98 98 98 96 100 100 96 99 96 96 100 100 98 98 99 96 100 100 96 99 96 96 100 100 98 98 99 97 100 100 96 99 96 96 100 100 99 99 99 97 100 100 96 99 96 96 100 100 99 99 99 97 100 100 96 99 96 97 100 100 99 99 99 97 100 100 96 99 97 97 100 100 99 99 99 99 100 100 97 99 97 97 100 100 100 100 100 100 100 100 100 100 100 100 —_—0 0 O— APPENDIX V WEIGHTS FOR THE 31 TAT VARIABLES ON THE SIX UNCORRELATED FACTORS Table IX. Weights for the 31 TAT variables on the six uncorrelated factors TAT factor Variable I I1 111 Iv Vv VI 1. Adverbs--=----ccemcacccc cece eee 0.15 -0.02 -0.04 0.04 0.05 0.06 2. PauSeS=-=-=---mcmmcmeeee meee 0.24 -0.04 0.03 -0.14 - 3. Verbatim repetitions-------=cccccecn-- 0.13 -0.04 0.03 -0.15 -0.01 0.11 4, CorrectionS====--emeemcccmem cme cena 0.31 = -0.01 -0.13 = -0.06 5. Past reference--==---ccmcmcmencccn nnn 0,27 -0.01 -0.04 0.02 © -0.17 6. Future reference---==---cecemecceacanx 0.27 - -0.05 0.10 - -0.23 7. Unhappy outcome======ceceemcecmeeeecen=" 0.03 0.30 -0.07 0.20 0.03 -0.23 8. Death-=---memccemmm cece cree cee em -0.05 0.41 -0.01 -0.02 0.08 0.06 9. Murder-killing=====-meeemee ccc cee -0.05 0.39 ” -0.08 0.03 0.08 10. Rejection=====-meeccmccmcm ecm e mee 0.01 0.02 -0.41 0.12 -0.01 0.01 11. Level of interpretation---------c--ce--- -0.08 0.03 0.19 0.11 0.04 . 12. Situation complexity===-====e-eeceaon- 0.04 0.01 0.17 0.06 0.02 -0.05 13. Present reference-=--=--=----coecemonon -0.01 ~0.03 0.41 -0.11 0.01 -0.02 14. Happy outcoOme=======--emmcmccmmmccnenono -0.04 -0.05 -0.07 0.27 0.06 -0.02 15. Causally connected statementS=-=--=--=-- -0.15 0.07 -0.04 0.21 0.05 0.09 16. Expression of feeling---=-ccecccnoao-- -0.02 -0.01 - 0.18 -0.01 -0.05 17. Outcome=====-cmmeoee meee cme m oe 0.03 0.09 -0.08 0.31 0.06 -0.16 18. Kind-loving---====-ccmcmcmmmmm meee -0.16 -0.13 -0.03 0.10 -0.14 0.12 19. Happy-glad--=-=-cec cece cmcee eee -0.04 -0.07 -0.06 0.13 0.03 0.07 20. Goal behavior-===-----ceecocmmmmcnnannn -0.07 -0.09 0.05 0.10 -0.22 -0.06 21. Antagonisme==--==---ccmmommmmmmeeeeo -0.02 -0.11 -0.06 0.03 -0.32 -0.05 22. Morbid mood quality=-=-=-------ceecemea-n 0.08 -0.11 0.03 -0.14 -0.20 23. Bizarre theme===-===--c-cccmomcmcmcannn -0.03 0.08 -0.01 -0.05 -0.26 -0.03 24, EgocentriSme=====---emecomm mcm 0.11 -0.02 -0.03 0.02 -0.21 -0.17 25. Mean-rejectinge==-=-ceeccmemmnocnnaa -—— -0.03 -0.02 -0.05 0.02 -0.31 -0.05 26. Aggression-===----emeeemem meme eee -0.01 0.05 0.06 -0.10 -0.27 -0.03 27. Possessive adjectives=====-cecmecnnaoao -0.02 - -0.03 0.03 0.22 28. COMMON NOUNS ========-emee mem me ————— -0.02 - - -0.06 0.03 0.26 29. PronounS======-=-= meee - eee = - -0.01 -0.02 0.02 0.21 30. Single verbs====cecmceeecc emcee enna - = -0.05 0.03 0.24 31. Dialogue==-===cmccccmcm eee -0.10 0.02 -0.03 +0.05 0.05 0.32 sommes C3 C0) mms 70 # U. 8S. GOVERNMENT PRINTING OFFICE : 1974 543-881/49 Sevies 1. Series 2, Series 3. Series 4, Series 10. Series 11. Series 12. Series 13. Series 14. Series 20. Series 21. Series 22, VITAL AND HEALTH STATISTICS PUBLICATION SERIES Originally Public Health Service Publication No. 1000 Programs and collection procedures.— Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data. Data evaluation and methods reseavch.— Studies of new statistical methodology including: experi- mental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory. Analytical studies —Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series. Documents and committee rveports.—Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birth and death certificates. Data from the Health Interview Survev.— Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey. Data from the Health Examination Survey.—Data from direct examination, testing, and measure- ment of national samples of the civilian, noninstitutional population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psycho- logical characteristics; and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons, Data from the Institutional Population Surveys — Statistics relating tothe health characteristics of persons in institutions, and their medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients. Data from the Hospital Discharge Survey.—Statistics relating to discharged patients in short-stay hospitals, based on a sample of patient records in a national sample of hospitals. Data on health resources: manpower and facilities. —Statistics on the numbers, geographic distri- bution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities, Data on mortality.—Various statistics on mortality other than as included in regular annual or monthly reports—special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses. Data on natality, marriage, and divorce,—Various statistics on natality, marriage, and divorce other than as included in regular annual or monthly reports—special analyses by demographic variables, also geographic and time series analyses, studies of fertility. Data from the National Natality and Mortality Surveys.— Statistics on characteristics of births and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, hospital experience in the last year of life, medical care during pregnancy, health insurance coverage, etc. For a list of titles of reports published in these series, write to: Office of Information National Center for Health Statistics Public Health Service, HRA Rockville, Md. 20852 DHEW Publication No. (HRA) 74-1332 Series 2 -No. 58 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Health Resources Administration 5600 Fishers Lane Rockville, Maryland 20852 POSTAGE AND FEES PAID U.S. DEPARTMENT OF HEW OFFICIAL BUSINESS HEW 390 Penalty for Private Use $300 THIRD CLASS BLK. RT. L Cg Z Fo 0 rs x 0 /4 4 CASTS Vision Test Validation Study for the Health Examination Survey Among Youths 12-17 Years U.S. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE : Public Health Service Health Resources Administration Vital and Health Statistics—-Series 2-No. 59 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 - Price 65 cents DATA EVALUATION AND METHODS RESEARCH 201052 ie Vision Test Validation Study for the Health Examination Survey Among Youths 12-17 Years Validation of selected parts of the vision test battery used in the Health Examination Survey of 1966-70 among youths 12-17 years of age against a standard clinical ophthalmological examination for distance visual acuity and eye muscle imbalance. DHEW Publication No. (HRA) 74-1333 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration National Center for Health Statistics Rockville, Md. December 1973 NATIONAL CENTER FOR HEALTH STATISTICS EDWARD B. PERRIN, Ph.D., Acting Director PHILIP S. LAWRENCE, Sc.D., Deputy Director GAIL F. FISHER, Assistant Director for Health Statistics Development WALT R. SIMMONS, M.A. Assistant Director for Research and Scientific Development JOHN J. HANLON, M.D., Medical Advisor JAMES E. KELLY, D.D.S., Dental Advisor EDWARD E. MINTY, Executive Officer ALICE HAYWOOD, Information Officer DIVISION OF HEALTH EXAMINATION STATISTICS ARTHUR J. McDOWELL, Director GARRIE J. LOSEE, Deputy Director PETER V. V. HAMILL, M.D., Medical Advisor, Children and Youth Programs HENRY W. MILLER, Chief, Operations and Quality Control Branch JEAN ROBERTS, Chief, Medical Statistics Branch COOPERATION OF THE BUREAU OF THE CENSUS In accordance with specifications established by the National Health Survey, the Bureau of the Census, under a contractual agreement, participated in the design and selection of the sample, and carried out the first stage of the field interviewing and certain parts of the statistical processing. Vital and Health Statistics-Series 2-No. 59 DHEW Publication No. (HRA) 74-1333 Library of Congress Catalog Card Number 73-600218 CONTENTS Page Introduction == === === mmo mmm em eee 1 Study Plan-- == comm me meee 2 Regular Survey Examination==--=--= ccm momo eee 3 Clinical Examination----- =o oom mm momo eee eee 3 Findings ---=-=-=-=-ccmm mmm eee 4 Phoria Tests === om mmm mo ee eee eee 4 Refraction === === comm m mm meee eee 6 DisSCUSSION == == === mm mmm ee eee 10 SUMMA TY === == = = = = mm mmm mm ee ee ee ee eee 10 References ----------m momo mmm I1 List of Detailed Tables---=---=-=-ommmmm moomoo 12 Appendix. Recording Forms--------c-ccommmm mmc 30 SYMBOLS Data not available--------seressermeresnsmrnesennesennes Category not applicable------ceeeesemmmmmeceiaannnns Quantity zero Quantity more than 0 but less than 0.05----- Figure does not meet standards of reliability or precision----------se-seeemeeeeeeenee VISION TEST VALIDATION STUDY FOR THE HEALTH EXAMINATION SURVEY AMONG YOUTHS Jean Roberts, Division of Health Examination Statistics INTRODUCTION Vision tests were included in the standardized examination given the national probability samples of children and youths in the Health Examination Surveys of 1963-65 and 1966-70, which focused primarily on health factors related to growth and development, as previously described. 1.2 In the survey among children 6-11 years of age, visual acuity and the degree of eye muscle imbalance were determined using selected Armed Forces Vision-Tester targets in Master Ortho- Rater instruments under carefully controlled conditions, as shown in the first vision and eye examination reports from that study, 3,4 Chil- dren were tested only without glasses or other corrective lenses. Because of the reported substantial increase in the incidence of myopia at or around puberty, the vision test battery for the study of youths 12-17 years of age was expanded beyond that for children to include visual acuity tests with their usual refractive lenses and a set of trial lenses used to determine the presence and severity of myopia. Lensometer readings of the prescriptions used in the youths' present glasses or contact lenses were also obtained. The new vision test battery for the youth study was developed primarily by ophthalmol- ogists Dr. J. Theodore Schwartz of the National Eye Institute and Dr. Herbert A. Urweider of George Washington University School of Medicine. A feasibility test of the new battery was made, under the guidance of Dr. Urweider, in collab- oration with Dr. Lawrence E. Van Kirk, Health Examination Survey Dental Advisor, by the two initial survey dental examiners who would be giving both the dental and vision test parts of the survey examination, Since essentially no information was avail- able on the comparability of results from two parts of the vision battery as they were being administered in the survey-—the trial lens test for myopia or the phoria (eye muscle im- balance) tests—with those from the usual clinical ophthalmologic examination, a validation study planned with the advisory group and arranged by the author of this report was carried out under Dr. Urweider's direction in collaboration with Dr. Van Kirk. The study was conducted during July and August 1968 in Chicago, Illinois, imme- diately following completion of the regular survey examinations at the two locations of the mobile examination centers in that city. Dr. Mary Dahl, I1linois-licensed ophthalmologist, performed the clinical examinations with the assistance of Mr. John Petroff of Dr, Urweider's staff, who was the field manager for the clinical part of the validation study. Health Examination Survey field management and field representative staff made arrangements for the return of the youths who met the study criteria for these additional examina- tions. It was recognized at the outset that three factors would affect to an unknown extent the comparability of results between survey tests and the clinical examination. The first and most critical of these was that in the clinical examina- tion the best corrected acuity was obtained under cycloplegia (with the pupils dilated), while in the survey only an approximation to this best corrected acuity could be obtained with the simple lens and without the use of cycloplegics. A second factor was the fundamental difference between the Ortho-Rater instruments and com- monly used clinical tests. Only in the former does the optical distance of both distance and near test targets differ from their actual distance. The targets in the Ortho-Raters used to test phoria and visual acuity in the survey were actually only 13 inches from the eyes, and the desired relaxation of accommodation was pro- duced by means of plus lenses before the eyes.” The third factor was that both acuity and degree of eye muscle imbalance are known to be affected by the individual's physical condition, in partic- ular, bodily fatigue.® No attempt was made to determine or to control for any such changes in an individual youth's condition by the time of his reexamination which was scheduled a week or more after his survey tests. STUDY PLAN The vision test validation study for the Health Examination Survey among youths was designed to determine the degree of corre- spondence, with respect to myopia and lateral heterophoria, between actual survey test results and those obtained in the usual clinical examina- tion by an ophthalmologist. The study was conducted in Chicago, Illionois, during July and August 1968 immediately follow- ing completion of the regular survey examinations at the two locations of the mobile center in that city. Youths were given their regular standard survey examination, then a sample was selected for the validation study which was to include all of those with abnormal and one-third of those with normal vision test findings. Criteria for the abnormal group were as follows: 1. Distance acuity of less than 20/20 (Snellen ratio) in either eye, and/or 2. Distance lateral phoria outside the range of scores of 6-16 where a score of 11 shows no heterophoria, and/or Table A. Visually normal and abnormal youths 12-17 years of age from the Chicago area (stand 25) selected and reexamined in the special vision study: July-August 1968 All Chicago Study sample Reexamined in area examinees selected special study Vision test results pe Pevgent Percent a eg st a Number | of ex- Number Rae Number Seer aminees study reex- sample amined Total=-c-eeomrc cm cencmmmm 210 100.0 148 70.5 98 66.2 Normal -===ccoemoe emcee meee eo 92 43,8 30 14.3 29 19.6 Abnormal-----v--- Seem emem emo 118 56.2 118 56.2 69 46.6 Type of vision abnormality: Acuity-=ceom mmm eee 106 50.5 106 50.5 59 39.9 Phoria=-v--v-ccmemcennnn- 55 26,2 55 26.2 33 22.3 I Includes duplication— 43 youths had both types of abnormality. 3. Near lateral phoria outside the range of scores of 8-18 where 13 is the position of no lateral misalignment in binocular vision. Of the 254 youths in the sample draw for the Chicago area, 210 were examined as part of the regular survey, Vision test results for them showed 92 as normal and 118 as abnormal under the special study criteria. At the time arrange- ments were made for the regular examinations, the Health Examination Survey representative had described the purpose of the additional special vision study and had obtained consent from the parents for the youths' participation in this later study, should they be selected. Arrangements were made to transport those youths to be re- turned to the special study center which was in the Public Health Service Outpatient Clinic. Approximately two-thirds of those selected— 98 out of 148—returned for the special vision study, These included 29 out of the 30 selected systematically from the normal group and 69 of the 118 visually abnormal group. Original survey examination findings for the visually abnormal group who were and were not reexamined are shown in table A, Vacations and work inter- fered with the return of the remaining 50 youths despite substantial followup effort by the Health Examination Survey representatives and the field manager for the clinical part of this study. REGULAR SURVEY EXAMINATION The test results from the regular survey examination that are compared in this report with the findings for the youths in the subsequent special vision study, with and without their glasses, include: lateral phoria at distance and near and monocular visual acuity at distance; the axis deviation and the power of the spherical and cylindrical lens correction in the youths' own glasses; and the findings from the trial lens test for myopia. To preserve the independence of the subsequent clinical examination findings, the survey test results were not made available to the special study ophthalmologist prior to the special study. Monocular visual acuity was tested in the regular survey examination using specially de- signed targets in the Bausch and Lombe Master Ortho-Rater as described in the report, "Visual Acuity of Youths, United States.'"'7 Special care was taken to keep the youths from squinting and hence reaching a spuriously high acuity level during the test, Lateral phoria of youths was also tested with and without correction in the regular survey examination using the appropriate plates for distance and near in the Bausch and Lombe Master Ortho-Rater in the same manner as the corresponding tests among children described in the report "Eye Examination Findings Among Children, United States."! For this part of the survey examination the targets permitted measur - ing the degree of lateral phoria in single prism diopters (4)at distance up to 114 of esophoria and 114 of exophoria and at near up to 134 of esophoria and 214 of exophoria. The regular survey examination included a trial lens test for myopia for all youths whose distance acuity in either eye was less than 20/20 (Snellen). The power in diopters (D) of the seven spherical trial lenses used in the test were: O, -1, -1.5, -2, -3, -4, and -5. The trial lens test, which was always started first with the O diopter lens, was given without cycloplegia. No attempt was made to determine the extent of cylindrical correction or axis deviation for those with some astigmatism or to test with positive lenses for those with hyperopia. Hence this trial lens test was intended to give only an indication of the presence or absence of myopia and a crude measure of the best spherical equivalent correc- tion for myopia. A lensometer was used in the survey ex- amination to measure the power of the spherical and cylindrical lens corrections and the degree of axis deviation between the two in the present glasses of the examined youths, The recording forms used in the survey are included in the appendix. CLINICAL EXAMINATION At the start of the subsequent clinical ex- amination each youth in the special study was first tested without, then with, his own glasses (if he had glasses) for the degree of lateral phoria at distance and near. The special study ophthalmologist used the alternate cover tech- nique, employing prism bars for the quantitative determinations which permitted measurements in single prism diopter units ranging up to 258 of esophoria and 308 of exophoria at distance and up to 302 of esophoria and 352 of exophoria at near. A standard dosage of cycloplegic (2 drops of 19% Mydriacil 5 minutes apart) was administered. Twenty minutes after the last drop of Mydriacil was given, the study ophthalmologist performed a retinoscopic examination and determined the best possible correction for the youths at distance. The power of the spherical and cylindrical correc- tion in each of these lenses was recorded to the nearest 0,25 diopter and the axis deviation to the nearest degree. The monocular acuity with this maximum correction was also obtained. Results were recorded on examination forms shown in the appendix. The clinical examination was given from 1 to 4 weeks after the regular survey testing for each youth was completed. FINDINGS Phoria Tests For youths in the special study, lateral phoria test results without glasses from the survey and later clinical examination were in better agreement.on distance than on near tests among both the abnormal and normal control groups. At near, agreement was better on these tests among normal than abnormal subjects. Since the range in degree of lateral heterophoria was similar at distance and near but substantially greater among abnormal than normal subjects, the extent of agreement or lack of it between the survey and clinical tests does not appear to be a function of the severity of heterophoria. The proportion of youths for whom com- parable survey-clinical test results differed by no more than 1 prism diopter was highest for normal subjects at distance without glasses (41 percent) and lowest for abnormal subjects at near without glasses (10 percent), as shown in tables B and 1-4. Table B. Extent of agreement between phoria test results on survey and clinical ex- amination of youths 12-17 years of age: Chicago Special Vision Study, 1968 Number Difference between survey and of clinical scores in prism diopters Group and test ig both 0d 14 or 28 or 34 or tests less less more Percent of examinees Abnormal group Distance: Uncorrected-====-cmmmemcccmcccc ccc e mee 47 6.4 31.9 57.4 42.6 With correctionl---cecccccmccccccacaaa- 37 5.4 24.3 37.8 62.2 Near: Uncorrected=-====-em coc cmccccc cece eee 60 1.7 10.0 16.7 83.3 With correction! -=-ceeecccmccccccccceeee 37 13.5 27.0 29.7 70.3 Normal group Distance: Uncorrected=--==-=cemcccmccmccc ccc ceca 29 20.7 41.4 65.5 34.5 Near: Uncorrected=--=-===cmcmcmemm cece ccccnan 28 10.7 21.4 39.3 60.7 "With own glasses or contact lenses. On these tests without glasses, the proportion for whom survey and clinical phoria test findings differed by 3 prism diopters or more was significantly greater on near than distance tests among both normal subjects (61 percent compared with 34 percent) and abnormal subjects (83 per- cent compared with 43 percent), The respective near -distance differences in these proportions are statistically significant at the S-percent prob- ability level or lower. The proportion showing this degree of difference on clinical retest (3 prism diopters or more) without glasses is also significantly greater onnear, but notdistance, tests among the abnormal than the normal group (83 percent compared with 61 percent), Findings with respect to the agreement between clinical and survey phoria tests with glasses among abnormal subjects are inconclusive; the re- spective proportions of substantial disagreement (3 prism diopters or more) do not differ sig- nificantly from those found between survey- clinical test results among normal subjects. Survey tests generally tended to rate the subjects as having a greater degree of lateral heterophoria than did the clinical tests. More than half of the normal and abnormal subjects scored lower on the clinical than on the corre- sponding survey test for all but the normal group when tested at near. The proportions with lower clinical than survey scores ranged from 64 percent for the abnormal group at distance without correction to 58 percent among normal subjects at distance but dropped to 46 percent for normal subjects when tested at near. For the remainder whose clinical score was not lower than their survey test, the clinical score was substantially more likely to have exceeded than to have been the same as the survey score among abnormal subjects on three of the four tests—at distance without correction and at near without and with correction—and among normal subjects at near. When the type of heterophoria in any degree was considered, substantially more youths were rated as having 1 prism diopter or more of esophoria at distance on survey than on clinical tests, the proportions ranging from 69 to 78 percent for the abnormal group with and without correction and for the normal group on the survey compared with 3 to 6 percent on the respective clinical tests, as shown in table C, At near, the survey test results with respect to some degree of esophoria are less consistent than those at distance, but for two of the three groups or tests-——abnormals with correction and normals—proportionately more than twice as many were rated as esophoric in the survey than in the clinical examination. At near, the propor- tion rated as exophoric (1 prism diopter or more deviation) was similar on survey and clinical examinations for all three groups or tests— abnormals without and with correction and the normals, However, atdistance, significantly more (proportionately two to three times as many) were found to have some degree of exophoria (1 prismdiopter or more)on the clinical than the survey examination. The survey tests at distance were sub- stantially more likely to show lateral eye muscle imbalance than were the clinical tests: the three survey tests showed only 8-21 percent as normal or orthophoric (0 prism diopters of deviation) compared with 54-76 percent for the corre- sponding clinical tests. At near, this pattern was also found among abnormal subjects when tested with correction (but not without) and among normal subjects. The degree of association as measured by the correlation coefficient between clinical and survey phoria test results among abnormal subjects is significant and slightly higher for tests without glasses at distance than near (r=+.55 and +.44, respectively), A significant association also may be seen on tests with glasses and for normal subjects where the chi-square test for independ- ence shows a relationship or lack of independence significant at the 1-percent probability level or lower (tables 1-4), Since it is the purpose of the survey tests to identify and determine the extent of significant esophoria or exophoria rather than to give a precise measure or distribution of the degree of imbalance in the youth population, the extent of agreement between survey and clinical ex- amination on this basis is of primary interest here. The critical levels of significant hetero- phoria most frequently recommended in standards for referring children for further study and care are 5 prism diopters or more of esophoria or exophoria at distance and atnear 6 prism diopters Table C. Consistency of phoria ratings on clinical and survey tests of youths 12-17 years of age: Chicago Special Vision Study, 1968 + 3 A Esophoria aa or A Exophoria (1° or|Clinical- more) Orthophoria (0%) more) survey agreement Group and test on Clinical | Survey | Clinical [Survey [Clinical | Survey 88seniial test test test test test test phorial Percent of examinees Abnormal group Distance:. Uncorrected-======- 6.4 72.3 57.4 12.8 36.2 14.9 95.1 With correction2--- 5.4 78.4 54.1 8.1 40.5 13.5 90.6 Near: Uncorrected=-=-===-= 20.0 11.7 10.0 10.0 70.0 78.3 71.4 With correction?=--- Lee3 56.8 43.3 2.7 32.4 40.5 72.7 Normal group Distance: Uncorrected=--====- - 3.4 69.0 75.9 20.7 20.7 10.3 100.0 Near: Uncorrected---=---=- 14.2 39.3 39.3 14.2 46.5 46.5 75.0 lysing critical levels: distance esophoria of 5% or more, exophoria of 5% or more, 0-44 considered essentially orthophoric; near esophoria of 64 or more, exophoria of 104 or more, with remainder considered essentially orthophoric. 4,89 With own glasses or contact lenses. 100 — xxx) es x ORR ZR 208 Xd 0 2 2% % 2, 90 — HX) SE XR 2 > DROLs 2555 X55 bo; ik zs SEs 2% Q 80 — 2 RK XX > oR % CX Q RRR 2% 3X xd 5 Sd 2 JBKE | 70 (— x i XK 3% RX SEE RRS 20% SB rr RS 5% z SR XX X X23 QRS KK xxx > RRR ZR SRR 60 — 6%%" ZT 0X abl 5 2 2 6% I RR 2 XX XS ORR X 0 o% % 2 3 2 2% $05 0% 2 BE %% 50 +— > oes 5 5 > 3% 300% RRR EX EX CX SR ZS 0, 2555 S50 x 05% 2 oon eos oo etalon n 40 [— SR QR 5 35005 os 2 xx Xx Os XL Oe XX xX XX XX % KXxX] Te C0 2 bo x XX ORR 3% bo, 5 XXX 3 ® a XX X Rodedel 5 9, 0X QS oe XL 3% ox 8 7 03S 3X 30 — xx SEZ QS KK CK XK XX XX XK Rs XR % 5% 00% 0? QE 00000, IS IS b> 0 F305 §XXY Be & IS 3 CD 0%" Teele 30K I 25020858 RD oS SX n S SER 200505 25005 XXX QR 2% XXX ZX TEX ee RX o eX XK XX xX 25 o¥ KEK 20 00%%" ex XX XX 3X5 0a x 5% PERCENT AGREEMENT BETWEEN CLINICAL AND SURVEY PHORIA TEST RESULTS 5% x oe os x 0% roo RX XK ss PS <> 335 & 0% 2 2s X os & Uncorrected Corrected Uncorrected Corrected Distance Near ABNORMAL GROUP Distance ~~ Near NORMAL GROUP Figure |. Percent agreement between clinical and sur- vey tests among youths 12-17 years of age in iden- tifying essential orthophoria: Chicago Special Vi- sion Study, 1968. or more ot esophoria and 10 prism diopters or more of exophoria.+8,9 Considering the lesser degrees of heterophoria as orthophoria, on the basis of these broad groupings (significant es- ophoria, significant exophoria, and essentially normal or orthophoric), clinical and survey test results show a high level of agreement on essential orthophoria (table C and figure 1). The percentage with complete agreement between survey and clinical test results on this basis was slightly higher on distance than near tests (95, 91, and 100 percent at distance, respectively, for the abnormal subjects tested without and with correction and the normal controls, compared with the corresponding percentages of 71, 73, and 75 at near). Refraction From the survey and clinical examination findings for the youths in this study it was possible to determine the extent of agreement among three measures of monocular distance acuity—the best corrected acuity as determined with cycloplegia in the refraction part of the clinical examination, the best level obtained with the trial lenses but without cycloplegia in the survey, and the level at which they could read with their present glasses. As previously indicated, the trial lens test for myopia was given each youth in the survey who tested less than 20/20 in either eye without glasses, The failure to reach that level may have been due to simple myopia, astigmatism, or a combination of these or other conditions affecting acuity, It was the purpose of this special study to determine how accurately this crude screening device consisting of a plano lens and six simple negative spherical lenses ranging in power from 1 to 5 diopters could identify and roughly grade the degree of simple myopia. Obviously, the refraction done in the clinical examination with cycloplegia and that done at the time the youths were examined for their present glasses would have determined the best correction possible at those respective times and would not have been limited to just the negative spherical corrections of 5 diopters or less used in the survey tests. The best apparent agreement among these three measures of corrected acuity (disregarding the strength of the correction needed) was between the level obtained with refraction in the clinical examination and that with present glasses at the time of the survey (tables D and 5). Agreement Table D. between acuity on the trial lens test and the re- fractive examination was slightly but not sig- nificantly less good, while the poorest agreement was that between results with the trial lens and those with present glasses both done at the time of the survey. Complete agreement with respect todistance acuity level was reached on the survey tests with present glasses and with refraction on the clinical examination for 61 percent of the youths compared with 57 percent complete agreement between the survey trial lens test results and those from the refractive examination, Agreement within one acuity level was reached for 81 percent of the youths between their survey tests with glasses and their refractive examination compared with 74 percent between trial lens and refractive examination. Substantially less good agreement was found between acuity on the trial lens test and with their own glasses among these youths-- only 43 percent reached the same acuity level on both types of tests while for 60 percent acuity differed by no more than one level. The poorer agreement between the trial lens test results and those with their present glasses reflects the fact that not all of the youths were reaching their best corrected acuity with their present glasses at the time of the survey. Consideration of the acuity level reached on each of the three types of tests in relation to the spherical equivalence of the corrective lens used gives some further insight into the lack of Extent of agreement on visual acuity level among findings from refraction in clinical examination, trial lens test in survey, and tests with present glasses in sur- vey of youths 12-17 years of age: Chicago Special Vision Study, 1968 Difference in monocular Nuther acuity level Tests for determining acuity of tests None One Two Three or more Percent of tests Refraction vs. trial lens--=--=-e-comooeeaooa_-o 103] 57.2 | 16.6 8.8 17.4 Trial lens vs. present glasseS---=---=eocccaaao-- 75 | 42,7 | 17.2 | 12,2 27.9 Present glasses vs. refraction----------cco--o-- 84 | 60.7 20,2 11.9 7:2 complete agreement in the measurement of acuity among these three tests, As used in this report, the spherical equivalence of a lens (system) is that described by Copeland (1928) 10 as the algebraic sum of the spherical power of the lens and half the power of the cylinder. This ap- proximation of the strength of the lens has the effect of ignoring or omitting the astigmatic correction in compound lenses (those with both a spherical and cylindrical correction) to the extent described by Duke-Elder (1970).11 In a simple spherical correction the power (the reciprocal of the focal length) and the spherical equivalency of the lens are identical. In the present study, when the strength of the lens in terms of its spherical equivalency was taken into account, agreement between the acuity on refraction and on the trial lens test was found to be better than that between acuity on the refractive ex- amination and with their own glasses or between acuity test results with their glasses and with the trial lens (tables 6-8). The proportion of youths in the study reach- ing at least the 20/25 level on each of the three Table E. Proportion of tests in which acu- ity of at least 20/25 was obtained for youths 12-17 years of age with the re- fractive examination and the trial lens test, by the spherical equivalence of the corrective lens used: Chicago Spe- cial Vision Study, 1968 Percent of monocu- lar tests with cor- rection to at least Spheviea) equiva- 20/25 level ence! in diop- ters Trial Re - Pres - lens frac- ent test tion glasses O--mmmmm- ———————— 27.2 |. 94.4 55.5 elececemmccece——e 92,0 | 100.0 100.0 “1,5 cme a 100.0 90.9 50.0 “2emmmm——————————— 66,7 80.0 66,7 “3mm ————— 91.7 88.2 91.7 A — —————— 100.0 | 100.0 75.0 -5 or moreZ------- 21,7 | 68.2 76.7 lplgebraic sum of the spherical and one-half of cylindrical lens power. 2 Upper limit of spherical equivalence in trial lens test was -5 diopters. BR Survey trial lens Refraction > 3% 5% x2 % 5% > 5 02 - 2 > x 55 o bor x COR 0S 8! a Xx XK RR > TR : RRR 22 cx 255 tele! CETTE 5 5 3 PERCENT REACHING AT LEAST 20/25 LEVEL bs LOR LRLR 0X x 2 o2e! RX 25 0% -4 -5 or more SPHERICAL EQUIVALENCE OF LENS IN DIOPTERS Figure 2. Proportion of monocular tests in which acuity of at least20/25 was reached with trial lens test and refractive examination, by spherical eauiv- alence of lens for those requiring correction of | to 5 diopters or more: Chicago Special Vision Study, 1968. acuity tests shows generally good agreement when a lens with spherical equivalency of -1 through -4 diopters was used, as may be seen in figure 2 and tables LE, 9-11. The poor agree- ment evident at the extremes of the trial lens range—0 diopters or no correction and -5 diopters—reflects the limitations of this survey test. At the lower extreme are those whose visual problem is not one of simple myopia, while at the upper extreme are those needing a stronger corrective lens. About 3 percent of these youths were found on clinical examination to be hyperopic rather than myopic, so that no real improvement in acuity could be expected with a simple negative lens, Seventeen percent of youths reached the same acuity level with the same spherical equivalency of lens on the refractive examination and trial lens test compared with 11 percent on the re- fractive examination and their own glasses and 12 percent on tests with their own glasses and those with the trial lens (tables 6-8). The better agreement is found only for those with a simple spherical correction (the respective percentages being 12 percent, 6 percent, and 5 percent), while youths with some degree of astigmatism requiring a complex lens correction show about the same level of agreement on all three com- parisons (the respective percentages being 5S percent, 5 percent, and 7 percent). The same level of acuity was reached more frequently with a weaker correction (spherical equivalence) on the refractive examination than either the trial lens test or tests with their own glasses (16 percent agreement in acuity with a stronger correction in the trial lens and 21 per- cent agreement in acuity with a stronger correc- tion in their glasses), as might be expected since the refractive examination was given with the examinee's eyes in a relaxed condition under cycloplegics. A negligible proportion reached the same acuity level with a weaker correction in their glasses than with the trial lens, Better acuity was reached with a stronger correction on the refractive examination than either the trial lens test or tests with their own glasses (22 percent reached better acuity with a stronger correction on refraction than that used in the trial lens test and 14 percent than that in their own glasses). If comparison is limited here to the possible range of the trial lens test, the former proportion is reduced to 12 percent. Substantially more youths reached better acuity with a stronger correction in their own glasses than that used in the trial lens-—-44 percent for the entire group or 20 percent if comparison is limited to the possible range of the trial lens test (less than 6 diopters). For refraction in the clinical examination more than half of the visually abnormal youths (53 percent) required a complex lens with both spherical and cylindrical correction to com- pensate for astigmatism to reach their best corrected acuity (table 6). Hence the agreement between the clinical examination and trial lens test findings with respect to the power of the corrective lens needed and with respect to the best corrected acuity with that strength is sub- stantially poorer among these subjects than among the remaining 47 percent where no cylinder in the lens was needed. For the latter group, with no astigmatism, 25 percent reached the same acuity level with the same lens spherical equiv- alence on both the clinical examination and trial lens test compared with 9 percent among those for whom a cylindrical correction was also needed. (The difference in these proportions is statistically significant at the S-percent prob- ability level.) More than one-half of the results (52 percent) from the trial lens tests understated the best acuity attained on refraction with about 70 percent of this being due to the need for a stronger lens or cylinder or both in the correction. Nearly 7 percent of the trial lens tests apparently overcorrected the acuity beyond that obtained in the clinical examination despite the fact that care was taken in the survey examination to keep the youths from squinting. Slightly but not significantly more of these were among youths requiring only a simple negative spherical lens correction, without a cylinder. Comparison between the degree of refraction In the present glasses for these youths at the time of the survey and in the best correction for them at the time of the clinical examination is shown in tables 12-15. The degree of association or extent of agreement with respect to both the spherical equivalence and the spherical lens part in both corrections is very high (r = + .84 and x2 = 1,155.53, p<.0001). No significant association or agreement was found with respect to the power of the cylindrical correction or the axis deviation in the complex lenses (tables 13 and 14). It is of interest to compare the acuity levels reached with the trial lens and with their present glasses for the youths in this special study, both tests done in the survey without dilation, but within a period of less than 20 minutes. The correlation here was of a very low order — +.05 for the entire group or +.20 if limited to those with simple spherical correction in their glasses. The correlation between acuity with their present glasses in the survey and that found on refraction (with cycloplegia) in the clinical examination was +.40 for the entire group but increased to +.70 when limited to the group with simple spherical lenses, Thus on the basis of the Chicago study the trial lens test results from the survey would appear to differentiate myopia and to provide a slightly better estimate of the best corrected acuity level for the youth population than that obtained from test results with their present glasses within the limits of the strength of the trial lens test, The estimates will be better for those youths who require only a simple correction of 6 diopters or less than those requiring a stronger lens or complex correction. DISCUSSION Previous studies have shown correlations between clinical and Ortho-Rater lateral phoria tests ranging from +.53 to +.94 at distance and +.64 to +.77 at near.’12-15 From these studies it is also evident that, as measured by the corre- lation coefficient, the association between machine tests (including the Ortho-Rater) and clinical tests is as close as that between the clinical tests themselves when given under controlled conditions with only a short timelag between the first test and the retest. The findings with respect to agreement between clinical and survey (Ortho-Rater) phoria tests at distance in the present clinical study are within the range of the previous survey results (r=+.55), while at near they are somewhat lower (r =+.44). Considering the timelag between the survey and clinical examinations of from 1 to 4 weeks, these findings are remarkably consistent with those from previous, more closely controlled studies. Complete agreement for 70-90 percent on the various phoria tests was found when results were grouped into the three categories of significant esophoria, significant exophoria, and essential orthophoria. Hence the phoria findings among youths from the Health Ex- amination Survey in 1966-70, of which this study group is a small segment, can be expected to give fairly accurate estimates of the prev- alence of significant esophoria and exophoria among youths 12-17 years of age in the United States. With respect to the measurement of visual acuity, the comparability of machine test and clinical test scores has been investigated in at least three studies, but these studies used in- struments or targets differing somewhat from those in the present study. !3.16.17 The findings from these studies would indicate that the as- sociation between these machine and clinical tests are also as close as between the clinical tests themselves, ranging from correlations of +.,70 to +.90 when both types of test are done without dilation. Because of the limitation of the trial lens used in the survey, the timelag between the 10 survey and clinical tests, and the fact that the best correction was obtained by refraction with cycloplegia in the clinical examination, it is to be expected that the agreement between the survey and clinical acuity tests will be lower than those from the studies cited above. The correlation between the acuity obtained on the survey trial lens test (without cycloplegia) and that obtained by refraction (with cycloplegia) in the clinical examination was +.29. However, if the comparison is limited to those 47 percent of the youths for whom only a spherical correction was needed (without any astigmatism requiring a cylindrical correction also), the correlation was increased to +.54. SUMMARY The validation study of the vision test battery used in the Health Examination Survey of 1966-70 among youths 12-17 years of age was conducted among a sample of youth examinees in that survey from the Chicago area in July-August 1968. The study was designed primarily to determine the degree of correspondence with respect to myopia and lateral heterophoria be- tween actual survey test results and those obtained in the usual clinical examination by an ophthal- mologist. Following 1 to 4 weeks after their regular survey examination, a sample of 98 youths, including 69 who were judged visually abnormal by predetermined criteria and a control group of 29 normal youths, were given a standard clinical ophthalmological examination in which cyclo- plegics were used for the refractive examination, Findings from the special study indicate that the survey test results for lateral phoria will give fairly reliable estimates of the prevalence of significant esophoria and exophoria among the youth population of the United States in the 1966- 70 survey. The trial lens test for myopia will give a slightly better estimate of the best corrected acuity among the youth population than that obtained from test results with their present glasses when considered in relation to the strength of the correction needed. The estimates will be slightly better among those requiring only simple spherical lenses than those with astigmatism needing a more complex corrective lens. REFERENCES INational Center for Health Statistics: Plan, operation, and response results of a program of children’s examinations. Vital and Health Statistics. PHS Pub. No. 1000-Series 1-No. 5. Public Health Service. Washington. U.S. Government Printing Office, Oct. 1967. 2National Center for Health Statistics: Plan and operation of a Health Examination Survey of U.S. youths 12-17 years of age. Vital and Health Statistics. PHS Pub. No. 1000-Series1- No 8. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1969. 3National Center for Health Statistics: Visual acuity of children. Vital and Health Statistics. PHS Pub. No. 1000-Series 11-No. 101. Public Health Service. Washington. U.S. Govern- ment Printing Office, Feb. 1970. 4National Center for Health Statistics: Eye examination findings among children. Vital and Health Statistics. Series 11-No. 115. DHEW Pub. No. (HSM)72-1057. Health Services and Mental Health Administration. Washington. U.S. Govern- ment Printing Office, June 1972. 5Sloan, L. L., and Rowland, W. M.: Comparison of Ortho- Rater and Sight Screener tests of heterophoria with standard clinical tests. Am. I. Ophth. 34(10):1363-1375, Oct. 1951. 6Duke-Elder, Sir S.: Parsons’ Diseases of the Eye, ed. 14. Boston. Little, Brown and Co., 1964. "National Center for Health Statistics: Visual acuity of youths. Vital and Health Statistics. Series 11-No. 127. DHEW Pub. No. (HSM)73-1609. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, May 1973. 8Hirsch, M. J., and Wick, R. E., eds.: Vision of Children. Philadelphia. Chilton Co., 1963. pp. 333-359. 9Blum, H. L., Peters, H. B., and Bettman, J. W.: Vision Screening for Elementary Schools-Orinda Study. Berkeley. The University of California Press, 1968. 10Copeland, J.: An official study in the application of cylindrical correction. The Optom. Weekly 19:191, Apr. 1928. I1puke-Elder, Sir S., and Abrams, D.: Ophthalmic Optics and Refraction, vol. 5, in Sir S. Duke-Elder, ed., Systems of Ophthalmology. St. Louis. C. V. Mosby Co., 1970. 12wirt, S. E.: Studies in industrial vision. I. The validity of lateral phoria measurements in the Ortho-Rater. J. Appl. Psychol. 27:217-232, 1943. 13Davis, C. J.: Correlation between scores in Ortho-Rater tests and clinical test. J. Appl. Psychol. 30:596-603, 1946. Imus, H. A.: Industrial vision techniques. Am. J. Ophth. 32:145-152, June 1949. 15Sulzman, J. H., Cook, E. B., and Bartlett, N. R.: The validity and reliability of heterophoria scores yielded by three commerical optical devices. J. Appl. Psychol. 32:56-62, 1948. 16National Center for Health Statistics: Comparison of two vision-testing devices. Vital and Health Statistics. PHS Pub. No. 1000-Series 2-No. 1. Public Health Service. Washington. U.S. Government Printing Office, June 1963. 17Fonda, G. E., Green, E. L., and Heagan, F. V., Jr.: “Comparison of Results of Sight-Screener and Clinical Tests.” Project No. 480, Report No. 1. 27th AAF. Base Unit, AAF School of Aviation Medicine, Randolph Field, Texas, Sept. 4, 1946. 11 Table 12 1. 10. 11. 12. 13. 14. 158. LIST OF DETAILED TABLES Degree of binocular lateral phoria at distance without correction on survey test and clinical examination of youths 12-17 years of age: Chicago Special Vision Study, 1968==e=ccerececcrcc cmc emcee meee memes eec sees esses em eces—eeeaesoea—ee Degree of binocular near lateral phoria without correction on survey test and clinical examination of youths 12-17 years of age: Chicago Special Vision Study, LY Degree of binocular lateral phoria at distance with correction on survey test and clinical examination of youths 12-17 years of age: Chicago Special Vision Study, 1968-c-ceecerercmcmcmccnc em ec ecm e cece cece ec ecms acm cccec ces em ee nn—— Degree of binocular near lateral phoria with correction on survey test and clin- ical examination of youths 12-17 years of age: Chicago Special Vision Study, Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached with trial lens and present glasses in survey and on refraction in clinical examination: Chicago Special Vision Study, 1968--- Number and percent of monocular visual acuity tests for youths 12-17 years of age given the refractive examination in clinical examination and the trial lens test in survey, by the visual acuity level reached and the comparative strength of the lenses: Chicago Special Vision Study, 1968----ccec-ceccmcceccccccncnnecnan Number and percent of monocular visual acuity tests for youths 12-17 years of age given the refractive examination in clinical examination and tests with pres- ent glasses in survey, by the visual acuity level reached and the comparative strength of the lenses: Chicago Special Vision Study, 1968---=---ce-mecceconaoa- Number and percent of monocular visual acuity tests for youths 12-17 years of age given the trial lens test and tests with present glasses in survey, by the visual acuity level reached and the comparative strength of the lenses: Chicago Special Vision Study, 1968-=---eccccccccmcmccccemer cece meen c mec cem me e— esas o—eeaeen Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction in trial lens and refraction: Chicago Special Vision Study, 1968-==c-cecccccemccmcccecccccnnn—- Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction in trial lens and in present glasses: Chicago Special Vision Study, 1968==--=----cccccecacaaa= Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction on refraction and in present glasses: Chicago Special Vision Study, 1968==-=e-c-cemmccccanaaa= Spherical lens strength in best correction on refraction and in present glasses for youths 12-17 years of age: Chicago Special Vision Study, 1968---cc-cececee-a-- Spherical equivalence in best correction on refraction and in present glasses for youths 12-17 years of age: Chicago Special Vision Study, 1968--==--cceccecmcecnu== Cylindrical lens strength in best correction on refraction and in present glasses for youths 12-17 years of age: Chicago Special Vision Study, 1968-====em-em=ea--- Degree of axis rotation for lenses in best correction on refraction and in pres- ent glasses for youths 12-17 years of age: Chicago Special Vision Study, 1968--- Page 13 14 15 16 17 19 20 22 22 23 24 26 27 28 29 Table 1. test and clinical examination Study, 1968 of youths 12-17 years of age: Degree of binocular lateral phoria at distance without correction on survey Chicago Special Vision Total Survey test results § Sid Exophoria Fiodlogs on dimen youths Esophoria in prism diopters in prism |p. 00; study 04 diopters Bot visible 10°] 8% [5% |4* [32] 2° 1® 1] 2%] 5 ABNORMAL ON SURVEY Number of youths Total in study-- 69 1| 1 3| 4) 6| 8|11| 6] 5] 1| 1 22 Esophoria 1 - -| = - - -1 =] - - - - i 1 - ” - - - ” - " - 1 - =| 1 - - = - = - - 1 - -1 1 - - - - - - 35 = 1 3] 3| 4 6| 6 2 1] 1 - 8 5 - = - - = 1] 1 2 1 - - = 13 - - - = -1 1 3| 2 2 - = 5 3 - = - = 1 - - = -1 =f 1 1 3 - - =] - - - 1 -] 1 - = 1 1 2] =] «fj =} =] =] =] =] =| =] = 1 1 - - - - -1 - - - - - - 1 1 - - - - - - = - - - = 1 1 - -1 =] = -1 = -1 = - - - 1 1 - - - - - - = - - - - 0 1 - - -| - - - - - BE - - 1 NORMAL ON SURVEY Total in study-- 29 =| =] 2 -| 4] 8] 6] 6] 2] 1 - - Esophoria pL ——— 3 - - -| = -| - 1| - - - 08 mmc meee eo 22 - -| 2 -| 4] 7] 2| 6 1 - Exophoria 18 emma 1 - - - -| - -1 1 - - 28 mecca 4 - - 1] 2 - 1 - - - 4B meee em 1 - - -] 1 - - - - Table 2. Degree of binocular near lateral phoria without correction on survey test and clinical examination of youths 12-17 years f age: Chicago Special Vision Study, 1968 Survey test results Tar~- Total Findings on get clinical yogths LL in pris Exophoria in prism diopters not examination i opuers 0? vis- y ible 7 se [at 2 2 >a ett (et let 100] ut unt | wt st ae? | HEEL oN Number of youths Total in study=-- 69 iS 3 - - -1 3 6 3 3|2 2| 4) 5 1 7 3 4 1 i 3 3 2 3 9 Esophoria 1 - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - | = 1 - - - - - - - - - - - - - - - - - - 1 - - - - - | = - - - - - - - - - - - - - - - - - 1 1 - 1 - - - - - - - - - - - - - - - - - - - - - - wom ii smn 6 wl wl] =) wf »| =] 2] «} 2 | =f 2] 2} A} «| »{ = - - 4 - = = ® - 28 mmm eee 4 -| 1 - - - | - - - | 1 - - wi A -1 1 - - - - - - - - - 0% = emma 6 - 1 - - - 11 1 - - 11 -1 2 - - - - - - - - - - - - 2 - - - - - -1 1 - - - - = - 1 - - - - - - - - - - 7 - - - - - - - 1 - 11 = 1 1 -] 2 - - - - - 1 - - - 9 - - - - - - 11 1 - - - -1 1 - 2 1 1 1 - - i - - - 8 - - = - - 11 1 - - - - - - - - 1 1 - - 1 - 2 - 1 7 - - - - - - =) 1 1 - 1 - - - - - 1 - - 1 1 - - 1 3 = =f =] =] = -]=-1=-1-1-|-1-]-] -]-]- - - 1 - = = 1 1 8 1 - - - - - - - - - - -1 1 - - 1 1 - - 1 - - 2 1 1 el wl «| =! sli»! 2b 2] m=) =) =] 2] =f 2} = - - - - - = 3 1 wl ml wml =| ==] »] =] =] =) =f =] =] =] =| = - - - - - - BE 1 1 - - - - | - - - - - - - = = - 1 - - - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - 2 NORMAL ON SURVEY Total in study=--- 29 - 1 2 3 3/4143 21%] 3 1 - - - - - - - - - - - 1 Esophoria 68mm mmm emma 1 - - - - = 1 - - - - - - - - - - - - - - - - - - 2 - -1 1 - 1 - - - = = - - - - - | - - - - - - - - - 1 - - - - - - 11 - - - - - = - - - - - - - - - - - 11 - 1 1 1 1 1 1 =| 1) 4 - - - - - - - - - - - - - - 5 - - - - 11 1 - 1 - -0 1 1 - - - - - - - - - - - - 2 - - - - - - =| 1 - = 1 - - - - - - - - - - - - - 3 - - - - - - | 2 - - -1 1 - - - - - - - - - - - - - 2 - - - - - - - 11 - - - - - - - - - - - - - - - I 1 =f =f ~~] ~| = 2 wf om] wl =] =] =] =] = - - - - - - - - 1 - - - - = - - 11 - - - - - - - - - - - - - - - Table 3. Degree of binocular lateral phoria at distance with correction on survey test and clinical examination of youths 12-17 years of age: Chicago Special Vision Study, 1968 Survey test results Tar - Total g Findings on clinical youths Esophoria in prism Efophopia get examination in diopters a rea pl sendy ible a 7° a 4° a a 14 in 4: a ABNORMAL ON SURVEY Number of youths Total in study------ 42 2 1 2 3 7 i 3 3 1 1 1 Esophoria 258 cme em 1 - - - - - - - 1 - - - - UB ei rem 1 wih wit =| =] =f =) =f =| = - (I 20 - 1 1 3 5 2 6 2 - - - Exophoria I 2 - - - - - -| 2 - - - - - YR 7 1 - - - 2 3 - - 1 - - - 4B cme eam 3 - - - - - - 1 - 2 - - - 82 meee eeeee 1 - - - - - - - - - - 1 - EE 1 - - - - - - - - - - - 258 cme 1 - - - - - - - - - > - Not tested==-=--ccemeceaoa- 5 - - 1 - - 2 3 - - - - 1 NORMAL ON SURVEY Total in study------ 2 - - - - 1 1 - - - - - - I ee SS - = r- - = . 1 x - a = - - Not tested=--==-=-cceeea-o - - - - - i - - - - - - - Table 4. age: Chicago Special Vision Study, 1968 Degree of binocular near lateral phoria with correction on survey test and clinical examination of youths 12-17 years of Survey test results Total Tintiogs oo Slintend yogehs Esophoria in prism diopters . Exophoria in prism diopters study 0 12° | 11° |9* |8° re let (202 S13% at 5%le*| 8%] 9% [10% | 11° | 15% [16° ABNORMAL ON SURVEY Number of youth Total in study-=--- 42 3 22 1) LL] 312 4| 3 | 2] 3) 2 4 2l-{2] 2 1 1 1 i | 1 Esophoria 1 - -| - = = - = = = - - - - = =-]=-]1 - - - - - - 1 - - =] = -1 1 - - - - - - =| = == - - - - - - - 1 1 =| =f =] = -1 -1] - = =] =] = = = === - = - - - - 1 - i - | = - = =| =] =] = - - = = === = = - - - - 3 - - 11 - = 1 - = = = =] = 1 = === - - - - - - 2 - -| =] = - =] =] 1 1 - - = =] - - =~ - - - - - - 08 emma 16 1 1 1 1 1 - 1 2 - i 1 1 1 1 - - 1 1 1 - - - 2 - - - = - - | = - 1 - = - = 1 ==] - - - - - - - 3 1 - - =] - -1 1 -| 1 = =| - = = ==] - - - - - - 1 - - - -| = - - = - - = - -]11 === - - - - - - 1 - - = =] -| - - - = - -] - = = ===] 1 - - - - - 1 - wl =] wf wo] wf wf =f] «f wo] | =] of o] jw) =] - - - - 1 3 - - - =] - - = - - = - - =] 1 -l-]1 - = - 1 - - 1 - wl 2] wm} =) =f wf =| =f «| =] »] «| =} |e =} =| = - - 1 - 5 - - - = -1 1 -1 1 - = - 2 - = 1|-|=-] - - - - - - NORMAL ON SURVEY Total in study---- 2 - -{ =| -( - - - - = 1 - = - -| -l1|-] =| - - - - = Exophoria 28 emmmmmmnnmm——————— i - wf =) =f =] =] =f =] =f =f =| =| ={ =] ={2}] =| =| = = - - - Not tested-====mcmcecean- x - - - - - - - - - 1 - - - - - |=] = - - - - - - Table 5. Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached with trial lens and present glasses in survey and on refraction in clinical examination: Chicago Special Vision Study, 1968 Test for monocular acuity and acuity level Total Monocular acuity level 20/20 bet =~ ter 20/25 | 20/ 30 | 20/40 20/50 20/60 to 20/70 20/100 Trial lens 20/ 100~~==m mmm mmm meme wm mw wim D0 BOQ mm sim sist rs mm me sm i 20/200 F0760 Toy 20] TO mmwwmissimmsmsmmion aww 3007 OY es es 0 Number of tests with refraction 103 65 24 9 4 - 1 - \ 54 47 7 - - - - - 10 1 9 - - - - - 11 6 4 1 - - - - 12 4 2 4 2 - - - 4 3 1 - - - - - 3 2 - - 1 - - & 2 - 1 - - - 1 - 3 1 - 3 1 - - - 2 1 - 1 - - - = Number of tests with present glasses 75 43 9 10 5 2 3 3 37 28 5 3 - - 1 - 5 1 - 1 1 - - 2 9 5 1 2 1 - = - 8 4 - 1 1 2 - ” 4 2 1 - - - - 1 3 - 1 L - - 1 - 2 1 - - - - 1 - 5 1 1 1 2 - = - 2 1 - 1 - - - 2 Number of tests with refraction 84 58 15 7 3 - i - 50 43 7 - - - - - 10 5 3 2 - - - - 10 6 2 2 - - = - 5 1 1 1 2 - - ~ 2 - - 2 - - - < 4 2 - - 1 - 1 - 3 1 2 - - - - - Table 5. Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached with trial lens and present glasses in survey and on refraction in clinical examination: Chicago Special Vision Study, 1968 —Con. Monocular acuity level Test for monocular acuity and acuity level Total 20/m 20/60 20/25| 20/30| 20/40 | 20/50 to 20/100 bet- 20/70 ter Trial lens Percent of tests with refraction Total ----msemmmm mmm mcm mm mee oo 100.0 63.1 23.3 8.7 3.9 - 1.0 - 20/20 or better--=--e-eemeccocaaaa- -=-=| 52.4 45.6 6.8 - - - - - 20/25 === mmm mmm meee meen 9.7 1.0 8.7 - - - - - 20/30 =m mm mmm mm meee ema m 10.7 5.8 3:9 1.0 - - - - 20/40 mcm mm mmm mmm eee em 11.7 3.9 2.0 3.9 1.9 - - - 20/50 ==mmm mmm meme eee eee meen 3.9 2.9 1.0 - - - - - 20/60 to 20/70===mmmmcmmm meme ee 2.9 1.9 - - 1.0 - - - 20/100 == mcm mm meme meee 1.9 - 0.9 - - - 1.0 - 20/200====cmmm mmm mmm emma 4.8 1.0 - 2.8 1.0 - - - 20/400 mmm mmm mmm meee meee 1.9 0.9 - 1.0 - - - - Trial lens Percent of tests with present glasses Totalemeem mmm meme meee meen 100.0 i 12.0 13.3 6.7 2.7 4.0 4.0 20/20 or better-=-=--eceeemceccmcee———— 49.3 37.3 6.7 4.0 - - 1.3 - 20/25 mmm mmm mmm me eee 6.7 1:3 - 1.3 1.3 - - 2,8 20/30 === mmm mmm meee eee 12.0 6.7 1.3 2.7 1.3 - - - 20/40 mmm mmm mmm ee meme eee 10.7 5.4 - 1.3 1.3 2.7 - - 20/50 mcm mmm mmm meee een 5.3 2.7 1.4 - - - - 1.2 20/60 to 20/70===cmccmmem meme me 4.0 - 1.3 1.3 - - 1.4 - 20/100===mmmmm meme meee 2.6 1.3 - - - - 1.3 - 20/200 === mmm mmm mmm meme 6.7 1.3 1.3 1.3 2.8 - - - A 2.7 1.3 - 1.4 - - - - Present glasses Percent of tests with refraction Totale-meommm mm mcm e meme eee m 100.0 69.0 17.9 8.3 3.6 - 1.2 - 20/20 or better=====--mceemeomcmm———n 59.4 3%.1 8.3 - - - - - 20/25 === mm mm mmm mmm eee meen 11.9 6.0 3.6 2.3 - - - - 20/30 === mmm eee meee 11.9 7:1 2.4 2.4 - - - - 20/40 mmm mmm mm mm meee 6.0 1.2 1.2 1.2 2.4 - - - 20/50 ==m mmm mmm eee m 2.4 - - 2.4 - - - - 20/60 to 20/70====mmmm comme 4.8 24 - - 1.2 - 1.2 - 20/100==mmcmm mmm meee eee 3.6 1.2 2.4 - - - - - Table 6. Number and percent of monocular visual acuity tests for youths 12-17 years of age given the refractive examination in clinical examination and the trial lens test in survey, by the visual acuity level reached and the comparative strength of the lenses: Chicago Special Vision Study, 1968 Best acuity on Best acuity on refraction refraction 1 : Total Total Comparasiye yEvengsh’ 3p retractive eyes Same Better | Worse eyes Same Better | Worse tested as than than tested as than than with with | with with with |with trial | trial trial trial | trial trial lens lens lens lens lens lens Number of tests Percent of tests Spherical equivalence? of all lenses in refractive examination: Total mmemmmm meme emcee emma 103 42 54 2 100.0 40.8 52.4 6.8 Same as trial lens-----=----mcemeeanan 38 i 21 - 36.9 16.53 20.4 - Stronger than trial lens but within trial lens range=--=--=-==-cececeoaon 22 8 12 2 21.3 7.8 11.6 1.9 Weaker than trial lens---------cece--o 32 17 10 5 3.1 16.5 9.7 4.9 Beyond trial lens range (6 diopters OF MOYE)===mmmmcmccmcccce ce c—e——————— 11 - 11 - 10.7 - 10.7 - Spherical lens only used in refractive examination: TREC wim m0 mas i ss 48 21 23 4 46.6 20.4 22.3 3.9 Power same as trial lens---=-----cc-c-- 20 12 8 - 19.4 11.7 2.7 - Power stronger than trial lens but within trial lens range----------=--- 6 2 3 1 5.8 1.9 2.9 1.0 Power weaker than trial lens-----=---- 18 7 8 3 172.5 6.8 Z.8 2.9 Power beyond trial lens range (6 diopters Or more) --------------ceeaao 4 - 4 - 3:9 - 3.9 - Spherical and cylindrical lenses used in refractive examination: Total m-mec mmm mm meee eee ema m 55 21 31 3 53.4 20.4 30.1 2.9 Power? same as trial lens----==-=--au- 15 6 8 1 14.6 5.8 7.8 1:0 Power”? stronger than trial lens but within trial lens range-=--==-===---- 20 8 11 1 19.4 7.8 10.6 1.0 Power? weaker than trial lens=----=-=--= 9 7 1 1 8.7 6.8 1.0 0.9 Power? beyond trial lens range (6 diopters Or more) --=-----e-ceccccanao 11 - 11 - 10.7 - 10.7 - Spherical equivalence! same as trial lens ====mmemmccmcm meme 18 5 13 - 17.5 4.9 12,6 - Spherical equivalence? stronger than trial lens but within trial lens range====mmmmmmmem——— mmm mmm ——— 16 6 9 1 15.5 5.8 8.7 1.0 Spherical equivalence! weaker than trial lenS=---=----ecemccmmcmeeeeeeee 14 10 2 2 13.6 9.8 1.9 1.9 Spherical equivalence’ beyond trial lens range (6 diopters or more) =-=-=-=--=- 7 - 7 - 6.8 - 6.8 - !power and spherical equivalence. “Spherical lens power in simple lens or algebraic sum of power of sphere and one-half power of cy- linder in complex lens. 3Algebraic. sum of power of sphere and cylinder in complex lens. ‘Algebraic sum of power of sphere and one-half power of cylinder in complex lens. Table 7. Number and percent of monocular visual acuity tests for youths 12-17 years of age given the refractive examination in clinical examination and tests with present glasses in survey, by the visual acuity level reached and the comparative strength of lenses: Chicago Special Vision Study, 1968 Best acuity on refraction Best acuity on refraction : Total Total Comparative strength! of Better Worse Better Worse refractive lens and youth's eg Sams as than than oy S209 bs than than own glasses wh with with owt with with lasses own ira lasses or oun & glasses | glasses & glasses |glasses Number of tests Percent of tests Spherical equivalence? of all lenses in refractive exami- nation: POLL, wos cnr wos ss sw ron 84 31 28 25 100.0 36.9 33.3 29.8 Same as own glasses=--==-===-= 19 9 4 6 22.6 10.7 4.8 7:1 Stronger than own glasses---- 17 4 12 1 20,2 4.8 14.2 1.2 Weaker than own glasses==-=-=--= 48 18 12 18 57.2 21.4 14.3 21.5 Spherical lens only used in refractive examination: Total=--=-emcmmmmc meee 39 16 10 13 46.4 19.0 11.9 19.5 Power same as own glasses=-=--- 6 5 1 - 7.1 6.0 1.1 - Power stronger than own glasses==-mmmmcmccmmmcacnon 5 1 4 - 6.0 1.2 4.8 - Power weaker than own glasses====-memmcmmmmccnennn 28 10 5 13 33.3 11.8 6.0 15.3 Spherical and cylindrical lenses used in refractive examination: Total-==-mcmcmmemenmeneam 45 15 18 12 53.6 17.9 21.4 14.3 Power”? same as own glasses--- 8 2 3 3 9.6 2.4 3.6 3.6 Power? stronger than own glasses -===--cccmmmcccnncenn 11 2 6 3 13.1 2.4 7.1 3.6 Power? weaker than own glasses=---ccmmcmmmcccnaaan 26 11 9 6 30.9 13.1 10.7 7.1 Spherical equivalence? same as own glasses----=m=cec--o- 13 4 3 6 15.5 4.8 3.6 7:1 Spherical equivalence? stronger than own glasses=--- 12 3 8 1 14.3 3.6 9.5 1.2 Spherical equivalence weaker than own glasses=-=-=-- 20 8 7 5 23.8 9:5 8.3 6.0 power and spherical equivalence. “Spherical lens power in simple lens or algebraic sum of power of sphere and one-half power of cy- linder in complex lens. JAlgebraic sum of power of sphere and cylinder in complex lens. Algebraic sum of power of sphere and one-half power of cylinder in complex lens. 20 Table 8. Number and percent of monocular visual acuity tests for youths 12-17 years of age given the trial lens test and tests with present glasses in survey, by the visual acuity level the comparative strength of the lenses: Chicago Special Vision Study, 1968 reached and Actual acuity with own glasses Actual acuity with own glasses 7 i a ' Total Total Comparative stengih, of youth 8 ‘om eyes Same Better | Worse eyes Same Better | Worse & tested as than than tested as than than with with | with with with | with trial trial trial trial | trial trial lens lens lens lens lens lens Number of tests Percent of tests Spherical equivalence” of own glasses: Total ====-emmmmm mcm eee meme 75 19 39 17 100.0 25.3 52.0 22.7 Same as trial lens-=--=------eomeeomoo 19 9 6 4 25.3 12.0 8.0 5+3 Stronger than trial lens but within trial lens range----------==-c==c----- 24 6 15 3 32.0 8.0 20.0 4.0 Weaker than trial lens-=----=--==--u-- 11 3 - 8 14.7 4.0 - 10,7 Beyond trial lens range (6 diopters OT MOTE) ===m=m=momem cm mmmmmm mmm mee 21 1 18 2 28.0 1.3 24.0 2.7 Spherical lens only in own glasses: Total===memmmmmmmmmmmm meme emma om 34 8 18 8 45.4 10.7 24.0 10.7 Power same as trial lens==-=====ee-=-- 8 4 2 2 10.7 5.3 2.7 2,7 Power stronger than trial lens but within trial lens range==-========--- 9 6 - 12.0 4.0 8.0 - Power weaker than trial lens------=---- 5 - - 5 6.7 - - 6.7 Power beyond trial lens range (6 diopters Or more) ----=-=-=-c---c---ee-- 12 1 10 1 16.0 1.4 13.3 1.3 Spherical and cylindrical lenses in own glasses: Total === emer ccc creme cm mmm 41 11 21 9 54.6 14.7 28.0 1X9 Power” same as trial lens-===-===--==-- 4 - 3 1 5.3 - 4.0 1:3 Power” stronger than trial lens but within trial lens range--=-=======--- 19 8 7 4 25.3 10.7 9.3 5.3 Power? weaker than trial lens=--------- 5 2 - 3 6.7 2.7 - 4.0 Power? beyond trial lens range (6 diopters Or more) ----==-=-=-----eecmeo- 13 1 11 1 17.3 1.3 14.7 1.3 Spherical equivalence’ same as trial 1 Orage cits wi ww i m—————————————— 11 5 4 2 14.7 6.7 5:3 2.7 Spherical equivalence’ stronger than trial lens but within trial lens TRE 15 3 9 3 20.0 4.0 12.0 4.0 Spherical equivalence’ weaker than trial LOtig =n mdinimes meme ———— 6 3 - 3 8.0 4.0 - 4.0 Spherical equivalence’ beyond trial lens range (6 diopters or more)=------ 9 - 8 1 12.0 - 10.7 1.3 Power and spherical equivalence. “Spherical lens power in simple lens or algebraic sum of power of sphere and one-half power of cy- linder in complex lens. “Algebraic sum of power of sphere and cylinder in complex lens. Algebraic sum of power of sphere and one-half power of cylinder in complex lens. 21 Table 9. Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction in trial lens and refraction: Chicago Special Vision Study, 1968 Monocular acuity Test, power, and spherical 1 equivalence of lens Total 20/20 20/60 Get 20/25| 20/30| 20/40] 20/50| to 20/100| 20/200( 20/400 ror 20/70 TRIAL LENS Number of tests Totalesceamcccanncncmcacencnncann 103 54 10 11 12 4 3 2 5 2 23 4 1 5 i 4 2 1 1 1 9 7 2 - - - - ® - w 12 11 b 1 - - - - ® 6 4 - 1 1 - - - - - 6 5 1 - - - - - - - 25 23 - - 1 - - 1 1 - 22 - 6 A 9 - 1 - - 1 TEI rs 103 65 24 9 4 - 1 " # - -12 1 - - - - “ - ® - -10 - - 1 = - - - = - i - 1 - " - - - - - - - 2 " - - - » - - - - - - " 1 - - - = 5 1 - 2 - - - = - » 5 2 ~ - - - - - * 8 3 - - » - - - - = 11 4 2 - - " “ - - 6 2 2 - - - - - - - 7 3 - 1 - - - - - - 8 2 » - - - - = - 11 6 - 1 - - - - - + 2 1 - - - - - - - + - - i - - - - - - -10 D 1 - 1 - - - - = - - 9 - - 1 = - - - - - - 8 1 - 2 - - - - & - - 7 " - - - - - “6 5 @ » “ - - - * - -5 4 3 - - - 1 - - - - 4 7 1 - 2 - - - - - -3 12 6 - - - - ~ - - - 2 6 2 2 - - - - ” - -1. 6 2 2 - - - =~ - - -1 9 1 - 1 - - - - - 0 14 8 - 1 - - - - - + 1 - 1 - - - - - - - +2 - - 1 - - - - - - TRIAL LENS Percent of tests Totale---mmememcmcccm ccc ce mem m em 100.0 ||52.4 9.7 10.7 | 11,7 3.9 2.9 1.9 4.8 1.9 Negative lens=-===secmcemeccccmmmeennn 78.6 52.4 3.9 6.8 3.0 3.9 1.9 1.9 4.8 0.9 0 pOWer-====emccme mcm em cme mm mmme en 21.4 - 5.8 3.9 8.7 - 1.0 - - 1.0 REFRACTION (Spherical equivalence) Total==-e-mmccmccmem cece eee 100.0 || 63.1 23.3 8.7 3.9 - 1.0 - - - Negative lens 75.8 || 48.5 15.7 7.7 2.9 - 1.0 - - - 0 power==--s==cecececccancaann 22.3 14.6 6.7 - 1.0 - - - - - Positive lens 1.9 - 0.9 1.0 - - - - - !With both types of test. Power of lens in diopters (D)= algebraic sum of spherical power and cylindrical power in the correction. "Spherical equivalence of lens in diopters (D)= algebraic sum of spherical power and one-half power ofcylinder in the correction. 22 Table 10. Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction in trial lens and in present glasses: 1968 Chicago Special Vision Study, Monocular acuity Test, power, and spherical 1 equivalence of lens Total 20/20 Bet= 20/25 20/30 | 20/40 | 20/50 | 20/70 | 20/100 | 20/200 | 20/400 ter TRIAL LENS Number of tests 75 37 5 9 8 4 3 2 5 2 23 4 1 5 1 4 2 1 4 1 9 7 2 - - - - - - - 11 10 - 1 - - - - - - 5 3 - 1 1 - - - - - 5 4 1 - - - - - - - 12 9 - 1 1 - - 1 - - 10 - 1 1 5 - 1 - 1 i 75 43 9 10 5 2 3 3 - - 2 - 1 1 - - - - - - 2 - - 1 1 - - - ” - 1 z 1 z : - - 3 2 1 - - - - - - 1 1 - - - - - - - - 4 3 = 1 - - - - = -9 4 2 1 - - - - 1 - - -8 5 4 1 - - - - - - - -7 7 5 - 1 - - 1 - - - -6 -3 2 1 - - - - - - - - 5 3 3 - - - - - - = - - 4 9 6 1 2 - - - - ™ -3 9 3 2 - 2 - 2 - - - -2 10 7 1 - - - - 2 - - =1.5 Demmmmmm meme meen 1 1 - - - - - - - - -1 5 3 - 2 - - - - - - 0 4 1 - - i 2 - - - . + 1 - - - - - - - - - - + 2 2 - - 1 1 - - - - » 2 - 1 1 - - - - - " 2 E : 1 1 = a : : : 4 2 1 1 - . ’ : : : 2 2 - - - - - - - - 5 3 1 1 - - - - - ~ 6 4 1 - - - - 1 - - 7 6 - 1 - - - = = - 4 2 1 - - - 1 - - - 12 9 2 1 - - - - - - 12 7 1 1 2 - 1 - - - 6 3 = - - - 1 2 - - 4 3 1 - - - - - - - 5 2 - 2 1 - - - - - 2 - - - - 2 - - - - 2 - - 1 1 - - - - - Percent of tests TRIAL LENS TOA wwe ve im ow es i 100.0 49.3 6.7 12.0 10.7 5.3 4.0 2.7 6.7 2,7 Negative lens--===---cceccoacmcmanann 86.7 49.3 5.4 | 10.7 4.0 5.3 2.7 2.7 5.4 1.4 0 poWer==s==e--eccmmc enema ee 13.3 - 1.3 1:3 6.7 - 1.3 - 1.3 1,3 PRESENT GLASSES (Spherical equivalence) TWOEE] mime mmm isms ms es wr 100.0 57.3 | 12.0 | 13.3 6.7 2.7 4.0 4.0 = - Negative leng-==-=-cmeemcmmccmcmaanan. 92.0 56.0 | 12,0 | 12,0 4.1 - 4.0 4.0 - - 0 POWEY === mmm mmm mee eee em 5.3 1.3 - - 1.3 2.7 - - io Positive lens===---comccmmcmmmcccca 2.7 - - 1.3 1.3 - - - - - 'With both types of test. | ; Power of lens in diopters (D)= algebraic sum of spherical power and cylindrical power in the correction. ‘Spherical equivalence of lens in diopters (D)= algebraic sum of spherical power and one-half in the correction. power of cylinder 23 Table 11, Number and percent of monocular visual acuity tests for youths 12-17 years of age, by correction on refraction and in present the visual acuity level reached and the glasses: Chicago Special Vision Study, 1968 strength of Monocular acuity Test, power, and spherical 1 equivalence of lens Total 20/20 20/60 OF 120/25 20/30 | 20/40 {20/50 | to | 20/100 bet- 20/70 ter REFRACTION Number of tests Total=-em-mmmcemccmcccm emma meee 84 58 15 Z 3 - i - Lens power > “12 Deemeceeemceemce meee ———— 1 x - - - - - - =10 De-mmmmeecccemeeecm cme 2 1 - 1 - - - - = 9 Demmmmcmmcce cmc 3 2 - 1 - - - - = 8 Demmeemmmmmmmce ccc 2 - - 2 - - - - = 7 Demeemmecccmmme cme 1 - - - - - 1 - = 6 Demme meme 8 5 1 - 2 - - - El I EE 7 5 2 - - - - - = 4 Demme 11 8 3 - - - - - = 3 Demmemmmmmmm meee em 16 11 4 1 - - - - = 2 Deememeemmmm meee em 10 6 2 2 - - - - =1.5 De=memeemccmm cece ema 8 5 2 - 1 - - - = 1 Dememccmmcmmm meme em 5 4 1 - - - - - 0 De-emmemmmm mmm 8 8 - - - - - - + 1 Demme eee 2 2 - - - - - - Spherical equivalence’ =10 Deememcmm meme eme me meem 2 1 - 1 - - - - = 9 Dememeeeemcmcm eee 2 i - 1 - - - - = 8 Demme mmm 4 2 - 2 - - - - = 6 Dememeceemeceemece cme meee ———— 5 5 - - - # = - = 5 Demeseemmmmmmmee meme m 8 4 3 - - - 1 - = 4 Deemer 10 7 1 - 2 - - - = 3 Demme cee 18 12 6 - - - - - = 2 Demme emcee eee 9 6 2 1 - - - - =1.5 Demmmcmmm meee mem em 8 4 2 2 - - - - = 1 Desmememmmmmm meme eee 6 5 - - 1 - - - 0 Demme meee 12 11 i - - - - - PRESENT GLASSES Total=--mmmmcmmmm cme meee eam 84 50 10 10 5 2 4 3 Lens power > “18 Demmmmemmmcm cme 2 - 1 1 - - - - EI 2 - - 1 1 - - - “13 Deemer meee meee 2 1 - Ly® - - - - “12 De-eemmmmeme meme eee 3 2 1 - - - - - “11 Deemer em 2 2 - - - - - - “10 Demme eee em 4 3 - A = - - - = 9 Demme eee 4 2 1 - - - - 1 = 8 Demmemmmeem mmm eo 5 4 1 - - - - - = 7 Demos meee eee 9 5 - 1 - - i 2 = 6 Demme eee 3 2 1 - - - - - El I tata 3 3 - - - - - - = 4 Dememmmmm meee een 9 6 1 2 - - - - = 3 Deemmmemeeme meme eee emma 9 3 2 - 2 - 2 - = 2 Demmmmmemecmm emma 8 7 1 - - - - - =1.5 Demme 1 1 - - - - - - = 1 Demme eee 8 6 - 2 - - - - 0 Demmememcmcmmm emma 4 3 - - 1 - - - a I ET EL 2 - - - - 2 - - + 2 Dememmmmem emma 4 - 1 1 1 - 1 - ‘with both types of test. “Power of lens in diopters (D) = algebraic sum of spherical power and cylindrical power in the correction. “Spherical equivalence of lens in diopters power of cylinder in the correction. 24 (D) = algebraic sum of spherical power and one-half Table 11. Number and percent of monocular visual acuity tests for youths 12-17 years of age, by the visual acuity level reached and the strength of correction on refraction and in present glasses: Chicago Special Vision Study, 1968-=Con. Monocular acuity Test, power, and spherical 1 equivalence of lens Total 20/20 20/60 20/25 | 20/30 | 20/40 | 20/50 to 20/100 bet- 20/70 ter PRESENT GLASSES —Con. Number of tests Spherical equivalence’ 1 - - 1 - - - - 1 - 1 - - - - - 2 - - 1 1 - - - 5 3 1 gL - - - - 3 3 - - - - - - 5 3 1 1 - - - - 6 4 1 - - - - 1 7 6 - 1 - - - - 4 2 1 - - - 1 - 12 9 2 1 - - - - 12 7 it 1 2 - 1 - 6 3 - - - - 1 2 6 5 1 - - - - - 9 5 - 2 1 - 1 - 3 - 1 - - 2 - - 2 - - 3 1 - - REFRACTION Percent of tests (Spherical equivalence) Total=me-mmc meme mmcm cee cmm mem 100.0 69.0 17.9 8.3 3.6 - 1.2 - Negative lenS-=-=--emeemcmccocceaaaann 85.7 55.9 16.7 8.3 3.6 - 1.2 - 0 pOWEer==-sceem mmc emcee meee em 14.3 13.1 1.2 - - - - - Positive lens-=--e-ecccccmcecccccaaa= - - - - - - - - PRESENT GLASSES (Spherical equivalence) Total=meecmm mamma 100.0 || 59.5 11.9 11.9 6.0 2.4 .8 3.6 Negative lenS=-----ecececmcmccmcnaenx 83.3 53.3 10.7 8.3 3.6 - 3.6 3.6 0 pOWer=-=-m--ccmcmme mcmama mn 10.7 6.0 - 2.4 1.2 - Lui - Positive lenS=-==eecceemcmccmcccnaana" 6.0 - 1:2 1.2 1.2 2.4 - - "with both types of test. “Power of lens in diopters (D) = algebraic sumof spherical power and cylindrical power in the correction. ‘Spherical equivalence of lens in diopters (D) = algebraic sum of spherical power and one-half power of cylinder in the correction. 25 Table 12. Spherical lens strength in best correction on refraction and in present glasses for youths 12-17 years of age: Special Vision Study, 1968 Chicago Spherical correction in present glasses in diopters To- tal Spherical correction on refraction in diopters -9.50 -9.00 -8.50 -8.25 -8.00 -7.50 7.25 6.25 6.00 5.75 5.50 5.25 75.00 4.50 4.25 -4.00 -3.75 3.50 3 -2.75 -2.50 2.25 -1.75 -1.50 -1.25 -1.00 -0.75 -0.50 -0.25 +0.25 +0.50 © © Nui mber of lenses te sted HWNNO OHUVWW WAWE®X® NEOHN HPAWHW NHEWUFF WRN [I 10408 C3099 Feeley uw iy RAE NN Shag Sade Fresh AFEELD 4a Tas ny 0a Wa LAVA HAA NY EN EAN WEEYN FARE FX AOE ald wed REE FAWN NIE A ER] LR ya Fay WE Ee EEA AW AAE Porro nnn rr rrr Ler a= br Phra bn nt tn Lg PO ne herr rer rn Hr rao Porn nr nbn hn HEH = Lr rrr br rel ra Wr ba Perr rr rrr rer re tr PL re nh Ea Ear Ea ARIE I A I I EE EEE EE EEE ER EERE EE 0% dw er Bnei ERE HEL Fae OLIN AOE BE A A A BE I EE TN URE a EEE YE ARNE AINE EY aL yy WEN PE eR HEL ga BYE AEE ERE EYE WAFER PME bE A Er VEG ow a WE RN YE PEERY Aas TNONYE WH YY aE Nd wmaawm Eo LLL aE FEL Ls Lt ra PEER PR NE feral TEI REE BN WEN =a Pre ET aoa LEN Pg LEAT Lari Gist 1X09 8 wErwew TEVA W PFE RY ENE AREY FR dd FEED Eg Hea Er NYE TYEE EAA EAT WEY ab FA wane wr Ew awww Ed AEE ea ee ENE wade r= BENE AREY FAA CERNE WEEE W awd R= PEF EAR GEY TwRdy waxy dewrw mumtwy £0 oa g ENE TE MAAR E AERME THERE RAAT WRERY 26 Table 13. Spherical equivalence in best correction on Special Vision Study, 1968 refraction and in present glasses for youths 12-17 years of age: Chicago Spherical equivalence! of present glasses in diopters Spherical equiva- = lence! on Tos refraction in diopters -14,25 ~13.75 -11.25 -9.25 -9.00 -8.50 -8.00 -3.00 -2.50 =2.25 -2.00 -1.75 25 +1.25 +1.50 +1.75 +2.00 = o "t » — 1 ° J = — — ~N [N) w bot h tests 1 she] « 1 1|-] - i wl wl] = 1 -1 1] = 1 wif wl] alll =leqz 1 I a wild = 1 wi] an) 3 if om ff ve 4 wi) 0] = 1 wi} wf 3 wi 2 wl wl 4 wf =| 4 if = 7 wl) ew] = 1 wfje! a 6 oi] =f 2 sd =! 4 wf =| = 2 sled © i wil] @ 1 wif ow lf = 3 wile] iw 5 & fl} i =) wh 4 | fl 2 w j=) i lf 1 Jon | = 4 “Now aoa vam -|1 -l1 PL te hr ELE LLL Lr EE no ln |onn (INN |O|n [© (nn [© [wn RR REECE RAI8E RS SERRE RFR |S Number of lenses for youths with | 2| 1| 1 2] 4] 2(|2|3|3|1]|3] 3|4 Ll wl wy wo) @l om] feel ole] =] =] wf wl ml wml ow LY el] wld wl mje] =) = = = Bl =) #2 =f ll L rw] mly: oe ow] mf i] om = =| | 1] =| Lf == |=] ~] =| - wl we] ww] wo] wf LT} wf] | | ow] =] = wf wo) wy oe] el TL fs wf fa) wl = wl Ww) =] «| 1] el w]=l A) fel) =) = = | =1 of =f A = Vel] ~f= [=}2] =] = =| <= <==] 11 |=] -] | - “| =] =] =] =| -]=fYy1r{2|-|-]| -| - wl wl ow] wf of wo = [sla [ele I} © = =f =| =| =| =| =]=]=|-|=-|1]21 wf wf wf wl ww] «(ell iw] =] = 2 wl wy wey wf ow] ow] fw] ww fw] wd wl 1 LE [ant 0 TN | 11] - =| lf = EEE EE EE EC CT Hao LE Cc no |\nn |O (n nn (NO [~~ nN Hl SS |e ye 38 IY jv va 214] 1) 5]4]1]1 “itl el =] =] == | Lliw] wm] =| wi} = «{l] =| =] =] == 1 =| 1] =| =| =| ~- | wef =<) 3] =|= ll wl wy wd Ly =] 1 -]-|1 - = “if Li =] = w| = wl «| <1 3 1] = wf wl) =] XA | = - =] =] = -1 NE aoa HE Lea HY ard RARER AAR aA RE YAR EE Ra dra "The algebraic sum of the power of the spherical lens and one-half the power of [2 z © cylinder in a lens (system). 27 Table 14. Cylindrical lens strength in best correction on refraction and in present glasses youths 12-17 years of age: Chicago Special Vision Study, 1968 for Cylindrical correction in present glasses in diopters To- tal Cylindrial correction on refraction in diopters =4.00 -3.75 -3.50 -3.00 -2.25 -2.00 -1,75 -1.00 -0.75 -0.50 -0.25 +0..25 +0.50 73 +1.00 [eo] © Number tested ~ 41 — FEE HOPOW PPRPOWON HFWHWRN NNNWWW HFHEREFENHE FORE P13 80 3 3ENT HEY ENE WD V2 FE J EI ERE FPEENY FPEEEY TEE Pf 31 08 W313 T LL OENF $year xs 1 4 5 1 oye sd ¢3APN THIET ET TaXT AY I I RE | 03 ee 58a y I'~=3 1 3 EE I 4 Lex J ¥TFT ITF LATE F ITI ESE EPEEEE ATT R 3 3 3 2 Py FRAY iar WEEE HEF TE FET LN = Ps YEY 1980 yy LY a3 A NH a — rE 8 3g 1 1 13 ror LHL WHE NE Lv roa HEI = FEN rr rt 1a a Lar NH 1 FW NN = NWN ITH PNT tHE PAN A HOW = tig 2} ar 3 HENS y FAERIE WHETE FE] 28 Table 15. Degree of axis rotation for lenses in best correction on refraction and in present glasses for youths 12-17 years of age: Chicago Special Vision Study, 1968 Axis rotation in present glasses in degrees Total Axis rotation on refraction in degrees o° 10° 30° 60° 65% § 75° 80° 90° 95° 100° 105° 170° 180° © © Number of 1 1 0 25 lenses tested — No ~ FRRHERE NWHERE RON NRF WN HFNFFEFD HERE Se F2=y ¥ rd ff 4 1 ~WLn 1 == 100 > =< FH yer He NE £53 Ty eD $0 yes REN 9 09 $2 6089 = a Fv "42 0 Trot EEN 5 9 3 F099 rrr 3 N-] Terra if = - 1 TENN Na y= REE NTN 14013 rrr $3 Fe 50 0) FEY F< 9 59 R FEE LE I I | Vey 1 0 yey on ¥ 3 a8 FE AEE TYRE BETA naa Ss 17 1 =r py) rrr 3% 8X T= = =r biped fc W Vly 29 APPENDIX RECORDING FORMS HES-III June 4, 1968 Special Vision Study Appointment Form Chicago, Illinois, July 23-31, Aug. 15-24, 1968 Name Segment No. Serial No. Scheduling restrictions: Mon. Tue. Wed. Thu. Fri. Sat. [_/ Consent given / J Consent refused Remarks: Parent (or Guardian) Name and Address: Telephone No. Record of calls and appointment for Special Vision Study: Appointment time By Date Person Contacted Remarks ___Fxamination Findings*: /~/ Normal 17 Abnormal Tests without Correction -- Binocular lateral phoria, distance (Code) Monocular distance score: Rt. Lt. Monocular near score: Rt. Lt. Tests with Correction -- Binocular lateral phoria (Code): Distance Near * Abnormals include: Lateral phoria at distance less than 6 or more than 16; tateral phoria at near less than 8 or more than 18; visual acuity code at distance more than 20 in either eye. 30 PHS 5133-2 BUDGET BUREAU NO. 68-568048 6-68 EXP. DATE 12/31/68 Special Vision Test Validation Study Examination Form HES =~ III Chicago, Illinois __ July 23-31, 1968 August 15-24, 1968 Name Date Time Case No. I. Phoria tests (without cycloplegics) (in diopters) Without Correction With Correction Distance Near Distance Near E=__ _. gl or E=__ _. the X= . we . X= % la II. Refraction (with cycloplegics) + + oy or Eve| = Sphere - Cylinder Axis dev. Acuity R. || ow _ ow CD 20/ oll , _ — ~~ 20/ _ Comments : Note: Phoria readings in whole diopters (E=esophoria, X=exophoria). 31 HEALTH EXAMINATION SURVEY—III COLOR VISION EXAMINER NO REPORT Wears glasses for test: 10 COLOR VISION TEST NO. 2—H-R-R (Continued) Wears contact lenses for test: 2 O PLATE | 1 in wv Wears neither for test: 3] v s COLOR VISION TEST NO. 1—Ishihara binocular test 7 0 0 [J other PLATE READ AS : 8 x 1 Oz [[] Other [] None Sih 2 Os i O3 [other 1 | Mi. Vv 4 Os i [2 [Jother oe 9 [J None 8 Oe { [J Other | 10 % x [J oth 10 Os : [] other 0 oO er 14 [J Other Os 5 5 17 42 ; 02 042 mn x < [1 Other {O04 D042 i 12 [J Other ! O Other vio v o : Mod. v 0 v SCORE: (If total score for plates 2-17 is 6 skip to page 2 of Vision R-G 13 2 O Other Form) COLOR VISION TEST NUMBER 2—H-R-R 14 7 vy v IT] [C] Other PLATE | Ik 15 x x [J Other olx Sev. O Oo 1 [] other R-G 5 5 16 BY v 7 [[] Other o 2 v [1] Other SCORE: (7 through 16) High = [C] Protan [7] Deutan 3 xz O Other < ry 17 { h vod 7 o | O Other ov ad ox x o 4 [] Other 18 [C] other R-G o 19 0 & St 0 other 5 [J] other Sev. v B-¥ X X 20 v 7 O Other 6 [J] Other X SCORE: (17 through 20) __ SCORE (1-6): High= [] Tritan [7] Tetartan PHS—4611-6 (PAGE 1) SAMPLE NO. (1-5) REV. 11-66 32 HEALTH EXAMINATION SURVEY—III DISTANCE VISION—WITHOUT CORRECTION VISION TESTS Check tests given first. [| Far [[] Near (Odd numbers distance first; even numbers near first) DIAL 1. BINOCULAR LATERAL PHORIA—DISTANCE (Check number nearest arrow) Oerof1 [Jr O2 Dd3 O« Os Qe O77 Os Oe dro On Ow Or Ow Os Owe 70w Os (Jw Qo On [J Right of 21 [J] Arrow or number not visible. Code 2. MONOCULAR DISTANCE—SMALL* 3. MONOCULAR DISTANCE—LARGE®* (Omit if score on Dial 2) : n Score . ) Line [Right eye (Check) Left eye Score Line |Right eye Score Left eye Score 5 | VHDNS OZKRC_50 | CDZNO KSRVH ___ 50 1 SDK ——400| VNC —400 6 | DVZINC SRHKO _40 | CNRKH ZVSDO.___ 40 2 | |[RCSZO OZNKS ne, 200) wee 300 7 | KNZCO SRDHV _30 | DVHCK OZINSR___30 2 | |[KNHDV DRHCV 8 | KNDRS ZVCOH _25| CDKRO SZVNH ___25 3 |HNZOS KRCVD ___100| RZOHC KSNDV__100 9 | VICHD KNRSO_20 | CVHSZ ORKDN___ 20 4 |ZHODC SVNKR __ 70| RKNCZ HSDVO__ 70 10 | KZSYN HCRDO _17 | DNVHS OKRCZ__17 11 | RCSNV KDHOZ _15 | ZHODC SVNKR__15 12 | ROKHZ NSCVD.__12 | KHOZD CSNVR ___12 CODE CODE TRIAL LENS FOR MYOPIA (Score in lines 1-8, Plates 2, 3— OMIT IF CONTACT LENSES ARE WORN.) Rghteye [1 OO O O O O O O sore 0 1 1.5 2 3 4 5 N.A. Left eye 0O O O O Oo oO Oo oO SCORE 3A. BINOCULAR DISTANCE —SMALL* 4A. BINOCULAR DISTANCE—LARGE® (Omit if score on Dial 3A) Line Score Line Score 5 OSDNH VKZCR —_ 50 i KDS — 400 6 RHZCD OSVKN ____ 40 2 | ZSKCO _ 7 SVNHO KCRDZ —__ 30 2 | VRHDN 8 RHSCK OZDVN —__ 25 3 ZNSKH VDRCO —_ 100 9 OZRVN HSCKD — 20 4 OZCRH NSKDV — 70 10 DRHVN ZSKCO — 17 1" OSKCV RZHDN —_ 15 12 SKHDN OCVRZ —_ 12 Code *Diagonal line through each letter missed; horizontal line through sections of line not attempted and through top full line not attempted. PHS—4611-6 (PAGE 2) SAMPLE NO. (1-5) REV. 11-66 33 HEALTH EXAMINATION SURVEY—III NEAR VISION—WITHOUT CORRECTION 6. BINOCULAR LATERAL PHORIA—NEAR (Check number nearest arrow) Otetotr 1 O2 O33 O44 Os Oe O7/708 Oe Tro On Oz Tis [ie Os Oe Oz Ow s70w O20 O20 22023 242s 2627 [0280029 [(J30 [Jar [32 [J33 [J right of 33 CODE 7. MONOCULAR NEAR—SMALL® 8. MONOCULAR NEAR—LARGE* (Omit if score on Dial 7) Line Right eye Store Left eye Score Line Right eye Score Left eye Score (Check) 5 | CVRZS DKHNO ___ 50 | ZKCRV OHSDN 50 | 1 | NCV ___ 400 | DSK — 400 6 | VZKCO HRSDN 40 | SDKVO ZRHNC — 40 | 2|| HNRCD CRSZO 7 | HSZKN OVCDR ___ 30 | DHZRV SOKNC — 30 2] VOSZK — 200 \ovHK mee: 200. 8 | OVRHS CNDZK __ 25 | DKOSN RVZCH —__ 25 | 3 | NDOCV RSZKH ___ 100 | OKZHS NCVRD 100 9 | ZHCOR VDNSK ____ 20 | RKZVD OSNCH ___ 20 | 4 | VRCNZ OSDHK ___ 70 | RCOVN DHKSZ 70 10 | RHCVN SDKZO ___ 17 | OKSRN DHVCZ ___ 17 11 | CNZSR OHKDY — 15 | VRCHN OZKSD —_ 15 12 | ODCNH VRSKZ — 12 | ROHKS VDNCZ 12 CODE CODE 9. BINOCULAR NEAR—SMALL* NS5. BINOCULAR NEAR—LARGE® (Omit if score on Dial 9) Line Score Line Score 5 OCVKR ZNSDH sin 50 1 NVC 400 6 ZHOCV NDRKS 40 2| CZHSN | 7 SDOVK HRNZC ___30 2 DKORV | sesri200 8 DNHKO ZSRVC ET 3 KSDVO NHZCR 100 9 DSVKH ZNOCR 20 4 VZOCS HRNKD — 10 NZHKO RCVDS we TF 1 SNCZO RKVHD 15 12 DHNVO SCZKR ne V2 CODE *Diagonal line through each letter missed; horizontal line through sections of line not attempted and through top full line not attempted. NEAR VISION—WITH CORRECTION 6. BINOCULAR LATERAL PHORIA—NEAR (Check number nearest arrow) Oterofr [01 J2 Os [Da Os Oe Ohws Owe Ow Oasys Oe O20 On (Oso Oar O32 [033 [J right of 33 [CJ Arrow or number not visible d7/00s Oo CODE Co On Oz Ohis Cha [(J22 (23 [J24 (2s [26 [27 [28 [29 PHS—4611-6 (PAGE 3) REV. 11-66 34 SAMPLE NO. (1-5) HEALTH EXAMINATION SURVEY—I1I CORRECTED VISION DISTANCE VISION—WITH CORRECTION 1 Lf Wain dns 2 [_] With contact lenses VISION TESTS DIAL I. BINOCULAR LATERAL PHORIA—DISTANCE (Check number nearest arrow) [J Lett of 1 Oy O2 Os O« Os/06 Or Os Oe Oro On Oh Chis Ow Os Dies Ow Ore The O20 On Od Right of 21 O Arrow or number not visible. Code 5A. MONOCULAR DISTANCE —SMALL* 3. MONOCULAR DISTANCE—LARGE® (Omit if Score on Dial SA) Line | Right eye — Left eye Score | Line | Right eye Score | Left eye Score 5 | KDZNV SHROC.___50 | CRNDO SVZHK _ 50 1 SDK —— 400 | VNC 400 6 | VKRNZ CODHS __40 | ZVCOH DRSNK __ 40 2 || RCSZO OZNKS : w— 200 sm 200 7 |HSDRZ NCVOK __30 | ZKHSO VCDRN __ 30 2 KNHDV DRHCV 8 [ZOVCS NRKDH _25 | HNVZS CKRDO __ 25 3 HNZOS KRCVD_100|RZOHC KSNDV._—_ 100 9 | RHSDK ONCVZ __20 | RHCYN ODSZK ___ 20 4 | ZHODC SVNKR __ 70 |RKNCZ HSDVO___ 70 10 | KNRZD OHVCS _17 | KRNHC OSDVZ___ 17 CODE een CODE 11 | KZODR HNSCV _15| SCHZID VKNRO ___. 15 4A. BINOCULAR DISTANCE—LARGE®* (Omit if score on Dial 3A) 12 [RYNSZ KCDOH ___12 | CNDZK OHRVS 12 a 3A. BINOCULAR DISTANCE SMALL" line Bee 1 KDS s— 400 Line Score 2 ZSKCO wewinee 200 2 VRHDN 5 OSDNH VKZCR —-1] 3 ZNSKH VDRCO niine VOD 6 RHZCD OSVKN —40 4 OZCRH NSKDV — 70 7 SVYNHO KCRDZ —-30 8 RHSCK OZDVN — CODE LENSOMETER READINGS » ORM HECKD —20 eve Lens +4 FIRST READING |+ SECOND READING] AXis 10 DRHVN ZSKCO a V7 Right 1 OSKCV RZHDN — 1.1 12 SKHDN OCVRZ pire 3 2 Left *Diagonal line through each letter missed; horizontal line through sections of line not attempted and through top full line not attempted. TRIAL LENS TEST FOR MYOPIA (Score in lines 1-8, plates 5A, 3) Righteye [J O O O a a Ol a SCORE 0 1 1.5 2 3 4 5 N.A. left eye [J 0 a O 0 O a O SCORE PHS-4611-6 (PAGE 4) SAMPLE NO. (1-5) REV. 11-66 35 HEALTH EXAMINATION SURVEY—III VISION —LANDOLT RING TESTS DISTANCE* (at 10 feet) WITHOUT CORRECTION WITH CORRECTION 1 [] With Glasses 2 [] With Contact Lenses LINE (Code) | RIGHT EYE LEFT EYE | BINOCULAR LINE (Code) RIGHT EYE LEFT EYE BINOCULAR 1 200 [OO [200 [OO [200 [OI 1 200 [1 | 200 [J |200 [I 2 wo [OO {100 OO [100 O 2 wo OO [10 Owe O 3 na OO zi4 [1 na OJ 3 na 0 714 O na OJ 4 so O| so O | s0 0O 4 so [J so | so O 5 393 [| 303 OO | 393 [OO 5 393 OJ 393 [| 393 O 6 286 [1 | 286 [0 | 286 [J 6 28.6 [J 286 [| 286 [OJ 7 2s OO] 25 0O | 2 0O 7 25 [OO 25 OO] 25 0O 8 na OO 214 [J 21.4 [J 8 2.4 [I ns O| 224 O 8 we O io O | 179 O 9 179 OO ize O | ze O 10 143 [J 13 OO as OJ 10 143 0 143 0 13 OO n 07 O wz O | wz O n 07 O 7 O | wr O CODE CODE TRIAL LENS TEST FOR MYOPIA —without correction (Score in lines 1-8 Monocular Distance—Omit if contact lenses are warn) Rgteye (J [OO 0O O OO 0O O [O score 0 1 1.5 2 3 4 5 N.A. teheye [1 OO O O O 0O O O scoke NEAR* (at 14 inches) TRIAL LENS TEST FOR MYOPIA — with correction (Score — em in Lines 1-8, Monocular Distance) LINE (Code) RIGHT EYE LEFT EYE BINOCULAR Right eye 1 200 [J 200 [J 200 [J ght eye 0 a 0 0 2 160 [J 160 [J 160 [J 0 ) 1.5 2 3 Left eye 3 125 [J 125 OJ 12s OO | y = 1 0 A L 0 a 0 4 100 [J 100 [J 100 [J | Righteye [J 0 0 score 5 so [J so [J so [J 4 5 N.A 6 so [J so [J # DO {wwewe 0 [OO [OO sco 7 50 0 50 a 50 0 LENSOMETER READINGS (glasses, contact lenses) 2 40 ul 40 u 40 0 EYE LENS | + FIRST READING |+ SECOND READING] AXIS 9 30 [J 30 [0 so OO | TTT TT 10 25 [J 25 [J 25 [1 Right 1 20 20 [1] 20 [] ~ | A eles CODE Left *Check acuity level reached. } I . wr’ PHS-4611-6 (PAGE 5) SAMPLE NO. (1-5) REV. 11-66 36 Series 1. Series 2, Series 3. Series 4. Series 10. Series 11, Series 12. Series 13. Series 14. Series 20, Series 21. Series 22, VITAL AND HEALTH STATISTICS PUBLICATION SERIES Originally Public Health Service Publication No. 1000 Programs and collection procedures.— Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data. Data evaluation and methods reseavch.— Studies of new statistical methodology including: experi- mental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory. Analytical studies.—Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series, Documents and committee veports,—Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birth and death certificates. Data from the Health Interview Survev.—Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey, Data from the Health Examination Survey.—Data from direct examination, testing, and measure- ment of national samples of the civilian, noninstitutional population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psycho- logical characteristics; and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons, Data from the Institutional Population Surveys — Statistics relating tothe health characteristics of persons in institutions, and their medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients. Data from the Hospital Discharge Survey.— Statistics relating to discharged patients in short-stay hospitals, based on a sample of patient records in a national sample of hospitals. Data on health resources: manpower and facilities. —Statistics on the numbers, geographic distri- bution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities. Data on mortality,—Various statistics on mortality other than as included in regular annual or monthly reports—special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses. Data on natality, marriage, and divorce,—Various statistics on natality, marriage, and divorce other than as included in regular annual or monthly reports—special analyses by demographic variables, also geographic and time series analyses, studies of fertility. Data from the National Natality and Mortality Surveys,— Statistics on characteristics of births and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, hospital experience in the last year of life, medical care during pregnancy, health insurance coverage, etc. For a list of titles of reports published in these series, write to: Office of Information National Center for Health Statistics Public Health Service, HRA Rockville, Md. 20852 DHEW Publication No. (HRA) 74-1333 Series 2 -No. 59 (e7 = Fo 0 Ng, x 0) 4 $s CASA The Rationale, Development, and Standardization of a Basic Word Vocabulary Test U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Vital and Health Statistics-Series 2-NO. 60 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 - Price $1.15 DATA EVALUATION AND METHODS RESEARCH Series 2 Number 60 The Rationale, Development, and Standardization of a Basic Word Vocabulary Test A methodological report on the conceptual representation and measurement of American-English basic word vocabulary acquisition. DHEW Publication No. (HRA) 74-1334 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration National Center for Health Statistics Rockville, Md. April 1974 NATIONAL CENTER FOR HEALTH STATISTICS EDWARD B. PERRIN, Ph.D., Director PHILIP S. LAWRENCE, Sc.D., Deputy Director DEAN E. KRUEGER, Acting Associate Director for Analysis GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System ELIJAH L. WHITE, Associate Director for Data Systems IWAO M. MORIYAMA, Ph.D., Associate Director for International Statistical Programs EDWARD E. MINTY, Associate Director for Management ROBERT A. ISRAEL, Associate Director for Operations QUENTIN R. REMEIN, Associate Director for Program Development PHILIP S. LAWRENCE, Sc.D., Acting Associate Director for Research ALICE HAYWOOD, Information Officer DIVISION OF HEALTH EXAMINATION STATISTICS ARTHUR J. McDOWELL, Director GARRIE J. LOSEE, Deputy Director HENRY W. MILLER, Chief, Operations and Quality Control Branch LINCOLN I. OLIVER, Chief, Psychological Statistics Branch HAROLD J. DUPUY, Ph.D., Psychological Advisor Vital and Health Statistics-Series 2-No. 60 DHEW Publication No.(HRA) 74-1334 Library of Congress Catalog Card Number 73-600251 PREFACE The National Health Survey Act of 1956 provides for the establish- ment and continuation of a National Health Survey to obtain information about the health status of the population in the United States. The re- sponsibility for the development and conduct of that program is placed with the National Center for Health Statistics, a research-oriented sta- tistical organization within the Health Resources Administration of the Public Health Service. The Health Examination Survey is one of three different programs employed by the National Center for Health Sta- tistics to accomplish the objectives of the National Health Survey. It is used to collect data by drawing samples of the civilian noninstitution- alized population of the United States and undertakes to characterize the population under study by means of medical, dental, psychological, and nutritional examination and various tests and measurements. In addition to the data collected by the examining, measuring, and testing procedures, a wide range of other data are collected concern- ing each of the sample persons examined. Therefore it is not only pos- sible to study the many potential relationships of the examination find- ings to one another but also to investigate the relationships of these findings to demographic and socioeconomic factors. The psychological component of the Health Examination Surveys is included to provide a more complete assessment of the health and well- being of the U.S. population, It is embedded in an interdisciplinary ap- proach in the study of mental health, psychologic relationships with medical and nutritional conditions, and of growth, development, and aging, Examination conditions and competing requirements for examina- tion time dictate that each examination component must be specifically designed to fit within these constraints, A long range effort is under- way to develop specific psychological examination procedures within an overall plan of psychological assessments that can be employed in these Health Examination Surveys. A first effort was directed towards developing a test that could be used in assessing level of development in verbal ability, Verbal ability was selected because of its central role in intellectual development and in formal human communications, The result of this effort was the development of a vocabulary test, the Basic Word Vocabulary Test, The rationale and development of this test are described in this report. The test was developed to provide a meas- urement instrument of word knowledge acquisition with two additional properties that are not extant in any other standardized vocabulary test. These two properties are reflected in its content representation (content validity) of a carefully specified population of words and in its range of application from about the third grade level of literacy to the highest level of word knowledge acquisition, These two properties per- mit assessment of a wide range of vocabulary development in terms of absolute level (as estimates of the word population) and relative standing in reference to various normative groups, i.e., age-education standing, on one continuous scale, With proper developmental work, assessment of vocabulary development can be extended downward to about 2 years of age and thus extend measurement-capability along the full range of this cevelopmental aspect of psychosociai functioning. CONTENTS Page Preface --------==--mmmmmmr mmm eee iii Functions of Language and Vocabulary Development---------occcmooomoo_o i Vocabulary and Language Development and Growth----------cccoee_. 1 Vocabulary and General Intellectual Development----------=---=c-co---- 2 Vocabulary and Human Communication----=--=--coommmmmmmmmma ooo 2 Vocabulary and Symbolic Thinking-----==-=-cemcommmmmmm meee 3 Vocabulary Tests and Cultural Biag-=-=-==cccmmmmmmm meee 3 Rationale of the Basic Word Vocabulary Test---==--ecceommmmmemmen ooo 3 Conceptual Representation------------m-mmmmm meee meee 3 Purposes and Objective == -==- o-oo mmm 4 Development of the Test-=-=-=- momo mmm meee eee eee 4 Defining the Unit of Measurement and Estimating the Word Population---- 4 Criteria for Establishing Knowledge of the Basic Words-----------c----- 7 Standardization === === === mmm mmm een 9 Procedure —=----- mmm mmm ee emma 9 Sex and Grade RelationshipS---=--=--cmcmmmmmm eee 10 Item Analyses------=c oom mmm eee 11 Grade and Age NOTmS--==-- comm mmm meme 14 Adult NOIrmS===-= momo mm ome mee eee 18 Other NOTmMS===--==c =o cm mm eee mmm mee 19 Use of Tables-==----omc mmm mm mmm oem 20 Alternate Short Forms ofthe BWV Toc mcm m mm mm eee 22 Special Short Form of the BWV T--ccmm comme eee o 23 Recommended Scoring Method--=--==-=ccccmmm mmm meee 26 Reliability and Validity---===--=--- comm mmm mmm 29 Reliability of the BWV T= ccm m mmm mee meee 29 Validity of the BWV Teo ceo mmm m meme meee 30 DISCUSSION === =m mmm mm mmm me ee em 33 Limitations == === - === mmm mm mmm meee 33 Growth and Development of Basic Word Vocabulary---------------c---- 33 Applications of the BWV Toc mmm mmm meee eee eee 34 Further Research and Development----=----ccommm mmm 35 CONTENTS—Con, Summary and Conclusion---=-----cm comme References -------=---m-mmmmm mmm mmm eee Appendix I. Brief Description of Dictionaries-------=----cccceee--o Appendix II, Listing of Nonbasic Words in 1-Percent Sample from Webster's- Derived, Variant, and Redundant Words----=--=--cccmmmmmmmmmmeoo Technical, Archaic, Foreign, and Slang Words------------c-ceeeeeoo Words Not Main Entries in all Four Dictionaries-----==------ccocooo-- Abbreviations -------- momo mm ee Hyphenated Words and Word Compounds=------==-----commmmmmmmmo Proper Names--------=---mmmmmmm mm meee ee Appendix III, Instructions for Administering the Basic Word Vocabulary Test in a School Situation----===--com comme Appendix IV, The Basic Word Vocabulary Test------=-ccmmmoommooooaao Appendix V. Scoring Method for Full Scale Basic Word Vocabulary Test and Answer Key------=-- comm mmm eee Appendix VI, Short Forms X, Y, and Z, The Basic Word Vocabulary Test---- Appendix VII, Scoring Method for Short Forms and Answer Keys----------- 37 38 38 39 40 45 46 50 53 S54 61 62 SYMBOLS Data not available-----------eemee eee Category not applicable-----------ceeeeemmmrecaaance Quantity zero Quantity more than 0 but less than 0.05----- 0.0 Figure does not meet standards of reliability or precision--------------s-eeeeeeeeenna vii THE RATIONALE, DEVELOPMENT, AND STANDARDIZATION OF A BASIC WORD VOCABULARY TEST Harold J. Dupuy, Ph.D., Division of Health Examination Statistics FUNCTIONS OF LANGUAGE AND VOCABULARY DEVELOPMENT Language has been devised and developed for all kinds of uses—for exciting attention, for the expression of feelings, for graphic description, for conveying instructions, for service in closely reasoned thinking, for scientific exposition, for disputation, for rhythmic delight, for gossip, and for abuse, Language serves to assist memory and facilitate thought; to communicate meaning and, when necessary or desired, to disguise it; to state intentions or merely to intimate their nature; to influence or control the actions of others; and to provide substitute satisfactions for those that would normally be gained by the exercise of bodily activity. Measurement of vocabulary has long inter- ested educators and psychologists because of its importance in language development and growth, its relationship with general intellectual develop- ment, its use in human communication, and its function in symbolic thinking. In studying the relationships of vocabulary size with language development and growth, pre- cise definitions of terms, measurement proce- dures used, and the nature of the measuring sit- uation must be clearly stated. Attention should be given not only to measuring vocabulary growth in terms of the increase in number of words avail- able for use but also in terms of the knowledge of range of definitions and precision of meanings given words may have, The strong relationship between vocabulary size and measures of general intellectual devel- opment has long been noted not only among in- dividuals in the normal range of general intel- lectual ability and maturity but also among the gifted, mentally retarded, and for children as young as 2 years of age. A person's ability to read and listen with understanding, to express himself accurately and precisely in speech and writing, and to use words effectively in symbolic thought processes is undoubtedly related to the number and kinds of words he understands and has at his command. Vocabulary and Language Development and Growth One of the earliest studies, cited by McCarthy,’ of the measurement of vocabulary in language development and growth was done by Feldmann in 1833, when he reviewed the reports of the vocabulary of 33 children. Since that time a great number of studies of language develop- ment and growth have been conducted in trying to estimate the size of the general English lan- guage and of individual vocabularies for different age and educational levels.'” However, these efforts have not been successful. These authors!" and others” have noted some of the difficulties in obtaining consistent estimates across different studies. These include differences among authors in definition, or even failure to specify some or all of the following: (1) definition of the unit of measurement— the word, (2) estimates of the word population, (3) basis for sampling, e.g., the size of the dictionary or the nature of the use sit- uation from which the sampling for the test was taken, and (4) criteria used in determining word knowl- edge. For example, criteria of word knowledge which may be applied are: (1) recognition of the commonest meaning of a word, (2) definition in the subject's own words, (3) proper use of the word in a sentence, citing an illustration, or naming an ob- ject, or (4) simply counting the number of different words used in a given context, Thus it is important when using a measure of vocabulary size in studying language development and growth that all these aspects of measure- ment be clearly stated and explicitly defined. Vocabulary and General Intellectual Development The strong relationship between vocabulary and general intelligence was noted as early as 1838 by the French physician Esquirol in his studies of mental retardates.” He concluded that the individual's use of language provides the most dependable criterion of his intellectual level. The first acceptable measure of general intelligence, the Binet-Simon Scale developed in 1905, also put special emphasis on verbal skills,” Terman’ in 1918 reported a correlation of ,91 between mental age and vocabulary with the Stanford Revision of the Binet-Simon Scale. He concluded that a mental age based on a vocabulary test could serve as well as the entire scale. Miner” in 1957 re- viewed 21 different studies of the relationship of vocabulary with more comprehensive tests of general intellectual functioning and found a me- dian correlation of .83. Practically all major gen- eral educational achievement tests and aptitude test batteries for use in school and occupational counseling and personnel selection and classifi- cation include a test of verbal ability. Those which do not are usually explicitly labeled as non- verbal or as performance tests of intelligence. Thorndike and Gallup in 1944 ? indicated the need, both in research and in practical projects, for some yardstick with which to measure adult in- telligence. Thorndike and Gallup,” and Miner ° used a 20-item structured vocabulary test in their respective studies of American adult in- telligence. In the two major tests used for indi- vidual testing of general intelligence, the corre- lations between the vocabulary subtest scores and the total test scores are .83, .82, and .83 for three adult age levels in the Wechsler Adult In- telligence Scale!” and range from .86 to ,96 for four levels of adult intelligence in the Stanford- Binet Form L-M,!! Miner concludes from his review that vocabulary tests correlate at least as well with tests of general intelligence as the more comprehensive instruments correlate with each other, It is also worthwhile to note that tests of vocabulary or verbal ability can be used as early as age 2 years if not earlier in the meas- urement of general intellectual attainment, Vocabulary and Human Communication Words are our principal means of commu- nication with one another. A limited vocabulary hinders, restricts, and confines the possible use of one's social and intellectual potential, Educa- tional level and attainment of positions in higher level occupations are closely related to the size of one's vocabulary, A person's vocabulary can be divided into two categories: active, composed of speaking and writing vocabularies, and passive, composed of listening and reading vocabularies. Among literate adults speaking vocabulary is gen- erally the most limited while reading and listen- ing vocabularies are the largest. Young children, of course, first build listening and speaking vo- cabularies and these predominate until the time when reading and writing skills have been suffi- ciently developed for effective use and further development, Note should also be taken of the many specialized vocabularies in technical fields and occupational trades, among cultural subgroups, and geographic region to mention only a few, Also, there are many meanings or definitions for a given word as well as differences in the depth or breadth of meaning expressed in a definition of a word. Vocabulary size alone does not insure effective communication but is a major tool in such ef- forts, 1.4.12-14 Vocabulary and Symbolic Thinking Words may be regarded as ''thought ele- ments'' in the complicated and intricate process of symbolic thinking. Watts,! for example, ex- pressed the relationship between language and thought along the following lines: "We find some- times that we have been thinking only after we have said what we have thought." He quotes other sources, "I talk so as to find out what I think— don't you?" "We must continue to talk about our- selves... till we know ourselves." 'l endow'd thy purposes with words that made them known," He cites others who have indicated that intellec- tual insights may have to be expressed and thus seen for what they really are before the individ- ual himself can accept or reject them, For ex- ample, an artist does not, in general, first form a complete image of what he wants to express but finds out what he wants to express by expressing it; he does not know what he will say until he has said it, and it comes as a revelation to himself, A great many thoughts, of course, occur before they are expressed in words. However, when thought is tentatively following new tracks and breaking fresh ground we must put our thoughts into words to make them known. Then we are able to find out what we think by expressing it. Vocabulary Tests and Cultural Bias A common criticism of vocabulary tests is that they are unfair to culturally disadvantaged persons. Every psychological test measures a behavior sample. Insofar as culture affects be- havior, its influence will and should be reflected in the test. The same cultural differentials that impair an individual's test performance are likely to handicap him in schoolwork, job performance, or any other activity correlated with performance on the test, Tests are designed to show what an individual car do at a given point in time, They cannot tell why he performs as he does nor can they tell how well he might have performed if he had been reared in a more favorable environ- ment, Tests should reveal the effects of cultural deprivation (and the effects of other conditions) so that appropriate remedial steps can be taken, To conceal the effects of cultural disadvantages by rejecting tests can only retard progress to- ward a genuine solution of certain social prob- lems," Certainly an English vocabulary test should not be given to a non-English speaking person and then interpreted as an indicator of his gen- eral intellectual development. However, it can be used to ascertain the level of acquisition of Eng- lish word knowledge. While there are many dif- ferent vocabularies, for example baseball, math- ematics, carpentry, and gambling, a general purpose vocabulary test should be based on a good sample of basic American-English words that reflect the vocabulary acquisition of the main- stream of the American-English speaking culture. Verbal communication is important in most of our activities both in receiving and transmitting useful information to the individual and to society. RATIONALE OF THE BASIC WORD VOCABULARY TEST Conceptual Representation The fundamental conceptual formulation is based on an assumption that if there is a pop- ulation, or subset, of basic or core words in the American-English language that can be identified and defined by a set of criteria, then the acquisi- tion of knowledge about these words can be viewed as a sample of behavior of psychological interest, The construct term ''basic word vocabulary'' when applied to a person or persons will be used to refer to a sample of behavior presumed to re- flect the acquisition of knowledge about this sub- set of words. It is postulated that if the acquisi- tion of a basic word vocabulary reflects growth and development in basic word knowledge, in gen- eral verbal ability, and in general intellectual ability, then the measured level of basic word vocabulary will increase with age in the early years and will be positively correlated with other indicators of verbal and intellectual ability. For a given measure of basic word vocabulary, its psychometric properties, functional relationship with early age, and magnitude and direction of relationships with other indicators of verbal and intellectual abilities for specific samples of in- dividuals are questions for empirical investiga- tion, Purposes and Objective The importance and value of measuring vo- cabulary size are consistent with the currentview among some psychologists 5 that psychological tests, including tests of general intellectual de- velopment or intelligence, measure the level of one's developed abilities, If a suitable means can be developed to measure the size of one's basic word vocabulary, then methods, techniques, and conditions can be explored and developed where- by the size of one's basic word vocabulary can be further increased. A distinction can be made between the size of vocabulary in absolute and relative terms, By ""absolute' is meant the total number of words in one's vocabulary. This can be estimated by one's knowledge of a representative sample of a given population of words. By ''relative'' is meant the size of one's vocabulary in relation to the vo- cabularies of other groups of persons. There is a need for having some idea of the absolute size of vocabulary at the elementary and high school levels so that growth in size can be assessed through the school years.” At the adult level such information would be useful in determining the extent of cultural or environmental deprivation, vocabulary deficiency, and the amount of change over long time periods in vocabulary development due to educational enhancement and other influ- ences and in assessing the level of communication skills required in different occupations. Thus the purposes for developing a struc- tured basic word vocabulary test are to provide a measure, within certain limits, of the approx- imate size of an individual's basic word vocab- ulary and to provide a standard of comparison of his level of verbal development with others of similar characteristics such as age, education, and education within age. The need to develop such a vocabulary test is based upon the fact that no current vocabulary test exists which purports to measure both the absolute and relative size of one's vocabulary. Two previous studies were found in review of the literature in which attempts have been made to develop vocabulary tests of absolute size, 5,12 However, both of these studies are outdated and they suffer from some weaknesses in methodology and procedures. They donot provide clearly stated criteria of the population of words that their sam- ple represents, or the criteria used in defining their "basic'' words (they appear to be main entry words from the 1937 and 1940 editions of the Funk and Wagnall's Dictionary), nor do they provide explicit criteria of word meanings used in deter- mining whether one knows a word. Thus the objective was to develop a basic word vocabulary test which can serve as ameas- ure of both the absolute and relative sizeof one's vocabulary. This required developing and explic- itly stating the criteria to be used in (1) defining the basic unit of measurement—the basic word, (2) defining the population of basic words, and (3) determining whether one knows a given basic word for the measurement of the absolute size of one's vocabulary. To measure the relative size of one's vocabulary requires administering the test to a number of individuals and developing standards of performance onrepresentative sam- ples with certain characteristics. The results of this research and develop- ment effort should provide a useful tool or instru- ment that can be used in studying the development and growth of language, the effects of experimen- tal procedures to promote language growth, and that can be used as a measure of general verbal and intellectual development with results com- parable to individually or group administered tests or test batteries of these general abilities, DEVELOPMENT OF THE TEST Defining the Unit of Measurement and Estimating the Word Population The following procedures were used in de- fining the unit of measurement and in estimating the size of the population of words. First a set of criteria was prepared for drawing a sample of main entry words from Webster's Thivd New International Dictionary.” This dictionary has three columns of main entries per page whichare labelled herein as A, B, or C from left to right. The criteria for defining a main entry word were: 1. Only main entries were considered, i.e., those words appearing in boldface type and printed at the left margin of the col- umn, 2. All homographs (main entry words spelled the same) for a given word were counted as one word. In the dictionary they are preceded by a superscript number, If the first homograph appeared in the column, it was counted as one word while succeed- ing homographs were ignored. If the sec- ond, third, etc., homographs appeared in the column but the first homograph did not, the word was not counted at all. 3. Prefixes and suffixes were not counted as words, but abbreviations were counted. 4. The letters of the alphabet were not coun- ted as words in any case. The procedures used in selecting the pages for the sample count were: 1. Pages which were numbered but contained no main entry words, only charts or graphs, were counted and subtracted from the total number (2,662) of dictionary pages. There were 13 such pages. 2. The first and last pages for each letter of the alphabet were counted separately. The middle column was used to obtain an estimate of the number of words on these pages. The number of main entry words was estimated by this method for 49 pages. The letter itself was never coun- ted as a word. 3. Of the remaining 2,600 pages, a sample of 300 pages was drawn. Every 10th page was used, starting with page 10, unless the page to be used was a first or last page of a letter or was a chart page. In that case, the next page was used, Forty additional page numbers were selected randomly in order to get exactly 300 pages. A count was made of the number of words in a column, either the left- hand column (A), the middle column (B), or the right-hand column (C). Columns A, B, or C were counted alternately and only one column per page was counted. Thus for each column A, B, and C 100 separate pages were counted and the count by columns was recorded separately. An analysis of variance among the three col- umns was computed and the differences in mean number of words per column were not significant at P = .10 level (F = 2,102 with 2:297 df), The mean or average num- ber of main entry words per column for these 300 pages was 30.2. The estimated number of main entry words in Webster's Third New International Dictionary, based on the 300 sampled columns, was 235,693. An additional 3,813 words were estimated from the first and last pages of each letter, The es- timated total number of main entry words was 239,506 with a 95-percent confidence limit of +10,610 words. The next step in the procedure was to select a l-percent sample of main entry words from a rounded population estimate of 240,000 for further consideration, One word was taken from every page of the Webster dictionary except from pages whose numbers ended in 1 (e.g., 1, 521, 831, 1061), The third word from the top of the column was chosen, In determining which word was the third, the same criteria were applied as were used for counting words in the population (i.e., not counting prefixes and suffixes, ignoring all but first homographs, etc.). If the page number ended in 2, 5, or 8, the third word from the top of the left column (column A) was chosen, The third word down in the middle column (column B) was chosen from pages with numbers ending in 3, 6, or 9. Column C, the right column, was used for pages ending in 4, 7, or 0. An example of the procedure follows: Column and Page Numbers 1 1 O00 UN A BO am N Pages 1, 11, 21, and so forth were skipped. If there were fewer than three usable main entries in the column, the page number was noted and the page was omitted, When this procedure was com- pleted, the total word count in the sample was 56 words short of the 2,400, the number necessary for al-percent sample, so 56 pages ending in the number 1 were sampled. Every fourth page end- ing in 1,(31,71,...)was sampled until 2,400 words in all were obtained. Columns A, B, and C were successively chosen as in the original procedure, The words thus chosen were classified into four categories: (1) compounds of two or more words and hyphenated entries, (2) proper names, (3) abbreviations, and (4) others or remainders. Compounds were entries made up of two or more separate words such as "cough drop." Hyphen- ated words were any entries in which a hyphen appeared in the spelling of the word. Words clas- sified as proper names were main entries fol- lowed by an indication that the first letter was always, usually, or sometimes capitalized. Ab- breviations were entries followed by the diction- ary indication abbrev. Only those words des- ignated as "others or remainders were further considered. There were 1,360 main entry words in this category. Next, three other major American diction- aries were consulted: The Random House Dic- tionary of the English Language," the World Book Dictionary," and Funk and Wagnalls New Standard Dictionary of the English Language.'® (See Ap- pendix I for a brief description of the four dic- tionaries used.) Any main entry from Webster's dictionary which was in the "other" category but was not a main entry word in any one of these other three dictionaries was put into a separate category. There were 979 such words. The 381 remaining words were main entries in all four dictionaries that were not compounds, hyphenated, proper names, or abbreviations in Webster's. The Random House dictionary was used next to determine if a given word among the 381 remain- ing words was defined as foreign, archaic (in- cluding obsolete or rare), slang or informal, or technical. This dictionary precedes a given def- inition with an italicized indication of these cat- egories, If the italicized limited-usage indicator preceded all the definitions, the word was appro- priately classified. If there was more than one kind of limited-usage indicator, the first meaning was used to classify the word, A total of 74 words fell within one of these categories. If the word was listed as a main entry in all four dictionaries and was not of limited usage as specified in Random House, it was considered further. The remaining 307 words were classi- fied as either derived or basic according to a set of criteria developed for this purpose, A main entry was considered a derived or variant word form if in any of the four dictionaries 1. The definition mentioned or referred to another form of the same word (e.g., beck: a beckoning gesture) or was simply adif- ferent tense form (e.g., supposed: sup- pose). 2. The definition was simply a different spelling (e.g. , calimanco: calamanco). 3. The definition was a different word which provided a fuller definition (e.g., boxberry: the checkerberry). 4, The entry was a combination of two or more words and the definition included a reference to one or more of the words (e.g., bookkeeper: one who keeps account books). 5. The entry word was a derived form with a base word and affix whose meaning could be understood with knowledge of the mean- ing of the word and affix (e.g., adiabatic: not diabatic). Thus a basic word is a single word form and not a proper name, abbreviation, affix or letter with a main entry common to the four major American dictionaries whose referent terms furnish acom- prehensive definition, and it is not subordinate to another basic word form of the same term or classified as foreign, archaic, slang, or technical. This procedure also eliminates simple, regular, or common variations of basic word forms such as words formed with affixes, plurals, compar- atives, adjectives, verb forms, etc. The complete set of procedures used here resulted in a final sample of 123 main entry ba- sic words in Webster's which were also main entry basic words in the other three major Amer- ican dictionaries. Since these words came from a l-percent sample, the population estimate is 12,300 (123 X 100) basic vocabulary words that were main entries in the four major American Table A. Number and percent distribution of 1l-percent sample of main entry words se- lected from Webster's Third International Dictionary by categorization of words Number of words Percent Categorization of words distribution l-percent | Population sample estimate All main entry words! --eeeemeecemmasnamenn 2,400 240,000 100.0 Checked only in Websters'S=-=-=-meeccmcaaaaaa 1,040 104,000 43.3 Compound or hyphenated=--===-cececoeecmmancaanann 715 77,300 32.3 Proper NOUNS = === === = mm mm mee mmm m meme mmm = 239 23,900 9.9 Abbreviationg=---===ccecm meee e meen 26 2,600 1.1 Not a main entry in 3 other major dictionaries? =cemmcmcm commen 979 97,900 40.8 A main entry in all 4 dictionaries=----=----- 381 38,100 15.9 Classified in Random House as: Technical ===-eccm mcr cm cee meme mem 50 5,000 2.1 Foreign---=--mmm comme mmo emma 14 1,400 +6 Slang =-==-== =m meee mmm eee mm meme 7 700 v3 Archaice=-mmmm mcm mmc eee ered eee 3 300 +d Derived, variant, or redundant 3--=--ceoecacaaoo- 184 18,400 i BASIC mmm mmm mm mm em ee meme 123 12,300 1 1 . . . : Excludes main entries which were prefixes, suffixes, first-listed homographs. letters, and other than the “Random House, World Book, and Funk and Wagnalls Dictionaries. 3Categorized by three psychologists (1 Ph.D.; 2 B.S.'s) according to specified cri- teria (see text). pennant, following penis in Webster's. dictionaires, With a population estimate of 240,000, a sample size of 2,400, anda 5.125-per- cent incidence of basic words in the sample, under simple random sampling statistics the population estimate of 12,300 could be expected to fall with- in the range of 10,200 to 14,400 witha 95-percent level of confidence (Guilford,!” p. 168). Seetable A for a detailed breakdown of results of these procedures. Criteria for Establishing Knowledge of the Basic Words Having concluded the process of sampling and having arrived at a final list of 123 basic words, the next step was that of developing cri- teria for establishing knowledge of the words. One basic word, penis, was replaced by the next closest basic word, This was accomplished by specifying criteria to be used in the actual test formulation and con- struction. Thus the whole procedure provides an operational definition for establishing knowledge of the words for the Basic Word Vocabulary Test (BWVT), Of course, many other operational def- initions are possible and if used, could be com- pared with this procedure, The form used was a five-choice multiple-choice test with each item containing a stem word or phrase, the correct response, and four distractors. Several criteria were developed to act as guidelines in the item construction, These cri- teria were stringently adhered to to assure con- sistency within and between items, Where pos- sible, the stem was the single word being tested, In a number of cases, however, it was advanta- geous to use a phrase to make the item clearer and to aid in adherence to other specified cri- teria, The criteria used for constructing the cor- rect responses were: 1. The correct responses were chosen to represent the most common meaning of the stem word as indicated by the World Book Dictionary. 2. The correct response was a less difficult word than the stem word; that is, it was a more frequently used word as deter- mined by the Thorndike and Lorge = word count,” 3. Where possible, the correct response was a single word synonym of the stem word. Where this was not feasible, a word or phrase was used to set the context of the stem word. 4, Explicit attention was given to avoiding alliteration between the stem word and the correct response in order to prevent giving clues, Where this was not feasible, distractors were chosen that also sounded like the stem word. 5. Explicit attention was given to balancing the length of words or phrases so thatthe correct responses were not consistently longer or shorter than the stem word and distractors. 6. Where applicable, the correct response was given in parallel form to the stem “A few exceptions to this criterion exist. 1. Some items were at such a low level of difficulty (AAA in Thorndike and Lorge) that it was impossible to con- struct adequate, correct responses at a lower level of dif- ficulty; therefore, they are at the same level of difficulty. This is the case for the following stem words: car, poor, thus, shore, advice, desert, event, stage, witness. 2. In the item with the stem word destitute, the possible correct responses (other than poor which was avoided because earlier in the test it was a stem word) were all at amore difficult level. In this case, the word needy, which was at the closest level of difficulty to destitute, was cho- sen. 3. In the item with the stem word glib, there was a lack of any feasible correct responses at a lower level of difficul- ty; therefore, the word fluent, which is at the same level of difficulty, was used. word in relation to tense and part of speech. The following criteria were used for con- structing the distractors: 1. The distractors were less difficult than the stem word and at the same or slightly lower difficulty level than the correct response, 2. The distractors were in parallel form to the stem word, the correct response, and each other in regard to tense and part of speech. 3. Spelling and sound similarities were avoided between the stem word and the distractors except where necessitated because of sound or spelling similarities between the stem word and the correct response, 4, Distractors were chosen to assure that they had no relationship to any of the def- initions of the stem word. 5. Effort was made to keep repetition of distractors (and correct response) to a minimum throughout the test, With the use of the above lists of criteria, the actual test items were constructed. The items were then ordered from easiest to most difficult according to the frequency of occurrence in the Thorndike and Lorge word count. Where there was more than one stem word at any specific level, they were listed alphabetically. There were 39 words which were not listed at all in Thorndike, and they were placed alphabetically at the end of the list, This was a tentative order of difficulty to be used until empirical data could be obtained and used to order the items by level of difficulty, The next procedure was to assign the posi- tion of the correct response (A, B, C, D, or E) to each item, The format used was that of randomly assigning within each group of 20 items an equal bOne exception to this criterion exists, that being the item with the stem word piffon and correct response pine. Because of spelling and sound similarities between stem word and correct response, it was necessary to choose distractors with similarities in spelling and sound. Since none were available at the same or lower levels of difficulty, more difficult distractors were chosen. number of A, B, C, D, or E correct response pos- itions. Equalizing the number of times any par- ticular response (A, B, C, D, or E) was the cor- rect answer was done to compensate for the effect of any tendency among some subjects to choose particular response options merely by position, This also insured that no particular position was overselected or underselected for the correct answer, thus eliminating a possible response cue, STANDARDIZATION Procedure The next step in the development of the Basic Word Vocabulary Test was that of pretesting., This process was conducted in two phases and served the purpose of collecting data on subjects" actual performances, The pretesting also provided the opportunity to obtain a critical evaluation of the test by the subjects. In phase one of the pretesting, 15 adults vary- ing in age (19 to 45 years), occupation (secretary, statistician, physician), and level of education (high school to M.D. and Ph.D.) from the National Center for Health Statistics were tested. The second pretesting phase was more extensive, as it included 133 subjects from a variety of sources with an age range from 11 to 61 years. The range of occupations and the educational levels of these subjects included housewives and students with as little schooling as the sixth grade and as much as the doctorate level. About SO of the subjects who participated in one of the two pretests were personally in- terviewed and asked to evaluate each item in re- gard to several criteria: 1. Could the correct response be logically derived even though the meaning of the stem word was not known? 2. Were there any alternatives which could be eliminated immediately because of lack of plausibility? 3. Were there any grammatical inconsis- tencies within an item? 4, Were there any clues given as to the cor- rect response by spelling or sound sim- ilarities between the stem word and the right answer? 5. Were there any items in which there was more than one possible correct response? 6. Were there any other general faults such as ambiguity within an item, poor item construction, or spelling? After each of the two pretests, this evalua- tive information along with the actual data on test performance was used to revise and reorder the test items from easiest to most difficult, The development of age and educational norms on the BWVT, studying criterion-related validity by comparison with scores on standardized tests of verbal achievement and performing other test and item analyses, required that the standardiza- tion study be conducted on a rather massive scale, Help from the public schools in Fairfax County, Virginia, was obtained, and 3,100 students in grades 1 through 12 were given the second re- vision of the BWVT, Data from the standardiza- tion study also served as a basis for selecting items for shortened forms of the test and for making final test alterations. Students at three elementary schools (1st-6th grades), at one junior-senior high school (7th- 11th grades), and at two high schools (12th grade only) were given the test at a time that was mid- way in the academic year (January 1970), Parents of these children were mostly military, govern- ment, or construction employees and thus rep- resent a diversity of parental background with respect to geographic origin, occupation, and social status. Children in 1st and 2d grades answered only the first 45 items of the second test revision, 3d graders the first 71, 4th through 6th graders the first 99 items, and students in grades 7 through 12 took the entire test of 123 items. In administering the test, teachers read only the instructions to the children. Since part of the purpose of this testing situation was to develop a measure of reading vocabulary level, no help was given on reading any test items or answer choices even in the primary grades. Given orally the test would not have achieved the same pur- pose. There was no time limit for completing the test; however, most examinees finished in about 30 minutes, The instructions also called for the examinee to guess when he did not know the answer, To provide external criteria for validity and standardization studies of the BWVT, scores on established nationally standardized tests of ver- bal achievement were obtained from the children's school records. Date of birth, sex, and school grade were obtained directly from each student but were also verified from school records when questionable or incomplete responses were noted. Sex and Grade Relationships In scoring the tests, a formula to adjust for guessing was used. Scores were arrived at by the formula w i 3 i Iw S=R- =~ or in this particular case §=p - id n- 4 (S = score, R = number of right answers, W= number of wrong answers, n = number of response options). Omitted items were not counted, Fre- quency distributions of the corrected scores and of the standardized test scores were prepared for each grade for each sex. Chi square was used to determine if there were any significant differences by sex on the vocabulary and standardized tests within grades. The distributions of scores for those students with both standardized and vocabulary test scores were split at their medians for eachgrade. There were no significant (.05 level or better) sex dif- ferences by grade for the standardized tests, and only the second grade had a significant difference (chi square=5,76; 1 df; p = .02) on the vocabu- lary test, with girls scoring higher than boys. An overall test combining all grades 1-12 ex- cept grade 2 was performed next, The sex dif- ference was not significant (chi square = 1.735; 1 df; p = .20), although girls scored slightly higher. Table B shows how the distribution of scores through the 12 grades assumes a definite pattern. The expected relationship between grade in school and vocabulary score can be seen here. Table B. Grade in school distributions by sex and by BWVT scores Grade in school Score range All and sex grades lst | 2d 3d 4th | Sth | 6th | 7th | 8th | 9th | 10th | 11th | 12th Total -- 3,100 255| 274 1 309 | 288 | 259 | 239 | 243 | 175 | 248 228 257 325 Sex Male---=-==--- 1,566 123 | 142 | 172 | 142 | 140 | 129 | 129 70 | 104 104 134 177 Female------- 1,534 132 132 | 137 | 146 | 119 | 110 | 114 | 105 | 144 124 123 148 Score range 91-104 ------- 68 - - - - - - - 3 5 9 15 36 81-90-------- 224 - - - - - - 2 15 23 36 52 96 71-80--neucum- 379 - - - - 1 31 12 29 72 65 79 110 61-70-----=-- 390 - - - 3 16 35 39 | 47 68 66 62 54 51-60-------- 330 - - 1 16 49 57 | 43 38 49 26 30 21 41-50--=----- 294 - - 11 36 62 53 52 27 18 20 9 6 31-40-------- 233 - 1 30 58 45 32 41 8 7 3 6 2 21-30-------- 236 - 12 47 72 42 25 24 7 L 2 4 - 11-20----==-=~ 281 8 45 a1 61 29 22 19 1 4 1 - - 1-10==------- 459 141 | 157 97 37 14 3 9 - 1 - - - Less than 1-- 206 106 59 32 5 1 1 2 - - - = - The results of these analyses indicated that sex differences in vocabulary level by grade were not sufficiently great to warrant separate distri- butions by sex and that vocabulary development has a strong positive relationship with grade level attainment as expected. Item Analyses Item analyses were performed to determine difficulty level, internal consistency, distractor effectiveness, and sex differences for each of the 123 words on the test, Starting with the 302 tests with scores of 81-109, frequency counts of right answers were compiled for each vocabulary item. (Note: 10 adults scoring 91 or more were added to the 68 students scoring 91-104 to provide more stability in the analyses at this level.) Even for this high level group, less than 20 percent (be- low chance) correctly answered five of the words. Of the 302 subjects inthe 81-109 score group, only 9.5 percent chose the correct answer for the word durbar, which was the most difficult item on the test and was accordingly assigned the rank of 123, The 41 items which were an- swered correctly by less than 70 percent of the subjects in this top score group were assigned ranks on the basis of the percent passing each item, To continue the rank ordering of the items for difficulty, eight overlapping vocabulary score groups of 20 points each were used (groups scor- ing 71-90, 61-80, 51-70, 41-60, 31-50, 21-40, 11- 30, 1-20), and the performance of the subjects within these score groups served as the basis for ranking the remaining items. These tallies made computation of percent passing each item possible and provided necessary information for checking for sex differences by items and for studying over- chosen or underchosen distractors (see table C), The percent of correct responses to an item was used to place the items in rank order within a given group. Items with greater than 70 percent correct responses were carried on to the next lower score level for ordering by difficulty level. When the final order had been established, Spearman rank order correlations were computed to compare this order with the Thorndike-Lorge word-count order and with the order used in the second revision. In the first case, the result was a rho coefficient of .794; in the second, a rho of 964. These results indicate that using the Thorndike-Lorge ordering to select correct an- swer options and distractors at equal or lower frequency of occurrence than the stem word was appropriate and that the rank ordering finally ar - rived at should be relatively stable across differ- ent samples of subjects. With the items arranged inorder of difficulty, a measure of internal consistency was computed. Chi square values were computed for each item by comparing the number of correct answers for the item with total vocabulary score within score groups of 40-point ranges at about the 40-percent to 70-percent passing level for the item. There were 19 items with chi square values which did not reach the .,01 level of significance. These were all from the top 34 most difficult items and probably reflect a lack of subjects with scores high enough (110 or better) to provide differential results, Table C summarizes these data, giving the final rank order of item difficulty, the per- cent passing each item in its score group, the internal consistency contingency coefficient, and estimated product-moment correlation for each item within groups with a score range of 40. The pulling power of the four distractors for each item was evaluated by computing the percent selecting each distractor among those failing the item within the 20-point score ranges used to rank order the items for difficulty, Distractors that drew more than 40 percent or less than 10 per- cent of the incorrect answers were replaced. These limits were beyond two standard errors for all groups from an expected 25 percent level, There were 90 distractors outside these limits and almost cne-half of the test items had one or more distractors falling outside this range. These distractors were replaced based on the initial criteria of distractor selection, Sex differences were checked for every word, using the data groups of 20-point score ranges, to determine which items were correctly an- swered more often by one sex or the other, There were 25 words on the BWVT with sex differences within these restricted score ranges that had a chi square value significant at the p = .05 level or better (two-tail test). Fourteen were signifi- cant at the .01 level or better and the other 11 were significant at the .01-.05 level. Of these Table C. Rank order of difficulty, percent passing, and coefficients of internal consistency within total test score groups for each BWVT word : 1 Rank order Percent of Internal consistency of Score group and basic word students difficulty passing item 123 122 121 120 119 118 117 116 115 114 113 112 111 110 109 108 107 106 105 104 103 102 101 81-109 (median 86.3, N = 302)” pococurante fuscoug===== tringle-=- QUA =mm=mm meme emcee eee eee ees m esse —————— anthemion-===s==seeseeccaceesnenecscsccnnnccncne= sarcophagus==emeecm ccc ccc cece meee dint=ee-ececeec ccc ccc ccc meee meme glib==va- soredium=- cinereous fetid=w=- whist==== triphthonge==e===eeemmcmc ecco nubilous apropos grackle- picador 71-90 (median 77.7, N= 592)2 trajectory==e=esemcmce meme emcccemm emma mackintosh=-- ETE e Te EE tt 61-80 (median 70.8, N = 704)" destituteeemmccmccccceccneccccccccmamancceanan mesquite albacore horde=-eeeecmc ccc ccc ccc cece ccccmee eee 9.5 13.6 18.5 19.6 19.8 20.3 20.7 22.6 23.8 24.5 25.0 26.5 26.6 27.1 28.6 29.5 32.0 32.9 33.4 34.9 34.9 37.2 37.7 38.8 41.1 45.8 46.8 47.0 51.3 52.7 53.0 54.6 55.1 56.3 60.1 60.5 61.5 61.9 62.5 68.7 69.3 50.1 55.4 55.9 56.8 59.8 64.4 64.4 64.9 66.8 68.2 47.4 52.2 55.6 58.6 62.4 62.9 66.4 69.1 57.1 62.4 62.5 63.2 (1 3) (1 any +229 .350 L470 477 .341 L433 .384 .328 «577 .547 .486 «559 .366 +399 .28 +29 «32 «29 «51 .38 .50 .30 «36 «53 .63 .64 46 .58 «51 bb .77 «23 .65 +73 49 «33 ! Internal consistency coefficients: €¢ = contingency coefficient; 7 = estimated product-moment coefficient (see P-338 of reference 19). 2 2/V = number of persons. *Not significant at .05 level. Not significant at .0l1 level. Table C. Rank order of difficulty, percent passing, and coefficients of internal consistency within total test score groups for each BWVT word--Con. : 1 Rank order Percent of Internal consistency o Score group and basic word students difficulty passing item c r 51-70 (median 62.4, N = 545)°—Con. 60 64.4 456 .61 59 49.1 «524 «79 58 49.5 «392 «52 57 51.1 .396 “33 56 52:7 419 .56 55 56.9 +320 43 54 57.4 +336 +45 53 99,2 +3153 42 52 60.3 .381 +3) 51 60.4 524 .70 50 | jOltmmmamcm meme accc ccc ccc 61.3 483 .65 49 | BOrge=mmmme-mm meee meme emma e eee ————— 63.1 404 .54 48 | stage==m==mcemmecccccmcccccccecececcce mee ————— 65.6 .268 .36 BT | JOINT mist 0000 tr A REA 0 67.7 .500 .67 46 | MANGO====m=ecemccccc cece cece meme ——— 67.9 «251 .34 31-50 (median 41.8, N = 443)> 45 | exclude=semmmom ccm cece eee 57:5 .596 .80 44 | pennant-ee=eemeeee emma 61.0 L470 +63 43 | MUEfmmmc mmm eee em 61.7 440 «59 42 | ghetto=mmmm-mmac ccc 64.4 «341 +72 41 65.17 «321 .70 40 68.2 . 547 «73 39 48.8 «333 .71 38 49.8 .506 .68 37 50.5 496 .66 36 52.7 «321 .70 35 53.4 «331 wll 34 54.0 476 .64 33 55.0 .493 .66 32 55.2 465 .62 31 56.2 .566 .76 30 56.3 S447 .60 29 57:4 467 «63 28 58.4 «546 lS 27 59.1 .500 «B87 26 67.6 .583 wi5 25 69.2 L403 «54 24 69.7 +3353 74 23 69.9 . 549 «23 22 | tOMb==mmmemcc cece ccc eceeeecc ce ————— 49.3 +3535 wie 21 | advicee=mecmmc cmc cece ae 53.5 .596 .80 20 | CriSp===smecmcccmccm ccc mmmema 56.5 «399 «33 19 | phony=eeeccm acme ccc ccc mccecccecce mere 58.5 «328 wil 18 | encyclopedia===-eccmccmccccccccc ccc ae 61.0 «559 .75 17 | pUSS==mcmccmceccc cece ecccceecc ecm ————— 62.4 .389 «52 16 | quite emma cmc cee 64.8 421 »30 15 | howl=emc ccm ccm meee mem 67.4 «581 iB 14 | ambush- 68.4 «3522 .70 13 | witness-=-- 69.7 .590 29 1-20 (median 9.7, N = 573)° 12 43.5 «625 .84 11 44,1 «541 do 10 47.4 . 59% .80 9 48.0 .608 wal 8 55.6 +382 .78 7 63.53 .672 .90 6 67.4 .669 «90 5 68.6 .569 «15 4 70.3 .670 «90 3 72.5 .656 .88 2 75.8 L611 +82 1 84.7 «363 49 Internal consistency coefficients: €¢ = contingency coefficients; 7 = estimated product-moment coefficient (see_ p.338 of reference 19). 2N = number of persons. Table D. BWVT words correctly identified significantly more often by one sex in rank order of difficulty with percent of students passing item and chi square Percent of students Rank order passing Chi BWVT word difficulty squaze Male Female Words better known by males 1. edacious==-===ccemcmmmme eee 116 29.9 17.6 t4.6 2. sarcophagus--=----ceecmmcnmnnaanan 105 42.2 24.3 10.8 3, TYUMMEY--======-e==cmmmmm ee mm mm 100 46.1 32.4 14.6 4, emir-----c-eccccmmmmmmemm meme n 98 54.5 37.8 7.4 5. grackle---cecem comme cee n 84 59.9 49.7 5.7 6. picador-------cccmcmcm mmm eeeeem 83 63.9 45.9 20.3 7. trajectory-------cmcmccmcceonoaa- 82 75.5 20.7 137.6 8. afflux------c-ccmmmcmmmmcmceeeee 80 62.6 49.0 11.5 9. bastion==--c--eeccmcmmnm ieee 78 52.7 39.4 13.3 10. mullet-==mmmocmmmcm meee e meme 77 64.6 51.1 13.1 11. rafter=----c-mcmmmcm meme 58 59.6 42.0 12,2 12. scavenge---=-=-m=m=ccmmmmmmooam 57 58.2 46.6 15.1 13. joltememccmmmmm meee mmm em meee 50 69.0 55.0 7.9 14. pennant------=-ccmeemccmnm ema 44 68.2 52.2 13.6 15. plateau=---=-cmcmeecmmm cee meem 28 62.9 52.8 5.1 16. ambuSh=-=--om cece mm mmm meme ee 14 39.9 30.5 +5.8 17. combat====cm cece meme meen emma 8 60.1 50.2 5,7 Words better known by females 1. abstracted--------cammcmccmncaann 93 45.5 62.2 9,2 2, fetid---mmmcmmcm mmm cece eee 92 48.7 60.1 +349 3, whigtememmmmm mmc meme meee em 91 45.3 60.8 14.8 4, pomander-------------eceooomomam 87 41.4 50.0 14,5 5. mackintoshe--=eecocccmcmaenaaonno 81 47.4 65.5 18.9 6. aghast------cecmomcc cmc cee 53 50.7 68.9 17.3 7. SNEer-=-==m-mmmmmme—mmmeeemmmmn 38 42.0 53.8 16.0 8. howl--eememmmmmm cece 15 36.5 45.3 14.0 1 Dagger indicates .01l level or better. words, 17 favored males, and 8 favored females, which is not a significant difference from an even split (table D). Thus while sex dif- ferences in terms of total score within grades were not great, certain specific words appear to be better known by one sex over the other at comparable levels of overall vocabulary develop- ment, Although this finding is not surprising, what is notable is that this was found for about one-fifth of all the words. These analyses indicate that the words in the BWVT form an orderly pattern of item dif- 14 significance level between .0l and .05. All others significant at ficulty at various levels of attainment, the order of difficulty was very stable across samples, the items have a high degree of internal consistency except at the highest level of difficulty, and that sex differences in word knowledge for about 20 percent of the BWVT items were significant. Grade and Age Norms Nationally standardized test scores of ver- bal achievement were obtained from school rec- ords for over 70 percent of the students who had Table E. whom administered Standardized tests from which scores were obtained from school records, by type of score, date test administered, and number and grade in school of students to Grade Stand - Date Number in ardized Type of score adminis - of school test tered students 12th--- SCAT! 10th grade: verbal-grade percentile 9/67 41 12th grade: verbal-grade percentile 9/69 235 11th---| SCAT! verbal -grade percentile 9/69 227 10th---| scar! verbal -grade percentile 9/69 222 9th----| SCAT! verbal -grade percentile 9/69 238 8th---- DAT > verbal reasoning 10/69 166 grade-sex percentile 7th----| CTMM> language 1.Q. 9/69 212 6th---- L-Tt verbal -grade percentile 1/70 225 5th===~ L~z} verbal -grade percentile 9/68 106 CTMM ? language I.Q. 9/68 27 4th---- A verbal-grade percentile 9/69 261 3d----- ct™MM® language I.Q. 9/68 29 L-T? verbal -grade percentile 1/69 120 2d====- MRRT ° grade percentile 9/68 98 CTMM * language I.Q. 11/68 27 lst---- MRRT ~ grade percentile 6/69 112 9/69 51 SCAT - School and College Ability Tests DAT ~- Differential Aptitude Test 3CTMM - California Test of Mental Maturity 41.17 - Lorge-Thorndike Intelligence Test "MRRT - Metropolitan Reading Readiness Test taken the BWVT, Table E lists these tests, which scores were used, when they were given, and the number of students by grade level, The means, standard deviations, and the product-moment correlation coefficients for the BWVT and stand- ardized tests are shown in table F by grade. Because the BWVT was too difficult for grades 1 and 2, and ages 6 and 7, these groups were not considered in the development of the normative tables. Development of age norms based on stu- dents 18 years of age and over were not attempted because these subjects had a sharp drop in mean vocabulary scores compared to the peak mean level for 17-year-olds. The BWVT means, stand- ard deviations, and total number with BWVT test scores for all students are shown in table G by education and age. The decision was made to construct a 23- level percentile normative table by grade with a median at the 50th percentile and an age de- viation table showing a BWVT Vocabulary Devel- opment Quotient (BWVT VDQ or VDQ) with a mean of 100.0, standard deviation of 15.0, and a scale midpoint range of 72 points (plus or minus 2.40 standard deviations on the normal curve), These values correspond, respectively, to the Differential Aptitude Test grade norms and the Wechsler intelligence scales IQ means and stand- ard deviations based on age specific means and deviations. Table H presents some psychometric properties of the grade and age norm scales, Standardized test score distributions were or- dered into the same percentile intervals as shown in table H. 15 Table F. Means, medians, and standard deviations for the BWVT and standardized tests and correlation coefficients, by grade in school and number of students Standardized tests BWVT Number Corre - Percentiles Grade in school JE acim Lo dents cient Stand - ton + ard 1 : evia Mean | Median devine Mean Median tion tion 12th-=-=m emma ee 276 .756 78.0 78.2 10.8 77.3 79.0 .84 llth-===ccem cme emmem 227 .766 71.5 72.58 13.9 63.6 64.0 1.02 10th-=--memmm ccm mem 222 172 68.4 69.4 13.9 64.7 62.5 .88 9th--commm mmm aman 238 .788 65,1 66.9 14.2 70.3 70.5 .89 8th-vemem emcee eam 166 .603 60.7 62.5 15.3 55.3 60.6 .98 Jthesecm mcm cece eem 212 L664 45.5 47.8 17:5 60.6 65.0 .98 6th-=cemem cm mem meme 225 .839 45.3 47.4 16.9 67.7 65.5 .94 Sthe=-ceeeccm cee 133 .760 38.2 40.2 17.0 54.4 54.1 94 4the-emmcmemm meme 261 .801 26.6 24.9 14.3 54.9 58.4 .86 3d=-memmmmm eee 149 461 14.4 1L.6 12.2 56.2 58.6 .76 2d= mmm mmm em 125 L450 5.8 3.9 748 59.7 63.0 1.04 lst=-mmmmmmm meme 163 .282 1.5 1.0 4.2 70.7 68.0 .89 1 ‘ Percentile ranks were converted to midpoint standard scores and then the means were transformed back to percentile scores. Standard deviations are in standard score units for the standardized tests. The basic method used in developing the nor - mative tables was to transform the BWVT raw scores to represent a normal curve distribution of cases and then into the distributions shown in table H. However, the sample had higher means and generally lower standard deviations on the standardized tests than the expected values of 50.0 and 1.00, respectively (table F). Significant skewness in distributions were also noted on the BWVT for some education and age groups when means and medians were compared. So rather than doing a direct transformation on the sample cases, the following procedure was used to trans- form the BWVT raw scores. The mean BWVT scores were computed for each percentile level of the standardized tests for each grade. The average of the mean BWVT scores in the nine percentile levels from 30 to 70 were then computed to obtain a mid-50th per- centile score for each grade. These averages were plotted on a graph along with the grade medians. The mid-50th percentile values were then smoothed by inspection and judgment to ob- 16 tain the ''constructed'' midpoint values. These values are shown below, Mid- a : Constructed Grade in : point v : Median midpoint school aver- pa age 12the==e=e==- 77.2 69.6 69.5 llthe-==cee=- 72.4 67.4 6745 10theee=emm== 69.2 64.6 64.5 9th-====- ——— 66.8 59.3 59.5 8th---eeenen- 62.4 | 258.5 53.5 Jtheeeeccaeae 47.0 | 46.8 46.5 6theemceeenu- 47.31 39.1 39.5 Stheeeeeeeee- 40.4 | 37.4 31.5 4theweeeeneee 25.4 22.3 22.3 3demmmmmem——— 13.2 10.7 10.5 2deemcmmeneen 4.7 4.2 4.5 lStememmennan 1.0 0.7 0.5 aThese two values appear to be serious- ly out-of-line as midpoint indications and probably reflect a pertubation due to the standardized test score used in these determination. Table G. Number of cases, Basic Word Vocabulary Test (BWVT) means, medians, and standard deviations of all sample cases by education and age Num=- Num- Grade in bar M Medi Span Ace bor Mis Yediz Stan school te ean edian | jevia-~ 8 at n ecLan devia- dents tion dents ion 12th====== 3251 75.94 77.18 11.67 17 years=-- 271 74.22 76.68 14.44 llthe===== 2571 70.57 72.43 14,22 16 years--- 250 | 71.22 72.17 13.57 10th====== 228 | 68.02 69.25 14,55 15 years=--- 222 | 65,50 67.59 15.27 9th-=m===- 248 | 64,65 66.77 14,32 8th-=-====- 175 | 60,14 62,40 15.23 14 years=--=- 221 65,18 67.56 15.53 Jtheeee=- - 243 | 44,19 47,00 18. 26 13 years=-=-=- 190 | 52.43 57.10 21.32 6th=-==== -— 239 | 45,29 47,27 16,72 12 years=-=-- 247 | 44,55 47.09 17.94 Sth====w==-= 259 | 38.74 40,35 16.68 4the==we==- 288 | 27.04 25.39 14.52 11 years=--- 234 | 41,31 44,25 20.55 3d=m==m m= 309 | 15.32 13.25 12,54 10 years=-=-- 304 | 34,24 35.21 19.32 2d ===== mmm 274 6.38 4,70 2487 9 years---- 277 | 23.40 22.00 15, 54 lst===m==- 255 1,54 1.02 4,04 8 years--=-- 264 | 13,21 10.50 12,03 Table H. Some psychometric properties of the BWVT grade and age normative scales Grade scale Age scale Percent of area Mid- under normal ’ $ Per - oint 3 : Percentile interval centile Win BWVT VDQ interval Mid- curve level ard point Cumula score Within tive 135-137------ccceu-- 136 1.07 100.0 G8, Bm mm mic messin 99 2.40| 132-134--mcmmceaana- 133 0.72 98.9 96.5-98 4mmmmccmannn- 97 1.96 129-131 --=mmmcceame 130 1.08 98.2 92.596, 4=emmmmmennnn 05 1.60 126-128=-=-mmccceae- 127 1.59 97.1 87.5-92 4=mcmcac ana 90 1.28 123-125 ccc mmemmeeam 124 2.22 95.5 Ty 85 1.04 | 120-122----cemccena- 121 3.00 93.3 77 + SBT Lor vive mms mi roe 80 .84 117-119--=mcomcmeaam 118 3.39 90.3 TD Bund, yon mio gi 75 .67 114-116===mmmmmm eee 115 4.84 86.4 hr Jy EE —— 70 +52 111-113 ---ccmm cme 112 5+79 81.6 BZ, SmB7 o Lyssa wimin vein ma wasn 65 .39 108-110---=-=cueuuamn 109 6.65 75.8 57, Sub freien ewe mis mins 60 .25 105-107 === == cmcmeuun 106 7.65 69.2 572 .5nT7 fumes moi 55 13] 102-104----mcemannn- 103 7.81 61.8 G7 , 5mB2 , lpmmm emo mime on 50 .00 99-101===-==-ccmmunn 100 8.04 54.0 42 Soli] Amiens wma 45 -. 13 96-98-=--mmmencea- 97 7.81 46.0 37.542 fee~mmnmmnn- 40 =.25] 93-95=-ccmmcccannaao 94 7.65 38.2 32.537 rmmcmnmmmmnn 35 -.39| 90-92--ccmmemcnaaaaa 91 6.65 30.8 27 .5mBD Lymm seamen 30 -.52 87=89=cccccmcmcaaa 88 5.79 24.2 22,527 4mm mmmmmmmmam 25 -.67 84=86=mmmmmmccme aaa 85 4.84 18.4 17.5-22 4mmemmcm meme 20 -.84| B8l-83emececcceaoa- 82 3.89 13.6 12.5=17 fmmennmmmn——— 15 ~1.04| 78=80==cccmcmmmncaan 79 3.00 9.7 7.5=12 mcmama 10 -1.28 715=7]mmmmmmmmme cena 76 2.22 6.7 3 0. ST line im mmm ms imo 5 -1.60 712=7bmcmcc ccm 73 1.59 4.5 1l.5=3.4mc=mummmmm———— 3 -1.96 69-7l-mccmmcceeeeeee 70 1.08 2.9 0.01. 4ruemmunmmcun—— 1 -2.40 66=68-=---cmmcmeeaaa 67 0.72 1.5 63-65-------ccceean 64 1.07 1.1 Table J. Cumulative percent of sample cases across grade and age groups by normative scale values for the BWVT and grade for standard tests Percent for Percentile grades 3-12 BWVT |Percent level VDQ for ages scale scale 8-17 Standard test BWVT 136-=--- 100.0 100.0 | 100.0 133=w== 98.1 97.6 97.1 130==== 97.3 95.0 93.5 127 === 96.2 86.7 87.3 124m=== 94,2 78.9 719.5 12le==-= 91.6 70.4 71.3 118==== 87.0 64.9 64.3 115m=== 82.1 60.0 58.9 112ee== 74.5 55.0 52.5 109===~ 66.4 48.0 48.4 106==== 55.8 42,2 41.7 103==== 47.4 37.6 36.5 100==== 39.1 32.3 32.3 97 mmm 30.4 28.5 27.4 Yjmmmem 24.7 23.6 24.1 9lewmmm= 18.7 19.4 19.5 88=mme= 14.1 16.1 15.8 85m=men 11.3 3.1 13.1 82mmmmm BS 9.5 9.6 79=amm= 5.4 5.6 5.4 76==n=~ 3.6 2.8 2.6 73mmam= 2.1 1.0 1.3 70m cma 1.1 0.3 0.2 67===== 0.5 64mmmmm 0.2 Actual Actual scale scale me- medi- dian====== 62.8 61.3 an==== 104.0 Scale mid= point Scale mid=- cumu = point lative cumulative per- percent=--=- 35.0 | 34.4 cent-- 34.8 Number of Number of stu- students=-=- 2,109 2,109 dents~- 2,500 The area under the normal curve for each median was then obtained in terms of standard deviation units (table G) above the constructed midpoints. The BWVT raw scores were then normalized for the upper end of the distributions from the medians. Since the distribution of cases falling below the constructed midpoints appeared to be fairly normal, the raw scores were nor- malized for the bottom half below the constructed 18 midpoints of the distributions. The standard de- viation values for the raw scores from the con- structed midpoint values to the medians were used to complete the normalizing procedure for that portion of each grade distribution. Some score adjustments were then made within grades to provide a set of symmetrical values across grades for the full grade and normative table array. Case distributions were then compared between the normative table and the standardized test distributions by percentile intervals for each grade, The distributions were very close and thus indicated that the normalizing procedure provided a scale representative of the normal curve for a normaily distributed sample. The age normative table was constructed in the same way as the table for education except that the constructed midpoint values were de- rived differently, The mean educational level for each age was computed and plotted on the ed- ucational abscissa and the corresponding BWVT score was read from the ordinate, After the nor- mative table was constructed, case distributions were made and carefully inspected. The distri- butions appeared to be well in line with what could be expected for this sample in terms of medians, standard deviations, and lower and upper limits of case distributions. The overall distributions for education and age are shown in table J. Adult Norms After completing the grades 3-12 and ages 8-17 normative tables, projections for higher educational levels and the adult population were made, Pretest results from 84 cases beyond the high school level, including 9 cases at the doctorate level, indicated a fairly orderly progression of BWVT scores for the upper educational levels, The projection was made basically through use of nor- mative data from the Nelson-Denny Vocabulary Test?! and, of course, on some assumptions. The Nelson-Denny is a five-choice vocabulary test with norms for 9-16 years of education based on thou- sands of cases, Gains in mean vocabulary scores from the 9th grade upward were computed for the two tests based on each test's 12th grade standard deviation, The relative gains in standard deviation units from 9th to 10th, 9th to 11th, and 9th to 12th grades were then computed for each test and are as follows: Nelson=- Grade change BWVT Denny 9th to 12the=meeeccneea-- .86 .86 9th to llth-==--eceeeeea-- .68 .60 9th to 10th=--=e-eeeccena- «43 “2 These relative gains were accepted as being close enough for projection purposes for constructing midpoint values to the higher grades. The Nelson- Denny relative gains were then computed for 12 through 16 years of education and applied to the BWVT. The decision was made to use the standard deviation method for obtaining score distributions within each educational level on the assumption that basic word knowledge development would be fairly normally distributed about the median at these educational levels, Since the standard devia- tions decreased from grade 7 upward on the BWVT, a further decrease at higher grade levels was assumed. The standard deviation was decreased from 11.67 at 12th grade to 10.0 for grades 13, 14, and 15 and then further decreased slightly for higher educational levels as shown in the norma- tive table, Midpoint values beyond those obtained through grade 16 were also assumed to increase with a slightly greater increase from 16 to 17 (entering graduate school) than from 15 to 16 and then to show only a very small increase by edu- cational level thereafter. Note should be taken that a gain of one score represents an increase in basic word vocabulary knowledge of a hundred words and that these values are beginning to ap- proach the upper limits of the estimated population of basic words, In developing the general adult normative table, figures from a U.S. Bureau of the Census report on the educational attainment of adults as of March 1970 were used to estimate the mid- point BWVT score. The median schoolyears com- pleted by age groups as of March 1970 are shown in the table below. The median of 12.2 years of completed education for the age group 21 years and over was used as the midpoint value for the adult population. The estimated BWVT score equivalent tc this educational level was obtained by linear extrapolation between the normative Median Age school years completed 18-19 years-=mmemememacmaaaaa 12.2 20-21 yearS-=-==cemmemccmmmnaa 12.8 22-24 yearS-em-mmmmeecccaacna 12.7 25-29 years-=--eeecccmmacenaa- 12.6 30-34 years---=--ccmcmcmaeeao 12.5 35-44 yearg----mmmmmmmemme————— 12.4 45-54 years---m-mememmccmeeeen 12.2 55-64 yearS-==emeemcmcccme———— 10.7 65-74 years----=cmemmmmmeeean 8.8 75 years and over-----e-ecee-- 8.5 (21 years and over)=-==--=e=a- (12.2) midpoints ot the 12th and 13th grades which repre- sent completed educational attainment of 11.5and 12,5 years, which is equal to a BWVT score of 73.85. The distribution of scores on the BWVT for the Vocabulary Development Quotient (VDQ) was assumed to be similar to the distribution of the 17-year-olds. The derived VDQ distribution was them plotted on normal distribution graph paper to obtain the corresponding percentile level distribution, These projections for adult norms are offered as a guide to what could reasonably be expected based on the methods and assumptions used. Calibration and standardization on large repre- sentative samples would provide a more desirable basis for such norms. However, these norms should be worthwhile and usable for reporting re- search for comparison purposes across studies until more definitive norms are established. Other Norms Two additional sets of tables were constructe.! in order to provide more precise normative values for education and age. Grade and age equivalent values were derived graphically by connecting the grade and age mid- point normative values with straight lines between the points and then reading the BWVT score ordinate value corresponding to a given grade and age abscissa value for years and months of edu- cation and age. Adjustment factors for time of testing other than the midgrade and age periods used in the normative tables for children were also derived by the same method used for the grade and age equivalent values, 19 Table K. Midgrade percentile norms for the BWVT Grade in school Percentile level 3rd 4th 5th 6th 7th 8th 9th 10th | llth 12th 99 -cmm mmm mmm 45+ 58+ 65+ 71+ 77+ 83+ 88+ 92+ 95+ 97+ 97 mmm mmm —— 40-44 | 53-57 | 61-64 | 67-70 | 73-76 | 79-82 | 84-87 | 88-91 | 91-94 | 93-96 95 mmm meee em 35-39 | 48-52 | 56-60 | 63-66 | 69-72 | 75-78 | 80-83 | 84-87 | 87-90 | 89-92 90 --=mmmmemmmem 30-34 | 43-47 | 52-55| 59-62 | 65-68 | 71-74 | 76-79 | 81-83 | 84-86 | 86-88 85 mmm mem meme 26-29 | 39-42 | 48-51 | 55-58 | 61-64 | 68-70 | 73-75 | 78-80 | 81-83 | 83-85 80-mmmmm mmm mem 23-25| 36-38 | 45-47 | 52-54 | 58-60 | 65-67 | 71-72 | 76-77 | 79-80 | 81-82 75mm cen 20-22 | 33-35 | 42-44 | 49-51 | 56-57 | 63-64 | 69-70 | 74-75 | 77-78 79 -80 70-mommm cman 18-19 | 30-32 | 39-41 | 47-48 | 54-55 | 61-62 | 67-68 | 72-73 | 75-76 77-78 65mm mmm —— 16-17 | 28-29 | 37-38 | 45-46 | 52-53 | 59-60 | 65-66 | 70-71 | 73-74 75-76 60--mmm mmm mma 14-15 | 26-27 | 35-36 | 43-44 | 50-51 | 57-58 | 63-64 | 68-69 | 71-72 73-74 55m mmm mmm 12-13 | 24-25 | 33-34 | 41-42 | 48-49 | 55-56 | 61-62 | 66-67 | 69-70 71-72 50-==mmmem mm 10-11 | 22-23 | 31-32 | 39-40 | 46-47 | 53-54 | 59-60 | 64-65 | 67-68 | 69-70 45m mmm mmm mmm mmm 8-9 | 20-21 | 29-30 | 37-38 | 44-45 | 51-52 | 57-58 | 62-63 | 65-66 67-68 40mmm em mmm ema 7 | 18-19 | 27-28 | 35-36 | 42-43 | 49-50 | 55-56 | 60-61 | 63-64 | 65-66 35mm em ———— 6 | 16-17 | 24-26 | 32-34 | 39-41 | 47-48 | 53-54 | 58-59 | 61-62 | 63-64 30mm —————— 5] 13-15 21-23 | 29-31 | 36-38 | 45-46 | 51-52 | 56-57 | 59-60 | 61-62 25 mmm mmm mm 4| 9-12 | 17-20 | 25-28 | 33-35 | 42-44 | 49-50 | 54-55 | 57-58 59-60 20mm —————— 3 5-8 | 13-16 | 21-24 | 29-32 | 38-41 | 46-48 | 51-53 | 54-56 56 -58 15mm mm em 0-2 3-4 | 8-12 | 16-20 | 24-28 | 34-37 | 42-45 | 47-50 | 50-53 | 52-55 10-mmmmm me ————— 0-2 3-7 | 10-14 | 19-23 | 29-33 | 37-41 | 42-46 | 45-49 | 47-51 ae 0-2 3-9 | 12-18 | 22-28 | 30-36 | 35-41 | 38-44 | 40-46 Jom mmm ————— 0-2 3-11 | 10-21 | 18-29 | 23-24 | 26-37 28-39 mi mim om a i wm 0-2 0-9 0-17 | 0-22 | 0-25 0-27 Median--==-===- 10.5 22.5 31,5 39.5 | 46.5 53.5) 59.5, 64.5} 67.5 69.5 The six sets of normative and adjustment The grade percentile level is read as a mid- values are shown in tables K-P, Use of the Tables While an individual's earned score on the BWVT is the best estimate of his performance, the user should be aware that the standard error of measurement is about 3 raw scores on the BWVT, 20 point value. Thus if an individual's score places him in the 60th percentile level for his grade, he did about as well as or better than 60 percent of students in general do at his grade level, The age Vocabulary Development Quotient scale is based on a mean of 100.0 and a standard deviation of 15.0 and has the same order of relationship in basic word vocabulary development interpretation as other test scores reported in IQ terms. As an aid in qualitative interpretation the classification is shown below. ' a Qualitative Percent Midpoint VDQ classification included 130 and above=====cmmc mmc Very superior 2.9 121-127 mmm m mcm meme Superior 6.8 I Above average 14.5 91-109emerecrc emcee meer mmm ————— Average 51.6 82-88 -mrcmmc ccc creer ccc nme em Low development 14.5 73-79 ccarecc crc ccc rca emma ———— Very low development 6.8 70 and beloWe=-=cememcccmcc mca Deficient 2.9 - Table L. Projected higher educational norms for the BWVT College education’ Undergraduate Graduate Percentile level n FEoshe SOPRO. Junior | Senior Master's level | Doctorate level 13 14 15 16 17 18 19 20+ 99-mmmm meee 97+ 101+ 104+ 105+ 108+ 109+ | , 110+ 111+ 97 mm mmm mmm ee 94-96 | 98-100 | 101-103 | 102-104 | 105-107 | 106-108 | 107-109 108-110 95mm mmm eee 90-93 94-97 97-100 98-101 | 101-104 | 102-105 | 103-106 104-107 90 mmm mmm mmm 87-89 91-93 94-96 95-97 99-100 | 100-101 | 101-102 102-103 85mm mmm 85-86 89-90 92-93 93-94 97-98 98-99 99-100 100-101 80=-cemmmme neem 83-84 87-88 90-91 91-92 95-96 96-97 97-98 98-99 75 =m mmm mmm 81-82 85-86 88-89 89-90 93-94 95 96 97 70mmmmm mmm mmm a 79-80 83-84 86-87 88 92 94 95 96 65mm mmm 78 82 85 87 91 93 94 95 60--cmmmmm meen 77 81 84 86 90 92 93 94 55 =mmmm mmm em 76 80 83 85 89 91 92 93 50-cmmmm mm mee 75 79 82 84 88 90 91 92 45mm ene 74 78 81 83 87 89 90 91 40-mmmmmmm meen 73 77 80 82 86 88 89 90 35cm mmm meee 72 76 79 81 85 87 88 89 30-mmmmmm cen 70-71 74-75 77-78 80 83-84 86 87 88 25 mmm mmm eee 68-69 72-73 75-76 78-79 81-82 85 86 87 20====mmmmmm em 66-67 70-71 73-74 76-77 79-80 83-84 84-85 85-86 15mmmmmmm cee 64-65 68-69 71-72 74-75 77-78 81-82 82-83 83-84 10-=--cmmcmeeme 61-63 65-67 68-70 71-73 75-76 79-80 80-81 81-82 Jemma 57-60 | 61-64 64-67 67-70 71-74 75-78 76-79 77-80 3mm meme em 54-56 58-60 61-63 64-66 68-70 71-74 72-75 73-76 lomemmmmmeeee em 0-53 0-57 0-60 0-63 0-67 0-70 0-71 0-72 Median-======-= 75.0 79.0 82.0 84.0 88.0 90.0 91.0 92.0 Standard de- viation====---- 10.0 10.0 10.0 9.0 9.0 8.0 8.0 8.0 "Highest year attending, completed, or attended to or beyond the midyear. 21 Table M. Midage vocabulary development quotients (VDQ) for the EWVT Age in years 1 VDQ 8 9 10 11 12 13 14 15 16 17 136~mmmmnnnnn=— 46+ 55+ 64+ 71+ 77+ 83+ 88+ 92+ 96+ 98+ 133 =m mien 44-45] 53-54 63 70 76 82 87 91 a5 97 130cvmmmcmenna= 42-43 | 51-52 | 61-62 | 68-69 | 74-75 | 80-81 | 85-86 | 89-90 | 93-94 95-96 LT mimi mim soins 39-41 | 48-50 | 59-60 | 66-67 | 72-73 | 78-79 | 83-84 | 87-88 | 91-92 | 93-94 124m cccccaccme 36-38| 45-47 | 56-58 | 64-65| 70-71 | 76-77 | 81-82 | 85-86 | 89-90 91-92 121==ccmeccam=e 33-35] 42-44 | 53-55 | 61-63 | 67-69 | 73-75 | 78-80 | 82-84 | 86-88 88-90 118«-mmemmmnne 30-32 | 39-41 | 50-52 | 58-60 | 64-66 | 70-72 | 75-77 | 79-81 | 83-85 85-87 115mm 27-29 36-38 | 47-49 | 55-57 | 61-63 | 67-69 | 72-74 | 76-78 | 80-82 82-84 112=mennennnnn= 23-26 | 32-35 | 43-46 | 51-54 | 58-60 | 64-66 | 69-71 | 73-75 | 77-79 79-81 109-~mmmmmmmnn- 19-22 | 28-31 | 39-42 | 47-50 | 54-57 | 61-63 | 66-68 | 70-72 | 74-76 76-78 LOD =m wm mmm 15-18 | 24-27 | 35-38 | 43-46 | 50-53 | 57-60 | 63-65 | 67-69 | 71-73 73-73 103===ceemcnnun 11-14 | 20-23 | 31-34 | 39-42 | 46-49 | 53-56 | 60-62 | 64-66 | 68-70 70-72 100=mmnnnnnnmn= 8=10| 17-19 | 27-30 | 35-38 | 42-45 | 49-52 | 57-59 | 61-63 | 65-67 67-69 Q7wmemmmnm————— 5-7 | 14-16 | 24-26 | 31-34 | 38-41 | 45-48 | 54-56 | 58-60 | 62-64 64-66 Oj imm wiom w wm me 41 11-13 | 21-23 | 27-30 | 34-37 | 41-44 | 51-53 | 55-57 | 59-61 61-63 9lmcmmcmcccam—— 3 9-10 | 18-20 | 23-26 | 30-33 | 37-40 | 48-50 | 52-54 | 56-58 58-60 B85 = re iment 0-2 7-8 | 15-17 | 19-22 | 26-29 | 33-36 | 44-47 | 49-51 | 53-55 55-57 Bm mm mimi wm 5-6 | 12-14 | 15-18 | 22-25 | 29-32 | 40-43 | 46-48 | 50-52 52-54 B12 ww imi wm we 3-4 9-11 11-14 | 18-21 | 25-28 | 36-39 | 42-45 | 46-49 48-51 79mm mmcmcacaae— 0-2 6-8 | 8-10 | 14-17 | 21-24 | 32-35 | 38-41 | 42-45 | 44-47 TO mw mimi mmm 3-5 5-7 | 10-13 | 17-20 | 27-31 | 33-37 | 37-41 | 39-43 Tm veri mm nr 0-2 3-4 6-9 | 12-16 | 21-26 | 27-32 | 31-36 32-38 FD ire oneness simi 0-2 3-5 6-11 [ 14-20 | 20-26 | 23-30 24-31 6 Tie asian 0-2 3-5 7-13 | 11-19 | 14-22 15-23 Glin mmm —— 0-2 0-6 0-10 0-13 0-14 Median 9.0 18.0 28.5 36.5 43.5 50.5 58.0 62.0 | 66.0 68.0 "Mean = 100.0; standard deviation = 15.0. To use the grade equivalent values, locate the in- dividual's score in the body of table O and then read his grade and school month coordinate values. Thus if the score is 45, the grade equivalent is 7th grade, 4th month, If the score is 72 or above, table L can be used to obtain higher grade level equivalence by reference to the nearest grade level midpoint (50th percentile) value, The grade equi- valent values thus correspond to BWVT scores cqual to the midpoint performance at that educa- tional level, 22 The age equivalent values are used and inter - preted in the same way as the grade equivalent values. Thus a score of 66 is cquivalent to the midpoint attainment of individuals 16 years and 5 to 9 months of age, or 16 years7 months. To use the grade and age score adjustments for time of testing in table P, note the time of testing and add (or subtract) the given value to the individual's BWVT raw score and use that score in the grade or age norms table, Table N., Projected adult norms by percen= tile level and BWVT vocabulary develop- ment quotient Percentile BWVT BWVT BWVT level scores vVDQ scores | 136-==w== 103+ 99m emmcmnn- 103+ || 133==aw-- 102 97mm 99-102 || 130-===-- 100-101 IE = wma 9598 | 197ecnsns 98-99 0m =nmnannne 91-94 || 19, 96-97 85=mm mmm 88-90 || 757 _~"°°° - 121-ammu- 93-95 80==cmmmmmm 85-87 || 118====u- 90-92 750mm cane 83-84 + 81-87 || 115--=--- 87-89 E3=mammmmmns 79-80 f| 112mmmmes 84-86 60-mmmmcmma- 77-78 {| 109==-=u- 81-83 55 mmmanae= 75-76 || 106==-=-=-- 78-80 Swear 74 [| 103w==men- 75-77 EV ——— 72-73 100-===-= 73-75 {Ow mmmmm——— 70-71 || 97===cu-- 70-72 35-mcmcmanan 68-69 || 94=-==-m-u- 67-69 30--=mmmmmmn 66-67 || 9l-===u-= 64-66 25=mmcmmmaen 64-65 || 88===-=-- 61-63 20-=mmmma—- 61-63 || g5mucuen- 58-60 ————— 37-60 || g9.uuen.. 54-57 10-=cemnac=n 51-56 79=cccnam= 50-53 a 41-30 | 7¢ " 45-49 ia 26-40 Eo - 38-44 bmn guis {| 73====- = 70=acamun 30-37 67mm 21-29 YR 0-20 Median 74.0 74.0 For individuals of 18 years and older the edu- cational norms tables should be used, since basic word vocabulary development is presumed to be highly related to educational level dueto selective factors as well as formal learning among adults, However, if a general adult comparison is to be made, then table N should be used, Alternate Short Forms of the BWVT Two alternate 40-item forms of the BWVT were developed from the pool of 123 items in the BWVT (short forms X and Y, appendix VI), Eighty items based on no significant sex differences and with less than three distractor changes were se- lected. A sample of 111 boys and 111 girls was drawn with equal score distributions from -8 to 104. The percent failing each of the 80 items was computed for this sample, and two pools of 40 items each were selected by cumulating the per- cent failing each item with those below it starting with the easiest two items to form the two pools. A second sample of 103 boys and 102 girls with equal and full score distributions was drawn for cross-validation purposes. Test papers were rescored for the two short forms for both samples. Means, standard deviations, and prod- uct-moment correlations are shown for the two forms in table Q. Score distributions were checked for each form and were tairly uniform throughout the scale length. Since the correlations between the two forms were uniformly high (,92 and above across sex and samples) and since both forms correlated .98 with the full scale BWVT for the total of 427 cases, equivalent score transforma- tions to the BWVT were constructed. The incre- ment in total score for each short form score was obtained by taking the average standard deviation for both forms and dividing into the standard deviation for the full scale BWVT for these cases. Then the Y intercept ""a'' was derived. The result- ant equation is Y' = 2,729(X) -3.769. Scores 0, 1, and 2 were given unit weights; then the Y' value was used for each short form score, Table R shows the BWVT full scale equivalent scores for both forms. When the short forms are used, the equiva- lent full scale BWVT scores can be used in the normative tables. These forms are recommended for use when {wo short forms are needed. The special short form described next should be used when only one short form is needed. Special Short Form of the BWVT A special short form of the BWVT with 41 items (short form Z, appendix VI) was constructed by selecting those items from the full scale which correlated highest with the verbal scores on the nationally standardized tests for grades 1, 2, 3, 4, 8, and 12. The procedure used was to divide the first grade into two groups, a high and a low score group based on their standardized test 23 Table O. Grade and age equivalent scores for the BWVT School month Grade in school i 2 3 4 5 6 7 8 9 10 12th==ccccccmccccccnccann= 69 69 69 69 70 70 70 70 70 71 llth=w=menennermneennnnn= 66 67 67 67 68 68 68 68 68 69 TO Fs nino ie rs cna nim 63 63 64 64 65 65 65 66 66 66 AD Fenn mim co wm A AT 57 58 58 59 60 60 61 61 62 62 8th-emeccccccaccccccaaana 50 51 52 53 54 54 55 55 56 57 Jtheeecacccc cc cc cece 43 43 44 45 46 47 47 48 49 49 btheeeeeccccc ccc cccm came 36 37 37 38 39 39 40 41 41 42 Sthew-==meccceeccccccaann- 29 29 30 31 32 32 33 34 34 35 Lth=ececacccccecemcnnnnan 19 20 21 22 23 24 25 26 27 28 30 eo 6 7 8 9 10 12 13 14 16 17 Usual school month====--- Sep Oct Nov Dec | Jan Feb Mar Apr May Jun Months of age to the nearest 15th day Age 0 1 2 314 5 6 7 8 9 10 11 17 years==memeemecmccccccecccacrcanmnn= 67| 67| 67 | 68| 68 | 68| 68 | 68 | 69| 69] 69 69 16 yearsee=--cecccccccecccmaccccann=n= 64 | 64 | 65] 65| 65 |66| 66 | 66 | 66] 66| 67 67 15 yearS=m=memmmemememcmecomaccsaanana= 60| 60| 61 | 61 | 61 | 62| 62 | 62 | 63| 63| 63 64 14 yearSe=smeeemecaccccccccececnccnnen—= 54| 533) 55( 36] 57 {57} 58153159 59. 59 60 13 years===emmmcecmcccccccconcancon== 47 | 48 | 48 | 49] 49 | 50| 50 | 51 | 52] 52 53 54 12 yearS=mmeemmeccccecccceccecanccansa- 40 | 40 | 41 | 41 | 42 | 43 | 43 | 44 | 44] 45] 46 46 11 yearS===eeccccccecccccmcec ccna 32133] 3413413536] 36, 37 38] 38! 39 39 10 yearS====ecccccccaccomcneccnnena— 23 | 242526 27 | 28] 28| 29 |30| 30] 31 32 9) yearS=mmm=mmmmcmmeccecemeaceceo—ama— 13| 14 15|16| 16 | 17] 18 | 19 | 20| 21 | 22 22 8 yearS==eememcmcccccccccmenc eee 4 4 5 6 7 8 9110 (11 11{ 12 13 Table P. Grade and age BWVT score adjustments for time tested from midpoint , 4-month age 3-month intervals Intervals Grade in school Age Sept. l- | Dec. 1- | Mar. 1- Nov. 30 | Feb. 28 | May 31 0-3 | 4-7 | 8-11 1.0 0.0 -1.0 17 years=========- 1.00.0 =1.0 1.0 0.0 -1.0 16 years--=======- 1.0] 0.0 -1.0 2,0 0.0 -1.0 15 years=-======== 1.00.0 -1.0 2.0 0.0 -2.0 14 years===------- 2.0 | 0,0 -2,0 3.0 0.0 -3.0 13 years==e--===--== 2.00.0 -2.0 3.0 0.0 -3.0 12 years===--===== 2.00.0 -2,0 3.0 0.0 -3.0 11 years===-====== 3.0] 0,0 -3.0 3.0 0.0 -3.0 10 years====-=c--== 3.00.0 -3.0 3.0 0.0 -3.0 9 years=--ve-===e= 3.01 0.0 -3.0 4.0 0.0 -3.0 8 years===w--e--a=- 4,010.0 -3.0 To nearest 15 days of age. interval 12 years, 4-7 months. 24 Thus 12 years, 3 months, and 16 days would fall in the Table Q. Means, standard deviations, and product-moment correlations of full scale BWVT and short forms X and Y, by sex within samples Sample 1 Sample 2 Item Total Male Female Male Female Number of studentS-=-=-=--ececae-a--- 427 111 111 103 102 Full scale BWVT Mean -==-=-== meme eeee ooo 47.4 48.8 48.9 46.4 45.5 Standard deviation--------ccccmaccaaa--- 30.7 31.7 31.8 29.5 29.4 Short form X Mean -===-c--cemmmm emcee cme mmm ema 18.6 18.8 19.2 18.1 18.2 Standard deviation-------=cc-cccccacaoa- 11.4 11.6 11.5 11.0 11:3 Short form Y Mean====-=m-ce mmm ecm m mcm m——— mn 18.9 18.9 19.6 18.2 18.8 Standard deviation--==--=ceccccmmcacaaaa. 11.1 11.1 11.4 11.0 10.8 Correlations Full scale BWVT and: FOrm Xe-=sm-omemmmmcem cme cm meee em .98 .98 +28 +27 .98 FOrm Ye--omecmcm mmm meme ecm cmm meee emo = .98 .98 +99 .96 .97 Form X and Form Y------ecmcamceemnoaooa- +95 .94 .99 .93 .92 score distributions. Chi square was used to select the most discriminating BWVT item, Item 1 was highly significant and was selected first, There- after the two most discriminating items out of each block of six items arranged by item difficulty level were selected, If the chi square values were not significant at the ,001 level, the next higher grade was used. The lastnine items were selected based on their internal consistency chi square values (table D), again selecting two in each block of six items, The 222 cases used in sample 1 for developing alternate test short forms were scored on the 41 selected items. Total scores were obtained first by the conventional R - W/4 scoring method and then by scoring the number of right answers through the 3d, 4th, and 5th errors and omitted items. Scoring through the 4th error and omits (4 - EO) yielded the same mean score as the R - W/4 method. The correlation coefficients between the full scale scores and the short form scores were .,948 and .979 for the R - W/4 and the 4 - EO methods, respectively. The latter two correlated .965. The 4 - EO scores also: correlated .961 with the scores obtained from the 82 items not in the short form scale. Seventh grade students were selected to further study the relationships of the short form Z, scored 4 - EO, and the BWVT full scale scores obtained by the R - W/4 method and scoring the 25 Table R. Equivalent full scale BWVT scores for both short forms X and Y Full Full Short form scale Short form scele score SEOTC scores Soars 40 -cccm emma 105 20--mecme mem 51 ER 103 19---ccmeem- 48 38mm me 100 18-ccocmeaa- 45 37 mmm eee 97 | 43 36---mcmemo- 94 16-=ccmmman 40 35 ccc 92 15-ccccmana- 37 frrermsan To [— x 33cm emma 8G 2 = 12 ww mmm me mise 29 32-mcmeeema- 84 —_—— m | Wom 2 30--mmemm a= 78 o "TTT TTT Er 21 29mm 75 Bs sonsnarmen 18 A 73 Tmeemcmmcea-n 15 27 meme meee 70 bomen mm 13 26--=cmemm mo 67 5) te atoms ssn om 10 25 cme 64 EE 7 24 momma 62 Bem 4 23 ccm 59 Dermrnesamen 2 22 cme mmm 56 lose ea 1 L ——— CE en 0 NOTE: Equation: Y' = 2.729(x) - 3.769 number of right answers through the 10th error (10 - E method, described in the next section). The relationships of these three scores with the standardized test scores from the California Test of Mental Maturity (CTMM) were also considered. The items for the short form had been selected based on four other nationally standardized tests (see table E). The seventh grade had not been used in this item selection procedure, and very few students used in grades 2 and 3 had CTMM test scores, Thus these students and the CTMM test scores can be considered an independent cross- validation sample. The product-moment inter- correlations among the three BWVT test scores and with the language, nonlanguage, and full scale CTMM scores are shown in table S, The short form correlated slightly higher with the BWVT 26 full scale 10 - E scores than with the BWVT full scale R - W/4 scores, It also correlated as well with the three CTMM scores as did the BWVT full scale R - W/4 scores. The BWVT full scale 10 - E scores correlated somewhat higher with all vari- ables compared to the BWVT full scale R - W/4 method. These results indicate that the short form correlated as well with the criteria as the BWVT full scale and that the 10 - E method may be a slightly more accurate scoring method than the conventional R - W/4 method. In order to check the relationship of the short form with the full scale BWVT at high score levels, 168 cases scoring from 70 through 109 onthe full scale were also scored on the short form. The means were 86.18 and 30.24 for the full scale and short form, respectively, The product-moment correlation was .881, which indicates that the short form functions quite well even at the high end of the full scale. The linear regression equations for the BWVT full scale (Y) from the short form Z (indicated as X) for the 222 persons in sample 1, for the 212 7th graders, and the high level sample of 168 per - sons are shown below, The general equation is: tee UH io We 5 X-%)+7 ay br) ( ) Sample 1 ) (31.758) Y'=.979 227) (X_17.87) + 48.85 (10.752) Y'=.979 (2.954X) - 2.83= 2.892X - 2.83 7th grade (17.524) ( 5.896) Y'=.906 (2.986X) + 2.43= 2.705X + 2.43 Y'=906 (X-15.97) + 45.63 Both groups (25.856) Y= 960 ( 8.769) (X-16.94) + 47.27 Y'=.962 (2.949X) - 0.79= 2.837X - 0.79 High level group (10.063) (4.999) Y' =.881 (X- 30.24) + 86.18 Y'=.881 (2.013X) + 32.56 = 1.773X + 32.56 Full Full The increment in the full scale scores for each Soon) Sow scale Sho} fom 2 eerie form Z score was obtained by dividing the standard score score deviation of the full scale by the standard deviation hmm emm eee 108 20 36 of the short form scored 4 - EO for the combined tN 106 y A———— 53 sample 1 and the 7th graders, The Y intercept "a" 0 i sr 104 1 Breuer 50 was also derived. The equation is Y' = 2,49X A 102 17- Risto Set 47 - 2.686. However, when the equation was applied at I 98 SE 42 the higher scoring levels, the equivalent full scale 35mm mm——— 96 TY, Zor ri 39 scores were higher than the mean full scale values 24 a —— x i; Si 36 obtained from the high level sample. The equation 3mm 90 ET 33 for this sample is Y'=2.013X + 25.307. Full scale FY wm 88 10=ssmmmmn 27 equivalents were computed by both methods and 4) a 86| 9-=-mmmmmm- 24 compared. Equivalent values converged at a full 28mm 32 Jrmmmmmnnne scale score of 86 for a shortform score of 30 and 0) Fvecen meine seg Z79 1 mmm mm— 15 then diverged for scores above and below 30, The 26 —— 74 5 a 12 first equation was used for deriving full scale 2 Smee L nme ? equivalents below 30, and the second equation was PY mmm 55 | Demme 3 used for scores 30 and above on the short form, 22cccccamen 62 lo=eeem -——— 1 Equivalent score transformations to the full scale 2lmmmmmmmme 59 | Oewemeeeea- 0 are shown at left. Scores of 0 and 1 were given Table S. Intercorrelations of some BWVT and CTMM scores of 7th grade students, by sex [115 male; 97 female BWVT full| BWVT full CTMM CTMM CTMM scale scale non - full Test and sex scored scored language language scale R - W/& 10 - E score score BWVT short form scored 4 - EO! Male--mmmmm momma .907 +947 «725 +439 +675 Female---=---cmcmm momo mmm oo +392 .920 . 646 426 +592 BWVT full scale scored R - W/4 | MALE mm mm mmm me mem mmm eee .954 722 .360 .633 Female — === mem mm mm mim mmm mie . 944 .643 .450 .610 BWVT full scale scored 10 - E VIET, re smn sce gs se os ss sl 0 744 .396 .673 Female--=-=weeecemcc meee meee . 654 467 +627 CTMM language score MBL im mimi io mms swim. i oo i 0 .679 sae Female-=-=-commcm meme eee .614 ve Variables: 141 items selected in terms of through 4th error or omitted item. correlations with standardized test scores. Scored 27 unit weights, and then the equations were applied to all scores 2 and above, Recommended Scoring Method Since the BWVT was developed from a sample (1 percent) of words selected from a defined sub- population of main entry words common to the four major American dictionaries, and since it is a five-choice test, adjusting or correcting for chance or guessing is necessary in estimating the number of words from the subpopulation that an individual would know if he were actually tested on all the words in exactly the same way as is done in the BWVT, The usual method for making adjustments for chance is to subtract the num- ber of items incorrectly answered (wrongs) di- vided by one less than the number of choices from the number of items answered correctly. Omitted items are not counted. The formula for the BWVT is R - W/4 = adjusted score. This formula of course assumes that when the indi- vidual has to make a guess, any one of the five choices is equally likely to be chosen. When the individual can accurately reject any of the distractors, his chance of selecting the correct answer is better than one in five. A common observation in the BWVT pretesting, however, was that when the words were in rank order of difficulty and the individual had missed several words he would indicate that he was "just guess- ing." Thus it appeared that when an individual had reached his upper limit of certainty of the correct answers, he in fact began to make random guesses for most of the remaining items, It was reported even from the school testing program that the items were easy up to a point and then they suddenly became difficult for the individual. In reviewing scored test records it was very ap- parent that after only a few errors the remain- ing correctly answered items assumed a random pattern, Thus for the BWVT there is an abrupt change from known to unknown words for each individual as he reaches the upper limits of the BWVT words known by him. These observations led to trying an alternative method of scoring the 28 BWVT. This method was to find the point where beyond a certain number of errors the number of correct answers for the remaining items would be at about the chance level of one-fifth and the score wouid be about equal to the adjusted score The point beyond the first 10 errors was found to satisfy both of these conditions when tried on 265 12th grade records. The method was simply to score through the 10th error and count the number of items answered correctly below that point, not counting omitted items. Since out of 10 errors one probably guessed correctly 2.5 items, then the number of items answered correctly beyond 10 errors when corrected for guessing should be close to this figure, Another way of studying this is to compare total scores from the adjusted method with the 10-error (10 - E) method. This was done for the 427 cases used in developing short forms X and Y of the BWVT. Tables T and U present the results of this study for mean differences and the product-moment correlations for the two methods. Since the mean differences are minor and the two scores correlate ,994, the 10 - E method provides essentially the same scores as the adjusted method. As can be noted in table T, the 10 - E method shows a much higher score than the adjusted method for the two inter- vals at 5 and below. This is because the 10 - E method does not yield a negative score, Since the norm tables place scores 0-2 in the lowest scale value for each group, this will not have any im- portant effects. Since the standard error for guessing can be computed from these data a further analysis was performed. Assuming that the obtained mean of 47.4 by the adjustment method is a true score for the 427 cases, guessing then occurred on the remaining 75.6 items (123-47.4). The standard error for guessing would be equal to 3.48 (v/Npq = 75.6 x .2 x .8). The standard deviation of the actual score differences was 3.87. Also the vari- ance due to guessing increases as the adjusted scores get lower and more items are guessed at, while in the 10 - E method this variance remains constant with a standard error of only 1.41. This suggests that the 10 - E methods actually reduces the error variance due to guessing. Table T. Number of students participating in the BWVT and comparison of 10 - E and R - W/4 scoring methods Numbers | Score | R - W/4| 10 - E | Dif- of in- Mean Mean fer- students | terval ence 427 -- 47.4 47.5 «ll LR 91-104 95.1 95.3 ms 38-nunn-- 81-90 85.3 85.2 -.1 40--amucmm 71-80 75.5 74.7 -.8 40 -cmmae- 61-70 65.5 65.0 -.5 41 mmm 51-60 55.3 54.6 -.7 A 41-50 45.0 45.4 4 33---=-=a 31-40 34.7 33.7 -1.0 42 cme 21-30 25.5 25.4 -.4 Ly | — 11-20 15.2 15.4 «2 19-~~=su= 6-10 7.8 8.1 3 20----m--- 1-5 3.0 5.4 2.4 26 «=~ mim -6-0 -2.8 1.6 4.4 The 10 - E method is also much easier to use in scoring, since one stops at the 10th error; it is also much easier to use in computing the final score, since only 10 errors have to be counted plus only omitted items up to that point, which are rare inasmuch as mostomitting occurs beyond the 10 - E level. When there are no omitted items, the most usual case, all one has to do is subtract 10 from the number of the 10th error item. Thus if the 10th error occurred at item 67 and there were no omits to that point, 10 is subtracted and the final score is 57, } Another final point in favor of the 10 - E method is that whole number scores are obtained at all points. In the adjusted method for the BWVT one obtains decimal scores most of the time, i.e., in R - W/4 with 62 right, 61 wrong, the adjusted score would be 62-61/4 =62-15.25 =46.75. The practice used in the scoring of the BWVT was to round to the nearest whole number. However since the decimal values include .25, .50, and ./5, the values .25 and .50 were dropped in all cases before subtracting from the number of right answers. Since the even-odd rounding practice is hard to explain and use by most test scorers, this was not used. However, when scoring the BWVT this way, score gaps occur at every five-point interval, i.e., 120, 115,110, 105, etc., unless some of the 123 items were omitted. The 10 - E method is the recommended procedure for scoring the full length BWVT, The short forms are scored through the 4th error but omitted items are counted as errors and 4 subtracted from the 4th error or omitted item number. Thus if an individual made two errors and omitted one through item 15 and then missed or omitted item 16, his score would be 12 (16-4). Table U. Product-moment correlations of 10 - E scoring method with R - W/4 scoring method by sex within samples Sample 1 Sample 2 Score range Total Male Female | Male Female Number of studentS=s=e-e-cceccccccccccacacnaa- 427 11) 11} 103 102 Full range==s=-eeeceecccccccncccnncacan- «994 .989 «994 «9293 .998 R - W/4 Scores 51 and more-====e=eecccccaaa-- 272 +271, +972 974 .971 R - W/4 Scores 50 and less===-emmccccccccaaa-n .970 .949 .980 «973 .976 29 RELIABILITY AND VALIDITY Reliability of the BWVT Test reliability refers to the accuracy (con- sistency and stability) of measurement by a test, Several estimates of the internal consistency of the BWVT were obtained from the standardization sample. As indicated in the subsection on Item Analy- ses, chi square values were computed for each item within groups with a 40 score range. All chi square values were significant except for 19 items in the top 34 most difficult items, Table C also shows the contingency coefficients derived from chi square and estimated product-moment co- efficients for each item, Eighty-four of the items had contingency coefficients above .300, which corresponds to product-moment coefficient esti- mates of .400 and above. Internal consistency estimates of reliability were also computed at different test score levels as shown below, Number BWVT score range of Reliability items 81-109 ~mmnmmmnmmn nm 43 .693 7 LO mm sna smn vm on ve 20 .892 61-80 ~mmmmnmmmm——— 20 .889 51~70~erennm—————— 20 .905 LY ml mamma coms sos im we 20 .896 BL 50 wim mn 20 .915 21=40~=rrmemmm mm ——— 20 «950 11-30 ~~ mmm mammmm— 20 .948 1-20 =r mmm mma 20 .932 These results are consistent with the item analy- ses data and indicate very high levels of internal consistency even within ranges of only 20 score points. The correlation of ,95 between the two short forms X and Y of the BWVT also provides a basis for estimating full scale internal consistency reliability by the Spearman-Brown formula (p. 458 of reference 19). The coefficient is .97. The 41- item short form Z also correlated .961 with the scores obtained on the remaining 82 items. Taking the mean of 60.14 and the standard deviation of 15.23 for the 8th grade (table G), the 30 following estimate is made. The standard error for guessing is 3.165; dividing this by 15.23. squaring the results and subtracting from 1.000 gives an estimated reliability of .957, These results indicate that the overall inter- nal consistency reliability of the BWVT is close to .96, which is about as reliable as a five-choice test can be, which is about .96. Assuming a stand- ard deviation of 15.0, the standard error of measurement is 3.00 raw score points. No data are available on test-retest overtime or alternate form reliabilities. Validity of the BWVT Validity information indicates the degree to which a test is capable of achieving certain aims. The Standards for Educational and Psychological Tests”” describe three aspects of validity cor- responding to three aims of testing and arenamed criterion-related validity, content validity, and construct validity. Critervion-velated wvalidity,—Criterion-re- lated validity aims at estimating an individual's present or future standing on some variable of particular significance that is different from the test, It is demonstrated by comparing the test scores with one or more external variables con- sidered to provide a direct measure of the characteristic or behavior in question, This com- parison is most commonly shown by correlating the test score to a criterion measure, The BWVT scores were correlated with several criteria obtained from the standardization sample. These were education, age, test scores on the verbal sections of five different nationally standardized tests, and test scores from five different tests of the Sequential Tests of Edu- cational Progress (STEP) and the School and College Ability Tests (SCAT) published by the Educational Testing Service. Table F presents the 12 correlations of the BWVT with the verbal sections of the five standardized tests, The median correlation was .76. The low correlations for grades 1, 2, and 3 are consistent with the findings that the BWVT is too difficult at these levels when given as a reading test, Thus there was not enough differentiation on the BWVT to show the full range of individual differences. Also the standardized tests had been administered up to 18 months earlier than the BWVT (see table E) which means that at the early ages of 6, 7, and 8 considerable differential changes in level of achievement had probably occurred. Eta correlation coefficients were computed for education and age because the BWVT had a curvilinear relationship with them, The BWVT test score was the dependent variable. Eta co- efficients were also computed for the STEP and SCAT tests. These test scores were the dependent variables. The correlations are shown in table V, The means of the arrays for STEP and SCAT were linear and positive. All the correlations are statistically significant at better than the .01 level Table V. Eta correlations of BWVT with various criteria Number of Corre- Leen stu- lation dents Educational level Grades 3-12------- 2.571 .806 Grades 3-7 -----cmemeaeo- 1,338 .600 Grades 8-12--cccocaoao-o 1,233 .361 Age Ages 8-17 years---| 2,500 «773 Ages 8-12 years--------- 1,326 «351 Ages 13-17 years-------- 1,174 412 Sequential Tests of Educational Progress Reading ---------- Boys --- 99 .696 Girls -- 116 .756 Writing ---------- Boys --- 102 .683 Girls -- 117 +107 Science-=------=-- Boys --- 99 .606 Girls -- 119 .662 Math----ce-mee=u- Boys --- 98 +332 Girls -- 119 +315 School and college ability tests! Quantitative----- Boys --- 104 .602 Girls -- 1¥9 .377 grade 10 and are as high as, ifnot higher than, most corre- lations found between two tests specifically de- signed to measure the same general factor from two different nationally standardized tests, These results indicate that basic word knowledge level of attainment as measured by the BWVT is highly re- lated to educational and age level for children and relates quite well to subject matter achievement in four areas including science and mathematics. Content wvalidity.--Content validity aims at determing how an individual performs at present in a universe of situations that the test situation is claimed to represents. The Standards give an example of content validity wherein a vocabulary test might be used simply as a measure of present vocabulary, the universe being all words in the language. A useful way of looking at this universe of words is to consider it tocomprise a definition of the achievement to be measured by the test, The BWVT test was developed from a l-per- cent sample of words that were defined as basic words based on several explicitly stated criteria, The population source of basic words was also explicitly defined. Two problems of content validity seem par- ticulary relevant for the BWVT, The first problem is concerned with the size of the estimated popu- lation of basic words. This population was esti- mated based on a 1-percent sample of the esti- mated number of main entries in Webster's Third Inlevnational Dictionary of the English Language. The best method for determining this population is to go through all the main entries and the other steps that were taken to obtain the full population. Efforts are underway to do this now, Until this is accomplished an estimate of the size of one's basic word vocabulary knowledge as measured by the BWVT is subject to con- siderable variance, The second problem relates to how accurate the BWVT is in estimating knowledge of the popu- lation of basic words even though it may be some- what more ci less than a l-percent sample of such words. Results from the item and the inter- nal consistency analyses and short forms analyses indicate that the BWVT covers a wide enough range of basic word knowledge acquisition and provides reliable measurements throughout the range except possibly at the verv top; hence 31 accurate estimates can probably be made when the population of basic words is finally determined. The heart of the notion of content validity is that the test items constitute a representative sample of the content universe to which a general- ization ran be made, The procedures that were used in drawing the sample were designed with the explicit purpose of providing a basis for inferring content validity, How adequately this was accom- plished must be checked by a logical evaluacion of these procedures and by comparing this sample of words with other samples or the population itself, Construct validity,— Construct validity aims at providing a basis for inferring the degree to which an individual possesses some hypothetical trait or quality (construct) presumed to be re- flected in the test performance. The Standards provide an example where a vocabulary test might be used as a means of making inferences about "intellectual capacity." Construct validity is evaluated by investigating what qualities a test measures, that is, by determining the degree to which certain explanatory concepts or constructs account for performance on the test. To examine construct validity requires a combination of logi- cal and empirical attack, A simple procedure for investigating what a test measures is tocorrelate it with other measures or tests, Construct validity is relevant when no existing measure is acceptable as a definitive criterion of the quality of interest, or when a test will be used in so many diverse decisions that no single criterion applies. The logical basis from which the BWVT test was constructed was to develop a vocabulary test with content validity as a sample from an ex- plicitly defined subpopulation of words to which the construct term "basic word vocabulary' was applied. The properties of this construct, and the behavioral domain it represents, were explicated by means of a set of specific criteria which pro- vides its operational definition rather than by logi- cal linguistic analyses. An assumption implicit in the construct formulation is that one's basic word vocabulary forms the core of one's larger vocabulary. Webster's Dictionary was selected as the population from which to start because of its comprehensive coverage and its authoritative 32 standing. Abbreviations, hyphenated words, com- pounds of two or more separate words, and proper nouns were included and recorded separately in the 1-percent sample count but not considered later because they were viewed as developed, perhaps fairly temporal, phrases or expressions which did not coincide with the objective of de- termining the fairly basic or core words in the American-English language. The other three major American dictionaries were used toarrive at a set of words on which there was a type of consensus of their relevance in the American- English language, Foreign, archaic, slang, and technical words were considered as representing specialized vocabularies. The derived, variant, or redundant words, of course, were not con- sidered as basic words by definition. The procedures followed to the point of dif- ferentiating basic from derived words were straightforward and mechanical. However, the development of the criteria used for differentiat- ing basic from derived words represent con- siderable thought, evaluation, and deliberation. The criteria were applied by other individuals in the tedious and detailed work of sample selec- tion, population estimation, and cross-checking the four dictionaries. The whole procedure should be given careful attention in evaluating the prop- erties of the basic word vocabulary construct and in using these criteria, because any deviation will yield different results, The method usedin arriving at the operational definition of a basic word was logico-heuristic. The task was not begun with a well-defined or explicit idea of what constitutes a basic word but began with the general notion of a basic word vocabulary domain from which a sample could be extracted for use as a basic word vocabulary test. The general notion and the method to follow had been germinating for 10 years in thought and studies of vocabulary development, The decisions related to starting with main entries from Web- ster's, what to consider as a mainentry word, the size of the sample (1 percent), and the major categories used in classifying the sample of main entries were made prior to actually starting the final task. The elimination of certain categories and the use of the other three dictionaires were decided on after looking at the sample of main entries. The criteria that were used for differ- entiating basic from derived words were developed by careful study of the last 307 words and their definitions, If a word and its definitions appeared not to fit the general notion of what constitutes a basic word the question "Why not?" was asked, This led to the development of an explicit state- ment of how it differed from other words in the sample which had been considered as 'basic." Each word and its definitions were then evaluated by the resulting criteria. The total process thus led to sequential sets of explicitly stated decision logic rules which were applied to each word, Loevinger=”? provides three criteria for eval- uating the construct validity of a test, These cri- teria require that the substance or content of the items shall be consistent with the proposed in- terpretation, that the structural relations of the items shall be consistent with the structural re- lations of nontest manifestations of the same trait, and that the external correlations of the test score shall not all be zero and shall be consistent with predictions based on what is known of the postu- lated trait, Evidence for construct validity, ac- cording to Loevinger, can be broken down into evidence that the test measures something syste- matically and evidence for the particular inter- pretation of whatit measures. The degree of inter - nal structure of the items and the magnitude of external correlations are the former, or psycho- metric, evidence; the nature of the structure, con- tent of the items, and nature of the external re- lations are the latter, or psychological, evidence. ‘I'he procedures used in sampling, in defining the unit of measurement—the basic word-—and in developing the BWVT test were used to provide assurance that the substance or content of the BWVT items are consistent with the proposed interpretation, Since it was assumed that basic word knowledge is acquired and would increase with educational attainment and age in the early vears, the high correlations of the BWVT with education and age (table U) indicate that the structural relations of the BWVT items form a scale that is consistent with the structural re- lations of nontest manifestations of basic word knowledge development. The external corre- lations of the BWVT with other tests of verbal ability (tables F and U) were all high and con- sistent with the postulate thatthe BWVT measures growth in verbal ability related to reading and writing, Evidence that the BWVT measures some- thing systematically has been presented by show- ing the degree of internal structure of the items by item correlations with subsections of the test at several levels of difficulty (table C), theinter- nal consistency reliability of items within these levels (see section on reliability), and by the magnitude of the external correlations of the BWVT with other factors. Evidence on the nature of the structure of the BWVT was presented which indicated that the items form a progressive series or scale and the content of the items can be in- ferred to reflect the progressive acquisition of basic word knowledge inthe early years. Evidence on the nature of the external relations of the BWVT was presented showing a positive relationship with growth and acquisition of knowledge in other areas. These findings present positive evidence for the construct validity of the BWVT as a measure of the level of acquisition of basic word knowledge, vocabulary development, and more general as- pects of verbal ability. DISCUSSION Limitations A major limitation of the BWVT is that it is too difficult at the lower education and age range when given as a reading test. This is due mainly to limited reading ability at the early ages. Per- haps a pictorial type of vocabulary test can be developed for individual and/or group adminis- tration at the earlier ages which can be tied in with the BWVT. Orally given and responded to vocabulary tests can be given at about age 6. Pictorial materials can be used as early as age 2 as vocabulary measures, It appears that a full- range test of basic word vocabulary could be constructed for use from age 2 onward. A larger sample of basic words would have been useful for selecting a 1-percent sample more evenly distributed in terms of difficulty levels and for selecting more words at the easiestlevels for better differentiation among individuals at the lower grades and ages. Since the standardization sample of individ- uals was drawn from a limited geographic area, certain biases in word difficulty levels probably 33 occurred compared to a nationwide sample. This sample also was well above average in verbal ability as measured by the nationally standardized tests. The median percentile score was 61.4 instead of 50.0, which is about .29 standard scores above the national level. This problem led to the need for using constructed values for the nor- mative means and distributions rather than those provided directly by the sample. The number of cases per grade was also low for good standardi- zation, although having a wide range of grade coverage tended to compensate for this. While standardized test scores were obtained for most of the students, they came from five different tests reflecting verbal ability. Since the content of these tests varied, their correlations with the BWVT probably varied more thanif one standard- ized test had been available for all 12 grades, and the normative standards among these five tests probably differ quite a bit, Also only language 1Q instead of grade percentile scores were available for the 7th grade and in some cases in grades 2, 3, and 5. The time interval between the adminis- tration of the standardized tests and the BWVT also varied from less than a month to almost 2% years in some cases, Grade 12 students were obviously much higher in comparative verbal ability on the standardized tests than the other grades, and for some unknown reason the 7th grade students did not show the typical grade progression pattern above the 6th graders on the BWVT, All these factors contributed to some un- certainty in establishing midpoint values and score distributions for the normative tables. Growth and Development of Basic Word Vocabulary The BWVT was developed with the notion tua. it could serve as an indicator of the growth and development of basic word vocabulary by education and age among children. The findings derived from the standardization sample provide some indication of the growth function of basic word vocabulary. The fact that the words in the BWVT could be fairly evenly ordered in terms of difficulty levels and the observations and findings for the 10 - E scoring method indicate that the acquisi- tion of knowledge about given basic words does not occur in a random fashion. If there are no 34 theoretical reasons for assuming that one basic word should be learned earlier than another one, then exposure to, interest in, and awareness of these words may be the most important reasons for acquiring knowledge about them. Growth with education and age,—When the BWVT score distributions are studied by edu- cation and age (tables K and M) a definite pattern can be seen, Using age for example, the range of scores is much higher above than below the mid- point for years 8 and 9 and then shifts over to a larger range below the midpoint from about age 11 and above, Thus at age 17 the lower range for a VDQ of 67 is 43 raw scores below the median, while the upper range for a VDQ of 133 is only 29 raw scores. The differences between the means and medians (table G) also show this skew pattern in distribution of scores. The growth rate pattern by educational level is shown in figure 1. The actual median values e0 r— - 95th 7° percentile » scores Actual medians 60 — percentile scores wl or cS 50 S l = / 2 B40 fe I = 2 om vd 5th 30 — / percentile scores 20 / , 10) ire- 0 ow dhe? bdo eld) 1 2 3 4 5 6 7 8 3 10 11 12 MIDGRADE EDUCATIONAL LEVEL Figure 1. Basic word vocabulary growth pattern of children by educational level. show a fairly orderly pattern of growth from grade to grade except for the 7th and 12th grades which was discussed in the previous section on limita- tions, The constructed normative values for the Sth, 50th, and 95th percentile levels are also shown, The growth pattern of basic word vocabu- lary as shown by the BWVT increases fairly rapidly up to grade 9 and then begins to slow down rapidly. Estimated absolute size of basic word voca- bulary.—An estimate of the absolute size of basic word vocabulary represented by a given score on the BWVT can be obtained by multiplying that score by 100, The percent level of attainment can be obtained by dividing the given score by 123. These estimates are, of course, subject toerror, The two major sources of error are the standara error of the sample to population estimate of basic words and the standard error of measure- ment as reflected in the measurement reliability of the test. The standard error of the sample esti- mate is 1,073 and the standard error of measure- ment for the BWVT is about 3 raw scores or about 300 for the population estimate. Thus if anindivid- ual's raw score on the BWVT is 60, the estimated absolute size of his basic word vocabulary is 6,000 with a combined standard error of about plus or minus 1,114 words. Another feature of the BWVT is that a given score reflects quite accurately the actual items that were passed. Thus the midpoint score of 60 for 9th grade students indicates that about half of the students at this grade level know the BWVT word Item 60, which is "lank." Applications of the BWVT Probably the two most widespread applica- tions of the BWVT will be in education and in personnel selection and training. Since the BWVT is easy to administer, score, and interpret, teachers and personnel officers who have reasons to believe that a basic word vocabulary is im- portant in learning their course materials or for effectively handling a given job can give the BWVT and evaluate the individual as to his probable competence in the given situation. The BWVT can also be used as a standardized test for evaluating growth and development of individuals and of groups. One of the advantages of the BWVT over many other standardized tests is that the content of what is being measured is easily grasped both by the individual taking the test and by the person who must interpret it and translate the findings into some action programs, Another application of the BWVT, particularly the short forms, would be in research studies. Not only the level of basic word vocabulary of the research subjects could be ascertained but experimental and control groups could be equated on this factor whenever it had a bearing on the dependent variables of interest, Further Research and Development The most immediate research and develop- ment need for the BWVT is to obtain more pre- cise normative data for educational, age, and occupational groups as well as for specific school courses and subject matter areas. Efforts could also be made to extend the BWVT content notion down to about 2 years of age. Development of other basic word vocabulary tests from other samples of basic words would permit recurrent testing for evaluating growth and development during each school year. Validation studies of the relationship of the BWVT with school course grades, occupational success, and measures of general intellectual attainment can be undertaken. The research and development implications that can be generated are almost limitless if the construct properties of a basic word vocabulary prove to be sound. Some possibilities that are opened up are for studying the relationships of the develcpment cf a basic werd vocabulary with language growth and development, learning to read, effective verbal communication, and changes in symbolic thinking and reasoning as well as its relationship with general intellectual develop- ment, If a large basic word vocabulary is related to effective coping with a number of practical problems such as formal learning and occu- pational success, then ways and means of ef- fectively developing a large usable basic word vocabulary should be explored. 35 SUMMARY AND CONCLUSION The results of the studies todate indicate that the Basic Word Vocabulary Test provides a range of items in terms of item difficulty levels useful in printed form from about the third grade to the highest educational levels, Since pictorial and orally given vocabulary tests are used from about ages 2 to 8 years, further work should be done to extend the scale downward so that a single com- prehensive vocabulary scale ranging from age 2 years to the highest level of verbal development is available for general use. Validation studies should also be conducted with other well-known intelligence tests so that scores can be compared. Alternate forms need to be developed to allow for longitudinal studies of growth and development. The use of a single standard of measurement of vocabulary development, suitable over a wide range of age and ability levels, by different in- vestigators should materially aid in comparing results across studies and samples and lead to more consistent findings, advances in knowledge, and wider application of findings in practical circumstances. The findings presented in this reportindicate that the Basic Word Vocabulary Test adequately measures basic word knowledge acquisition and development. The BWVT is suitable for evaluation of individuals and for use in making group com- parisons in levels of basic word knowledge attain- ment, growth, and development. REFERENCES "Watts, A. F.: The language and mental development of children. London. Harrap, 1944. 2McCarthy, D.: Language development in children, L. Carmichael, ed., Manual of Child Psychology. New York. Wiley, 1946. 3Smith, M. K.: Measurement of the size of general English vocabulary through the elementary grades and high school. Genet. Psychol. Monogr. 24:311-345, 1941. 4Dolch, E. W., and Leeds, D.: Vocabulary tests and depth of meaning. J. Educ. Res. 47:181-189, 1953. 5Seashore, R. H., and Eckerson, L. D.: The measurement of individual differences in general English vocabularies. J. Educ. Psychol. 31:14-38, 1940. 6 Anastasi, A.: Psychological testing. New York. MacMillan, 1968. 7Terman, L. M.: The vocabulary test as a measure of intelli- gence. J. Educ. Psychol. 9:452-466, 1918. 8Miner, J.B.: Intelligence in the United States. New York. Springer, 1957. 9Thorndike, R. L., and Gallup, G. H.: Verbal intelligence of the American adult. J. Gen. Psychol. 75-85, 1944. 10Wechsler, D.: Manual for the Wechsler Adult Intelligence Scale. New York. Psychological Corp., 1955. Terman, L. M., and Merrill, M. A.: Stanford-Binet Intelli- gence Scale; Form L-M. Boston. Houghton-Mifflin, 1960. 12Brown, J.: Vocabulary, key to communication. Educa- tion. 80:80-84, 1959. 13Funk, E.: The way to vocabulary power and culture. New York. Wilfred Funk, Inc., 1946. H4Rinsland, H. D.: A basic vocabulary of elementary school children. New York. MacMillan, 1945. 1S Webster's Third New International Dictionary of the Eng- lish Language, Unabridged. Springfield, Mass. G. & C. Merriam Co., 1961. 16 Random House Dictionary of the English Language, J. Stein, ed. New York. Random House, Inc., 1966. 17Barnhart, C. L.: The World Book Dictionary. Chicago. Chicago Field Enterprises Educational Corp., 1969. 18 Funk and Wagnalls New Standard Dictionary of the Eng- lish Language. New York. Funk and Wagnalls Co., 1965. 19Guilford, J. P.: Fundamental Statistics in Psychology and Education. New York. McGraw-Hill, 1965. 20Thorndike, E. L. and Lorge, 1.: The Teacher’s Word Book of 30,000 Words. New York. Bureau of Publications, Teachers College, Columbia University, 1944. 21The Nelson-Denny Reading Test. Boston. Houghton- Mifflin Co., 1960. 22Standards for Educational and Psychological Tests and Manuals. Washington. American Psychological Association, 1966. 23 Loevinger, J.: Objective tests as instruments of psycholog- ical theory. Psychol. Rep., 1957, Mongr. Suppl. 9. C00 36 APPENDIX | BRIEF DESCRIPTION OF DICTIONARIES The following brief descriptions were obtained from the self-description of each dictionary used indevelop- ing the Basic Word Vocabulary Test. Entries or terms as used by these dictionaries are not main entries, that is, the alphabetic entry, but are probably used to des- ignate all the main entries plus derived forms and sub- entries that are defined. Webster's:'’ More than 450,000 entries; 2,662 pages ” Funk and Wagnalls: 458,000 terms defined; 2 757 pages . World Book:'" Over 200,000 entries; 2,415 pages Random House: !* 260,000 entries; 1,664 pages O00 37 LISTING OF Derived, Variant, and Redundant Words adiabatic advanced anesthetize anywise armiger assortment beck bespangle billionaire bookkeeper bootee boxberry bracer bressummer builder catfoot chanceful charitable checkered civility clamper clerkly collectanea coloratura comforter communitarian conceited congelation conquistador constringent cowled cullender dashen deceptive deconate decorative defiance defrock deliverance despumate 38 APPENDIX [1 NONBASIC WORDS IN 1-PERCENT SAMPLE FROM WEBSTER'S dictation diesis dilatorily diffidence discontinuity discrimination disinfect dispatcher dissuasive domination draught drifter easterly ebon elucidate embay endamage endurance episcopalism exalted exhibition exorcism extravaganza failing fatalism fiddlewood flapdragon floatage follower further ghostly godchild grandchild gunboat gymnasiast hagberry hardness howbeit hydromedusa hypnotize immorality implant impropriety inefficiency infamy inkstand insanitary insphere institutionalize insuppressible intelligential interstitial irate isostacy isthmian jetton koorajong leapfrog leper lethargize liberalism locator logging marrowbone mediaeval melodious methodology metrify midwinter milfoil mimicry monocular narcotism nominal obscenity occultation offense outbreed overarch overfly overwrite package padodite palpitation pantaloon papyraceous parsimonious payable persuasive pestilential politesse proa pregnancy provisional radiant rampancy rarefy reality relict reproachful respectively resupine rhombohedron robustious rookery rusticate sacramental scorching scuta sedulity seepage seismoscope serving severalty silviculture singularity skeletonize slaty slumberous smithy spreader strength stylographic subsurface sulfatize sunken superstratum supposed threadfin titled toothache tragedion trainee transformation turnabout unbelief valedictorian vaporize varioloid venturesome visionary visitant warranter Zip Technical, Archaic, Foreign, and Slang Words Technical alopecia anaphase antienzyme antilogarithm aposematic architrave aril buccinator buntline carpellate cessionary chalaza choripetalous coda concha corody courmarin creosol digitalin dourine epigastrium euplastic fantigue fluor forestay formaldehyde grippe herpes holmium interplead lymphadenitis lytic martensite methyl nasute nullipora orthogonal placebo prussiate pygidium retinitis rousant sonorant superciliary thionyl tribach vacuole viosterol voltage zamindar Archaic amusive lucarne paly Foreign agee byre claught grutch jillet licht makimono ruddock sel tirl trachle wa’ waggon wyte y 39 Slang batty benny confab offish snotty splendiferous walloping Words Not Main Entries In All Four Dictionaries abembryonic abolitionism abruptly academician accelerograph accipitrid acephalina acknowledgeable acridan actability ada administrable adorno aeration aesthetician affability agal agpaite akepiro alif alkyd allactite allophanamide allothimorph allylene alternamente alumnal alveon ambassadorship amenably amis amor amphid ampyx anaerobian anamite anchimonomineral andrite anhungered anionotyopy anonymuncule 40 antagonistically antiquitarian anxiously aphelinidae apocha applicableness apting arborary archband arcticize aristoi arrayer arrowplate ashery assailment assever asthenobiosis astonishable attrist aurinasal autarchic autoerotism autoing autotomy avulse axe azon babbling backwoodsy bacteriofrenic badmash baledos balloonberry banjoist barbarousness barmote barns basichromatin bataleur batoneer beezer befrogged behite belonite benday benzal beringite besetment betitle bibliolatrous bieberite bikini binds bismoclite blackacre blas blazingly blowback bobachec boildown bolted bondar boozer bority bosse bowden brachyblast braveness breezeway butterball butyrate byzant caballer calathos calcifuge calimanco canniness cantilate capriciousness caraibe cartilaginous caseinate cassing catalytic catskin cattleman causse cavitoma caza celebrator cembalist cephalization ceremonialism changeroom channelbill charaban chased chaussure chenfish chidra chiffonade chitosan chloroanemia chloroma choirwise chondropharyngeus choosy chroman chromoisomer chrysography churchless circumvene citoler clasmatocyte cliqueless closefisted closestool cloudlet coactive coastways coccosphere cockier codehydrogenase [1 coerulignol coho coleoptile collogen colophene columbate comfiest commendatore committeeman compensability complanation compromission configurative confusingly conjury consonantal conster contravindicate convalescent convertend coracobrachialis cornerbind corticoafferent cosmologist countercheck counterslope countinghouse coupled crazyweed creeded crocked crosnes crownbeard cruisie cumbersomely cupidon cupressineous curioso cutbank cyclopedist cytogamy dacent daughterly davy deathtrap decrassify deducible detacement degreed dehrnite delegator delorenzite demonstrability dendrophysis dentiform dependableness depraver derangeable deridingly des designata desmoneme deuced devilry dibutyl diminutival dimpsy dipcoat diphtheroid dipotassium disally discission disgracious dismask disposability dispositions dissave dissolvable distinctiveness diting dividedly dizoic doctorhood dogana doltish dopehead doryline dozened dragged drawling dromic drostdy drunkery dudleyite dwined dysgonic ecstatically editorialist effectible eidetic eightfoil ekhimi electroanalysis clectroplexy clementarily clongation embroiler emulsifier encephalosis endolimax engrained ennobling cntad enthrallment entireness entropion epibolic epiphytic epizootiological equatorially eremitic erogeny escaped escaping esotery essoin cstoque etherification etiolation evactor exceptionless execrator expiator exploitee eyne fagoter falcula familiarization farmhand farruca fatcake federacy feeless feelingly fenceless fertileness filopodium flakeless flavorpurpurin fleshless floodboard flosculus fluoroform flyway foldaway footback formularize forslow foundationary freezes fretize 41 frightenedly fronting fronts fumigatory fundo gadge galactocele gallas gallused gangs gant gastroptosis gayatri geisotherm gener generalcy gentlefolk geomagnetician geoselenic germinator gidgee gilling gimlety glady ¢liffing olode glossopyrosis glutonously gnawing gonif gonosome griffonne groundier groutite gul gymnosophical gyrocompass habitally habronemiasis hairstane halloth hamble handlebar hangbird haploid harmal hatband hatchettine haustration headrail hemipteroid heptyne heresiologist heterachrome hexamethylene hexed 42 hideout highveld hinderlands histogenesis hitching hiveless hockeyist hohlfléie homeotic homolateral hooplike husbandly husked hydrazobenzene hydrocarbonate hypaethral hypermotility hypochloremia hypophysectomize hypsometry ichthammol ideological idyllium illustrational imitational impartment implementation imposttrous imprinting inbearing inconnected inconstantness incubational indenter inducing infatuator informalize informingly inheritage inquistively intellectualist intercreedal interdictory inter jaculatory intimation intolerability intrauterine intuitionalist inundable inversion invited iodhydrin ironize ironback irremissive isard ishikawaite isodrin iteming ivybells javali jellybread jocundness joining kampferol kayles keelbill keffiych kiaki kif kinder kirkman knicht knobwood knucklebone kommetje kweek k'ri kurveyor labellate labyrinthian ladkin lampless lapetted latherer laverwort laxist leeve legitimation leontiasis leptotene leucoindigo leveled lexicostatistics lieutenantry lifted ligg liked limbs limnephilid lineable linolein liquifiable lithocyst loamless localite locustarian looked lovey lovingly luller lurdane luringly lutulent macroblast magniloquence majoration malleableness mantellone marimonda marketability mashed massivity matchboarding matureness matie mattness memoryless meningioma mercurialism meriter merocyanine mesophere metachromatism metanym metensomatosis microfiche microlepidopterist microsporon middler millering millable mineralocorticoid misadjustment misdescriptive misogynist misput mitochondrion mockage monaxial monetite mononucleosis monotrigiyph monumentality moosewood morsal mosaicist motory mouthbreeder muliebral mower munga munitioneer musaf mycotrophic myelopathic myrmecophilism mythicist myxine napalm nativeness naturally navigational nebby nectarean neighboring nephograph nephrosis nestable neurine neuroglia nicotinate nightshirt nitraniline niyoga nominatively noncontagious nonmedical nonoptical nontheistic northwards normalness notacanthid notharctid notifiable noticeably nucleocytoplasmic numeric oater obeah obstructive oilskinned oleoplast omohyoid ontogenesis onychosis oppilate optimity orchiectomy orthopsychiatric osteolepiformes osteria outgoer outpouching outstep outvalue overpayment overedger oversimplify paddleboard paints palatability paleothermal palimbacchius palmaceous pand paralyzing paradoxology parallelogrammatic parcellation pards patrilocality paulin pedimented pegasoid pellicula peloric penciled pensionnaire pentose peracute perfidiousness pericarpoidal perishableness peroxidation persifleur perspectivist petrifactive petzite phenomenality philomath phloroglucinal photomural phrenological phyllozooid physiologue pickover picudilla piezochemistry piked pinacolone pingle pintadoite piratical platyfish pleuracanthea plombage plumpness poggy pointes pollenizer polycomponent polyene polymicrobic polyps polyspore portability portsider possessingly postclypeus 43 practicedness prakarana preanimism precipitately precisionist predicator prefilter prepalatal presentably presiding presgious pretypify prevelar primmer prickier procaviid proctorize profligateness proliferous prolongate proneness propalinal properdin prosciutto prosternation proportioning protocolist protohistoric provolette pseudozoea pteridoid pteropaedic Puericulture pulmonate pulpiter puncturation puppetize pursiness purringly putrescine pyrazoline pyrotechny quadruplicity quaters quickbeam quivering rachitic rageous ransomer ratherish rattlebag reactivity rebute recondemn reconstructional 44 recruiting redeemable reech reformade refusible regulant reimbursable relatedness relentment reluctate reminiscently remix renting repenter rephotograph repost reproductionist requin resentiment respiteless resolutioneer retablo renaturation retrocessive reused revokingly revolvable rhapontin ribaldrous ridgebone rimate risen ritualization robing roestone romanticalness rootiest rostralis rowed rottlerin riickumlaut ruggedize rumpot saddlenose sadly sagaciously sainting salmonfly salutariness samel sandaled sapin satisfier sauropod scenarist scobicular scolding scrapler screenlike scripter scrupulousness scutiped sectoral sellaite semiround sensile sentimentalist sequestree serpolet serriferous shadbelly shaping shareef sheaveman shroudless shutten sidescraper sig sighted simlin simplified sisalana skipdent slangish slapdab slickens slouchily Snoopy soapbox soaring sociometrist solderless solubilize somer soroche sourberry, souths sparger spasmogenic spatuliform speechcraft spirocyclic spewy spies spindleberry sSpiracular splathering sportful sprug squares stalworth startling stearic stenion sterning stockinged stoury straightways stretchberry strikingness striving strontianiferous strutter stuffer stupendously subduedly subfauna subjunctively subnutrition subsidizable subvertical sucken suff sufficientness suggestiveness superlunary supportation surfer surrenderor susception susuration swashbucklering swilling swingingly swoosh swordsplayer symbion symphylid synkinesia synonymic tablecloth talari tallygalone tamperer tanglehead tautness tawery teched tegu teloblast tempestuousness tendenz tenorist terai termine testability tetchiness tetrapterous tetramethylenediamine textus thermoclinal thinghood thisness thundercrack tiddler tiewig tinsmithy toa toddick tongawalla tongueless topeng toucher towable toxigenic transfusionist translator transplanter trapball treating trellage trestleman triazo trichoid trihydrated tritencephalon trocheameter trothless truxilline tubectomy tumbled turbiner typecase unadjusted uncessant unchristianize unconsonant undelude underair underleaf understanded undissected unemployability unexpended unfraternal unhang unhelped unimagined unital unliteral unmown unneutrality unpossible unrecollected unrelievable unscale unsimilar unstudious untillathle unwandered unweeting upstander uranoscopid urva vancourier varnisher velveret vengefully verdit vernacularize vertically vestural virtuose vitaminology vraicking walkaway wardwalk wasteless whatman wiggy winterkill wolframine worthily wouldst wreather wronged xeromorphic xiphisternum yad yarner yawner yous zwinger Abbreviations abn, appd. dol. E.O.H.P, extl, fgn, F.C.R, F. PO, 45 lit. Me MOI MP1 Obl OCS OL OTS prof, refd, SC and 5 Sing. S.S.W THI U and O Hyphenated Words and Word Compounds absorption band acetaldehyde ammonia achievement test activated sludge process addition polymerization addressing machine adjutant's call agent intellect ahead of air engine all-fired alphabet book angle iron angular displacement annual bluegrass apple leafhopper arabonic acid arrack punsch art form artificial nucleation artist's proof asexual spore aspect ratio atom smasher 46 average bond azimuthal equidistant projection backache brake back load bail below balance coil banded olive snake barren brome grass basal wall basket salt beam and scales bearded argali beat back beaver dam bed rot bell crown binomial expansion biotic formation bird's-foot violet bitter aloes black-backed gull black flag black oyster catcher black root blade back blind tire blister canker blood pheasant blood type blue asbestos blue beam blue nevus blur circle boathouse rum body cell bois cotelet bosun bird bottom break boundary layer branch circuit breach of trust break and entry breast-beating bridge bird bright aqua blue bright peach broadleaf tree brokers" board brood capsule brown brush brush arbor bubble chamber buck sail buffalo currant bulk eraser bull oak bull thistle bum steer bush doe bustard quail butterfly crab cab-over cadency mark calendar stone call price calyx tooth cameo glass camphorated oil canal cell canary cedar candlestick lily canoe cedar cap-and-ball capital assets carbonic oxide cardinal climber carnation rose carrion beetle cartridge starter castor oil catch colt cellulose ester cera flava cervical canal chaff-flower charge-a-plate chevron molding chime maul chip carving chunk honey cidar apple cinnamon teal circulating decimal clam catcher claver grass cleaning mark clearing bath climb-down clip-clop clumphead grass cognovit note collective bargaining commissioning pennant comparative literature complement-fixation test composite dike compressibility effect conditional complex con gusto contact bed content analysis cone-bearing contingent fund contract bond contraction joint cook cheese coordinate geometry copper nickel coralline limestone core bit corn bran correspondence theory cossack post cough drop courtesy card cover charge crab plover crack arrester cramp iron crape jasmine cribriform plate crinkum-crankum crossed belt cross-staff crowfoot grass cry back crypt-analyst crystal vinegar cuckoo-bread curry powder cushion dance cut-and-cover cut square dandy fever dark beaver dead-smooth declaration of war dependent variable detention home dew-drink dialectical theology diaphragm horn direct control direct salesman directional gyro discharge coefficient distribution box dog cockle donkey engine doppio movimento double-action double capital double-talk dove's-foot down-and-out dragon boat festival dray horse dress circle dropping bottle dry-waxed dual union dumb ague dung worm dyer's cleavers ear rot earth lichen cau de Javelle economy coil effective horsepower egg albumin elbow chair elementary body empire building empty-headed en passant equilateral arch equivalence zone essential hypertension eudemis moth even court evil eye executive session experimental psychology express car extended family extreme fiber eye appeal face and fill fair use false annual ring faucal plosive favorite son feather bed fellow feeling fender bolt fern clubmoss fictitious person field kitchen fifty-three fighter-bomber file signal finder switch fingernail clam fire and brimstone fire blanket fire-retarded fish-and-chips fissure of Rolando five-finger flare gun flat back flax-sick flight pay flowering straw fly-about focal area fool hay force account force of friction foreign-born forty-second foul berth four-poster freak of nature free field freeze-drying frogbit family fruit bark beetle fuel dope full bottom functional calculus fur breeder future tense games-all gas bacillus gas helmet zaudy night gentleman-ranker give off glass run glove box going forth gold bloc cold import point 20 to governor's council grade beam grain beetle grand father-in-law grapple plant gray antimony great anteater greater omentum green adder's mouth green-striped mapleworm greeting card grooving saw growing zone guardian by custom guide card halfhead bedstead hand and foot hand nut harmonic interval harsh-furred hare hawkbilled hawthorne rust heart attack heather ale 47 heavy spar heel-and-toe watch hell driver helve hammer hemp tree herdld of arms high-angle fire hight court hokus-pokus hold over hollow newel holy day homogeneous reaction honey badger honor system hooded milfoil horny laminae horseshoe bat hot-air furnace hotel dieu hue circle human ecology house board hum note hunter's moon hybrid coil hysteresis loss ice partridge icterus gravis ill at ease imperial city in chief included sapwood indefinite proposition indirect lighting inductive inference infinite canon innominate vein inside quire intentional species intermittent pulse jaal goat jack-by-the-hedge jet black judgment by default jumble sale jus in re kahili ginger kick around king ortolan knot garden lag fault last clear chance last-ditch 48 laughing jackass law of the minimum layon leaf -and-tongue leaf-cushion lead arsenate leave in legal jointure let down licensed premises lightning calculator line space lever listener-in little house livery cupboard living language long hundred look down loose scrum lord register lowland plover lug chair lumpy skin disease magazine safety magnesium hydroxide magpie moth mail clerk make-peace malignant hypertension man-about-town mandarin orange manrope knot many-valued masked bobwhite master station meadow nematode mean place meat chopper mechanical aptitude medium chrome green melon fruit mesh knot metropolitan borough mine detector minister plenipotentiary minute hand miter joint mixtie-maxtie modern figure molding book mole crab molybdic acid monotorial system mooring board moral sense mother bulb mother ship mountain hare mountain rosebay muck soil multiplier onion mushroom jelly fish mussel poisoning naked boys nature philosophy negative angle neutral conductor night hitch ninety-seventh nodding lily novel assignment nurse's aide obscure glass occupational therapy offset well one-night stand open-tank ophthalmic glass optical pyrometer orange scale organ neurosis original contract orographic rain osmic acid out and away oxeye daisy oyster agaric package bees paper bail para-analgesia parietal eye parlor game parrot blue partial correlation parting pulley partition coefficient pass out pastry bag patent right pat hand peacock butterfly pear thrips pectoral ridge pep talk perfecting press periodic acid periodic comet permanent hardness perpetual canon pharyngopalatine arch phase-contrast phosphorus trioxide pilaster strip pillow fight pinch bar pipe-band pit canal pitch-and-run shot pit-pair place name plain clothes plain sailing plantage seed plaster base plate metal play back play-pretty plug flow plunge pool pocket beach poker-faced polecat tree pond-scum parasite poor man's orchid population pressure post-office potassium ferrocyanide potato-leaved tomato pound cake pour batter power appendant pre-med prerogative writ press agent primary alcohol principle of association prison camp private bank progressive dies protein crystal pseudogeneric name psychological distance public assistance puddle duck pump-action purchase-money mortgage quail call quantitative inheritance quarter butt quenching bath quick match quinine flower radiohumeral bursitis rain barrel raked joint raking course range-bred range of accomodation rate basis raw water rayless goldenrod reasonable care recessed arch re-claim red seaweed red-tailed hawk reference line regimental combat team remade milk remittance man residual estate resting nucleus reverse bearing rift-sawed rigging loft right-handed rope rind discase ring plover rip-rap road brand rocking pier roi fainéant rolling eight roseate spoonbill rose family rubber belt Tr unit rural servitude sales check sand mullet sanitary cordon scale bark scarf cloud screw arbor sea devil sea mail season crack second angle second-story man self-analysis self-involved semicircular canal semipalmated snipe sense-datum sepa a tilage series parallel set aid settle bed seventy-three sex cord shagbark hickory shamanistic dance shave hook sheet chain shield bearer shift bid shingle tow ship of war shock bump short line shoulder arm shoulder-of-mutton sail shrinkage rule sib test side arm significant figures silica gel silicone rubber silver ash single transferable vote six-whecler skill facet skirmish line sky hook sleeper shark sling unloader slip stitch sliver lapper slugging match small-beer smash fixer smooth-tongued snake fly snap bean snuffbox bean social ascidian sodium fluosilicate sodium propionate soft solder solar parallax sou markee sour dock space-charge effect spangled glass special deposit specific surface speckled turtle spencer mast spheroidal state spike bull spiral spring split-board spoils system spontaneous generation spool heel spotted nemophila spot welding square body squeeze off stained paper 49 standing rope starch blue star thistle statute fair steady load steering arm step trench stereo camera stick rider stinging nettle stinking badger stitch aloft stock-share lease stomodaeal food stoop crop storage car straight grain strangulated hernia strawberry cactus straw man stripe smut stubborn disease substitution instance sulfonated oil summum jus superior conjunction swamp ash sweep check sweet oil synchronous telegraph systemic circulation tableau curtain tack and half tack tailored gardenia take in tall bellflower tank barge tap drill tarragon oil tassel-gentle tea borer teasel gourd telephone transmitter ten-cent store ten-week stock terrestrial magnetism theater-in-the-round then and there third basemen thorough-band threshing floor through arch through-composed thrush lichen tile ore time allowance tittle-tattle 50 toilet set token money tossed salad total-annular eclipse tower clock trade agreement transcendental equation traveling post office trigonal tristetrahedron triple-space troop duck truck light true balsam trunk call try for point tuck box tungsten bronze turntable ladder twenty-nine twin valve tWO-gun two-sided umbilical cord unfair method of competition universal mill upper alveolar index uric acid usurae usurarum utter barrister vacuum-tube voltmeter vegetable leather vegetative mutation vestibular nerve vicar apostolic voice glottis vulturine guinea fowl wandering tattler wantage rod warp and woof washer-up water bailiff water -ground water purslane water -smoke wave band weak feints weathered oak wedge gage weigh-in welfare factor western ring-necked snake whack-up wheel scraper whet slate whing-ding whip crane white-crested touraco white flesher white pelican white work whole-time wicket dam wild allspice wild peach willow beauty window-efficiency ratio wing cover wise guy wood alloy wood snail word association work-and-back working ball worm conveyor wrinkle-lipped bat yellow azalea yellow sedge youthful offender zenith telescope zero drift zone of mobility Proper Names Accra Acnida Africanization Afro-European Aida trumpet Aix Alcyonacea Alexandrine rat American scoter Andaman padauk Anno Hegirae Argasidac Anthropomorphidae Ascarops Asurini Athecoidea Athiorhodaceae Attalea Audubon's shearwater Aureomycin Balahi Balling scale Bamba Bantam Barbarea Bauré Bdzllonemertea Bellacoola Bignoniaceae Blenheim spaniel Blockflote Bonpa Brahman Branchiopoda Brownism Buprestidae Burow's solution Cagoulard Calyceraceae Cariama Castalia Central American cedar Chamar Cheilodactylidae Cherokee Chinese bush cherry Christmas begonia Clootie Cocceian Colaciales Connecticut Conservative Baptist Cotonerol A Crescentia Cyathaspis Cyclostoma Cynoglossidae Cystophora Dahomean Dardanian Debye-Hiickel theory Demerara sugar Deuterostomata Diapensiales Dictyonina Dutch bargain Dutch pink Lichinopanax Englemann spruce beetle Lpanorthidae Erwinia European apple sawfly Exogyra Expectation week Ferungulata First Reader Florida moss Frankfurt horizontal French vermillion Fuchsine Gaelicize Geneva crystal Girdle of Venus Goa Bean Goodyera Grantia Guatemalteean Hamitic languages Hebrician Helenium Hemigalus Heteropidae Hippophae Hyenia latmul Igneri Indian cherry Indicatoridae Ingaevonic Jagatai Jane Doe Japan lacquer Job's tears Jove Junebud Karmatian Kepler's Law Keres Keyauwee Kingdom Hall Kiwanian Klemantan Lacrima Christi Lagos rubber Lambeth Delft Lancashire Landolphia Laudnum Bunches Leblanc process Linum London brown Loricati Macedonian Madagascar Malayic Mammalia Mangania Marchantia Marquis of Queensbury rules Maxwell triangle Megaloceros Megarhyssa Melanoplus Michaelinas Monstera Mormoness Nabothian cyst Naticidae Nelumbium Neo—Lamarckian New Lngland aster New Yorky Ngbaka Nyctimene Odacidae Odontosyllis Old German Baptist Brethren Olmec Ona Ordines Oxypolis Pace egg Pan-Hispanism FParascaris Paschens law Passalus Pathan Pauropodidae Pedicellinidae Percopsis Phallales Philippize Phthalogen Brilliant Blue IF3G Physopsis Plectospondyli Plymouth Rock Polish berry Porphyrula Primates Procellariitormes Protura Purkinje's network Rabbinics Receptaculida Redjang Reinecke acid Rhinonyssidae Rhizidiaceae Richardson's grouse Rydberg 51 Sabbats Sabine Saint Andrew's cross Salop Sammite Sarcina Satsuma ware Savoyard Say's phoebe Scandahoovian Scheuchzeriaceae Schmidt telescope Schopenhaureanism Scotch stone Scottishness Senecio Shelta Sino-Japanese Sirenidae Solidago Springfield 52 Stanford-Binet test States' Rights Stegosauria Strigeidae Sub- Atlantic Suboscines Supreme Court of Judicature Svan Swave Sympetalae Syphacia Taeniarhynchus Tagakaolo Therapeutae Thibet Tibareni Tinamiformes Torah Torredn Treasurer of the Household lo] e)e] Turdidae Tutchone Tyroglyphidae Ulotrichales Upland cotton Ustilago Valparaiso Vat Jade Green Verona earth Victorian hazel Vizsla Waiwai Welsh groin Western bezoar William and Mary Wisconsin white pine Wittgensteinian Yokohama fowl APPENDIX IMI INSTRUCTIONS FOR ADMINISTERING THE BASIC WORD VOCABULARY TEST IN A SCHOOL SITUATION Basically the test should be administered as in any normal testing situation. Each teacher is expected to use a procedure suitable to the grade level being tested. After handing out the tests, read to the students what they have to do (fill in name (possibly print): first name, middle initial, last name, date tested, date of birth, current grade level). Read the DIRECTIONS and the example—walk around the class to see if each stu- dent seems to understand what is required. Discourage looking at other students' answers of course! Try to insure that they answer all items—even if only guessing. DO NOT READ THE TEST ITEMS TO THE STU- DENTS. Do not pronounce any words either. Partof the function of the test is to determine literacy level; thus the ability to 7vead and understand these words is part of the test's purpose. If the student cannot read, be sure the identifying information is completed on the test form. NOTE.—Try to insure that all identifying informa- tion is correct. Note particularly the grade level and date of birth—often the curvent year will be written instead of year of birth. Grade levels.—Each person should answer every item for his grade level. Test through the following items for each grade, If a student makes fewer than 10 errors by the end of the test, return it to him to com- plete more items. This will be the rare case. Grade items 3d--mm mmm mmm eee 1-55 4thecm mmm 1-68 Sthem mm mmm 1-75 Oth=mmm mmm meme eeeee 1-81 them meme 1-87 Bthe mm meme 1-93 EE er 1-98 ns san mein AREA 1-102 I1th=12th cmc mm mmmmememmee 1-107 College ----====-omcecun- 1-123 O00 53 APPENDIX IV UNTIMED THE BASIC WORD VOCABULARY TEST FORM A Month Day Year NAME: DATE TESTED: SEX: M F DATE OF BIRTH: EDUCATION: Current grade level _________. If not in school, highest grade successfully completed - If in college, or college graduate: Academic major and highest degree earned EXAMPLE DIRECTIONS: Select the word or phrase which has the same meaning, or most nearly the same meaning, as the underlined word. CIRCLE a boyisa the letter (A, B, C, D, or E) of your answer choice. Read all answer A. lip choices before making your choice. If you do not know the correct B. bush answer—guess! C. rock (D child E. horse 1. acaristo 4. poor means having 7. a tricycle is to A. start fires with very little A. hear with B. eaton A. money B. ride on C. take pictures with B. hair C. lie on D. ride in C. sun D. walk under E. draw with D. time E. see through E. snow 2. the shore is by the 8. combat: A. sea 5. shower: A. point B. train A. field B. report C. letter B. doctor C. fight D. table C. rain D. start E. paper D. post E. admit E. battle 3. ink is used to 9. stable: A. walk on 6. eagle: A. husband B. write with A. family B. window C. cut with B. cup C. ocean D. serve with C. lake D. building E. stand on D. coat E. street E. bird 54 10. 11. 12. 13. 14. 1s. 16. a mistake is something done A. first B. wrong C. next D. often E. alone violet: A. plant B. ship C. story D. home E. river adesertis very A. kind B. strong C. dry D. brave E. dark a witness is a person who A. trains animals B. bakes cakes C. observes actions D. fixes machines E. grows wheat b ambush: A. attitude B. address C. artist D. attack E. authority howl A. roar B. design C. propose D. depart E. succeed quit: “A. hope B. trade C. learn D. take E. stop 17. 18. 19. 20. 21. 22. 23. puss: “A. factory B. devil C. exercise D. camp E. cat encyclopedia: A. woman B. reason C. nation D. food E. book phony: A. tough B. neutral C. vivid D. fake E. hasty crisp: A. safe and warm B. hard and thin C. deep and wide D. soft and short E. round and heavy advice: A. record B. visit C. bridge D. opinion E. minute tomb: A. baby B. market C. grave D. roof E. scale corps: A. angry teacher B. tired worker C. sick animal D. military unit E. special vacation 24. 25. 26. 27. 28. 29. 30. mo Ow a oc 8 f= = mons ® . * . . CB tunnel medicine soil engine fabric lady voice bay party region a seamstress is a woman who A. writes B. sews C. sings D. paints E. bakes tremendous: A. serious B. enormous C. religious D. famous E. precious plateau: A. large post B. big present C. kind prince D. great play E. high plain a jurist is an expert in “A. law B. business C. weather D. art E. history approach means to come A. through B. with C. into D. between E. near 55 31. 32. 33. 34. 3s. 36. 37. 56 event A. occasion B. temper C. notion D. monument E. explanation bristle: A. difficult problem B. stiff hair C. official order D. sweet fruit E. broad stream abandon: A. look over B. hold on C. liftup D. fall down E. give up tarantula: A. grape B. highway C. button D. spider E. verse barely: A. generally B. scarcely C. completely D. especially E. gradually minus: A. about B. through C. across D. less E. into mutiny: A. stranger B. puzzle C. rebellion D. lemon E. tenant 38. 39. 40. 41. 42. 43. 44. sneer: A. listen with interest B. practice with care C. look with scorn D. lift with ease E. dance with joy eligible: A. lonesome B. careless C. qualified D. inferior E. profound a gust is a sudden A. rush of wind B. act of duty C. increase of pain D. loss of friends E. need of money sassafras: A. tree B. wave C. egg D. board E. yard a ghetto is a section of a A. story B. wall C. church D. city E. garden muff: A. water heater B. hand warmer C. glass cleaner D. paint dryer E. wood burner pennant: A. route B. flag C. journal D. speech E. leader 45. 46. 47. 48. 49. 50. 51. exclude: A. educate B. excite C. eliminate D. encourage E. ensure mango; A. fruit B. army C. uncle D. star E. stone juvenile: A. haunted B. youthful C. intimate D. favorable E. unable stage: A. step in a process B. tear in a net C. condition in a treaty D. light in a tower E. articleina newspaper gorge: “A. circle B. chain C. valley D. hall E. queen jolt: “A. justify B. join C. judge D. jar E. journey gratify: "A. heat B. shout C. hope D. charge E. please 52. 53. 54. 55. 56. 57. 58. cardiac means of the A. arm B. feet C. heart D. legs E. head aghast: A. similar B. modern C. lucky D. limited E. terrified demote: A. invite B. reduce C. stroke D. pause E. excuse situate: A. wear B. add C. take D. place E. study thus: A. not B. too C. why D. so E. do scavenge: A. check certificates B. change residence C. support legislation D. divide inheritance E. remove rubbish rafter: A. angel B. canal C. beam D. lamb E. trunk 59. 60. 61. 62. 63. 64. 65. curriculum: A. school of fish B. collection of pictures C. type of window D. range of mountains E. program of studies lank: “A. slender B. grateful C. musical D. lively E. rare gristle: “A. fortitude B. cartilage C. graphite D. arrogance E. overture faction: A. dinner B. blood C. group D. passage E. hill decelerate means reducing A. velocity B. disorder C. enthusiasm D. hazards E. expenditures console: A. compare B. conclude C. comfort D. command E. collect horde: A. circle B. shade C. word D. crowd E. sand 66. 67. 68. 69. 70. 71. 72. manipulate: A. reserve B. devote C. handle D. inquire E. introduce sumac: A. prayer B. reward C. shrub D. doctrine E. porch potpourri: A. tailor B. embassy C. schooner D. medley E. parson concrete: A. clean B. mean: C. low D. nice E. real albacose: A. tire B. soldier C. box D. fish E. stick mesquite: A. office B. tree C. fire D. store E. gate destitute: A. respectful B. divine C. urgent D. slippery E. needy 57 73. 74. 75. 76. 77 78. 79, 58 discreet moOw isopod: mo Ow p> " ST . . g nn monn 5 — mullet: mTOw > bastion > FE mOOw» mow fragrant prudent unpleasant radiant gallant advertisement edifice meteorite philanthropist crustacean candy echo poem harvest brick saloon sickle shawl saliva sermon bird ball dog stone fish fortification qualification appropriation legislation illustration represent sacrifice justify determine display 80. 81. 82. 83. 84. 85. 86. afflux: A. flow B. fool C. fall D. fly E. floor mackintosh: A. raincoat B. tractor C. honeybee D. cartoon E. saucepan trajectory: A. curved path B. ill health C. bold type D. glorious spirit E. strong back picador: A. statesman B. horseman C. conductor D. sultan E. fisherman grackle: A. chipmunk B. pumpkin C. strawberry D. blackbird E. caterpillar apropos: A. instructive B. respectful C. forbidden D. pertinent E. dominant yew: “A. evergreen tree B. dismal day C. shabby house D. twisty road E. frightful dream 87. 88. 89. 90. 91. 92. 93. a pomander is A. magnetic B. explosive C. aromatic D. frail E. rotten nubilous: A. cloudy B. incredible C. liberal D. spiritual E. ragged a triphthong is a combination of three A. fossils B. cables C. diagrams D. vowels E. atoms brob: A. jail B. pouch C. tax D. spike E. cavern whist: A. captain B. game C. soul D. finger E. rock fetid: A. exhausted B. stinking C. pathetic D. meager E. insane abstracted: A. unmoved B. insulated C. preoccupied D. dominated E. devastated 94. 95. 96. 97. 98. 99. 100. pifion: A. piano B. pioneer C. pine D. pinch E. pint terrine: A. knife B. railway C. chicken D. wagon E. vessel conventicle: A. major enemy B. royal gentleman C. impossible question D. sharp object E. secret meeting bezant: A. hotel B. coin C. mil D. harbor E. desk an emir is an Arabian A. drink B. farmer C. chief D. song E. horse scintillate: A. develop B. whistle C. ruin D. breathe E. flash rummer: A. union B. knight C. coal D. shoe E. glass 101. 102. 103. glib 104. 105. 106. 107. cinereous: “A. ashen B. precise C. bashful D. valiant E. nimble soredium: A. cell B. building C. convention D. powder E. funeral glib A. unaware B. fluent C. reluctant D. philosoplical E. inquisitive dint: A. supply B. wish C. force D. price E. demand sarcophagus: A. coffin B. insect C. interview D. wharf E. mushroom anthemion: A. department B. remedy C. ornament D. punishment E. election qua: "A. during B. as C. while D. if E. when 108. 109. 110. 111. 112 113. 114. larine means like a A. sleigh B. mirror C. wreath D. gull E. matron flabellum: A. fort B. frost C. fan D. file E. flock tringle: A. wave B. bench C. light D. rod E. mirror fuscous: A. outrageous B. austere C. contagious D. swarthy E. eloquent pococurante: A. ignorant B. frightened C. distinguished D. indifferent E. dainty maenad: A. insidious laugh B. picturesque scene C. unscrupulous master D. caustic reply E. frenzied woman A. bed B. dance C. game D. mark E. record 59 115. lempira: mMoO® chair money salt earth music 116. edacious: mOO® > auspicious voracious malicious atrocious luscious 117. pyrope: 60 moO reptile heather slogan mantle garnet 118. garganey: A. hero B. frame C. bush D. skirt E. duck 119. redact: A. edit B. invert C. convict D. inherit E. afflict 120. jaconet: A. tribe B. gift C. port D. treaty E. cloth O00 121. 122. 123. seecatch: A. shield B. scheme C. settlement D. seal E. sport centaury: A. herb B. signal C. torch D. payment E. fortress durbar: A. quarrel B. sailor C. audience D. painting E. province APPENDIX V SCORING METHOD FOR FULL SCALE BASIC WORD VOCABULARY TEST AND ANSWER KEY Recommended scoring method. —Simply score through the 10th error and subtract 10 plus omitted items up to the 10 - E item from the item number of the 10th error. Thus if an individual’s 10th error occurred on item 60 and he had omitted two items below 60, his score would be 60-(10+2) or 48. Page 54 Page 55 Page 56 Page 57 1-D 10 - B 21 - D 31 - A 42 - D 52 - C 63 - A 2 - A 11 - A 22 . C 32 - B 43 - B 53 - E 64 - C 3- B 12 - C 23 - D 33 - E 44 - B 54 - B 66 - D 4 - A 13 - C 24 - E 34 - D 45 - C 5 -- D 66 - C 5- C 14 - D 25 - A 3, - B 46 - A 56 - D 67 - C 6 - E 15 - A 26 - B 36 - D 47 - B 57 E 68 - D 7 - B 16 - E 27 - B 37 - C 48 - A 58 - C 69 - E 8 - C 17 - E 28 - E 38 - C 49 - C 59 - E 70 - D 9-D 18 - E 29 - A 39 - C 50 - D 60 A 71 - B 19 - D 30 - E 40 A 51 - E 61 B 72 - E 20 B 41 A 62 - C Page 58 Page 59 Page 60 73 - B 84 - D 94 - C 105 - A 115 - B 74 - E 8, - D 95 - E 106 - C 116 - B 75 - A 86 - A 9 - E 107 - B 117 - E 76 - D 87 - C 97 - B 108 - D 118 - E 77 - E 88 - A 98 - C 109 - C 119 - A 78 - A 8 -D 99 - E 110 - D 120 - E 79 - B 90 -D 100 - E 111 - D 121 - D 80 - A 91 - B 101 - A 112 - D 122 - A 81 - A 92 - B 102 - A 113 - E 123 - C 82 - A 93 - C 103 - B 114 - C 83 - B 104 - C 6 APPENDIX VI SHORT FORMS X, Y, AND Z UNTIMED THE BASIC WORD VOCABULARY TEST SHORT FORM X Month Day Year NAME: DATETESTED: __ _ SEX: M F DATE OF BIRTH: EDUCATION: Current grade level _________. If not in school, highest grade successfully completed. If in college, or college graduate: Academic major and highest degree earned : EXAMPLE DIRECTIONS: Select the word or phrase which has the same meaning, or most nearly the same meaning, as the underlined word. CIRCLE a boy isa the letter (A, B, C, D, or E) of your answer choice. Read all answer A. lip choices before making your choice. If you do not know the correct B. bush answer—guess! C. rock (D) child E. horse 1. acaristo 4. stable: 7. quit: A. start fires with A. husband “A. hope B. eaton B. window B. trade C. take pictures with C. ocean ~C. learn D. ride in D. building D. take E. draw with E. street E. stop 2. poor means having 5. violet: 8. crisp: very little A. plant A. safe and warm A. money B. ship B. hard and thin B. hair C. story C. deep and wide C. sun D. home D. soft and short D. time E. river E. round and heavy E. snow 6. a desert is very 9. burlap 3. shower: A. kind A. tunnel A. field B. strong B. medicine B. doctor C. dry C. soil C. rain D. brave D. engine D. post E. dark E. fabric E. battle 62 10. 11. 12. 13. 14. 15. 16. A. lady B. voice C. bay D. party E. region a seamstress is a woman who A. writes B. sews C. sings D. paints E. bakes a jurist is an expert in A. law B. business C. weather D. art E. history event: A. occasion B. temper C. notion D. monument E. explanation bristle: A. difficult problem B. stiff hair C. official order D. sweet fruit E. broad stream barely A. generally B. scarcely C. completely D. especially E. gradually minus: A. about B. through C. across D. less E. into 17. 18. 19. 20. 21. 22. 23. a gust is a sudden “A. rush of wind B. act of duty C. increase of pain D. loss of friends E. need of money a ghetto is a section of a A. story B. wall C. church D. city E. garden exclude: A. educate B. excite C. eliminate D. encourage E. ensure mango: A. fruit B. army C. uncle D. star E. stone gorge: A. circle B. chain C. valley D. hall E. queen situate: A. wear B. add C. take D. place E. study curriculum: A. school of fish B. collection of pictures C. type of window D. range of mountains E. program of studies 24. 25. 26. 27. 28. 29. 30. gristle: A. fortitude B. cartilage C. graphite D. arrogance E. overture decelerate means reducing A. velocity B. disorder C. enthusiasm D. hazards E. expenditures manipulate: A. reserve B. devote C. handle D. inquire E. introduce sumac: A. prayer B. reward C. shrub D. doctrine E. porch concrete: A. clean B. mean C. low D. nice E. real discreet: A. fragrant B. prudent C. unpleasant D. radiant E. gallant isopod: A. advertisement B. edifice C. meteorite D. philanthropist E. crustacean 63 31. 32. 33. 34. 3s. 64 sputum: A. saloon B. sickle C. shawl D. saliva E. sermon forgo: A. represent B. sacrifice C. justify D. determine E. display apropos: A. instructive B. respectful C. forbidden D. pertinent E. dominant yew: A. evergreen tree B. dismal day C. shabby house D. twisty road E. frightful dream conventicle: A. major enemy B. royal gentleman C. impossible question D. sharp object E. secret meeting 36. 37. 38. 39. 40. scintillate: A. develop B. whistle C. ruin D. breathe E. flash A. unaware B. fluent C. reluctant D. philosophical E. inquisitive flabellum: A. fort B. frost C. fan D. file E. flock pyrope: A. reptile B. heather C. slogan D. mantle E. garnet durbar: A. quarrel B. sailor C. audience D. painting E. province UNTIMED THE BASIC WORD VOCABULARY TEST SHORT FORM Y Month Day Year NAME: DATE TESTED: SEX: M F DATE OF BIRTH: EDUCATION: Current grade level completed and highest degree earned If not in school, highest grade successfully If in college, or college graduate: Academic major EXAMPLE DIRECTIONS: Select the word or phrase which has the same meaning, or most nearly the same meaning, as the underlined word. CIRCLE aboyisa the letter (A, B, C, D, or E) of your answer choice. Read all answer A. lip choices before making your choice. If you do not know the correct B. bush answer—guess! C. rock D child E. horse 1. the shore is by the a mistake is 9. advice A. sea something done A. record B. train A. first B. visit C. letter B. wrong C. bridge D. table C. next D. opinion E. paper D. often E. minute E. alone 2. ink is used to 10. tomb: A. walk on a witness is a person who A. baby B. write with A. trains animals B. market C. cut with B. bakes cakes C. grave D. serve with C. observes actions D. roof E. stand on D. fixes machines E. scale E. grows wheat 3. eagle: 11. corps: A. family puss: A. angry teacher B. cup A. factory B. tired worker C. lake B. devil C. sick animal D. coat C. exercise D. military unit E. bird D. camp E. special vacation E. cat 4. a tricycle is to 12. tremendous: A. hear with encyclopedia: A. serious B. ride on A. woman B. enormous C. lie on B. reason C. religious D. walk under C. nation D. famous E. see through D. food E. precious E. book 65 13. 14. 15. 16. 17 18. 19. 66 approach means to come A. through B. with C. into D. between E. near abandon: A. look over B. hold on C. liftup D. fall down E. give up tarantula: A. grape B. highway C. button D. spider E. verse mutiny: A. stranger B. puzzle C. rebellion D. lemon E. tenant eligible: A. lonesome B. careless C. qualified D. inferior E. profound sassafras: A. tree B. wave C. egg D. board E. yard muff: A. water heater B. hand warmer C. glass cleaner D. paint dryer E. wood burner 20. 21. 22. 23. 24. 25, 26. step in a process tear in a net light in a tower A B C. condition in a treaty D E article in a newspaper gratify: A. heat B. shout C. hope D. charge E. please cardiac means of the A. arm B. feet C. heart D. legs E. head thus: A. not B. too C. why D. so E. do A. slender B. grateful C. musical D. lively E. rare faction: A. dinner B. blood C. group D. passage E. hill console: A. compare B. conclude C. comfort D. command E. collect 27. 28. 29. 30. 31. 32. 33. horde: A. circle B. shade C. word D. crowd E. sand potpourri: A. tailor B. embassy C. schooner D. medley E. parson albacore: A. tire B. soldier C. box D. fish E. stick mesquite: A. office B. tree C. fire D. store E. gate destitute: A. respectful B. divine C. urgent D. slippery E. needy jujube: A. candy B. echo C. poem D. harvest E. brick a triphthong is a combination of three moO®E fossils cables diagrams vowels atoms 34. 3s. 36. 37. pifion: A. piano B. pioneer C. pine D. pinch E. pint bezant: A. hotel B. coin C. mill D. harbor E. desk cinereous: A. ashen B. precise C. bashful D. valiant E. nimble dint A. supply B. wish C. force D. price E. demand qua: redact: 40. jaconet A. moOws moOw meow during as while if when edit invert convict inherit afflict tribe gift port treaty cloth 67 UNTIMED THE BASIC WORD VOCABULARY TEST SHORT FORM 2 Month Day Year NAME: DATE TESTED: SEX: M F DATE OF BIRTH: EDUCATION: Current grade level ________. If not in school, highest grade successfully completed. In in college, or college graduate: Academic major and highest degree earned EXAMPLE DIRECTIONS: Select the word or phrase which has the same meaning, or most nearly the same meaning, as the underlined word. CIRCLE a boy isa the letter (A, B, C, D, or E) of your answer choice. Read all answer A. lip choices before making your choice. If you do not know the correct B. bush answer—guess! C. rock ® child E. horse 1. acaris to 5. a mistake is 9. burlap: A. start fires with something done A. tunnel B. eaton A. first B. medicine C. take pictures with B. wrong C. soil D. ride in C. next D. engine E. draw with D. often E. fabric E. alone 2. ink is used to 10. a seamstress is a A. walk on 6. howl: woman who B. write with A. roar A. writes C. cut with B. design B. sews D. serve with C. propose C. sings E. stand on D. depart D. paints E. succeed E. bakes 3. poor means having very little 7. phony: 11. approach means to come A. money A. tough A. through B. hair B. neutral B. with C. sun C. vivid C. into D. time D. fake D. between E. snow E. hasty E. near 4. combat: 8. advice: 12. abandon: A. point A. record A. look over B. report B. visit B. hold on C. fight C. bridge C. lift up D. start D. opinion D. fall down E. admit E. minute E. give up 68 13. 14. 18. 16. 17. 18. 19. barely: A. generally B. scarcely C. completely D. especially E. gradually sneer: A. listen with interest B. practice with care C. look with scorn D. lift with ease E. dance with joy eligible: A. lonesome B. careless C. qualified D. inferior E. profound exclude: A. educate B. excite C. eliminate D. encourage E. ensure juvenile: A. haunted B. youthful C. intimate D. favorable E. unable jolt: A. justify B. join C. judge D. jar E. journey gratify: A. heat B. shout C. hope D. charge E. please 20. 21. 22. 23. 24. 25. 26. rafter: A. angel B. canal C. beam D. lamb E. trunk lank: A. slender B. grateful C. musical D. lively E. rare console: A. compare B. conclude C. comfort D. command E. collect manipulate: A. reserve B. devote C. handle D. inquire E. introduce concrete: A. clean B. mean C. low D. nice E. real destitute: A. respectful B. divine C. urgent D. slippery E. needy bastion: A. fortification B. qualification C. appropriation D. legislation E. illustration 27. 28. 29. 30. 31. 32. 33. forgo: A. represent B. sacrifice C. justify D. determine E. display mackintosh: A. raincoat B. tractor C. honeybee D. cartoon E. saucepan trajectory: A. curved path B. ill health C. bold type D. glorious spirit E. strong back a triphthong is a combination of three A! fossils B. cables C. diagrams D. vowels E. atoms whist: A. captain B. game C. soul D. finger E. rock fetid: A. exhausted B. stinking C. pathetic D. meager E. insane bezant: A. hotel B. coin C. mil D. harbor E. desk 69 34. 3s. 36. 37. 70 scintillate: 02, & S E = mow sE moaxE> moOR > develop whistle ruin breathe flash unaware fluent reluctant philosophical inquisitive supply wish force price demand sarcophagus: moOowp coffin insect interview wharf mushroom 38. 39. 40. 41. diabolo: A. bed B. dance C. game D. mark E. record lempira: A. chair B. money C. salt D. earth E. music pyrope: A. reptile B. heather C. slogan D. mantle E. garnet redact: A. edit B. invert C. convict D. inherit E. afflict 000 APPENDIX VII SCORING METHOD FOR SHORT FORMS AND ANSWER KEYS Recommended scoring method.—Score through the 4th error or omitted item and subtract 4 from the 4th error or omitted item number. Thus if an individual made two errors and omitted one item through item 19 and then missed or omitted item 20, his score would be 20-4 or 16. Answer Keys Form X FormY Form Z 1 -D 21 -C 1 - A 21 E 1 D 21 - A 2 - A 22 - D 2 B 29 C 2 B 22 - C 3 - C 23 - E 3 E 23 D 3 A 23 - C 4 -D 24 - B 4 - B 24 A 4 C 24 - E 5 - A 25 - A 5 B 25 GC 5 B 25 - E 6 - C 26 - C 6 C 26 C 6 A 26 - A 7 - E 27 - C 7 E 27 D 7 D 27 - B 8 - B 28 - E 8 E 28 D 8 D 28 - A 9 - E 29 B 9 D 29 D 9 E 29 - A 10 - A 30 E 10 C 30 B 10 - B 30 - D 11 - B 31 - D 11 D 31 E 11 E 31 - B 12 - A 32 - B 12 B 32 A 12 E 32 - B 13 - A 33 - D 13 E 33 D 13 - B 33 - B 14 - B 34 - A 14 E 34 Cc 14 C 34 - E 15 - B 35 - E 15 D 35 B 15 C 35 - B 16 - D 36 - E 16 C 36 A 16 C 36 - GC 17 - A 37 - B 17 C 37 C 17 B 37 - A 18 - D 38 - C 18 A 38 A 18 D 38 - C 19 - C 39 - E 19 B 39 A 19 E 39 - B 20 A 40 C 20 A 40 E 20 C 40 - E 41 A O00 71 Series 1. Series 2. Series 3. Series 4. Series 10. Series 11. Series 12. Series 13. Series 14. Series 20. Series 21. Series 22, VITAL AND HEALTH STATISTICS PUBLICATION SERIES Originally Public Health Service Publication No. 1000 Programs and collection procedures.— Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data. Data evaluation and methods rvesearch.— Studies of new statistical methodology including: experi- mental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory. Analytical studies.—Reports presenting analytical or interpretive studies basedon vital and health statistics, carrying the analysis further than the expository types of reports in the other series, Documents and committee veports.—Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birth and death certificates. Data from the Health Interview Suvvev.— Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey. Data from the Health Examination Survey.—Data from direct examination, testing, and measure- ment of national samples of the civilian, noninstitutional population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psycho- logical characteristics; and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons. Data from the Institutional Population Surveys. .— Statistics relating to the health characteristics of persons in institutions, and their medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients. Data from the Hospital Discharge Survey.—Statistics relating to discharged patients in short-stay hospitals, based on a sample of patient records in a national sample of hospitals. Data on health resources: manpower and facilities.—Statistics on the numbers, geographic distri- bution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities. Data on mortality.—Various statistics on mortality other than as included in regular annual or monthly reports—special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses. Data on natality, marriage, and divorce.—Various statistics on natality, marriage, and divorce other than as included in regular annual or monthly reports—special analyses by demographic variables, also geographic and time series analyses, studies of fertility. Data from the National Natality and Mortality Surveys.— Statistics on characteristics of births and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, hospital experience in the last year of life, medical care during pregnancy, health insurance coverage, etc. For a list of titles of reports published in these series, write to: Office of Information National Center for Health Statistics Public Health Service, HRA Rockville, Md, 20852 DHEW Publication No. (HRA) 74-1334 Series 2-No.60 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Health Resources Administration 5600 Fishers Lane POSTAGE AND FEES PAID Rockville, Maryland 20852 YS DEPARTMENT OE Rey HEW 390 OFFICIAL BUSINESS Penalty for Private Use $300 THIRD CLASS BLK. RT. oA ee a A a lie + SET VITALand HEALTH STATISTICS Series 2-Number 61 ")JATA EVALUATION AND METHODS RESEARCH z Q NCHS % Wi National Ambulatory Medical Care Survey: Background and Methodology Public Health Service Health Resources Administration Library of Congress Cataloging in Publication Data National ambulatory medical care statistics. (Data evaluation and methods research, series 2, no. 61) (DHEW publication no. (HRA) 74-1335) “Prepared for the Division of Health Resources Statistics, National Center for Health Statistics.” Supt. Docs. no.: HE 20.6209: 2/61 Includes bibliographical references. 1. Medical statistics. 2. Medical care—United States—Statistics. I. White, Kerr L., joint author. II. Williamson, John W., joint author. III. United States. National Center for Health Statistics. Division of Health Resources Statistics. IV. Title. V. Series: United States. National Center for Health Statistics. Vital and health statistics. Series 2: Data evaluation and methods research, no. 61. VI. Series: United States. Dept. of Health, Education, and Welfare. DHEW publication no. (HRA) 74-1335. [DNLM: 1. Ambulatory care—Statistics. 2. Health surveys—U.S. WB16 T298n 1967-72] RA409.U45 no. 61 312°.01’82s [362.1°0973] 73-20225 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 - Price $1.25 DATA EVALUATION AND METHODS RESEARCH Series 2 Number 61 National Ambulatory Medical Care Survey: Background and Methodology United States-1967-72 A report on feasibility studies of methods developed for collecting national ambulatory medical care data from practicing office-based physicians in the United States, 1967-72, prepared for the Division of Health Resources Statistics, National Center for Health Statistics, Health Resources Adminis- tration, U.S. Department of Health, Education, and Welfare. DHEW Publication No. (HRA) 74-1335 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration National Center for Health Statistics Rockville, Md. April 1974 NATIONAL CENTER FOR HEALTH STATISTICS EDWARD B. PERRIN, Ph.D., Director PHILIP S. LAWRENCE, Sc.D., Deputy Director DEAN E. KRUEGER, Acting Associate Director for Analysis GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System ELIJAH L. WHITE, Associate Director for Data Systems IWAO M. MORIYAMA, Ph.D., Associate Director for International Statistical Programs EDWARD E. MINTY, Associate Director for Management ROBERT A. ISRAEL, Associate Director for Operations QUENTIN R. REMEIN, Associate Director for Program Development PHILIP S. LAWRENCE, Sc.D., Acting Associate Director for Research ALICE HAYWOOD, Information Officer DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS SIEGFRIED A. HOERMANN, Acting Director PETER L. HURLEY, Acting Deputy Director JAMES E. DELOZIER, Acting Chief, Ambulatory Care Statistics Branch WILLIAM F. STEWART, Chief, Family Planning Statistics Branch ABRAHAM L. RANOFSKY, Chief, Hospital Discharge Survey Branch Vital and Health Statistics-Series 2-No. 61 DHEW Publication No. (HRA) 74-1335 Library of Congress Catalog Card Number 73-20225 PREFACE This report describes the initial design and the preliminary background exploration, subsequent development, and feasibility testing of methods for conducting a continuing National Ambulatory Medical Care Survey (NAMCS). The purpose of NAMCS is to gather and disseminate statistical information on the provision and use of ambulatory health care services in the United States. The work reported here was accomplished from 1967 through 1972, but germinal planning for these methodologic studies stemmed from the report of the Subcommittee on National Morbidity Survey of the U.S. National Committee on Vital and Health Statistics published in 1953.1 In the 20-year interim, social and technologic changes as well as the efforts of interested organizations, involved individuals, and farsighted leaders contributed to the inauguration of the 1973 NAMCS. Principal contributors during the period of this report were representatives from endorsing medical organizations; the NAMCS ~ Technical Advisory Panel; the contracting organizations—Lea, Inc., and the National Opinion Research Center; the Department of Medical Care and Hospitals of The Johns Hopkins University; and both the National Center for Health Services Research and Develop- ment and the National Center for Health Statistics, of the Health Services and Mental Health Administration, U.S. Department of Health, Education, and Welfare. The principal national sources of statistical information about ambulatory medical care are the practicing, office-based physicians. Without their cooperation this research would not have been possible. Major medical organizations that endorsed the NAMCS project early were as follows: American Medical Association; National Medical Association; American Academy of Dermatology; American Academy of Family Physicians; American Academy of Neurology; American Academy of Orthopaedic Surgeons; American Academy of Pediatrics; American Association of Neurologic Sur- geons; American College of Obstetricians and Gynecologists; Ameri- can College of Physicians; American College of Preventive Medicine; American College of Surgeons; American Osteopathic Association; American Proctologic Society; American Psychiatric Association; American Society of Internal Medicine; American Society of Plastic and Reconstructive Surgeons; American Urologic Association; and Association of American Medical Colleges. The NAMCS Technical Advisory Panel of individuals with ambula- tory health care interests and expertise served as a committee of consultants to the feasibility study from its beginning. Committee members were the following: Theodore R. Ervin; Todd M. Frazier; and Drs. Barbara Bates, Robert J. Haggerty, Jean L. Harris, Howard H. Hiatt, Robert R. Huntley, Hugh H. Hussey, R. Robert Kalinowski, Chester F. Keefer (deceased), Charles E. Lewis, Kenneth D. Rogers, Paul J. Sanazaro, Patrick B. Storey, and Kerr L.. White. Consultants from the Department of Medical Care and Hospitals of the Johns Hopkins University School of Hygiene and Public Health in Baltimore were Drs. James B. Tenney, Kerr L. White, and John W. Williamson. The National Center for Health Statistics provided sponsorship, supervision, and technical staff support for the entire NAMCS methodologic development project. Siegfried A. Hoermann, Director of the Division of Health Resources Statistics, was Project Adminis- trator and Supervisor; James E. DeLozier has been the Project Officer for the study since 1969; and E. Earl Bryant, of the Office of Statistical Methods, gave consultation and expert assistance for aspects of sampling and survey design. CONTENTS Page Prefage ic mri uns rin ovme pn +8 8% kb bp rambme a6 suman iil Introduction. «+ 4 ss vo wv sw os sw Bm 2 bu 8 #3 ® 3 Cea mwa ERE HS 1 Ambulatory Medical Care . . . . ....... 00... 1 Defmition and Orientation. + « « os « tvs ss v8 sw wo 8 0 8% % 3 3 1 NecdsandUsesforInformationn « « + . vss ss snes ss sas ssas 2 National Center for Health Statistics Program . . . . . . .......... 2 Authority and Purpose. . . LL. Lo L000 ooo 2 Current Survey Operations + « « « s vs a wx vv sv a ws v3 wu ® 5 2 » 3 National Ambulatory Medical Care Survey . . . . . . .. ........... 3 Purpose and Seope +o « oc 4 sv sp mh 6 BH ss ew naa me 3 Sample DESIZN + + vs # vs x wa Be BEES EE ve BE Ee WBE EE EEE 3 SuorveyMethods . . cc ss ssa sss sams sp asin vas awsne a 4 PleldProceduid « + «x vs s s 0 ws 6 2 5 2 © 9 0 5&8 0 % 6 & tw oo wn 4 Data Collection . . . «oo... 00 ee 4 Data Processingand Resuis - + « « «0 vo 4 5 0 2 0 0 2.0 03 5 6 2 8 4 3°83 5H Background and Methodology . . . . . .. ... 000000 5 Exploratory Studies . . + + « 2 6 2 5 0 2 2 5 6 5 2 5 52 0 3 04 55 5 8 5 8 6 Jaterature Summary . . : 4 i vi ws vs ew ms EE saws 6 EE a ea 6 Office Records Barvey © + + wo 2 6 5 sv 6% os 0 da & 5% bm wom oy 6 Nal Borms Design. = + 2 5 0 62 000 40 © 0 0% & #8 #6 % #10 2 98 3 7 Feasibility Studies: Field Test: Phase I, 1968-69 . . . . . ......... 7 Purposcand Design « « + : # = vs x « 5 5% 5 55 8 0 « ® 5 $4 & ® 5 4 7 Survey RESUS + + «cw 54 «2 + 5 8 0 3% % 6 40 @ 84% § 02 ww uno 8 Conclusions . « : + « # 2% 5 2 « a 5» 2 8 % 2 + % 2 55 5 » +8 ® 8 = & & 8 Feasibility Studies: Field Test: Phase II, 1970-71 . . . . ......... 9 Porpose and Design . « + » so st 6 © 5 65 0 v3 5a 5a & kas aE ns a 9 SUIVEY Results . » 5 + + « ® 2 4 0 65 2 5 % 52 uw sx sew saw wn 11 Conclusions . « « « wu + «6 & 2 « # « + % & » © « 2 08 vs & 8 8fas 12 Illustrative Feasibility Study Findings . . . . . . . .............. 13 Introduction and Methods . . . . . . . . o.oo 0000 LLL. 13 DataSource and VOIUINE © . « « «wu ov 0 a ws 4 mv 5 5 0 vv 8 8 8 5 #3 13 Ageand Sex of Patients . « « « « « = 5 + a = £1 4 0 85+ 2 8 8 + 3 8 6 Fs 3 14 Problemsand Diagnoses . . « + tv vw vs os vn sw ms vs wo 3 08 8 84 5 a 15 Selected Characteristics of Visits. . . . . . . o.oo... 16 Summary and Conclusion + « « 4 «=» «0% o mos 0 moe sm om sms ws ews 17 References . « « vc sve v i sas ss srr sm sta ss an pinas snes 19 vi CONTENTS —Con. Page Appendix I. Data Collection Forms, 1973 National Ambulatory McdicalCare Survey » w+ 2 vw 2 2 3 8 83 5s 9 8 26 & 2 wow 5 6% % & 35 Patient Log and Patient Record, Sampling Every Patient . . . . . . . . .. 35 Patient Log and Patient Record, Sampling Every Second Patient . . . . . . 36 Patient Log and Patient Record, Sampling Every Third Patient . . . . . . . 36 Patient Log and Patient Record, Sampling Every Fifth Patient . . . . . . . 37 InductionInterview Schedule . « « + ¢s wv 4s cs sv vv ames a0 vr ws 38 Appendix II. Introductory Letters, 1973 National Ambulatory MeAicdl CHESUIVEY csr sw nwt ws RR 8 ws ww G5 @ 0 8 % 2 5 BF 5 4 46 Appendix III. Data Collection Forms, Field Test: Phase I . . . . . . . .. .. 48 LongPorm—-Patlent Data « « « w sc so vn a st vv 5 3 3% wo 2 2 24 8 2 3 » « 48 Short Form—Patient Data . © « «4 vo 0 ca 2 4 ss 5 0 v6 0 5 53 95 59 49 Induction Interview Schedule « « « « sw vw wv ww 2 22 vw oa 5 2 uw ® 5 2 50 Patient Form Evaluation Interview Schedule . . . . . ........... 54 Appendix IV. Data Collection Forms, Field Test: Phase II. . . . . . . . . .. 60 Short Form and Patient Log for Nonsampling Procedure . . . . . . .. .. 60 Short Form With Patient Log for Sampling Procedure . . . . . . . .. .. 61 Miniform and Patient Log for Nonsampling Procedure . . . . . . .. . .. 62 Miniform With Patient Log for Sampling Procedure . . . . . . . .. .. .. 63 Miniform Without Patient Log for Nonsampling Procedure . . . . . . . .. 64 Enlistment Interview Schedule . . . . ................... 65 Evaluation Interview Schedule +. + + 0 2 vv vv s 3 ws am mes v0 on 69 SYMBOLS Data not available------seeeemmmmeoeeeeeee Category not applicable---------eomerereeeeeeeees Quantity ZEro---ssssmssmssseemmeeonmnneee eee Quantity more than 0 but less than 0.05----- 0.0 Figure does not meet standards of reliability or precision------------ooooemeeemneeeeee %* NATIONAL AMBULATORY MEDICAL CARE SURVEY: BACKGROUND AND METHODOLOGY James B. Tenney, M.D., Dr. P.H.; Kerr L. White, M.D.; and John W. Williamson, M.D.2 INTRODUCTION In April 1973 the National Center for Health Statistics inaugurated the National Ambulatory Medical Care Survey to gather and disseminate statistical information about ambulatory health care provided by office-based physicians to the population of the United States. It is the purpose of the present report to relate the current survey design characteristics and to describe the background and methodology for developing the National Ambulatory Medical Care Survey. Selected feasibility study findings are presented to illustrate collected data and suggest kinds of information that may be ex- pected when substantive survey results become available on a continuing national basis. AMBULATORY MEDICAL CARE Definition and Orientation’ Ambulatory medical care is the predominant pathway for the provision and use of profes- Dr. Tenney is Assistant Professor and Drs. White and Williamson are Professors at the Johns Hopkins University School of Hygiene and Public Health, Department of Medical Care and Hospitals, Baltimore, Maryland. sional medical services in the United States. It is defined as health services rendered individuals under their own cognizance, at a time when they are not in a hospital or other health care institution. These services, for the largest part, fall under the category of primary care. Primary care is characterized by direct personal contact between patients seeking help for their health problems, and physicians or other health profes- sionals who try to provide it. Secondary or tertiary care applies to services provided ambula- tory patients who are referred to specialists or consultant physicians.2 By definition ambula- tory medical care does not include secondary- and tertiary-level care provided hospital in- patients, or lay services given outside formal health care systems. Ambulatory care takes place in many settings, from patients’ homes, neighborhood health cen- ters, and public clinics to hospital outpatient departments and emergency rooms. However, the largest volume of ambulatory care in this country is provided at the doctor’s office.3 It is there that people go when sick, in distress, or out of sorts, and it is there physicians attend them. Approximately 7 of every 10 Americans consult a physician 1 time or more annually, and 7 of every 10 physicians engaged in patient-care activities do so principally in office-based prac- tice.*»> According to unpublished data from the 1972 National Health Interview Survey, exclud- ing telephone calls, 80 percent of all physician visits take place in the doctor’s office; 13 percent at hospital clinics and emergency rooms; and 7 percent at homes, on jobs, or elsewhere. NEEDS AND USES FOR INFORMATION Important needs for and uses of statistical data on the volume and characteristics of health care provided in physicians’ offices are manifest. Yet the apparent importance of population use and professional practice of ambulatory medical care is not reflected in currently available knowledge. Five broad areas for application are particularly prominent: 1. National statistics—The summary account- ing of events affecting the Nation’s governmen- tal as well as public interest—should have con- tinuing data input for surveillance to reflect the ambulatory care component of the Nation’s health services systems. Specifically, the infor- mation given should be useful in comparing the use of ambulatory services among different groups of the population over time and in assessing the kind and magnitude of effects associated with changes that occur in health care systems. 2. Professional education—The systematic preparation of physicians and other health per- sonnel to meet the health care requirements of the public—needs regular reliable data on the health problems of ambulatory and institutional- ized patients and on the professional care they receive. The information would be useful in developing educational priorities and in planning desirable curriculum changes in medical and other health care schools. This would insure that graduates are prepared for the tasks they are called to perform or the medical problems they will be encountering. 3. Health policy formulation—The selection, at all levels of care, of alternative directions for administration, management, and implementa- tion in personal health services systems—needs relevant data about ambulatory and institutional services to evaluate sound choices and rational decisions. The information would be useful in assessing alternative plans for modifying health services organizations and delivery systems. 4. Medical practice management—The admin- istration and implementation of decisions af- fecting the planning and conduct of ordinary office practice and patient care—needs regional and national data reflecting contemporary trends in use of services and treatment of patients. The information would be useful in assuring the maintenance of standards and in comparing the effects of alternative procedural patterns and manpower organizational distributions. 5. Quality assurance—The systematic effort to assess and improve the effectivene:: and efficiency of medical care—needs ambulatory care data to develop baselines for implementing programs of professional standards review. The information would be particularly useful in establishing priorities for research and develop- ment of quality assessment standards, instru- ments, guidelines, and methods. THE NATIONAL CENTER FOR HEALTH STATISTICS PROGRAM Authority and Purpose The National Center for Health Statistics (NCHS) is the principal Federal agency with comprehensive responsibility for compilation, analysis, and dissemination of health statistics; and it serves as a recognized focal point for national leadership in developing coordinated data collection systems to meet public and private needs. Established in 1960 by authoriza- tion under both the Public Health Service and National Health Survey Acts, the Center is a separate organizational part of the Health Re- sources Administration in the U.S. Department of Health, Education, and Welfare. Its major mission is “. .. to develop and maintain systems capable of providing reliable general purpose, national, descriptive health statistics on a contin- uing basis, and to publish these statistics for the use of the health and related professions and industries, both public and private.” Accord- ingly, NCHS is fundamentally concerned with the need for, and has a clear mandate to develop and provide national statistics regarding, ambula- tory medical care in the United States. Current Survey Operations The Center operates a number of national statistical data collection systems: the national vital statistics of births, deaths, fetal deaths, marriages, and divorces; surveys based on sam- ples of the birth and death records; a continuing nationwide survey of households by interviews; a series of national surveys based on physical examinations of population samples; periodic surveys of nursing homes, hospitals, and other health care facilities and their patients or resi- dents; a continuous national sampling of short- stay hospital records; and surveys of various categories of health manpower based on license renewals, reports from establishments, or other sources. Results are published in several series of statistical reports and are also provided in reference to specific special requests for statis- tical data or technical assistance. A constant program is maintained to improve these systems and to develop new ones in response to changing needs and demands. NATIONAL AMBULATORY MEDICAL CARE SURVEY The National Ambulatory Medical Care Sur- vey (NAMCS) is the contemporary data collec- tion system constituting the outcome of NCHS’ concern with developing objective and reliable quantitative information to measure and de- scribe ambulatory health care services for the U.S. population.” The initial (1973) NAMCS design is presented here. The features are en- dorsed by major organizations within the medi- cal profession listed in the preface and are the result of decisions based on experience from the background investigation and methodologic de- velopment described in subsequent sections of the report. PURPOSE AND SCOPE The purpose of the NAMCS is to meet needs and demands for statistical information about the provision and use of ambulatory medical care services in the United States. Initially, the target population consists of all office visits within the coterminous United States made by ambulatory patients to physicians who are prin- cipally engaged in office-based practice but not in the specialties of anesthesiology, pathology, and radiology or in Government service. Tele- phone contacts and nonoffice visits are ex- cluded. When resources permit feasible survey methods to be developed, the target population will also include visits to other locations and professionals, thus encompassing the remaining fraction of ambulatory medical care initially not within its scope. Complex sampling and re- porting problems must be resolved to produce reliable statistical information from hospital outpatient departments and emergency rooms, a most important component of this remainder. SAMPLE DESIGN The only objective and reliable sources of data about physicians’ services rendered to ambulatory patients during office visits are the physicians themselves and members of their office staffs. The survey population for the NAMCS’ multistage probability sample, there- fore, includes all physicians in office-based practice responsible for ambulatory patient care, excluding those in anesthesiology, pathology, and radiology or in Government service. The sampling frame is a list of licensed physicians in office-based practice compiled from files that are classified and maintained by the American Medical Association (AMA) and the American Osteopathic Association (AOA). These files are continuously updated by the AMA and AOA, "making them as current and correct as possible at the time of sample selection. The first-stage sample was designed and se- lected by the National Opinion Research Center (NORC), a nonprofit research organization affil- iated with the University of Chicago, which contracted to carry out all phases of NAMCS field work. A modified probability-proportional- to-size procedure using separate sampling frames for standard metropolitan statistical areas (SMSA’s) and for nonmetropolitan counties was employed. After sorting and stratifying by size, region, and demographic characteristics, each frame was divided into sequential zones of 1 million residents, and a random number was drawn to determine which primary sampling unit (PSU) came into the sample from each zone. The final first-stage sample contained 87 PSU’s, corresponding to individual counties or small groups of contiguous counties across the country. The second-stage sample was selected from the list of physicians located in sample PSU’s ordered by major specialty categories, so that the overall probability for including any individ- ual was the reciprocal of the number of physi- cians in the frame at the time of selection. A final sample of 1,705 office-based physicians was thus drawn and assigned by random meth- ods to one of the 52 one-week periods in the year for data collection. Samples for subsequent years will exclude with certainty physicians included within the previous 2 years. In subse- quent years larger samples may be employed for more precise estimates or more detailed repre- sentation of ambulatory medical care informa- tion. Reliability will continue to require preserv- ing strict statistical sampling procedures, unsubstituted collection period assignments, and high participation levels among sample physicians. SURVEY METHODS Field Procedures To maximize participation levels and mini- mize data collection requirements, assuring ob- jective and reliable information as a result, NAMCS field procedures uniformly emphasize and accommodate the individual circumstances of sample physicians. After receiving introduc- tory letters from NCHS and AMA or AOA, sample physicians are telephoned by informed and trained NORC interviewers who explain the survey briefly and arrange personal appoint ments to relate more detailed instructions. When interviewers visit, they determine sample physicians’ eligibility, ascertain their coopera- tion, deliver survey materials with printed in- structions, and assign predetermined Monday- through-Sunday data collection periods. A short interview concerning basic practice characteris- tics, such as estimated numbers of patients to be expected, is administered. Office staff who will assist with data collection are invited to attend or are offered separate instruction sessions. Sample physicians are informed of support for the NAMCS by their respective specialty socie- ties. State and local medical societies are made aware of the survey through communications from the AMA as well as from interviewers and field staff supervisors. Before the beginning and again during the week assigned for data collection, interviewers telephone sample physicians to answer possible questions and to insure that procedures are going smoothly. At the end of the survey week, participating physicians mail finished survey materials to interviewers who edit the forms for completeness before transmitting them for cen- tral data processing. Problems at this stage are resolved by interviewer telephone calls to sample physicians; if there are no problems, field procedures are complete with respect to the sample physicians’ participation in the NAMCS. Missing information is generally obtained from the patient’s medical record by the physician’s staff or provided from memory by the physician. Data Collection The actual data collection for the NAMCS is carried out by participating physicians, aided by their office assistants when possible. They are requested to complete data collection forms concerning ambulatory patient visits taking place during assigned 1-week periods in their office practices. Based on their own estimates of the numbers of patients expected to visit during the survey period, physicians are assigned to use an ‘“‘every-patient” or a “‘patient-sampling’ pro- cedure. All procedures are designed so that encounter forms for approximately 10 patient visits be completed each day. Physicians expect- ing 10 or fewer visits daily record data for all of them, while those expecting more than 10 visits record data after every second, or third, or fifth visit, observing the same predetermined sampling interval continuously. These procedures mini- mize the workload of data collection and main- tain equal reporting levels among sample physi- cians regardless of the size of their practices. Each form requires 1-2 minutes to complete, so that approximately 15 minutes are required on days when ambulatory patients are attended in their offices. Two data collection forms are employed by the participating physicians: the Patient Log and the Patient Record. The Patient Log is a sequential list of patients visiting throughout the survey week that serves to indicate at which visits data should be recorded. The Patient Record is an encounter form which requires 12 items of data about a visit: date and duration of the visit; patient’s birthdate, sex, color, and principal problem; physician’s estimate of the seriousness of the problem, and whether the patient has been seen for it before; major categorical reasons for the visit; diagnoses; treat- ment or services; and disposition. Together these items constitute a brief but informative general account of an ambulatory patient visit. The Patient Log and the Patient Record are separate, or attached only by perforation so that sample physicians can keep the Log and mail the Patient Record back to the interviewer after comple- tion, without any indication of patient names to protect confidentiality. Copies of the various Patient Logs and Patient Records are shown in appendix I. DATA PROCESSING AND RESULTS Edited NAMCS Patient Records and physician interview information are mailed by the inter- viewers to NORC for further editing, subsequent coding, and entry on magnetic tapes. Any remaining information identifying individual ambulatory patients is positively deleted. All information that would permit identification of a physician, a practice, or an establishment is held in strict confidence for use only by persons engaged in and for the purposes of the survey, secure from disclosure or release to other per- sons or use for other purposes. Initial NAMCS results in the form of sum- mary statistical tabulations of national and regional estimates for numbers of visits, percent distribution, and population rates of use are published as soon as each annual cycle of the continuing NAMCS is complete. More detailed tabulations of visit characteristics by major physician specialties, patient groups, diagnostic categories, treatment provided, and disposition arranged will follow. Cross-tabulations of less common visit characteristics will be published when sufficient data about them are available to meet practical standards of precision. In addi- tion, research findings on the reliability and validity of NAMCS methods, the means to improve and extend them, and on statistics related to specific questions from States or professional specialty groups are under development. BACKGROUND AND METHODOLOGY In 1967 the National Center for Health Statistics began planning the project from which the current NAMCS design and methods ulti- mately developed. NCHS staff members entered into discussions with consultants, practicing physicians, statisticians, and potential contrac- tors to identify ambulatory care data collection problems and prospective approaches to solu- tions. Contract proposals were solicited for a “pilot study on a survey of physician’s records” to develop methods for expanding *... the health records program to include samples from records of private physicians.” The request was intended to elicit as many proposals and ideas as possible since the prospect appeared more diffi- cult than any the Center had attempted previ- ously, and a heuristic problem-solving approach seemed indicated. After numerous inquiries, half a dozen proposals were finally submitted; the one by Lea, Inc., of Ambler, Pennsylvania, was selected as most likely to succeed on the basis of that company’s prior experience and existing resources for surveys involving collection of data from ambulatory medical practice. A technical advisory group of individuals with nationally recognized interest or experience was named. Initial discussions established a tentative proto- col that called for periodic meetings of a working group comprised of the Director of the NCHS Division of Health Resources Statistics, the Project Officer and staff, the contractor’s representatives, and a consultant group from The Johns Hopkins University in Baltimore. After several working group meetings and pre- liminary exploratory investigations, the purpose of the project became clear: a methodologic study was needed to determine the feasibility of collecting ambulatory care data from office- based physicians on an ongoing national survey basis. It would require developing alternative instruments and procedures for data collection, testing them by application among samples of physicians, and evaluating the results according to criteria for feasibility. The NAMCS methodo- logic study design subsequently evolved in three stages: first, a stage of exploratory studies followed by two stages of feasibility studies, Field Test: Phase I and Field Test: Phase II, each with specific objectives related to the project’s purpose. EXPLORATORY STUDIES Objectives of the exploratory stage were to define operationally the boundaries and com- ponents of the ambulatory care data problem for research and to formulate alternative meth- ods and procedures for subsequent testing and evaluation. The international literature was re- viewed, a sample of practicing physicians was interviewed, and individuals with identified in- terests or experience in the subject were consulted. Literature Summary Published accounts of ambulatory care stud- ies, particularly those involving data collection from office-based physicians, documented the relative lack of existing information or broad experience with methods of population-based medical practice surveys outside hospitals or institutions. Since the earliest account in 1842, occasional individuals or small groups of physi- cians have reported studies of morbidity en- countered and services rendered in home and office settings, based principally on analysis of existing records.® Reports were reviewed from many countries, including Great Britain, Canada, Australia, Denmark, Germany, Holland, Nor- way, and the United States.” The Royal College of General Practitioners and the General Regis- ter Office of the United Kingdom carried out an important survey of 171 physicians from 106 general practices in England and Wales over a l-year period in 1955-56. It was undertaken after lengthy preliminary explorations of record- keeping techniques following the advent of the National Health Service there.!? In the United States, relatively extensive studies were re- stricted to selected groups of practices; notable ones included the surveys reported by Standish et al., by Peterson et al., by the Chronic Illness Project, Inc., and by Kroeger et al.1 1-14 Ambu- latory care services and utilization among pre- paid insurance plan populations had been stud- ied by Weissman and by Densen et al., and from insurance claim form data by Avnet.!5-17 The sole existing source for continuing, profession- ally defined ambulatory care statistics identified in this country was National Disease and Thera- peutic Index by Lea, Inc., a commercial survey conducted principally for pharmaceutical mar- keting research purposes among a quota-sample panel of private physicians.!® The literature revealed the need for developing uniform termi- nology, common units of measurement, widely accepted definitions, and for agreeing on prac- tical classifications of patients’ problems and diagnostic conditions encountered in ambula- tory practice. Information from all the available accounts was sought to help in formulating initial NAMCS methods and feasibility study design. Office Records Survey A direct personal interview survey was con- ducted by Lea, Inc., among a random sample of physicians in private practice, in accordance with contract provisions to explore possible applications of existing office records as a source of national ambulatory care information. A commercial list of physicians was stratified by medical specialty group and geographic region of the country to provide the sampling frame; 358 interviews were successfully completed among the 400 physicians who were selected as the sample. Results revealed that whereas nearly all respondents kept records, variations in their form, style, content, completeness, and accessi- bility were extensive. The use of illegible terms, abbreviations, and symbols precluded their use by anyone but the recording physician in 20 percent of cases, and alphabetic filing systems precluded ready relation to defined time periods in 80 percent. Examination of specimen records, which were obtained from two-thirds of the respondents, substantiated the interview find- ings. It was concluded that practicing physicians alone could provide a range of information concerning ambulatory patient visits in their offices, provided that confidentiality and ano- nymity were preserved. Since existing records were not a feasible source for data collection, ad hoc encounter forms of some sort, designed for the purpose, became necessary. Initial Forms Design Different styles and versions of modified encounter forms were drafted to facilitate the collection of ambulatory patient visit data by physicians. Basic precepts were to minimize workload or practice interference due to record- keeping and to maximize usefulness of the data to be gathered. Form designs were revised repeatedly after consultation with survey re- search specialists and again after pretesting them among 22 selected physicians practicing in a large metropolitan area. Interviews following their pretest experience suggested that physi- cians preferred shorter (i.e., 2 days quarterly) instead of longer (i.e., 1 week or 1 month) data collection periods, as well as shorter instead of longer data collection forms as an initial ap- proach to field testing. Most of these explora- tory study results were incorporated in the design of subsequent stages of feasibility studies for the NAMCS project. FEASIBILITY STUDIES: FIELD TEST: PHASE I, 1968-69 Purpose and Design The purpose of the first phase of feasibility study field testing was to evaluate ambulatory patient visit data collection by a national sample of physicians, using two different data collection forms and three different methods to enlist their participation. The objective was to determine whether any combination of the forms and methods was more feasible as to the proportions of sample physicians agreeing to participate in a national ambulatory medical care survey and later satisfactorily completing data collection forms as requested. The two forms employed to determine the quantity of data that was feasible for physicians to collect are shown in appendix III. The longer form required about 3 minutes per patient visit to complete, and the shorter one about 1 minute. Both forms requested entries for the patients’ purpose or problem, diagnosis, age, race, sex, marital status, and prior visit status, as well as the location and duration of contact, diagnostic procedure, treatment, and disposi- tion. In addition, the longer form requested entries for the patient’s socioeconomic, health, and referral status; the physician’s estimate of the seriousness of the problem; and more spe- cific diagnostic test details. If physicians wished to retain completed records, the forms were designed so that contact-sensitive code sheets beneath each one could be detached and re- turned alone. The three methods of enlisting sample physi- clans to participate in the survey which were evaluated for feasibility in the Phase I field test were (1) telephone contact by a physician in residency training, (2) telephone contact by a lay interviewer, and (3) personal visit contact by a lay interviewer. Since each approach was employed to enlist physicians for data collection using the long form and the short form, there were six different form-approach combinations for comparison. The sampling frame was constructed from a commercially maintained list to represent the survey population of all non-Federal, patient care-oriented physicians in office-based practice in the continental United States, excluding specialists in anesthesiology, pathology, and radiology. It was stratified by physician’s age group, medical specialty group, and geographic region; and a systematic sample was selected containing 899 doctors of medicine or osteop- athy. Each physician was randomly assigned to one of the six form-approach combinations for the data collection field test. First, introductory letters were sent to all sample physicians from the Director of the NCHS, which briefly explained the purpose of the study and advised them of the forthcoming call by a representative of the Center. Then efforts were made to contact each physician according to the assigned procedures and to enlist participation of those who were ascer- tained to be within the predefined scope of the study. Eligible physicians were defined as those who provided care for any ambulatory patients in their practice. Home, office, hospital clinic, or emergency room visits and telephone contacts were included to establish feasibility. They were asked to participate for an assigned 2-day period of data collection, which would recur quarterly for a year. An enlistment interview to elicit practice characteristics, provide instructions, and answer questions was held beforehand, and survey materials with printed instructions were supplied. Finally, after completing data collec- tion forms concerning ambulatory patient visits, participating sample physicians returned them by mail to a central location for tabulation and described their experience at a postsurvey eval- uation interview conducted by telephone. Survey Results Results of the feasibility study’s first phase of field testing are shown in table 1. Of 899 physicians in the total sample at the time it was drawn, 679 (76 percent) were still eligible and available at the time the field test was con- ducted; they constituted the effective or target sample that was actually approached and asked to participate. Others could not be located, had left practice by death or retirement, did not provide services for ambulatory patients, were unavailable during the survey period, or they were not requested to participate. The relatively large number of ineligible or unavailable physi- cians was attributed in part to the 6-month period elapsing between drawing the sample and conducting the field test. Of the effective sample approached, nearly three-fourths (74 percent) were enlisted or agreed to participate, and more than one-half (55 percent) did so by completing and returning data collection forms. Differences between sample proportions using and complet- ing the long form and the proportions using and completing the short form were negligible. The expected difference in response for the two forms was not realized, perhaps because both forms seemed long to respondents using only one of them. The different approaches also appeared to have slight overall effect, although telephone contact by resident physicians was slightly more successful than other methods of enlistment, and personal contact by lay inter- viewers was marginally more successful for completion. Item completion, the proportion of returned data collection forms on which data were supplied as requested for each specific item, ranged from 90 to 99 percent for items on the short form, and from 85 to 99 percent for items on the long form. Nonresponse to some items was attributed to their relatively inconspicuous position on the forms; for others it seemed more related to the increased time required to make necessary judgments for reply. Hospital emer- gency room or clinic visit and telephone contact data were relatively underrecorded. Interviewing at the time of enlistment pro- vided data about practice characteristics that facilitated interpretation of the field test results. Postsurvey interviewing gathered impressions of the physicians’ experience and their suggestions for improving survey methods. Reducing the workload for participating physicians and in- creasing their awareness of the purposes of the methodologic study were the most frequently mentioned practical suggestions to improve fu- ture participation. Conclusions Conclusions from Field Test: Phase I of feasibility studies for the NAMCS methodologic project were tentative. Ambulatory medical care data collection instruments and procedures had been designed and tested among a national sample of office-based physicians. The results in terms of sample proportions enlisting for parti- cipation in the study and actually completing data collection assignments suggested that a national ambulatory medical care survey using such instruments and procedures was potentially feasible. Revisions and improvements appeared necessary to assure that continuing naticnal statistical information based on methods for data collection by practicing physicians would also meet required NCHS standards of quality and completeness of response. FEASIBILITY STUDIES: FIELD TEST: PHASE II, 1970-71 Purpose and Design The purpose of the second phase of feasibility study field testing was to develop and evaluate ambulatory patient visit data collection methods further. Improvements suggested by Phase I field test experience were incorporated in the design, which was aimed specifically at reducing data collection workload and practice interference, increasing the participants’ awareness of the purposes of the survey, and strengthening pre- viously established levels of professional interest and support. A subcontract was arranged for the National Opinion Research Center (NORC) to assist with the design and to conduct all survey field work. The scope of the survey was limited to ambulatory patient visits to physicians in their offices, since other methods would be required for outpatient clinics and telephone contacts. Objectives were to increase the propor- tions of sample physicians agreeing to partici- pate in the survey and satisfactorily completing assigned data collection procedures. Two data collection forms again were tested: a “short” one required about 1 minute per visit to complete, and a “mini” one required only seconds per visit. The short form corresponded to the shorter form used in Field Test: Phase I; and the miniform embraced an irreducible mini- mum of useful data, requesting only the pa- tient’s age and sex and the physician’s diagnosis and type of treatment. The miniform was used primarily to test whether the size of the form would have any effect on physicians’ willingness to participate in the survey. The detachable record and code she=t feature of Phase I forms had not proved useful and was discontinued. A patient sampling procedure was devised to test this method for reducing the data collection workload of participating physicians. Instead of completing a form for every patient visit, those using the sampling procedure were to record data for only every third patient visit. A complete list of every patient visit was needed to insure that the sequence was observed; it would provide a patient sampling frame and afford the added benefit of relative assurance that the data collection process was complete. The number of missed patient visits would be minimized and become measurable in part by this method. Accordingly, a “log” was devised for use in addition to data collection forms, for listing patients visits in the sequence of their arrival in the office, or in any systematic order that fitted usual office procedures and assured complete- ness. The additional procedure made it necessary to design the field test so as to assess the effect of the log as well as that of the different forms. One uniform approach to enlisting sample physicians to participate in the survey was adopted as a result of the Phase I experience. A combined telephone-personal-contact method using lay interviewers was employed. The tele- phone contact served to determine a sample physician’s eligibility and availability and to make an appointment for an interviewer’s sub- sequent personal contact. At that time participa- tion was enlisted, data collection requirements and survey procedures were explained, and an interview concerning practice characteristics was held. Sample physicians were encouraged to assign office assistants, secretaries, receptionists, or nurses to help with data collection as much as possible and to maintain the log of patients visiting. Five data collection form/procedure combina- tions were tested in Field Test: Phase II of the feasibility study: Short form, log, no sampling Short form, log, sampling Miniform, log, no sampling Miniform, log, sampling Miniform, no log, no sampling Peano Io Appendix IV shows copies of these forms and logs. Survey participation was again enlisted for a 2-day period that would recur quarterly within a year. Six pairs of consecutive days were identi- fied so that sample physicians could be assigned randomly to one of them; for feasibility study purposes, however, a preselected second pair could be assigned if a physician were unavailable on the first. The same sample of physicians was contacted within 6 months after the initial data collection assignment period to repeat the process in a second quarter in order to estimate expectable attrition if the same methods became feasible to employ for a continuing national survey. Perhaps the single most important aspect of Phase II field testing was to develop methods of making the medical profession at large and particularly the sample physicians requested to participate more aware of the purpose and significance of an ambulatory medical care survey. Endorsement was first provided by the AMA, and a letter from its Executive Secretary was sent to all sample physicians before an interviewer’s telephone call indicating full organ- izational and professional support for the re- quest to participate. Nineteen medical and pro- fessional specialty societies subsequently endorsed the survey in principle. Their support was indicated in the introductory letter sent to all sample physicians from the Director of NCHS to introduce the survey and describe needs and uses for the information expected to result. (Copies of the AMA and the NCHS introductory letters are given in appendix II.) An informative NCHS press release was used by a number of mass-circulation and medical specialty journals, increasing the possibility that physicians would know of the survey. Just before initial telephone contact, supervisory interviewers also called lo- cal medical society executives to inform them about the nature and purpose of the survey and to tell them sample physicians in their vicinity would be asked to participate. All these methods were applied to achieve the increased awareness of the survey considered necessary to attain high enlistment and completion rates among a na- tional sample of office-based physicians. A multistage, stratified national probability sample was selected from a survey population containing all office-based doctors of medicine practicing in the coterminous United States, excluding anesthesiologists, pathologists, and radiologists. Physicians were defined and classi- fied for survey purposes as they are represented on the AMA master list, from which the final sampling frame was constructed. First the pre- selected sample of PSU’s maintained and staffed 10 by NORC was stratified by geographic region and physician population size, and a subsample of PSU’s was selected with probability propor- tional to the number of physicians practicing in each one. Next the AMA list of physicians in the sample PSU’s was stratified by age and specialty group, and individuals were systematically se- lected with a probability inversely proportional to the number practicing in their PSU to form the total sample of 831 physicians. Finally, each sample physician was randomly allocated to one of the five survey form and procedure combina- tions, to one of the six pairs of consecutive days for data collection, and to one of the inter- viewers assigned to work in his PSU. Contacts with physicians began about 3 weeks before the survey period. Letters from both the NCHS Director and the AMA Executive Director were sent to all sample physicians. Efforts were made to telephone physicians by trained lay interviewers who ascertained their eligibility, i.e., whether they provided services for ambula- tory patients from offices where they were primarily responsible for the care of such pa- tients over time. The interviewers tried to arrange personal visits with eligible physicians, to explain survey procedures to them and to any designated office assistant whose help could be expected. Data collection forms and printed survey materials were delivered at that time, and a structured enlistment interview was adminis- tered to obtain information about anticipated numbers of ambulatory patient visits and other practice characteristics. Later, just before the first data collection days, interviewers tele- phoned physicians again to remind them of the survey and answer any questions arising in the meantime. When the data collection period was finished, participating physicians mailed survey materials to interviewers, who edited them for completeness and telephoned the participant for a brief postsurvey evaluation interview to obtain information about his experience. All completed data collection forms and interview returns were mailed to a central location for editing, coding, and data processing for analysis. Appendix IV contains copies of the two interview schedules. At the second-quarter data collection period 6 months later, the same physicians were re- minded by letters, contacted by telephone, and sent survey materials by mail, except in in- stances where additional instructions or answers to questions required personal visits. Interviews conducted with participants after the data col- lection period were abbreviated at this stage. Data processing was oriented toward analysis of survey enlistment and data collection form completion for feasibility study test purposes. Since analysis of the substantive content of patient visit record forms was secondary, survey participation factors were emphasized in coding and tabulation. Information was amalgamated from the interviewers’ control folders regarding contacts with physicians, from the enlistment interviews regarding practice characteristics, from the data collection forms regarding patien: visits, and from the postsurvey evaluation inter- views regarding the data collection process itself. All was coded, entered, and stored on magnetic tape for subsequent computer. tabulation and analysis. Weighting factors corresponding to the reciprocal of their probability of selection in the sample were calculated for each physician and employed for interpreting enlistment and com- pletion rates, which constituted the principal feasibility study results. Survey Results Results of the second phase of feasibility study field testing are shown in table 2. Of 831 physicians in the total sample at the time it was selected, 746 (90 percent) were both eligible and available to participate at the time of the survey and constituted the effective or target sample for study. The remainder could not be located after persistent attempts, had died or retired, did not have primary responsibility for ambulatory patient care in their offices, or would not be available during the survey period. Eighty-three percent (621) of the effective sample of physi- cians enlisted or agreed to participate, and 80 percent (595) actually completed forms and returned them following the first-quarter data collection period. If the same proportions are calculated using the weighting factors to adjust for the probability of selection into the sample, 86 percent enlisted and 83 percent completed assigned data collection procedures. The propor- tion of sample physicians participating in the Phase II survey calculated with or without weighting factors is substantially greater than the 55-percent completion achieved in the Phase I field test. Higher proportions of miniform users than of short form users participated in the survey. Little difference was observed between proportions enlisting in the survey and propor- tions actually completing data collection for either form. Similarly, negligible differences were noted between proportions of sample physicians using the work-reducing, patient- sampling procedures and those listing every patient and completing forms for each one. There ‘was also little noticeable effect on re- sponse by use of the Patient Log; completion rates were 86 and 85 percent, respectively, for physicians using the miniform with the log and those using the miniform without the log. Differences between completion rates by geo- graphic region, specialty, or age group were not significant. Results after the second quarter of the Phase II field test show that 79 percent of the effective or target sample of 721 physicians agreed to participate, and 73 percent of them actually did so. The difference between the effective sample numbers in the two quarters reflects changes among the sample physicians over the interval that affected their eligibility or availability. Additional members left practice, could not be located, or were no longer directly responsible for ambulatory patient care; a few not available the first quarter were eligible to participate in the second, however. Eighty:six percent of those physicians who actually completed data collec- tion forms in the first quarter also completed forms in the second quarter. An overall attrition of 7 percent between quarters was therefore observed. The decrement was slightly greater among physicians listing and recording data for all patients than for those using work-saving sampling procedures. The quality of data collection represented by the enlistment and completion rates reached in Field Test: Phase II of the feasibility studies is indicated by the record form item completion, and by the proportion of their ambulatory office patients the sample physicians included during their assigned data collection periods. Item completion on Field Test: Phase II first- quarter record forms ranged from 95 to 98 percent for the four miniform items, and from 83 to 99 percent for the 17 variably applicable short form items; the rates were higher than had been achieved in Field Test: Phase I. Sample physicians completing forms were asked whether 1 they recalled not recording data concerning any ambulatory patients attended in their offices during their assigned periods; 93 percent were confident all were included, and only 2 percent thought more than two patients might have been missed. The number of patients represented by returned data collection forms was consistently about 85 percent of the number of patients these physicians previously had expected would visit, regardless of the data collection form or procedure used. This difference may be due to ambulatory patient visits in nonoffice locations, such as hospital emergency rooms, outpatient clinics, or patient’s homes, which did occur as the physicians recalled at the postsurvey evalua- tion interview but were excluded from the scope of study. The majority (73 percent) of the 595 sample physicians participating in the first quarter of the feasibility study’s Field Test: Phase II survey collected data concerning ambulatory patient visits during the randomly preselected 2-day period first assigned to them. Alternative periods were assigned to another 15 percent who were initially interviewed after the first preselected period had passed, and to 9 percent more who expected to see no ambulatory patients in the first preselected period. These reasons were sufficient for alternative data collection period assignments for feasibility study purposes; alter- native periods would be unnecessary for pur- poses of a continuing survey using similar methods because physicians could be inter- viewed early and could record zero visits on nonpractice days. Postsurvey evaluation interviews after the first quarter of Field Test: Phase II showed that methods designed to increase awareness of the survey and its potential benefits had been effective and warranted. More than half the responding sample physicians indicated that the introductory letters they received beforehand favorably influenced their decision to partici- pate. The proportions were 63 percent for the AMA letter and 56 percent for the NCHS letter; the remainder indicated they were uninfluenced 12 by or did not recall receiving either letter. Half the NCHS letters were sent by certified mail, with no discernible effects on recall or participa- tion. Only a few respondent physicians con- sulted local medical society officials or discussed survey participation with colleagues. Other favorable factors cited were the worthwhile purpose of the survey and the persuasiveness of the interviewers. Forms, procedures, and survey materials presented no consistent problems for these participants, although a number of mini- form users questioned the usefulness of the small amount of data they collected for poten- tial ambulatory care statistics. Conclusions Based on the foregoing results and accrued experience after Field Test: Phase II of the feasibility studies, the maturing methods and procedures developed and tested to date were considered feasible for application when the continuing NAMCS was inaugurated. Extensive and improved levels of participation by prac- ticing office-based physicians, in terms of sample proportions collecting patient visit data under field trial conditions, supported this conclusion. Nevertheless, the critical importance of main- taining high levels of participation also war- ranted variation and testing of methods and procedures to refine them further under actual continuing survey conditions. Short data collec- tion forms and simple patient sampling pro- cedures were found to be practicable. Advance information about the survey’s nature, purpose, and significance appeared to be a prerequisite for success; and support from organized medi- cine, professional societies, and publications at national and local levels proved to be a practical means of increasing physician response. The completeness and quality of patient visit data collection as estimated in the field trial seemed sufficient to support feasibility study results, but procedural reliability and content validity remain to be established after the NAMCS has commenced. ILLUSTRATIVE FEASIBILITY STUDY FINDINGS INTRODUCTION AND METHODS The purposes of both field phases of the NAMCS feasibility studies described in this report were methodologic, by design. These surveys were conducted to develop and test, and subsequently improve and test, instruments and procedures for ambulatory care data collection by practicing office-based physicians on a con- tinuing national basis. The instruments and procedures that were developed and the results of their feasibility testing have been related in foregoing sections. It is through the application, continuing evaluation, and refinement of such methods that the goal of statistical information reflecting the important but relatively under- represented ambulatory component of health care services for the population may be realized. As a byproduct of Field Test: Phase II of the feasibility studies, a volume of data collected from actual ambulatory patient visits to practic- ing office-based physicians regarding the pa- tients’ visits and the services they were provided became available. These data are subject to important limitations by virtue of their by- product nature and cannot be presented either as a quantitatively precise or statistically ac- curate representation of the subjects contained within them. Participation by physicians was less than complete and it varied within and between quarters. Five different form-procedure com- binations were employed for data collection, and substitution for preassigned recordkeeping periods was permitted for feasibility study pur- poses. The amount of data collected at ambula- tory patient visits concerning different charac- teristics varied because of the different form lengths and patient sampling procedures that were required. For these reasons as well as the costs that would be incurred, the feasibility study data were not adjusted for nonresponse or weighted to reflect the national population basis for the probability samples of PSU’s as well as physicians. The small sample size and volume of data and the lack of uniform content or collec- tion methods also precluded calculating useful estimates of national utilization rates or other office-based ambulatory medical care param- eters. Statistical information of the necessary kind and quality still depends on results of the continuing NAMCS. At the same time, these data have inherent interest for potential users of NAMCS infor- mation. Selected summary findings may indicate kinds of information to be expected or suggest useful analyses or tabulations for practical ap- plication when continuing survey results may be obtained. The authors therefore undertook a limited exploration of the Field Test: Phase II byproduct data, with permission, cooperation, collaboration, and support from NCHS. Under their direction a group of summer apprentice- ship-traineeship medical and dental students, supervised by preceptors, applied standardized computer programs to tabulate and analyze the magnetic-tape-stored data. Additional coding and key punching for patient problem and diagnosis data were accomplished by exper- ienced staff from the Center. The proportional distributions, ranked frequencies, and cross- tabulations that follow are the findings from this analysis. Wherever bias may appear due to aggregation or subdivision of entries, it is a consequence of described data limitations and the authors’ judgment and does not necessarily reflect the style or format of subsequent NAMCS results or tabulations. The data are presented here with only minimal discussion, which represents comments that could accompany similar data from the NAMCS. The reader is CAUTIONED, however, that these data are not to be considered repre- sentative of national statistics and should be regarded only as illustrative of tabulations ex- pected in the future from the NAMCS. DATA SOURCE AND VOLUME Office-based physicians participating in Field Test: Phase II of the feasibility study and the patient visits from which they collected data for analysis and presentation here are shown in table 3 by number and percent according to specialty groups. The numbers of physicians shown in the first column of table 3 used short form procedures in the first and/or second quarters of the survey to record patient visit data. Although the short 13 form procedures provided over four times as many items of data per visit as miniforms and produced the only survey data that were col- lected about a number of visit characteristics, they constituted only two of the five survey procedures. The number of physicians assigned short form procedures was correspondingly small compared to the overall number of partici- pating physicians. For these reasons, subsequent analyses of data provided by short forms alone did not include characterization by the specialty groups listed in table 3, but were limited to the physicians’ type of practice, either specialty or general and family practice. The numbers of physicians in each type of practice may be ascertained by reference to this table. The percent distribution of participating physicians using all survey procedures, shown in the third column of table 3, was compared with the corresponding distribution calculated from the numbers of all office-based physicians (ex- cluding anesthesiologists, pathologists, and radi- ologists) in the United States and possessions at the end of December 1971.19 Differences ex- ceeding approximately 2 percent were found for two specialty groups; 4.4 percent more partici- pating than all office-based physicians were in general surgery, and 8.2 percent fewer were in the “remaining other specialties’ category. The percent distribution of participating physicians is less similar to the percent distribu- tion of patient visits, also shown in table 3, in several respects. Physicians in primary care specialties reported relatively more patient visits and those in secondary/tertiary care specialties reported relatively fewer patient visits than might be expected on the basis of their propor- tions among the participants. Physicians in general and family practice comprised a quarter of those participating and reported a third of the visits; pediatricians comprised 4.7 percent and reported 8 percent. Psychiatrists and neurolo- gists, who made up 6.8% percent of all partici- pants, reported 3.1 percent of all visits. AGE AND SEX OF PATIENTS Tables 4 and 5 show the ambulatory visits to each specialty group of office-based physicians according to the age group and sex of patients visiting, respectively. Table 6 shows the distribu- 14 tion of all visits by both sex and age group of patients visiting. Together these tables provide a quantitative description of two major demo- graphic variables for the entire group of ambula- tory care visits, as well as for visits to physicians in major specialty groups providing ambulatory medical care services. The first row of table 4 displays the percent distribution of all ambulatory patient visits reported during Field Test: Phase II among broad age groups of patients. By comparison, proportionately more visits to physicians in primary care specialties were made by younger patients. A small percentage of visits to pediatri- cians was made by patients over the age of 14, and a still smaller percentage of visits to general internists was made by patients of 14 years or less. The age distribution of patients visiting physicians in general and family practice resem- bles that of all patient visits. By contrast, relatively fewer patient visits to secondary/ tertiary care physicians were made by the younger patients. The bulk of visits to obstetri- cian-gynecologists were, of course, by patients in their childbearing years; this is also true for patient visits to psychiatrists-neurologists, for reasons that are less obvious. The sex of patients visiting physicians in different specialty groups is shown in table 5. The majority of ambulatory patient visits are made by females, but not in pediatric or orthopedic surgery practices. The distributions by sex of visits to physicians in primary and in secondary/tertiary care specialties are similar, although, as expected, females made nearly all visits to obstetrician-gynecologists. Table 6 shows the overall number and percent distribution of all Field Test: Phase II office visits by patient sex and age group. The majority are made by females, but males predominate slightly at ages 65 years and over. By compari- son with a similar distribution constructed for the estimated total U.S. population in 1971, the proportion of office visits by females is 5 percent greater than the proportion of females in the U.S. population.2? For the youngest age group, the proportions of visits and of the population are similar: but for the age group 5-14 years, the proportion of visits is approxi- mately half their proportion of the total. Visits by women aged 25-44 years make up more than 16 percent of all visits, though women of this age group constitute 12 percent of the entire population. Additional data will afford a closer examination of such characteristics when NAMCS results are available. PROBLEMS AND DIAGNOSES The most common patient problems encoun- tered by the office-based physicians using short form procedures are shown in table 7, and the most common diagnoses and the major classes of diagnoses recorded at all ambulatory patient visits during both quarters of Field Test: Phase II are shown in tables 8 and 9. These three tables represent results of coding using the Eighth Revision International Classifi- cation of Diseases, Adapted for Use in the United States (ICDA), with its supplementary classification for “Special Conditions and Exam- ination Without Sickness.”?! Individuals experi- enced in using the classification for coding hospital discharge abstracts and death certificate diagnoses were employed to apply its rules and procedures for entries recorded after the ambu- latory patient visits. Entries for the patients’ purpose, problem, or chief complaint could not be coded for 2.6 percent of the short form procedure visits, and entries for the most impor- tant diagnosis accounting for the visit could not be coded for 8.5 percent of all the visits. In part this was because these items were not completed by the data-collecting physicians and in part because entries that were made could not be assigned to any categories of the classification. The ICDA, which was designed to code and classify well-defined diseases and causes of death, was difficult and unwieldy to apply for many of the relatively ill-defined symptoms, problems, complaints, and clinical impressions that label conditions which ambulatory patients present in office-based medical practice. Follow- ing recommendations of the Chicago Conference on Ambulatory Medical Care Records, NCHS has subsequently been participating actively in the development of improved classifications for patients’ problems and conditions encountered in ambulatory medical care.? 2 Common patient problems within the diag- nostic categories listed in table 7 were reasons for the majority of these ambulatory patient visits. Examinations of essentially well persons and followup care for others were most promi- nent. Lower on the list but still within the first 15 categories were such nonspecific and well- known conditions as sore throat, nervousness, backache, common cold, and obesity, which bring numbers of patients to visit doctors and require a proportion of the ambulatory health care services they provide. Essential benign hypertension, elsewhere a specific diagnosis, here reflects visits for the purpose of having bood pressure checked. The common reasons patients present for ambulatory care visits are principally classified in broadly defined, non- specific, and residual ICDA categories. The diagnostic categories listed in table 8 contain the common diagnoses or disease labels participating office-based physicians assigned to the patients’ conditions that they thought ac- counted for each ambulatory care visit during the survey. Relatively few of the 872 ICDA three-digit categories include a good many of the diagnoses they assigned; none of the remainder contained diagnoses made at more than 1 percent of the visits. Although nonspecific, residual, and combined categories appear on the list, many contain well-defined disease entities such as hypertension, chronic ischemic heart disease, diabetes, obesity, otitis media, acute pharyngitis, bronchitis, hay fever, and acute tonsillitis. Visits for diagnoses under followup care, examination, and prenatal care categories are as prominent in order of frequency as these categories were found to be among the patient problems in table 7. In part, this finding may reflect agreement between physicians’ views of patients’ purposes or reasons for visiting and of their own professionally defined diagnostic la- bels for their patients’ conditions. The first listed category of unassigned diagnoses in part reflects the measure of uncertainty with which specific diagnoses are often made in office-based practice. Provisional treatment for expected disease and early management of undiagnosed and still-undifferentiated symptoms or symp- tom complexes in ambulatory patients is commonplace. Table 9 lists the major ICDA classes of diagnostic categories in the rank order of their frequency as reasons for the ambulatory patient visits included in Field Test: Phase II. Compari- 15 son of this ranked list with similar ones for hospital discharge diagnoses and for causes of death in the United States facilitates inter- pretation.23.24 The supplementary class, “Special conditions and examinations without sickness,” leads the ambulatory visit list, fol- lowed by “Diseases of the respiratory system” and the class of conditions for which no diagnostic category was assigned. The class containing conditions responsible for the largest number of deaths in this country, “Diseases of the circulatory system,” appears fourth on the list for visits. “Neoplasms,” second in order as a cause of death and seventh as a cause of hospitalization, is 15th as a cause for ambula- tory patient visits here, followed by classes of conditions for which fewer than 1 percent of the visits were made. “Diseases of the digestive system,” the second most common cause of hospitalization and fifth of deaths, is 14th in table 9. “Accidents, poisonings, and violence” and “Diseases of the respiratory system” are classes accounting for relatively large propor- tions of ambulatory visits as well as of hospitali- zations and deaths. The differences and similari- ties observed between ranked classes of diagnostic categories accounting for ambulatory visits, for hospital-treated morbidity, and for mortality suggest the potential utility of such statistical information to provide perspective for establishing priorities and policy for health care services. SELECTED CHARACTERISTICS OF VISITS Tables 10-18 show distributions of Field Test: Phase II ambulatory patient visits to office-based physicians in two broad types of practice, according to selected characteristics related to patients visiting, services and treatment pro- vided, dispositions arranged, and durations of visits. Data concerning these characteristics were collected by physicians using the two short form survey procedures, and thus the majority of these analyses and tabulated findings are based on the subsample of visits they reported. Data on treatment provided at visits were also col- lected by physicians using miniform procedures, and table 16 is consequently based on all visits during the survey. 16 The color and current marital status of patients visiting are presented in tables 10 and 11. Over 90 percent were white, about 3 percent more than the proportion of white persons in the resident United States population.?? In part, this is because larger proportions of persons other than white than of white persons may visit less frequently, or attend hospital clinics and emergency rooms instead of physicians’ offices, for ambulatory health care services. More than half the patients were married, and about one-third were single. The findings presented in table 12 show that less than one in five visits were made by patients new to the physician. About 63 percent of patients visiting physicians in specialty practice had previously been seen for the same problem, and about 16 percent for other problems. By contrast, 49 percent of patients visiting physi- cians in general and family practice had been seen before for the same problem, and about 30 percent for other problems. The extent to which histories were taken and phys al examinations performed at ambulatory patient visits is shown in table 13. Histories were obtained in about 87 percent of visits; these were limited in extent about twice as frequently as they were general. The proportion of visits to physicians in specialty practice at which no history was taken exceeds the comparable pro- portion in general and family practice. Examinations followed the same pattern as histories. An examination was performed at 9 of 10 visits, and more than twice as many were limited as were general in nature. Proportions of visits including general examinations were lower, and limited examinations higher, in general and family practice than in specialty practice. Visits at which examinations were not performed at all were more frequent among physicians in spe- cialty than in general and family practice. Table 14 shows the distribution of ambula- tory patient visits according to whether diag- nostic tests were ordered, and for what purpose they were intended. Laboratory procedures, X-ray examinations, and other diagnostic proce- dures were not ordered for any reason at a large majority of visits, and at others physicians did not know or did not record whether tests were ordered or their intent. Visits to physicians in specialty practice included laboratory proce- dures for screening more commonly than visits to physicians in general and family practice. The proportion of visits at which diagnostic test data were incomplete or unknown may reflect the middle position this item occupied on the data collection form, or uncertainty by physicians as to how to classify the purpose of tests that were ordered or performed. Diagnostic specimens such as blood, urine, and other samples needed for diagnostic tests were not taken at approximately two-thirds of these ambulatory patient visits, as shown in table 15. At the remainder, specimens were taken less commonly by physicians themselves than by office staff or others, particularly in specialty practice, where they were obtained at 31 percent of visits. The proportions of visits at which specimens were taken are similar to those at which laboratory procedures were ordered, on comparison with percentages shown in table 14. Table 16 presents findings from all Field Test: Phase II ambulatory patient visits and shows their distribution according to broad types of treatment provided by the office-based physi- cians. At more than half of the visits drugs of some type were prescribed, administered, dis- pensed, or advised; drug therapy was provided more commonly in general and family practice than in specialty practice. No treatment was considered needed at 17 percent of the visits, and advice concerning diet, exercise, or habit changes was given at 12 percent. Therapeutic listening or psychotherapy was recorded as a type of treatment employed at almost 8 percent of the visits. This 8 percent may be an under- estimate, since it included visits at which the modality was purposefully pursued, but not others at which it may have gone unrecognized as part of the therapeutic exchange between the patient and the physician. Other treatment was provided at one-fourth of the visits; it was proportionally more prominent among visits to physicians in specialty types of practice, as might be expected. In contrast to the findings concerning diagnostic tests and specimens in tables 14 and 15, treatment was unknown or unrecorded at less than 1 percent of visits. Disposition and followup plans after visits to physicians using short form survey procedures are presented in table 17. Appointments for return visits were specifically arranged following the majority, and less specific directions to return if necessary were given at one-fourth of the visits. Relatively fewer specific appointments and more general arrangements were made after visits to physicians in general and family practice than in specialty practice. No further followup or telephone followup was planned after 9 and 7 percent of these visits, respectively. Patients were referred for admission to hospital after approximately 4 percent of visits, predomi- nantly to remain under the same physician’s care there. Patients were referred to another physi- cian after 2 percent of visits, and directed to return to another referring physician or agency after 1 percent. The different proportional distributions observed between visits to physi- cians in specialty and in general and family practice are expected, as these broad types of practice differ with respect to the patients served, conditions treated, and services provided. Table 18 shows the volume and distribution of ambulatory patient visits by their duration in minutes spent in face-to-face or other direct contact between patients and physicians. Nearly half the visits were completed within 10 minutes or less, and only a small minority lasted more than 30 minutes. Shorter visits predominated in general and family practice, longer ones in specialty practice. From the illustrative findings contained in this section of the report, an impression may be gained concerning the ambulatory care data gathered by office-based physicians during Field Test: Phase II of the NAMCS Feasibility Study. The same kinds of data, modified, refined, and multiplied, are expected to be collected during the ongoing NAMCS. Results will make varied and detailed analyses possible, and quantitative statistical information concerning office-based ambulatory health care services provided for the U.S. population will become available. SUMMARY AND CONCLUSION In 1973 the National Ambulatory Medical Care Survey was inaugurated by the National Center for Health Statistics to gather data and promulgate statistical information concerning 17 the provision and use of ambulatory health care services for the population of the United States. A national probability sample of office-based physicians now collects data from ambulatory patient visits during 1-week periods in their practices. Processing and analysis of the results provide national and regional estimates of the annual volume and rates of ambulatory patient visits for population groups, medical specialty groups, and geographic areas. Quantitative descriptions of visit characteristics include tabu- lations of patient’s problems, reasons for visiting, medical diagnoses, services, treatment, and subsequent disposition. The background and development of methods employed for the NAMCS required exploratory and feasibility studies conducted over a period of 6 years. Literature review and consultation documented needs and potential uses for na- tional ambulatory medical care statistics. Infor- mation regarding accepted definitions, uniform terminology, procedural experience, or practical classifications for the problems and conditions encountered in ambulatory care settings was found to be limited. First, data collection forms and procedures were developed and tested by sample physicians in a national field survey, which demonstrated the difficulty of achieving high levels of participation. Refined data collec- 18 tion forms and improved procedures were fur- ther tested by a second sample of physicians in an extensive national survey lasting over 2 quarters in 1 year. Results demonstrated the usefulness of professional endorsement, proce- dural efficiency, and minimal work requirements in achieving physician-participation levels ex- ceeding 80 percent. As a byproduct of the latter phase of feasibil- ity studies, a volume of ambulatory visit data became available. It was analyzed and presented to illustrate kinds of information NAMCS results will provide. Subject to described limitations of the data, percent distributions of 23,407 ambu- latory patient visits to a national probability sample of office-based physicians are shown by categories of patients, specialty groups of physi- cians, and characteristics of visits. Common patient problems and physician diagnoses are ranked in order of their frequency. These findings may suggest potential applications for NAMCS results, which will supplement existing NCHS programs with information from ambula- tory patient visits in office-based practice. The added NAMCS results will assure that a more comprehensive range of statistical information is available concerning the entire spectrum of health care services for the population of the United States. REFERENCES INational Health Center for Health Statistics: Origin, pro- gram and operation of the United States National Health Survey. Vital and Health Statistics. PHS Pub. No. 1000-Series 1-No. 1. Public Health Service. Washington. U.S. Government Printing Office, Aug. 1963. 2White, K.: Patterns of medical practice. In Clark, D., and MacMahon, B. (eds.), Preventive Medicine. Boston, Little, Brown, and Co., 1967. 3National Center for Health Statistics: Physician visits, volume and interval since last visit, United States, 1969. Vital and Health Statistics. Series 10, No. 75. DHEW Pub. No. (HSM)72-1064. Health Services and Mental Health Administra- tion. Washington. U.S. Government Printing Office, July 1972. #National Center for Health Statistics: Current estimates from the Health Interview Survey, United States, 1971. Vital and Health Statistics. Series 10, No. 79. DHEW Pub. No. (HSM)73-1505. Health Services and Mental Health Administra- tion. Washington. U.S. Government Printing Office, Feb. 1973. 5National Center for Health Statistics: Health Resources Statistics. Health Manpower and Health Facilities, 1971. DHEW Pub. No. (HSM)72-1509. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, Feb. 1972, 6National Center for Health Statistics: The Mission and Policies of the National Center for Health Statistics. DHEW Pub. No. (HSM)73-1201. Health Services and Mental Health Adminis- tration. Rockville, Md. THoermann, S.: The national ambulatory medical care survey. Med. Care 11:(Suppl.) 196-205 (Mar.-Apr.), 1973. 8Cowan, C.: Report of private medical practice for 1840. J.R.Stat.Soc. 5: 81-86 (Apr.), 1842. 9Tenney, J.: The Content of Medical Practice: A Research Bibliography. Baltimore, The Johns Hopkins University School of Hygiene and Public Health, Department of Medical Care and Hospitals, 1968. 01,0gan W., and Cushion, A.: Morbidity Statistics From General Practice. Vol. Illustrated (Great Britain). General Regis- ter Office. Studies on medical and population subjects No. 14. London, Her Majesty’s Stationery Office, 1958. 1gtandish, S., Bennett, B., White, K., et al: Why Patients See Doctors. Seattle. University of Washington Press, 1955. 12peterson, 0., Andrews, LL., Spain, R., et al.: An analytical study of North Carolina general practice 1953-1954. J.Med. Educ. 31 (Part 2):1-165, (Dec.) 1965. 13Chronic Nliness Project, Inc.: Physician reporting morbidity survey report. Miami, Fla., Chronic Illness Project in Dade County, 1963. 14g roeger, H., Altman, I., Clark, D., et al.: The office practice of internists. JAMA 193:371-376, 667-672, 916-922; and 194:177-181, 533-538, 1965. 15yeissman, A.: Morbidity study of Permanente health plan population; a preliminary report. Permanente Found.Med.Bull. 9:1-17, (Jan.) 1951. 16pensen, P., Balamuth, E., and Deardorff, N.: Medical care plans as a source of morbidity data. The prevalence of illness and associated volume of service. Milbank Mem.Fund Quart. 38:48-101, (Jan.) 1960. Avnet, H.: Physician service patterns and illness rates: a research report on medical data retrieved from insurance records. New York, Group Health Insurance, 1967. 18 ca, Inc.: Annual report. A continuing study of morbidity in private medical practice in the United States: National disease and therapeutic index. Ambler, Pa., Lea (undated). American Medical Association, Center for Health Services Research and Development: 1972 Reference data on the profile of medical practice. Chicago, American Medical Association, 1972. 20y.S. Bureau of the Census: Estimates of the population of the United States by age and sex: July 1, 1971 (Preliminary Report). Current Population Reports: Populations Estimates and Projections. Series P-25, No. 466. Washington. U.S. Government Printing Office, Sept. 1971. 2INational Center ior Health Statistics: Eighth Revision International Classification of Diseases, Adapted for Use in the United States. PHS Pub. No. 1693. Public Health Service. Washington. U.S. Government Printing Office, 1967. 22Conference on ambulatory medical care records: In J.H. Murnaghan (ed.), Ambulatory Medical Care Data: Report of the Conference on Ambulatory Medical Care Records, held at Chicago, Ill. Apr. 18-22, 1972. Philadelphia, J.B. Lippincott, 1973, pp. 10-12. 23National Center for Health Statistics: Inpatient utilization of short-stay hospitals by diagnosis. United States, 1968. Vital and Health Statistics. Series 13, No. 12. DHEW Pub. No. (HSM)78-01763. Health Services and Mental Health Administra- tion. Washington. U.S. Government Printing Office, Mar. 1973. 24National Health Center for Health Statistics: Provisional statistics. Annual summary for the United States, 1971: Births, deaths, marriages, and divorces. Vital and Health Statistics. Monthly Vital Statistics Report Series, Vol. 20, No. 13. DHEW Pub. No. (HSM)73-1121. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office, Aug. 1972. ’ 250.5. Bureau of the Census: Statistical Abstract of the United States: 1971. (92d edition). Washington. U.S. Govern- ment Printing Office, 1971. 19 Table 1. 20 10. 17. 12. 13. LIST OF DETAILED TABLES Number of physicians in sample and percent enlisting in and completing forms for Field Test: Phase |, NAMCS Feasibility Study, by enlistment method and length of form: United States, 1969 . . . . . . . . .......... . Number of physicians in sample and percent enlisting in and completing forms for Field Test: Phase II, NAMCS Feasibility Study, by data collection form and procedure: United States, 1971 . . . . . . . . . . . . ....... . Number and percent distribution of 645 office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study and of 23,407 ambulatory patient visits, by specialty of physicians: United States, 1971 . . . . . . Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase 11, NAMCS Feasibility Study, by age of patients and specialty of physicians: United States, 1971 . Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by sex of patients and specialty of physicians: United States, 1971 . Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by sex and age of patients: United States, 1971 . . . . . . . ..... .. . Number, percent, and cumulative percent of 7,514 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by the 20 most common three-digit ICDS categories assigned for patient's purpose, problem, or chief complaint: United States, 1971 . Number, percent, and cumulative percent of 23,407 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by the 20 most common three-digit ICDA categories assigned for their most important diagnosis: United States, 1971 . . . . . . . . .. .. . Number and percent distribution of 23,407 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by the 19 major ICDA classes containing thelr most important diagnosis: UnitediSIates, TOTT uw. «v6 wo iv 5 6 5 6 ww #0 & & 6 in 5 ie & #0 5 % nw © 5% 0 Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase 11, NAMCS Feasibility Study, by type of physician practice and color of patients: United States, 1971. . Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and marital status of patients: United States, 187) sv ic Ge BIBS PRG TEES TUES LITE od Bw ms 0 Ewe We EWE Wu we Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and by whether patient had been seen before by same physician: United States, 1971 uv + a» wv a Ba Bis 53 Bo a bs Bo Go 4 Ha BG os whe. Number and percent of 7,614 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and extent of history taken and examination made at VISITE: UN States, 1071 + vs vd tu ss BE BT 6 3 RE TST HP Gd Wr Bon aE EEE EERE aE Page 22 23 24 25 26 26 27 28 29 30 30 31 Table 14 15. 16. 17. 18. LIST OF DETAILED TABLES—Con. . Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and laboratory procedure, X-ray examinations, and other diagnostic procedures ordered: United States, 1971 . . . . . . . . . . . . ......... Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and diagnostic specimen taken: United SOEs. TON i: vic mis 5lv © 5 0 5 5 8 4 & % Sa & $i ow Hi ¢ 6 ® ESS SEH IELERE REDE ES Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and treatment provided for patients: United States, TO7T ow sv ws 5 5 6 8 wm 5 ws bi dE se ww sw eek 6 ow EEE WE WE WEE YE YEE EE SESE 6 Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and disposition following patient VISIT: UNIT SIBLIES, 1977 . . . vv tc 4 t vt 2 sv 4 + + 4 0 + vv" se sv Ev a vv va wen vs ne sms Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and duration of visit: United States, 1971 . . Page 32 33 33 34 34 21 Table 1. Number of physicians in sample and percent enlisting in and completing forms for Field Test: Phase |, NAMCS Feasibility Study, by enlistment method and length of form: United States, 1969 Enlistment method and form length Number of Pefegnt Percent physicians enlisting | completing Total, all MEthOdS ANG TONING oor mi sn sa ssa 2 EEs CH ME LHe BE 100s 679 74 55 Total, long forms eee 351 73 54 TOA, SHOVETORMNS , 0 0m 509% 3006 DYE F ©.508 © 0H F900 55h Sw we wan a 5h 328 75 56 Telephone contact by resident physician TORRY 5 (5% ws 2 0) 010 0 0000 0 9 a at 3 ww wr dp le DR 224 80 54 LONGTOIMS. . nisi ams imei ARP EMF IEE IER RM RA © F SEE vm mee 118 78 50 SHOETIGUMNG, «von: 5.5005 0. 000000 0 commit ie cous: 4100s 0 AD 0 Sw i Sd lo A SR 0 #0 210 0 410 i 106 82 58 Telephone contact by lay interviewer i Rr rr mmm Tr 241 73 47 LONGIOIMMS: . .uiminmrswmsssimmninsi IRI RRA IER Iai ERI REE IEG SHEE ERT 122 73 50 SHOFLIONNS . run nmr mms summa cmms mms smmedmb seas s RAP SEBS IMIs SRE EWE 119 74 54 Personal contact by lay interviewer Total :crvinas smut rR NIE RBI EPIRA EN BEAR Rr RRP Rs FAS SWS 214 70 61 LONGIONMS can inms vans sa Ri sRns imme nmol waa ERE RE 55 5 GEE owls ew 111 75 65 SIUOFTIONMNG: + iv act viv Sewiions 0 cos won oom ovn mun bit 00 chads 85 8 100 Bows 3 oot Gol 8 8 op 80 81 4 1 0 BOE 0 6 106 Wh ok 2 103 64 57 ! Effective or target sample number is given; it excludes 220 (24 percent) of 899 total sample physicians, who were unavailable or ineligible according to prior survey definitions, and hence were not requested to participate or complete forms. Table 2. Number of physicians in sample and percent enlisting in and completing forms for Field Test: Phase II, NAMCS Feasibility Study, by data collection form and procedure: United States, 1971 First quarter Second quarter Datg'eollectioniform ghd procedure Number of Percent Percent Number of Percent Percent physicians’ enlisting | completing | physicians® enlisting | completing Total, all forms and procedures . . . .. 746 83 80 mm 79 73 Total, short form a .ceuvswa ss was s 301 78 74 291 74 67 Tod, mInIform ...cemmnsssns swans 445 87 84 430 82 78 Log and sampling procedures Total = ivms vomns aamny vs smarts was 285 84 78 278 81 73 Bhortfonms. ou sms amms + male wm @ sb ® ms ows 143 82 76 141 79 72 MINHOIMS soi vu niswvs seme Bw iG moses’ 142 86 80 137 83 74 Log, no sampling procedures TOR ars worn 00 0 0 Wh 0 310 81 78 298 74 69 Shortioms: cus sssv ams sous amas ss 0s snes 158 74 72 150 68 62 MITITORIMNS wove wine inn 0m x 0 00 6e 00 0 0% 00 20d 152 88 86 148 80 77 No log, no sampling procedure NDITOTINS «vio 4: 60s 0 00 rok @0 00 6 6 ET" 8 0 nr Te 4 0 151 87 85 145 83 82 ! Effective or target sample numbers are given; they exclude 85 (10 percent) of 831 total sample physicians the first quarter, and 56 (7 percent) of 777 the second quarter, who were unavailable or ineligible according to prior survey definitions, and hence were not requested to participate or complete forms. 23 Table 3. Number and percent distribution of 645 office-based physicians participating in Field Test: Study and of 23,407 ambulatory patient visits, by specialty of physicians: United States, 1971 Phase II, NAMCS Feasibility Participating physicians Patient visits Specialty of physicians Number of | Number of z Percent Number of . Pergent distribution of distribution of short-form all study all study all study all study procedures | procedures procedures procedures procedures Total, all specialties . . ................ 246 645 100.0 23,407 100.0 Primary care specialties Total suze musnEs IP ERATIVE RART IEEE 101 283 439 12,538 53.6 General and family practice . .................. 62 166 25.7 7,932 33.9 General internal medicine .................... 27 87 13.5 2723 11.6 General pediatrics . ........ viii 12 30 4.7 1,883 8.0 Secondary /tertiary care specialties TTOLBY ce. 0s iw an svi wives con oz 1 5 20s a0 9 00 wor fod 300 00 0 145 362 56.1 10,869 46.4 GONeral SUrGBIY «vn + x wiv sm wes s@ Es 2 WES vows §iw ws 39 92 14.3 2.512 10.7 Obstetrics-gynecolOgy . : «wv: snvs sums sus ss 23 52 8.1 1,873 8.0 OrthopediCSUIGBIY . cx vwmio s sm ms sos sms s mals 16 38 59 1,507 6.4 Other surgical specialties . . ...............0.0... 32 84 13.0 2421 10.3 Psychiatry-neurology . ............c..uuuenen.. 1 44 6.8 718 3.1 Other medical specialties: , . «vv wus sw ms » wos sw 19 40 6.2 1,461 6.2 Remaining other specialties . .................. 5 12 19 377 1.6 24 Table 4. Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by age of patients and specialty of physicians: United States, 1971 LL Number of All 0-14 1544 | 45-64 | 65 years Not Specialty of physicians : patients ages years years years and over | stated Percent distribution Total, all specialties ............c0uuuuennnn 23,407 | 100.0 19.1 43.0 25.7 12.7 1.5 Primary care specialties TOW vv snms voms ami REI IRANI ERI FER Bw 12,538 | 100.0 26.9 36.6 22.1 129 1.8 General and family practice . .............cuuuuenn.n 7932 | 100.0 19.2 43.7 22.7 12.7 1.8 General internal medicine . . ...... iii 2,723 | 100.0 2.8 38.1 35.0 227 1.3 General PEAIALIICS «viv s w wis viv 3 mE Bis ¥ 53 ww wa wey we 1,883 | 100.0 94.0 49 0.5 0.6 Secondary /tertiary care specialties TOMBE «5.015 5 wits 31 wis nim swoon waste io hess ton oi V0 SHEL ob I 10,869 | 100.0 10.1 50.4 255 12.4 1.5 General SUTTEIY' + 5.4 » wo 38 a 93 0% Fw wn si aw wows vole 4 2512 | 100.0 10.3 45.6 29.9 124 1.8 Obstotrics-gynecolOBY ov. p 5am 09 £9 88 #3 %% wa aa a 2 mw s 1873 | 100.0 09 84.7 11.0 1.9 1.6 Orthopedic SUIGBRY. + +: vv sss 3m EE EERE HE FH 6 50s 2% wns 1,507 | 100.0 204 42.7 27.3 8.8 0.9 Other surgical specialties , , ...:cassumsrsrmrovns owns 2421 | 100.0 15.2 35.1 30.8 17.9 1.0 Psychiatry-neurology . ............oiiiiiiiinnen.n 718 | 100.0 53 73.4 17.1 1.9 2.2 Other medical specialties ................uuuniun.. 1,461 100.0 7 374 27.4 26.7 1.3 Remaining other specialties , . , vc sv es cwms vwmsvwevewns 377 | 100.0 19 48.5 355 9.8 4.2 25 Table 5. Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by sex of patients and specialty of physicians: United States, 1971 ; boc Number of Not Specialty of physicians patients Both sexes || Male | Female — Percent distribution Total, oll SPEciAItIES . » vv vo wws mms ww wa ws sim & ods ss vse 23,407 100.0 || 41.6 56.6 1.8 Primary care specialties Total tiie TT FS ENE 5 hp 6 Em HR 0 0 Tr 12,538 100.0 {| 43.1 55.1 1.8 General and family PractiCl . . cs ss rch ss wos sm as aT as mass was beens 7.932 100.0 || 41.3 56.7 2.0 General internal MBOICING . ...cisvvnsnsrsssns amram masmnssanss 2,723 100.0 || 40.4 58.0 1.7 GENEEB DBOIBLIICE + vor ow: vie ioe io ir ca os oe kh 00 190 500 #0 T0000 in O00 oo #0 08 0 1 4 1,883 100.0 || 54.8 44.2 1.0 Secondary /tertiary care specialties TOMBE vs minis mms seo aim we sas 3 B60 SE AEG AEE 10,869 100.0 {| 39.9 58.3 1.8 GONEIal SUIgBIY « vss mo s mss mma s RETA FN ANNE EH s AWE sr aa we 2512 100.0 || 47.6 50.8 1.6 ObSIEtriCS-QYNEUOIONY ov. ss Biss SES SMBS sw mE SH Ma SHS 3m Ho @ ois s 1,873 } 100.0 7 96.1 22 OrthopediCSUIGETY . os: sss snus is Bas Mps mM Ao spEmIm ma smE my 1,507 100.0 || 51.6 47.4 1.0 Other surgical specialties . . ........... itt intense 2421 100.0 || 47.9 60.7 1.4 Psychiatry-neurolOgy . . .. «cs «ome soma smo vinnie va sm insesinnsosss 718 100.0 || 40.5 57.1 24 Other medical specialties . . . ...... iii it itis ene ene 1,461 100.0 || 43.8 54.5 1.7 Remaining Other SPeclaltiBe ,. ..o » «oi ww mis vhs vimas amu ew wesivmosssss 377 100.0 || 65.3 30.0 4.8 Table 6. Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase 11, NAMCS Feasibility Study, by sex and age of patients: United States, 1971 Both sexes Male Female Not stated Age-of patients Percent P t P P ercen ercent ercent N aad distribution Numiber distribution Number distribution Mumbser distribution Total, all ages . 23,407 100.0 9,749 41.6 13,243 56.6 415 1.8 O4vyears ............ 1,993 8.5 1,044 4.5 930 4.0 19 0.1 on RTT 2477 10.6 1,310 5.6 1,148 49 19 0.1 15-24 years . . is ans ns 3,908 16.7 1,505 6.4 2,376 10.2 27 0.1 2544 years ........... 6,166 26.3 2,280 9.7 3,839 16.4 47 0.2 4564 years . .......... 5537 23.7 2,398 10.2 3,094 13.2 45 0.2 65 yearsand over , ...... 2973 12.7 1,158 99 1,798 bo 17 0.1 Notstated ...eerwones 353 15 54 0.2 58 0.2 241 1.0 26 Table 7. Number, percent, and cumulative percent of 7,514 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by the 20 most common three-digit ICDA categories assigned for patient's purpose, problem, or chief complaint: United States, 1971 [Diagnostic groupings and code number inclusions are based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States, 1965] Number | Percent Cumuistive Rank ICDA categories of of i. . percent visits visits 1 Medical or special examination . . . . . 0 Ro 8 RR fk Tk ee RE YO00 966 12.9 129 2 Medical and sUrgICal BTIBICEIR . ui vs sie vis 5 ws 3 wos SWi0 & HoT SEBS 8 Ww oH Y10 898 12.0 24.8 3 Proriatal COTE: ..« wines sms win wo 4 4 BAS © SW 2 10 0% F S000 0 8000 0 I 0°8 WENE 0 WO 8 Y06 412 5.5 30.3 4 Symptoms referable 10 respiratory SYStBMY . uc ens s sms smo ss vas sais aves 783 336 4.5 34.8 5 Other general sympPIOMIE «us & ws 5.5 @ 5 vom on ors 880804 0105p oo du B's eos 00 i lh 08 #1 #0 788 283 3.8 38.5 6 Symptoms referable to limbs and joints . . ... 0... 787 281 3.7 42.3 7 Diagnostic category (and 3-digit ICDA code) notassigned . ..............0o0ouun 198 2.6 449 8 ACUTE PRBIYNGIIS ov vie ssid» ime ds wae s oon #0 m8 dm soy We 00 as won owe 462 178 24 473 9 Symptoms referable to abdomen and lower gastrointestinal tract . ............ 785 174 23 49.6 10 Nervousness and’ deity .. . « cfs ¢ + 0.4 Wess Gao FE 4B BET 504 REET HE ow 790 155 2.1 51.7 1 Vertebrogenic Dall SYNOIOMIG. L... www» ok es a i 0 0 lr 0 100080008 #165 00 8 000008 0 0 9 w 20 0 4 728 149 2.0 53.6 12 Acute nasopharyngitis (common cold) . ........¢ccvtte rrr rir nates 460 141 1.9 55.5 13 Persons receiving prophylactic incculation and vaccination ................. Y02 135 1.8 57.3 14 Other ill-defined and unknown causes of morbidity and mortality ............ 796 133 1.8 59.1 15 Obesity not specified as of endocrine origin... ........ iii nnnnn.. 277 122 1.6 60.7 16 Essential benign RYDRrIeNsSION . . co. curs sw s@ms seals ¢ 5 Gass as ome wm 401 121 1.6 62.3 17 Injury, other, and unspeCified ... ccs immes cans m as cows oo esse sew ome ww NS36 120 1.6 63.9 18 Othereczema and dermatitls « . . cvs amu mois soos sms Ewa was sues ees 692 118 1.6 65.5 19 Follow-up examination with no need for further care or need for only WME Care ; curv camer mmr mms sams PEPE TRI IR HE FADE HEE IO mE YO03 89 1.2 66.7 20 Symptoms referable to genitourinary system . ......... ii 786 81 67.7 Other specified diagnostic categories (with 3-digit ICDA codes assigned) ........... 2,424 32.3 100.0 27 Table 8. Number, percent, and cumulative percent of 23,407 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by the 20 most common three-digit ICDA categories assigned for their most important diagnosis: United States, 1971 [Diagnostic groupings and code number inclusions are based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States, 1965] Number Percent Rank ICDA categories of of Cumulative Fon percent visits visits 1 Diagnostic category (and 3-digit ICDA code) notassigned . .................... 1,982 8.5 8.5 2 Medical and surgical aftercare . .............. iti Y10 1,878 8.0 16.5 3 Medical orspecial examination: .... cs saws swe smmrsmma smnis ewasi ve Y00 1,423 6.1 22.6 4 Prenatal Care cu ss amas tH HA IE REFERS IEE RE BER FEE TRE EWE Pa Y06 751 3.2 258 5 Essential benign hypertension. . . ss svi wvs ramps nab sams sms enna sass 401 699 3.0 28.8 6 Acute upper respiratory infection of multiple or unspecified sites . . ........... 465 662 2.8 316 7 INCUFOSES: 10. sin oo m0 sims simp simms sinnis minmen mins Hin cola sw smmes®as 300 558 24 34.0 8 Chronic ischemiohBart iSRasE ..... uv sm we wns swmie sma s wes CHa s@m me vin wis 412 445 1.9 35.9 9 DIabotes MENUS vu 1 iw wi ais or vi sie Ww a mms 2m we oo Wis bin 86 5 0 ah 0 08 250 362 1.6 37.4 10 Obesity not specified as of endocrine origin... ...........0iiiieernnnnn 277 346 1.5 38.9 1 Otitis media without mention of mastoiditis . ..................c.c....... 381 324 1.4 40.3 12 Othereczemaand dermatitis . ............uiiinnmunnneeeennnnnnnns 692 314 13 41.6 13 ACUE PRBTYNGITIS. vv mus sume mm meme sums sme sas obs E@manmusens 462 313 1.3 43.0 14 Follow-up examination with no need for further care or need for only Hi) fee IIT IeTITTIINIITTIITITMm YO03 285 1.2 44.2 15 Bronchitis, UnQUAHEIBE os sim as sms Sms s@ © s minh Bae 2005 £ ans 0 asm 490 283 1.2 454 16 YR eR I TET 507 276 1.2 46.6 17 Sprains and strains of other and unspecified partsof back ................. N847 270 1.2 47.7 18 CURE AGISIINEIS. osu: cr + 0 wo 00 01 0 wm 002 00 0 00 99 0 0 0 8 C0 0 9590 0 he 00 180 0 ol 0 08 1940 463 249 1.3 48.8 19 OLher VITaI CISBASES +. w wives iwi) 5% 090% 10 iw 390 5 0 (0 5500 4 10 5 91 0 G06 S05 000 190 05 oll 00 00 00 I: 079 223 0.9 49.7 20 Diseases of 5ebaceOusSOIaNGS wav wes ovis nsw ele ow vn WW 8 @ #5 5 ww wine 90 706 212 09 50.7 20 Synovitis, bursitis, and teNOSYNOVILS . .. sv issvs sms smas sais saws smn vue 731 212 0.9 51.6 Other specified diagnostic categories (with 3-digit ICDA codes assigned) ........... 11,340 48.4 100.0 28 Table 9. Number and percent distribution of 23,407 ambulatory patient visits (ranked in decreasing frequency) to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by the 19 major ICDA classes containing their most important diagnosis: United States, 1971 [Diagnostic groupings and code number inclusions are based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States, 1965] Number |Percent Rank Major ICDA classes of of visits visits gin ET eS LN re TA T ET 23,407 100.0 1 Supplementary classification: Special conditions and examinations without sickness . . . . .. Y00-Y13 4,779 20.1 2 VIII, Diseases Of the respiratory System . . .. .. iii i tt tits t tte snenessennnnnss 460-519 3,056 13.1 3 Unknown diagnoses (with no code assigned) . . . . oo. vv it vite ee eee 1,982 8.5 4 Vii. [Diseases of the'clrCulatOTY SYSIBIN 4. ois vine swim v £5 @s ow 0m ww sie wei ow ee se ww 88 20 390458 1,927 8.2 5 XVI. Accidents, poisonings, and VIOIBINOE « +» vs vv i some 45 sin aw s% 4% 56008 ow a N800-N999 1,879 8.0 6 VI. Diseases of the nervous system and SENSE Organs . . . . . «ovo vv ive vn vivo eee enon 320-389 1,195 5.1 7 X. Diseases of the genitourinary system . . ........... otter vrnensnnnnnnnees 580-629 1,191 5.1 8 XI1l. Diseases of the musculoskeletal system and connective tissue . ................. 710-738 1,144 49 9 X11. Diseases of the skin and subcutaneous tiSSUE . . . . ov vv vt tite tt eee tte ee ee ee 680-709 1,053 4.5 10 VV, Mental SOrders « vu uv vo wisn 4 BoE RBIE OE IFES INET RX ETHEL HH 8 ....290-315 988 4.2 1 111. Endocrine, nutritional, and metabolic diseases . .............c.uuuiiiuennnnn. 240-279 980 4.2 12 XVI. Symptoms and ill-defined conditions . .......... ttt. 780-796 878 3.8 13 I. Infective and parasitic diSBases . . . . . uv vv vit titi eee 000-136 801 34 14 IX. Diseases Of the dIDBSHVE SYSUBIM & vu ww sa os me 5 5 @ & 5 4 ws £iwie vs» isi owe vows vee 520-577 777 33 15 J NEODIASMS wimp nrnmo samo st dnb sR HINA eM GS TMG ES CREE HLA 55% we 140-239 397 1.7 16 IV. Diseases of blood and blood-formingorgans . .............. cities 280-289 183 0.6 17 XIV. Congenital anomalies , . «cv ins sm mina msims s@Hs sCRIR BNIB SHIH IE ® 740-759 136 0.6 18 XI1. Complications of pregnancy, childbirth, and the puerperium . ................... 630-678 56 0.2 19 XV. Certain causes of perinatal morbidity and mortality ..................¢c0o0ou... 760-779 5 0.0 Table 10. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and color of patients: United States, 1971 Total, all types General and Specialty of practice family practice practice Color of patients Percent Percent Percent Number distribution Number distribution Number distribution Total, all VISItS inv sums amas snnsams ue 7514 100.0 2,592 100.0 4,922 100.0 WHItE aio vwuis sama es s@ma mein sion smmms wn 6,827 90.9 2,343 90.4 4,484 91.1 PAIVOIABE owas sik T mus BE RE Te hme Rae 643 8.6 233 9.0 410 8.3 Notstated ...isowenmrnrsumb sade ame emus ys 44 0.6 16 0.6 28 0.6 29 Table 11. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and marital status of patients: United States, 1971 Total, all types General and Specialty of practice family practice practice Marital status of patients Percent Percent Percent Number | tribution § NUP | distribution | NYE | distribution Total, BH VISIS . .oivumrmssrves 9s aa vam 7514 100.0 2,592 100.0 4,922 100.0 SINGIB 1w. 3 o:1s 5s 0 5.1050 550 0 0 wie 0) 3 00a 41 rom Tm oh enw To Lon 2,598 346 823 31.8 1.775 36.1 MIERE o sivma win niy 8705 3-08 8 5 000 E00 0900 3,892 51.8 1375 53.0 2,517 51.1 Widowed cco veins ami s@me sede nme i a Rae 442 59 157 6.1 285 5.8 Separated/Aivorced . ... vers sana va ae aE LE 237 3.2 is 4.4 124 25 UNKBOWN «v5 ss wasn sm @ diss Ba sama § §E HAS 345 4.6 124 4.8 221 45 Table 12. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and by whether patient had been seen before by same physician: United States, 1971 Total, all types General and Specialty of practice family practice practice Patient seen before by same physician Percent Percent Percent Number | stribution [| NUmber | ciburion | NTP | vistribution Total, all visits .........couvununnnnn 7514 100.0 2,592 100.0 4,922 100.0 Seenbefore ... iss emur suns smas emars 6,172 82.1 2,106 81.3 4,066 82.6 Forpresent problem... . cova wnbinins sama s sans 4,377 58.3 1,261 48.6 3,116 63.3 Not for presentproblem .................... 1571 209 769 29.7 802 16.3 Unknown whether for present problem .......... 224 3.0 76 29 148 3.0 Notseenbefors ....sssssssessnswes vs 1,308 174 469 18.1 839 17.0 Unknown whether seen before . . .......... 34 0.5 17 0.7 17 0.3 Table 13. Number and percent of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and extent of history taken and examination made at visit: United States, 1971 Total, all types General and Specialty History taken and examination made at visit of practice family practice practice Number | Percent || Number | Percent | Number | Percent TO, BIVIBHS ui avmuin smma sms rms bm sma 7514 100.0 2,592 100.0 4.922 100.0 Total, history taken ...vssvessamssmss sas sas 6,510 86.6 2,338 90.2 4,172 84.8 Goneral BISIOrY + + coos vm vs mmm mur ng 8 5 HET Few 2121 28.2 722 279 1,399 28.4 LILO) BISTOPY vow vw im minis nbs 69 00 5 ha a 8 RR 4,389 58.4 1616 62.3 2.773 56.3 Total, history NOL 1aKeN .... vivn seme ae a5 sie me ems 964 12.8 245 95 719 14.6 Total, UNKAOWN RISTO . o.oo vo ov 5 uTa aio sino s sem 40 0.5 9 0.3 31 0.6 Total, examination made ...........o0vverunnn 6,783 90.3 2,399 92.6 4,384 89.1 General oXomiNAtION « .. csv iss sam ass wes oe ws ow mins 2,109 28.1 678 26.2 1,431 29.1 Limited examination . ... cov ssessosamrismsanness 4,674 62.2 1221 66.4 2,953 60.0 Total, examination notmade .................. 641 8.5 174 6.7 467 9.5 Total, unknown examination . ................. 90 1.2 19 0.7 71 1.4 31 Table 14. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase Il, NAMCS Feasibility Study, by type of physician practice and laboratory procedure, X-ray examinations, and other diagnostic procedures ordered: United States, 1971 Total, all types General and Specialty of practice family practice practice Diagnostic tests ordered at visit Percent Percent Percent Number | istribudion fi NODS | omibution | NIPERY | uibsution Total, All VISITS cu oi sis mus & & b&w dik wie 7514 100.0 2,592 100.0 4922 100.0 Lab procedures Tol cause rs os EEPITR BEET BE & ow 1,991 26.5 523 20.2 1,468 29.8 FOFSCEERIING + oi 0% 35% & GR 4-5 Al dole de 008 wie ny ies 1,000 133 222 8.6 778 15.8 Fordiagnosis . ......... 0.0. iiiiiiinnnn.. 574 7.6 217 8.4 357 7.3 FOrTONOWUD: wu vv wv as ® vs Sheds sre v8 5 5@ #5 417 55 84 3.2 333 6.8 NONB OTLBIBY iu «win 4 wiv sds vw wi 5 2x bw win Hw + 5 5 4 5,095 67.8 1,821 70.3 3,274 66.5 UNKNOWN 4 osm mss nm piss ni 63 59 sR PR Es Sm E 5 ne 428 5.7 248 9.6 180 37 X-ray exams Total wus vgs emus assay ene sw n0w mE 710 94 220 8.5 490 10.0 FOrsCreBning . cons amiss oh fs & 5 4 ains $85 ww Hs be 176 23 52 2.0 124 2.5 EOrQiagnosis .. . hee emessts dowwvs www nm 402 5.4 147 5.7 255 5.2 For followup ........... 0.0... 132 1.8 21 0.8 117 23 NONE OFABIBA iu «iv vis is mw iw wo 4 & i ow WE BE 6,040 80.4 2,072 79.9 3,968 80.6 UnKROWR 6 cu vo ta 25 32 BORE 5 5 85 & 55 56 67 06 we 764 10.2 300 11.6 464 9.4 Other diagnostic procedures TOW, vovvms www wn ses ee EEE 565 75 A 4.3 453 9.2 POrScreening su cv sr va v3 su sd a 705 0% 28 4 5 5% 192 2.6 42 1.6 150 3.0 Fordisgnosis cosas oes abs £006 585 66 58 EF 5 170 23 47 1.8 123 2.5 FOr folloWiiD: swe aus oR ak $6 aw a ms Su wll 8 5 os 203 2.7 23 0.9 180 3.7 Noneordered ................ccuiiuiuun.. 6,104 81.2 2,159 83.3 3,945 80.2 Unknown . .. ee 845 11.2 321 12.4 524 10.6 32 Table 15. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and diagnostic specimen taken: United States, 1971 Total, all types General and Specialty of practice family practice practice Diagnostic specimen taken at visits Number Percent Number Percent Number Percent kt distribution distribution distribution Total, all Visits uo... ws scmmiemmrnms 7,514 100.0 2,692 100.0 4,922 100.0 Total, specimen taken .....:..: ues eens 2,128 28.3 594 229 1,634 31.2 BY PHYSICIAN : ois smms pw ms smms rwms smms Fmms 910 12.1 283 10.9 627 12.7 BY SAF wus sums 10s tmp: Emm SREE ERPE ERAS 1,077 14.3 271 10.5 806 16.4 BY Other POISONS: & +000 sme sme amu vimms oinms 141 1.9 40 15 101 21 No specimen taken ................... 4,991 66.4 1,784 68.8 3,207 65.2 Unknown whether specimen taken . ........ 395 5.3 214 8.3 181 3.7 Table 16. Number and percent distribution of 23,407 ambulatory patient visits to office-based physicians participating in Field Test: Phase 11, NAMCS Feasibility Study, by type of physician practice and treatment provided for patients: United States, 1971 Total, all types General and Specialty of practice family practice practice Treatment provided for patients Percent Percent Percent N umber | istribution i NYO | retribution | MUPPR | erripution Total, all Visits! ...... 00s snese . 23,407 100.0 7.932 100.0 15,475 100.0 NODS TEQUIIFED «+ vw 0s 0 wiv 5 jw win (0 io 0 8 #10000 0 0 3,986 17.0 1,015 12.8 2,971 19.2 Drugtherapy .................0ooniunnnnn. 12,065 51.5 5,399 68.1 6,666 43.1 Office surgical treatment . . ... cows sms sa ma sis ons 1,908 8.2 486 6.1 1,422 9.2 Therapeutic listening and/or psychotherapy ....... 1,754 75 400 5.0 1,354 8.7 Advised diet, exercise, or habit changes .......... 2,825 12.1 999 12.6 1,826 11.8 Family planning .......v civ vrncnsnanscnns 293 13 90 1.1 203 1.3 Other treatment. . . cu. swws sans amas eens ses 5,872 25.1 1,394 17.6 4,478 289 UNKOWN RICBAINBNL os + in ois ois 00 wih imo 8 16 0 wo 194 0.8 63 0.8 131 08 ! The sum of column entries exceeds column totals since more than 1 type of treatment may have been provided per visit. 33 Table 17. Number and percent distribution of 7,514 ambulatory patient visits to office-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and disposition following patient visit: United States, 1971 Total, all types General and Specialty of practice family practice practice Disposition following patient visit Percent Percent Percent Number distribution Number distribution Dember distribution Total, All VISIT ws awaisiswus smile 2890s 7.514 100.0 2,592 100.0 4,922 100.0 No further followup planned ................. 670 89 293 11.3 377 7.7 Telephone followup planned ................. 510 6.8 174 6.7 336 6.8 Return to same physician anytime, prore nata ..... 1,884 25.1 779 30.1 1,105 225 Return to same physician at specified time or INEBIVEL a veiv as mis wim Bs Wi S508 Wh Ew Wh BREE 4423 58.9 1,274 49.2 3,142 64.0 Referred for diagnostic testsonly .............. 72 1.0 21 0.8 51 1.0 Referred to another physician for consultation, diagnosis ortreatment .......s evra v rena 181 24 71 2.7 110 22 Referred for hospital admission under same PHYSICIOI'S COTE ovovv vis ois wie ad dn 4 4 sW% Sian = 236 3.1 45 1.7 191 39 Referred for hospital admission, under another PRYSICISNSICANE & onium ois ie #0 wn oe as Sais 69 09 19 0.7 50 0.1 Returned to referring physician/agency .......... 67 09 3 0.1 64 1:3 Other diSgosition ss si sre is »R2 GEER Es Hv OF Be @s 65 09 12 0.5 53 0.1 ! The sum of column entries exceeds column totals since more than 1 kind of disposition may have been arranged per visit. Table 18. Number and percent distribution of 7,514 ambulatory patient visits to :*Tice-based physicians participating in Field Test: Phase II, NAMCS Feasibility Study, by type of physician practice and duration of visit: United States, 1971 Total, all types General and Specialty of practice family practice practice Duration of visit in minutes Percent Percent Percent Nurmioer distribution Number distribution Number distribution Total, AN VISHS sums rwursmmos mms ims 7514 100.0 2,592 100.0 4.922 100.0 CEBMINIES ..uns immss aus ines ind sonics 1,294 17.2 521 20.1 773 15.7 BAD MIAEES wn vont smms s HRs RHE bE ms BRE 2,229 29.7 898 34.6 1,331 27.0 11-15 MINES , ovo vivms simms ns mmm sm ms sim @rinms 2,033 27.1 785 30.3 1,248 25.4 1030MINUIeS , uv inns tmmsgmes s Hus sous as 1,529 20.3 330 12.7 1,859 37.8 B1BOMINULES , uns :anssmussmms sans immsmns 321 4.3 28 1.1 293 6.0 61 minutesand over . ...........c.0iuuinannn 28 04 5 0.2 23 0.5 Unknownduration . .............00uiuuenn.. 80 1.1 25 1.0 55 141 MEIN, IINUIBS, 4. 2 io wiv 6 160 5 2 5 4 00 4 iw id 3 sm 11.0 9.8 11.9 APPENDIX | DATA COLLECTION FORMS 1973 NATIONAL AMBULATORY MEDICAL CARE SURVEY PATIENT LOG AND PATIENT RECORD, SAMPLING EVERY PATIENT PATIENT LOG DATE aes rouse. 19 cian As each patient arrives, record his name on the log below, and complete the correspondingly num- bered patient record to the right. PATIENT'S NAME PHYSICIAN'S COPY ASSURANCE OF CONFIDENTIALITY —AIl information which would permit identification of an individual, 1. DATE OF VISIT Mo Day Yr establishment will be held confidential, will be used only he survey and will not be disclosed or released to other persons or used for any other purpose. by persons engaged in and for PATIENT RECORD NATIONAL AMBULATORY MEDICAL CARE SURVEY | A 121601 2. DATE OF BIRTH 4. COLOR OR RACE "TT \ 0 WHITE NEGRO/ 3. sex * 0 NESERK 1 [J FEMALE 3 [J OTHER : [0 MALE + 00 UNKNOWN 5. PATIENT'S PRINCIPAL PROBLEM(S) COMPLAINT(S), OR SYMPTOM(S) THIS VISIT a. MOST IMPORTANT. BOTHER: ciismismmessmerm————— 6. SERIOUSNESS OF PROBLEM IN ITEM 5a (Check one) [J VERY SERIOUS [OJ SERIOUS [J SLIGHTLY SERIOUS « [J NOT SERIOUS 7. HAVE YOU EVER SEEN THIS PATIENT BEFORE? vO ne 2 ONO If YES, for the problem indicated in ITEM 5a ? vO YES : ONO 8. MAJOR REASON(S) FOR THIS VISIT (Check all major reasons) [J ACUTE PROBLEM [J ACUTE PROBLEM, FOLLOW-UP [0 CHRONIC PROBLEM, ROUTINE 04 [J CHRONIC PROBLEM, FLARE-UP [J PRENATAL CARE [0] POSTNATAL CARE [J POSTOPERATIVE CARE — [J WELL ADULT/CHILD EXAM [0 FAMILY PLANNING [J COUNSELING/ADVICE [J IMMUNIZATION [J REFERRED BY OTHER PHYS/AGENCY [J ADMINISTRATIVE PURPOSE [0] OTHER (Specify) (Operative procedure) 9. PHYSICIAN'S PRINCIPAL DIAGNOSIS THIS VISIT a. DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY b. OTHER SIGNIFICANT CURRENT DIAGNOSES (In order of importance) 10. TREATMENT/SERVICE ORDERED OR PROVIDED THIS VISIT (Check all that apply) © [J NONE ORDERED/PROVIDED 02 [J GENERAL HISTORY/EXAM 0 [] LAB PROCEDURE/TEST oe [J X-RAYS 0 [J INJECTION/IMMUNIZATION o [J OFFICE SURGICAL TREATMENT [J PRESCRIPTION DRUG [J NON-PRESCRIPTION DRUG [J PSYCHOTHERAPY/THERAPETUIC LISTENING [J MEDICAL COUNSELING/ADVICE [] OTHER (Specify) 11. DISPOSITION THIS VISIT (Check all that apply) [J NO FOLLOW-UP PLANNED [J RETURN AT SPECIFIED TIME [J RETURN IF NEEDED, PRN. (J TELEPHONE FOLLOW-UP PLANNED [J REFERRED TO OTHER PHYSICIAN/AGENCY [J RETURNED TO REFERRING PHYSICIAN [J ADMIT TO HOSPITAL [J OTHER (Specify) 12. DURATION OF THIS VISIT (Time actually spent with Physicion) MINUTES (Specify) HSM-688-2 DEPARTMENT OF HEALTH, EDUCATION REV. 4.73 PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL H ND WELFARE EALTH ADMINISTRATION OVED «= OMB NO. 68-371089 1 NATIONAL CENTER FOR HEALTH STATISTICS 0.M.B. #68.572106 EXPIRATION DATE 6/30/75 re. Sd 35 PATIENT LOG AND PATIENT RECORD, SAMPLING EVERY SECOND PATIENT 2 ASSURANCE OF CONFIDENTIALITY — Al information which would permit identification of an individual, B 34320 a practice, or an establishment will be heid confidential, will be used only by persons engaged in and for B343202 the purposes of the survey and will not be disclosed or released 10 other persons or used for any other purpose. PATIENT LOG 1. DATE oF visiT PATIENT RECORD NATIONAL AMBULATORY MEDICAL CARE SURVEY Mo Day Yr As each patient arrives, record name snd time 2. DATE OF BIRTH 4. COLOR OR 5. PATIENT'S PRINCIPAL PROBLEM (S) 6. SERIOUSNESS OF 7. HAVE YOU EVES . 5 2 ; R SEEN of vai on the loo Seow. Fr the patent en RACE COMPLAINT(S), OR SYMPTOM(S) THIS VISIT PROBLEM IN ITEM 5a THIS PATIENT BEFORE? record to the right. / / (In patient's own words) (Check one) WHITE Rs Y els l% 2 NEGRO MOST + [0 VERY SERIOUS TY *DNo 2 ; NT’ TIME OF 3. sex ORK IMPORTANT. 2 [J SERIOUS If YES, for the problem PATIE S$ NAME VISIT indicated in ITEM 5a? + [J FEMALE 3 [0 OTHER 3 [J SLIGHTLY SERIOUS 2 [J MALE « [0 UNKNOWN | b. OTHER. + [0 NOT SERIOUS + O YES 2 OJ NO . MAJOR REASON(S) FOR THIS VISIT (Check o// major reasons) 9. PHYSICIAN'S PRINCIPAL DIAGNOSIS THIS VISIT a. DIAGNOSIS ASSOCIATED WITH ITEM 6a ENTRY [0 ACUTE PROBLEM on [J WELL ADULT/CHILD EXAM 2 [J ACUTE PROBLEM, FOLLOW-UP os [J FAMILY PLANNING > [J CHRONIC PROBLEM, ROUTINE 10 [J COUNSELING/ADVICE o [J CHRONIC PROBLEM, FLARE-UP nO IMMUNIZATION + [J PRENATAL CARE 12 [J REFERRED BY OTHER PHYS/AGENCY b. OTHER SIGNIFICANT CURRENT DIAGNOSES o [J] POSTNATAL CARE 13 [J ADMINISTRATIVE PURPOSE (In order of importance) © 0) POSTOPERATIVE CARE — 1 [0 OTHER (Specify) (Operative procedure) 10. TREATMENT/SERVICE ORDERED OR PROVIDED THIS VISIT (Check olf thet apply) 11. DISPOSITION THIS VISIT 12. DURATION oF heck IS VISIT ( (Check all that apply) sclelty pent wht or [J NONE ORDERED/PROVIDED physician) # [3 FRESCAIETION DRUG + [0 NO FOLLOW-UP PLANNED 0 [J GENERAL HISTORY/EXAM «0 [J NON-PRESCRIPTION DRUG + [J RETURN AT SPECIFIED TIME u CJ LAB PROCEDURE/TEST # [3 PSYCOTUE RAP HERAT ETI 3 [J RETURN IF NEEDED, P.R.N. “ J X-RAYS « [J TELEPHONE FOLLOW-UP PLANNED os [J INJECTION/IMMUNIZATION 10 [J MEDICAL COUNSELING/ADVICE + [] REFERRED TO OTHER MINUTES 0 [J OFFICE SURGICAL TREATMENT 1 [J OTHER (Specify) PHYSICIAN/AGENCY (Specity) ¢ [J RETURNED TO REFERRING PHYSICIAN 1 [J ADMIT TO HOSPITAL CONTINUE LISTING PATIENTS + 0) OTHER (Specify). ON NEXT PAGE ve DEPARTMENT OF QF Hea, FBUCATION AND WELFARE O.M.B. #68-572106 HEALTH SERV EXPIRATION DATE HEALTH SERVICES. AND MENTAL HEALTH ADMINISTRATION e/%0p5 NATIONAL CENTER FOR HEALTH STATISTICS 1a PATIENT LOG AND PATIENT RECORD, SAMPLING EVERY THIRD PATIENT ASSURANCE OF SONFIBENTIALITY Al information which would permit identification of an individual, C487202 a practice, or an establishment will confidential, will be used ory by parsons engaged in and for C487202 a aay or released to other persons or used for any other purpose. PATIENT LOG 1. DATE oF visiT PATIENT RECORD NATIONAL AMBULATORY MEDICAL CARE SURVEY Mo Day yr As each patient arrives, record name and time 2. DATE OF BIRTH 4. COLOR OR 5. PATIENT'S PRINCIPAL PROBLEM(S) 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN OF visi on tha log alow, For tha oiens wn- RACE COMPLAINT(S), OR SYMPTOM(S) THIS VISIT PROBLEM IN ITEM Sa THIS PATIENT BEFORE? tered on line #3, also complete the patient Tacs zp mm: (Check one) record to the right. / of, WATE (In patisnt’'s own words) YE Mo / Dey / Vr ; 2 Pacis WR i [J VERY SERIOUS 0s 0 No 2 ; oblem PATIENT'S NAME | "ME OF | 3. six BLACK | faPORTaNT___ + 0 serious If YES, for the pr vis \ [0 FEMALE + 0 OTHER 3 [] SLIGHTLY SeRious | Picated in ITEM 5a? : [J MALE «OUNKNOWN [b.OTHER___ ~~~ | « [J NOT SERIOUS vO YES : 0 NO 1 Lo *™ 1 8. MAJOR REASON(S) FOR THIS VISIT (Chock aif major rassons) . 9. PHYSICIAN'S PRINCIPAL DIAGNOSIS THIS VISIT on a. DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY ; . -. or [J ACUTE PROBLEM os [J WELL ADULT/CHILD EXAM a sm] = 0 ACUTE PROBLEM, FOLLOW-UP os [J FAMILY PLANNING oo os [J CHRONIC PROBLEM, ROUTINE 10 [J] COUNSELING/ADVICE pm] © 0 CHRONIC PROBLEM, FLARE-UP 1 O IMMUNIZATION os (J PRENATAL CARE 12 [J REFERRED BY OTHER PHYS/AGENCY b. OTHER SIGNIFICANT CURRENT DIAGNOSES am] © 0 POSTNATAL CARE 1s [J ADMINISTRATIVE PURPOSE (In order of importance) 3 or [J POSTOPERATIVE CARE — 1 [J OTHER (Specify) Record items 1-12 for this patient pn (Operative procedure) 10. TREATMENT/SERVICE ORDERED OR PROVIDED THIS VISIT (Check a that apply) 11. DISPOSITION THIS VISIT 12. puRATION OF (Check all that apply) THIS VISIT (Time po + [J NONE ORDERED/PROVIDED oO o2 [J PRESCRIPTION DRUG [J NO FOLLOW-UP PLANNED 02 [] GENERAL HISTORY/EXAM os [] NON-PRESCRIPTION DRUG + [J RETURN AT SPECIFIED TIME os [J LAB PROCEDURE/TEST os [J PSYCHOTHERAPY/THERAPETUIC 3 [0] RETURN IF NEEDED, P.R.N. ow [J X-RAYS LISTENING « [J TELEPHONE FOLLOW-UP PLANNED ot [J INJECTION/IMMUNIZATION 10 [J MEDICAL COUNSELING/ADVICE . REFERRED TO OTHER ————— MINUTES oO 0 o [J OFFICE SURGICAL TREATMENT vw [J OTHER (Specify) PHYSICIAN/AGENCY (Speciy) + [J RETURNED TO REFERRING PHYSICIAN 7 [J ADMIT TO HOSPITAL CONTINUE LISTING PATIENTS + [1 OTHER (Specify). ON NEXT PAGE HSM-688-4 DEPARTMENT oF HEALTH, EDUCATION AND WELFARE 0.M.B. #68-572108 REV. 4.73 PUBLIC HEALTH SERVICE EXPIRATION DATE 6/30/75 HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION NATIONAL CENTER FOR HEALTH STATISTICS 36 PATIENT LOG AND PATIENT RECORD, SAMPLING EVERY FIFTH PATIENT D6391705 PATIENT LOG a the 1. DATE OF VisiT Mo Yr practice, or purposes of the survey and will not be disclosed or heid confidential, will be used only by persons released to other ASSURANCE OF CONFIDENTIALITY —AIl information which would permit identification of an indi establishment PATIENT RECORD NATIONAL AMBULATORY MEDICAL CARE SURVEY D6921705 As each patient arrives, record name and time of visit on the log below. For the patient en- tered on line #5, also complete the patient record to the right. 2. DATE OF BIRTH 4. coLOR OR RACE * TIME OF PATIENT'S NAME VISIT 5. PATIENT'S PRINCIPAL PROBLEM(S) COMPLAINT(S), OR SYMPTOM(S) THIS VISIT (In patient's own words) i Z ATA + 0 WHITE NEGRO, MOST 3. sex * DO NEGRO | SSL: 1 [J FEMALE 3 [J OTHER 2 [J MALE « O00 b. OTHER. 6. SERIOUSNESS OF PROBLEM IN ITEM 5a (Check one) + [OJ VERY SERIOUS 2 [J SERIOUS 3 [J SLIGHTLY SERIOUS « [J NOT SERIOUS 7. HAVE YOU EVER SEEN THIS PATIENT BEFORE? v0 Ws : 0 NO If YES, for the problem indicated in ITEM 5a? + [0 YES : ONO o [J ACUTE PROBLEM 02 [] ACUTE PROBLEM, FOLLOW-UP 03 [J CHRONIC PROBLEM, ROUTINE oa [J CHRONIC PROBLEM, FLARE-UP os [J PRENATAL CARE oe [J POSTNATAL CARE 8. MAJOR REASON(S) FOR THIS VISIT (Check a/l major reasons) [J WELL ADULT/CHILD EXAM [0 FAMILY PLANNING [0 COUNSELING/ADVICE OO IMMUNIZATION [0 REFERRED BY OTHER PHYS/AGENCY [J ADMINISTRATIVE PURPOSE 9. PHYSICIAN'S PRINCIPAL DIAGNOSIS THIS VISIT a. DIAGNOSIS ASSOCIATED WITH ITEM 6a ENTRY b. OTHER SIGNIFICANT CURRENT DIAGNOSES (In order of importance) or [J POSTOPERATIVE CARE 3 14 [J OTHER (Specify) (Operative procedure) 10. TREATMENT/SERVICE ORDERED OR PROVIDED THIS VISIT (Check a that apply) 11. DISPOSITION THIS VISIT 12. DURATION OF § (Check all that apply) THIS VISIT (Time ; actually spent with o [J NONE ORDERED/PROVIDED 27 [0 PRESCRIPTION DRUG 3 NOV OCW UPREATRED physician) am. | °@ [J GENERAL HISTORY/EXAM os [] NON-PRESCRIPTION DRUG + [ RETURN AT SPECIFIED TIME 5 o [J LAB PROCEDURE/TEST os [0 PSYCHOTHERAPY/THERAPETUIC > [J RETURN IF NEEDED, P.RN. al pm] oo OO X-RAYS LISTENING + [O TELEPHONE FOLLOW-UP PLANNED Record items 1-12 for this patient o [J INJECTION/IMMUNIZATION 'o [J MEDICAL COUNSELING/ADVICE + [J REFERRED TO OTHER MINUTES os [J] OFFICE SURGICAL TREATMENT 1 [J OTHER (Specify) PHYSICIAN/AGENCY (Specify) © [J RETURNED TO REFERRING PHYSICIAN 7 [J ADMIT TO HOSPITAL CONTINUE LISTING PATIENTS + [J OTHER (Specify) ON NEXT PAGE ' HSM-688-5 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE O.M.E. #68-572106 REV. 4-73 PUBLIC HEALTH SERVICE EXPIRATION DATE 6/30/75 HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION S E NATIONAL CENTER FOR HEALTH STATISTIC! 37 INDUCTION INTERVIEW SCHEDULE CONFIDENTIAL Form Approved. NORC-4155 OMB No. 068-572106 Feb., 1973 Expires: June 30,1974 NATIONAL AMBULATORY MEDICAL CARE SURVEY TIME AM INDUCTION INTERVIEW BEGAN: i (Phys. ID Number) BEFORE STARTING INTERVIEW 1. ENTER PHYSICIAN I.D. NUMBER IN BOX TO RIGHT, ABOVE 2. ENTER DATES OF ASSIGNED REPORTING WEEK IN Q. 3, P.2 Doctor, before I begin, let me take a minute to give you a little background about this survey. Although ambulatory medical care accounts for nearly 90 per cent of all medical care received.in the United States, there is no systematic information about the characteristics and problems of people who consult physicians in their offices. This kind of information has been badly needed by medical educators and others concerned with the medical manpower situation. In response to increasing demands for this kind of information, the National Center for Health Statistics has conducted a series of feasibility studies to determine whether a workable data collection method could be developed. In close consultation with representatives of the medical profession, this National Ambulatory Medical Care Survey was designed and tested. Your own task in the survey is simple, carefully designed, and should not take much of your time. Essentially, it consists of your participation during a specified 7-day period. During this period, you simply check off a minimal amount of information concerning the patients you see. Now, before we get into the actual procedures, I have a few questions to ask about your practice. The answers you give me will be used only for classification and analysis, and of course all information you provide is held in strict confidence. 1. First, you are a . Is that right? (ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.) Né8 « » + » w » w 1 No . (ASK AY . . 2 A. IF NO: What is your specialty, (including general practice)? (Name of Specialty) *al1 information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by persons engaged in and for the purpose of the survey, and will not be disclosed or released to other persons or used for any other purpose. 2. Js Do you have a solo practice, or are you associated with other physicians in a partnership, in a group practice, or in some other way? Solo . - » . > ow 1 Partnership . . . (ASK A). . . 2 Group . . » (ASK AY + + vw +» +» +» 3 Other . (SPECIFY AND ASK A) . . 4 A. IF PARTNERSHIP, GROUP, OR OTHER: How many other physicians are associ- ated with you? (# of Physicians) Now, doctor, this study will be concerned with the ambulatory patients you will see in your office during the week of (READ REPORTING DATES ENTERED BELOW.) (that's a (that's a / Monday) through / Sunday) month date month date Are you likely to see any ambulatory patients in your office during that week? Yes . . . (GOTO Q. 4&4) . . . 1 No . .... (ASKA) ...2 A. IF NO: Why is that? RECORD VERBATIM, THEN READ PARAGRAPH BELOW Since it's very important, doctor, that we include any ambulatory patients that you do happen to see in your office during that week, I'd like to leave these forms with you anyway--just in case your plans change. I'll plan to check back with your office just before (STARTING DATE) to make sure, and I can explain them in detail then, if necessary. GIVE DOCTOR THE A PATIENT RECORD FORMS AND GO TO Q. 10, P. 6. 39 -3- At what office location will you be seeing ambulatory patients during that 7-day period? RECORD UNDER A BELOW AND ASK B WHEN INDICATED. B. IF HOSPITAL EMERGENCY ROOM, OUT-PATIENT CLINIC, OR OTHER INSTITUTIONAL LOCATION IN A: Thinking about the ambulatory patients you see in (PLACE IN A), do you, yourself, have primary responsibility for their care over time, or does (INSTITUTION IN A) have primary responsibility for their care over time? CODE UNDER B BELOW. A. B. . Dr. has prime Inst. has prime Office Location responsibility | responsibility (in scope) | (out-of-scope) a) 1 0 (2) 1 0 3) 1 0 (4) 1 0 C. Is that all of the office locations at which you expect to see ambulatory patients during that week? Yes, + » « + 1 No . . . . . 2 IF NO: OBTAIN OFFICE LOCATION(S), ENTER IN "A" ABOVE, AND REPEAT. IF ALL LOCATIONS ARE OUT-OF-SCOPE (CODE "0" IN Q. 4B), THANK THE DOCTOR AND LEAVE. 40 slim 5. A. During that week (REPEAT DATES), how many ambulatory patients do you expect to see in your office practice? (DO NOT COUNT PATIENTS SEEN AT [OUT-OF-SCOPE LOCATIONS] CODED IN 4-B.) ENTER TOTAL UNDER "A" BELOW AND CIRCLE ON APPROPRIATE LINE. B. And during those seven days (REPEAT DATES IF NECESSARY), on how many days do you expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR EXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION. ENTER TOTAL UNDER "B'" BELOW AND CIRCLE NUMBER IN APPROPRIATE COLUMN. DETERMINE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSS ON "TOTAL PATIENTS" LINE UNDER "A" AND CIRCLE LETTER IN APPROPRIATE "DAYS" COLUMN UNDER “B." THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D) SHOULD BE USED BY THIS DOCTOR. A. B. Expected total Total days in practice LOG FORM DESCRIPTION patients during during week. survey week, ENTER TOTAL ENTER TOTAL FROM FROM Q. 5-B. DAYS A--Patient Record is to be Q. 5-A. completed for ALL patients listed on Log. 1 2 3 4 516 7 1- 10 PATIENTS A A A A A A A - 2 B--Patient Record is to be L lt 3 2 458.58 completed for every 21- 30 C B A A A A A SECOND patient listed 31- 40 C B B A A A A on 108, 41- 50 D C B B A A A 51- 60 D C B B B A A C--Patient Record is to be 61- 70 D D C B B B A completed for every 71- 80 D D C B B B B THIRD patient listed on Log. 81- 90 D D C B B B B 91-100 D D C C B B B 101-110 D D C C B B B *D--Patient Record is to be completed for every 111-120 D b Db ¢ B B B FIFTH patient listed 121-130 D D D C C B B on Log. 131-140 D D D C C C B 141-150 D D D D C Cc C 151-160 D D D D C Cc C 161-170 D D D D D C C 171-180 bD DD D D D C C 181-190 bD DD D D D C C 191-200 D D D D D D C 200- + Vv D D D D D D D * In the rare instance the physician will see more than 500 patients during his assigned reporting week, give him two D Patient Log Folios and instruct him to complete a patient record form for only every tenth patient. Then you are to draw an X or line on line 5 on every other page of the two folio pads, starting with page 1 of the pad. 41 “Be 6. FIND PATIENT LOG FOLIO WITH APPROPRIATE LETTER AND ENTER LETTER AND NUMBER OF THIS FORM HERE. (Folio Number) ¥, HAND DOCTOR HIS FOLIO AND EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHOW DOCTOR JHE INSTRUCTIONS ON POCKET OF FOLIO TO WHICH HE CAN REFER AFTER YOU LEAVE. RECORD VERBATIM BELOW ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES. 8. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATION DURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S). ENTER THE FORM LETTER AND NUMBER(S) FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S). Location Patient Record Form Letter & Number 9. During the survey week (REPEAT EXACT DATES), will anyone be available to help you in filling out these records (at each IN-SCOPE location)? Yes . . . (ASK A) . . 1 NC wwo ov wo ww 2 ? * A. IF YES: Who would that be? B. “INTERVIEWER: WAS RECORD NAME, POSITION AND LOCATION. PERSON BRIEFED BY YOU? Name Position Location Yes No 1 2 1 2 1 2 1 2 * INTERVIEWER SHOULD BRIEF SUCH PERSON IF POSSIBLE. 42 10. Now I have just one more question about your practice. = (NOTE: IF DOCTOR PRACTICES IN LARGE GROUP, THE FOLLOWING INFORMATION CAN BE OBTAINED FROM SOMEONE ELSE.) A. What is the total number of full-time (35 hours or more per week) em- ployees of your (partnership/group) practice? employed who are now on vacation, temporarily ill, etc. other physicians. 1) How many of these full-time employees are . . BELOW AS NECESSARY AND RECORD NUMBER OF EACH IN COLUMN A.) RECORD ON TOP LINE OF COLUMN A BELOW. Include persons regularly Do not include (READ CATEGORIES B. And what is the total number of part-time (less than 35 hours per week) employees of your (partnership/group) practice? regularly employed who are now on vacation, ill, etc. other physicians. 1) How many of these part-time employees are . AS NECESSARY AND RECORD NUMBER OF EACH IN COLUMN B.) Again, include persons Do not include RECORD ON TOP LINE OF COLUMN B BELOW. . (READ CATEGORIES Employees ) A. Full-time (35 or more hours/week) B Part-time (Less than 35 hours/week) (1) Registered Nurse (2) Licensed Practical Nurse (3) Nursing Aide (4) Physician Assistant (5) Technician (6) Secretary or Receptionist (7) Other (Specify) TOTAL: TOTAL: 43 fw BEFORE YOU LEAVE, STRESS THAT EACH AMBULATORY PATIENT SEEN BY THE DOCTOR DURING THE 7-DAY PERIOD AT ALL IN-SCOPE OFFICE LOCATIONS (REPEAT THEM) IS TO BE IN- CLUDED IN THE SURVEY, THAT EACH PATIENT IS TO BE RECORDED ON THE LOG, AND ONLY THE APPROPRIATE NUMBER OF PATIENT RECORDS COMPLETED. Thank you for your time, Dr. . If you have any (more) questions, please feel free to call me. My phone number is written in the folio. I'll call you on Monday morning of your survey week just to remind you. 11. TIME INTERVIEW ENDED . AM PM 12. DATE OF INTERVIEW . . . . . . . . . . (Month) (Day) (Year) COMPLETE ITEMS ON LAST PAGE IMMEDIATELY AFTER THE INTERVIEW 44 1. How much interest do you think the doctor has in the survey? Great interest . Some interest Little interest . . . . No interest . . . . wu pM» ON Can't tell . . . II. How confident are you that the doctor will complete the forms? Definitely will . . . Probably will . . . . . 2 Doubtful . « « & = + » 3 INTERVIEWER NUMBER LTT TT 1 INTERVIEWER'S SIGNATURE 45 46 APPENDIX II INTRODUCTORY LETTERS 1973 NATIONAL AMBULATORY MEDICAL CARE SURVEY Endorsing Organizations American Medical Association E. B. Howard, M.D Executive Vice President National Medical Association Robert Watkins Executive Vice President American Academy of Dermatology Frederick A. J. Kingery, M.D. Secretary Treasurer American Academy of Family Physicians Roger Tusken Executive Director American Academy of Neurology Stanley A Neison Executive Secretary American Academy of Orthopaedic Surgeons Charles V. Heck, M.D Executive Director American Academy of Pediatrics Robert G. Frazier, M.D. Executive Director American Association of Neurological Surgeons Gordon van den Noort, M.D. Secretary American College of Obstetricians and Gynecologists Michael Newton, M.D Director American College of Physicians Edward C. Rosenow, Jr., M.D. Executive Vice President American College of Preventive Medicine Ward Bentley Executive Director American College of Surgeons C. Rollins Hanlon, M.D Executive Director American Osteopathic Association Edward P. Crowell, D.O. Executive Director American Protologic Society John E. Ray, M.D. President American Psychiatric Association Walter E. Barton, M.D Medical Director American Society of Internal Medicine William R. Ramsey Executive Director American Society of Plastic and Reconstructive Surgeons, Inc. Dallas F. Whaley Executive Vice President American Urologic Association Wyland F. Leadbetter, M.D President Association of American Medical Colleges John A. D. Cooper, M.D., Ph.D. President DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION ROCKVILLE, MARYLAND 20852 NATIONAL CENTER FOR HEALTH STATISTICS Dear Dr. : The National Center for Health Statistics, as part of its continuing program to provide information on the health status of the American people, is conducting a National Ambulatory Medical Care Survey (NAMCS). The purpose of this survey is to collect information about ambulatory patients, their problems, and the resources used for their care. The resulting published statistics will help your profession plan for more effective health services, determine health manpower requirements, and improve medical education. Since practicing physicians are the only reliable source of this information, we need your assistance in the NAMCS. As one of the physicians selected in our national sample, your participation is essential to the success of the survey. Of course, all information that you provide is held in strict confidence. Many organizations and leaders in the medical profession have expressed their support for this survey, including those shown to the left. In particular, your own specialty society has reviewed the NAMCS program and supports this effort (see enclosure). They join me in urging your cooperation in this important research. Within a few days, a survey representative will telephone you for an appointment to discuss the details of your participation. We greatly appreciate your cooperation. Sincerely yours, FE ; ; : 4 . ' : . = 4 in * or pe = Edward B. Perrin, Ph.D. Acting Director Enclosure AMERICAN MEDICAL ASSOCIATION 535 NORTH DEARBORN STREET « CHICAGO, ILLINOIS 60610 « PHONE (312) 527-1500 » TWX 910-221-0300 ERNEST B. HOWARD, M.D. Executive Vice President Dear Doctor The National Center for Health Statistics is conducting a survey to collect data on office-based ambulatory medical care. We urge you to co- operate in this survey from which we expect to obtain data of value to the medical profession in planning and organizing health services, in planning for the efficient utilization of health facilities and manpower, and in determining desirable modifications in medical education programs. The American Medical Association is keenly interested in having ac- curate information about medical care services provided by physicians in private practice and was represented on the Technical Advisory Panel which was consulted about the type and amount of patient information to be collected and the survey procedures to be used. The survey has been designed to require a minimal amount of recordkeeping and to ensure con- fidentiality of information on patients from physicians. Data from the survey will be presented in summary form. If you wish more details about the survey or the amount of time it will involve, please contact Mr. Theodore Woolsey, Director, National Cen- ter for Health Statistics, 5600 Fishers Lane, Rockville, Maryland 20852. | believe the data to be collected will be of value to the medical profession and urge you to support the study by providing the informa- tion requested. Sincerely, Siri . Boursrs Ernest B. Howard, M. D. 47 APPENDIX Ill DATA COLLECTION FORMS FIELD TEST: PHASE | LONG FORM—PATIENT DATA SURVEY OF AMBULATORY MEDICAL CARE PATIENT'S NAME (OPTIONAL) PHYSICIAN'S COPY 96426 REASONS FOR THIS CONTACT LOCATION OF THIS CONTACT Suman ) My office or clinic 0 Patient's purpose, problem or chief {other than for appointment) B i di i i isionall Emergency room Most impor g (definite or pi Outpatient clinic (hospital) a Other di —— Home of patient a Other (specify) — — a PATIENT CHARACTERISTICS DIAGNOSTIC PROCEDURES MANAGEMENT SOCIO-ECONO AOE MIC STATUS General 2 General = TREATMENT (advised, prescribed, dispensed, Years Upper a HISTORY Limited a EXAMINATION limited = td nee None N J Months (infant) Middle Oo Ne None required |] or Lower 0 DIAGNOSTIC TESTS ORDERED THIS VISIT? Yes [] No[] Brg heroy Oo Yoiia [=] Unknown a IF YES, PURPOSE OF TESTS NEON Oo m] Screening Diagnosis Follow-up Surgical procedures or treatments (specify| Oo Female PATIENT SEEN BY YOU BEFORE? LAsoraTORY PROCEDURES None [] 9 or specify) Yes O Urine sugar. 0 0 0 COLOR OR RACE Urine protein... 0 0 White 0 No 2 Urine microscop L] CL] Advised diet, exercise or behavior changes a IF YES, FOR THE PRESENT ' or ; Negro 0 PROBLEM OR COMPLAINT? Advised bed or house rest 0 Other 0 Yes 0 o = o Other health education or counselling a Unknown m} No 0 , g = C] Th ic listening 0 Psychotherapy 0 CURRENT MARITAL STATUS Corti apiin i Oo Ey a rvical LJ Physical therapy trois TEAUATIATS Sood ug. Ll g C] . 0 ape 0 Essentially healthy 0 tT J o ot ’ a ” i Oo Other (specify Widowed 0 Slightly ill 0 Moderately ill Separated or oO orofaly:s o Tay EXAMATNS None [] _ divorced ously i Ld ii Serioudy. Skeletal Structure. -_. 0 DISPOSITION Unknown 0 Unknown a Gi series, upper - ul No further follow-up planned a a doy oe ie C] REFERRAL STATUS Other (specify) Telephone follow-up planned a Referred by another physician a Return fo me at any fime, p.r.n. a Referred by other person or agency 5 Return to me at specified time or irterval 0 If-ref wi referred (or self-referred) 5 for io ost only Oo inknown Referred fo another bos hyiion for consultation, 0 diagnosis or treatment SERIOUSNESS OF PATIENT'S PROBLEM OR COMPLAINT . Referred for hospital admission In your opinion, how Based on your clinical Under my care a serious did the patient judgment, now serious was Under another physician's care a consider his problem to be? the problem in actuality? Returned to referring physician or agency 0 Very serious jm} Very serious a Other (specify Oo Moderately serious [] Moderately serious [1 0 0 [] CONFIDENTIAL — All information which would permit . Smear from pharynx... LJ Ll] identification of an individual or an establishment will be Slightly serious 0 Slightly serious a ECG tracing... [J [] held confidential, will be used only by persons en; i Smear from cervix a C1 [] in and for the purposes of the survey and will not be Not serious 0 Not serious a ; 0] C] ] disclosed or released to other persons or used for any Other (specify)-- mo -eoceemeeee Leeann % Unknown 0 other purpose. 48 To i ay PATIENT'S NAME (OPTIONAL) SHORT FORM—PATIENT DATA SURVEY OF AMBULATORY MEDICAL CARE 49416 PHYSICIAN'S COPY REASONS FOR THIS CONTACT MANAGEMENT LOCATION OF THIS CONTACT Boho - - - Patient's purpose, problem or chief complaint mors | TREATMENT (advised, prescribed, dispensed, My office or clinic 0 odministered or arranged) Telephone (other than for appointment) O " rad o Most important diagnosis (definite or provisional) Emergency room 0 one rsa Outpatient clinic (hospital) 0 Drug therapy 0 Home of patient Oo ; — Other pacify) 0 Surgical procedures or treatments (specify) a PATIENT CHARACTERISTICS DIAGNOSTIC PROCEDURES Th ic listening or advising 0 AGE COLOR OR RACE General [J General [J i : Oo oi White m] HISTORY Limited [J EXAMINATION Limited [J i N N Othe: ; Months (infant) Negro 0 one one J r (specify) a DI i Clin 0 DIAGNOSTIC TESTS ORDERED THIS VISIT? Yes [1 No [] ISPOSITION wn Oo ee Oo IF YES, PURPOSE OF TESTS No further follow-up planned 0 — =] Screening Diagnosis Follow-up Telephone follow-up planned 3 emale PATIENT SEEN BY YOU BEFORE? LABORATORY PROCEDURES 0 0 0 Return to me at any time, p.r.n. 0 Return to me at specified i interval 0 CURRENT MARITAL STATUS Yes 0 FRAT EXAMINATIONS 0 0 0 urn to me ied time or interval Oo Referred for diagnostic tests only 0 Never married 0 Ne SPECIAL PROCEDURES 0 0 Oo ici Referred to another physician for consul- Married 0 IF YES, FOR THE tation, diagnosis or treatment a ¢ IMEN TAKEN THIS VISIT FOR LABORATORY BY Widowed 0 PROBLEM OR COMPLAINT? SeEcim ORY PROCEDURES Referred for hospital admission a Under my care 0 Separated or oO Yes 0 None [J Physician [J staff [J Other [J Uren anchenihudidiansens 0 No Oo ; i Unknown 0 CONFIDENTIAL — All information which would permit identification of Returned to referring physician or agency 0 an individual or an establishment will be held confidential, will be used . only by persons engaged in and for the purposes of the survey and will Other (specify) 0 not be disclosed or released to other persons or used for any other purpose. or " vo No. 68 ny INDUCTION INTERVIEW SCHEDULE ED 03500 1-4 INDUCTION INTERVIEW - 5 SURVEY OF AMBULATORY MEDICAL CARE 6-7 8 ns 9 FOR CODERS DATE OF INTERVIEW: INTERVIEWER'S NOC: CITY WHERE INTERVIEWED: INTERVIEWER'S COMMENTS - RECORD ALL SIGNIFICANT OBSERVATIONS RELATING TO YOUR CONTACT WITH THIS DOCTOR: RESPONDENT: ( Prin! Last Name First Name Initial) (Print Street Address) (Print City State Zip) INTERVIEWER'S NAME: Form Approved - Budget Bureau 50 68-568099 SAMC INDUCTION QUESTIONNAIRE Doctor, I would like to ask you a few questions to make sure we have identified you properly, 1. 2a. 4a, First, you are a (SPECIALTY) , is that right? ( ) Yes ( ) No - What is your specialty, doctor? Do you practice ( ) solo or ( ) in a group or partnership? (Check one) (IF GROUP OR PARTNERSHIP) How many physicians are associated with you? physicians Do you treat any ambulatory patients in your practice? ( ) Yes (CONTINUE INTERVIEW) ( ) No - I treat no ambulatory patients (TERMINATE INTERVIEW) ( ) No - TI am no longer in practice (TERMINATE INTERVIEW) Would you tell me about how many hours you spend in a typical week in direct patient care and counseling? hours How many hours each week in other professional activity such as teaching, research, administration and continuing education? hours How many wecks per year do you usually practice? weeks 51 © 52 (REFER TO QUESTION 4a) You indicated you spend a total of hours per week in direct patient care and counseling. TI would like to find out the different ways in which you spend your patient care time, I am particularly interested in how you divide it among five areas, Let me read them all first and then go over them one at a time, They are: Face to face contact with patients in your own office or clinic, On the telephone, In a hospital emergency room, in its outpatient clinic or with its bed patients, Now, to start again, how much time per week do you usually spend in Hours or Percent (a) Face to face contact with patients in your own office or clinic? (PRORE) About how many minutes do you spend with each patient? (b) How much time per week on the telephone with patients? (PROBE) About how many minutes with each patient? (c) How much time per week in the hospital emergency room? (PROBE) About how many minutes with each patient? (d) How much time per week in a hospital outpatient department? (PROBE) About how many minutes with each patient? (e) How much time per week with your hospitalized patients? (PROBE) About how many minutes with each patient? min, min, min, min, min, (f) Are there any other places where you carry out or pursue patient care in a typical week? ( ) Yes ( ) No (IF YES, ASK) What are they? (ASK, FOR EACH) How much time is spent? Place Hours or Percent 6. How many people work for you in your practice, including persons shared with other doctors? Full time (35 hours or more per week) people Part-time (less than 35 hours per week) people 7. (ASK ONLY OF SOLO PRACTITIONERS, DO NOT READ CHOICES, BUT RECORD PHYSICIAN'S ANSWER,) What office facilities do you share with other doctors? ( ) None ( ) Reception room ( ) Examining rooms ( ) Consultation rooms ( ) Laboratory ( ) X-Ray ( ) Other, (please specify) 8. In a typical week, how many ambulatory patient contacts do you have, those seen in person and those contacted by telephone? patients per week PATIENT FORM EVALUATION INTERVIEW SCHEDULE ED 03500 1 «4 SAMC FORM EVALUATION INTERVIEW - 5 SURVEY OF AMBULATORY MEDICAL CARE b=7 8 ___ 6S FOR CODERS DATE OF INTERVIEW: INTERVIEWER'S NO: CITY WHERE INTERVIEWED: INTERVIEWER'S COMMENTS - RECORD ALL SIGNIFICANT OBSERVATIONS RELATING TO YOUR CONTACT WITH THIS DOCTOR: RESPONDENT: . (Print Last Name First Name Initial) (Print Street Address) (Print City State Zip) INTERVIEWER'S NAME: Form Approved - Budget Bureau No. 68-S68099 54 SAMC FORM EVALUATION INTERVIEW (To be administered to participating physicians after they have completed one quarterly assignment) 1. When were the patient record forms usually filled out? (Check one only) ( ) After each patient visit ( ) From time to time during the day, as time allowed ( ) All at once at end of each reporting day ( ) All at once at end of the reporting period ( ) Other 2, About how many minutes did it take to fill out each form? min, /form, 3. Who usually filled out the forms? Was anyone else involved? ( ) Yes ( ) No (IF YES) Who? What part did she (he, you) play in filling out the forms? 4, From what sources did you draw the information requested on the form? (DO NOT READ CHOICES, BUT RECORD PHYSICIAN'S ANSWER) ( ) Doctor's memory ( ) Nurse's or aide's memory ( ) Patient's medical record ( ) Bills/statements ( ) Other 55 56 Did you encounter any inconsistencies on the form? ( ) Yes ( ) No (IF YES) What were they? Was there any information not requested in the patient record form which you think should be added for the sake of completeness? ( ) Yes ( ) No (IF YES) What information? What design or format changes can you suggest which you feel would make the form more useful or easier to fill out? (IF NONE) Then, you are generally satisfied with its layout as it stands? ( ) Yes ( ) No - Why not? 10, 11, 12, Did you find that the use of the forms was helpful to you, in any way? ( ) Yes - How? ( ) No What did you do with your copies of the form? (DO NOT READ CHOICES, BUT RECORD PHYSICIAN'S ANSWER) ( ) Filed them in patient's record jackets ( ) Kept them all together in a file ( ) Sent them back ( ) Threw them away ( ) Other Was your patient load during your reporting days unusual in any way with respect to number of patients, location of contacts, or time out of the office? ( ) Yes = In what way? ( ) No From what you know of this study, do you think that other physicians would participate in it? ( ) Yes ( ) No = Why not? With regard to the annual reporting schedule, would you prefer to report one day each month rather than two consecutive days each quarter? ( ) Yes ( ) No ( ) No preference 57 13. 14, 58 What would you suggest be done to increase the likelihood of participation by other physicians? (IF MONEY OR COMPENSATION IS MENTIONED, ASK) How much? (IF MONEY OR COMPENSATION IS NOT MENTIONED, ASK) Would monetary compensation help? ( ) No ( ) Yes (IF YES, ASK) How much? There are some situations that a few physicians have been uncertain about including in this survey, Thinking back over the days during which you participated, do you recall seeing any patients who were ambulatory, perhaps at home or in an. emergency room prior to hospitalization, that you did not report on? ( ) No ( ) Yes - Where did these contacts take place? How many contacts were involved? ‘ 15, Do you keep any kind of daily list of patients contacted? ( ) Yes ( ) No (IF YES) Does it include: Yes No If no, proportion included a, All office patients? ( ) ( ) b. All telephone calls? ¢ ) ( ) c. All hospital patients? ( ) ( ) d. All emergency room patients? « ) «( ) e. All home visit patients? « ) ( ) Does it exclude any patients? ( ) No ( ) Yes, specify 59 DRTE cerns; iciincens: APPENDIX IV DATA COLLECTION FORMS FIELD TEST: PHASE li SHORT FORM AND PATIENT LOG FOR NONSAMPLING PROCEDURE PATIENT LOG Ves As each potient arrives, record his name on the log balow, and complete the correspondingly num- bered patient record to the right. NATIONAL AMBULATORY MEDICAL CARE SURVEY DATE FOR CODING ONLY [T1111 [T1 | | — PATIENT RECORD PATIENT NUMBER 1915R0 PATIENT NUMBER 1 PATIENT'S NAME ® REASONS FOR THIS VISIT Patient's purpos Most important diagnosis (defin, Other diagnoses , problem or chief complaint @ ace ®@ COLOR OR RACE ® PATIENT SEEN BY YOU ? 2 OJ Morried 2] Female s CiWidoned [) Widowe: Separated BE en 5 [J Unknown BEFORE vee + 0 White 3 (J Other winmsniniai MOB 4 2 [J Negro 4 [J Unknown VO) Yes 20) No @ sex (5) CURRENT MARITAL STATUS IF YES, FOR THE 1 Male 1 [INever Married (include children PRESENT PROBLEM? 10 Yes 200 No @ HISTORY + [J General 2 [J Limited 3 [J None t [J General 2 [J Limited 3 [J None EXAMINATION LABORATORY PROCEDURES ' [J Screening 2 [J Diagnosis 3 0 Follow-up 4 [J None DIAGNOSTIC TESTS ORDERED THIS VISIT (check all that apply) 1 [J Screening 2 [J Diagnosis 30 Follow-up 40 None 1 [0 Screening 2 [J Diagnosis 20 Follow-up 40 None X-RAY EXAMINATIONS OTHER DIAGNOSTIC PROCEDURES 0) DIAGNOSTIC SPECIMEN TAKEN THIS VISIT BY ' [J Physician 2 [J staff 3 [J Other 4 [J None PHYSICIAN'S COPY FORM B APPROVED - £XP. 9/30/ OMB NO. 68-37108" 7 TREATMENT THIS VISIT (check all that apply) 1 [J None required 2 [J Drug therapy 3 [) Office surgical treatment 4 [0 Therapeutic listening and/or psychotherapy 5 [J Advised diet, exercise or habit changes ¢ [J Family planning 7 [1 Other (specify) @ D 0 20 sd «0 sO sO ISPOSITION THIS VISIT (check all that apply) No further follow-up planned Telephone follow-up planned Return to me ot anytime, p.r.n, Return to me ot specified time or interval Referred for diagnostic tests only Referred to another physician for consultation, diagnosis or treatment Referred for hospital admission 7 under my care 8 [J under another physician's care © [J Returned to referring physician or agency x [J Other (specify) [® DURATION OF THIS VISIT —Minutes CONFIDENTIAL ~ All information which would permit identification of an individual or an establishment will be held confidential, will be used only by per- sons engaged in and for the purposes of the survey and will not be disclosed or released to other persons or used for any other purpose. FORM A APPROVED - BUDGET BUREAU NO. 68570085 £xP. 8/31/71 ee [11] IT (O11 0 O07 O17] 11 11 Page Missing Page Missing MINIFORM WITH PATIENT LOG FOR SAMPLING PROCEDURE 85154 PATIENT LOG DATE __ _ 19. As each patient arrives, record name, time of visit, age and sex on the log below. For the patient entered on line #3, also complete the patient record to the right. NATIONAL AMBULATORY MEDICAL CARE SURVEY PATIENT RECORD 85154 DIAGNOSIS THIS VISIT Most important diagnosis (definite or provisional) Other diagnoses AGE TIME OF | y PATIENT'S NAME May [Ye | sex Mos 1 am.| OM TREATMENT THIS VISIT (check all that apply) rs 1 J None required 5s [J Advised diet, exercise or habit change Pm] Mos QF 2 [J Drug therapy 6 [J Family planning am. | Om 2 's 3 [J Office surgical treatment 7 [J Other (specify) p.m OF Mos 4d Therapeutic listening and/or psychotherapy am | yo Om CONFIDENTIAL ~ All information which would permit identification of an individual or an es- 3 tablishment will be held confidential, will be used only by persons engaged in and for the Record dingnosis and treatment for p.m. OF | purposes of the survey and will not be disclosed or released to other persons or used for any this patient. Mos. other purpose. CONTINUE LISTING PATIENTS ON THE NEXT PAGE FORM F APPROVED - BUDGET BUREAU NO. 68-S70088 EXP. 8/31/71 63 MINIFORM WITHOUT PATIENT LOG FOR NONSAMPLING PROCEDURE NATIONAL AMBULATORY MEDICAL CARE SURVEY PATIENT RECORD AoE sex a Yrs. 1 [J Male DATE. 19. 5 g 798] or smn MOS 4 2 [] Female DIAGNOSIS THIS VISIT Most important diagnosis (definite or provisional) Other diagnoses TREATMENT THIS VISIT (check all that apply) 1 [J None required 5 (J Advised diet, exercise or habit changes 2 [1 Drug therapy es] Family planning 3 [J Office surgical treatment 70 Other (specify}o— +0 Therapeutic listening and/or psychotherapy CONFIDENTIAL — All information which would permit identification of an individual or an estab- lishment will be held confidential, will be used on'!y by persons engaged in and for the purposes of the survey and will not be disclosed or released to other persons or used for any other purpose. FORM D APPROVED - BUDGET BUREAU NO. 68-57006%5 EXP. 8/31/71 ENLISTMENT INTERVIEW SCHEDULE CONFIDENTIAL* Form approved. Budget Bureau No. 68-S70065 February 1971 NATIONAL OPINION RESEARCH CENTER University of Chicago Time AM NATIONAL AMBULATORY MEDICAL CARE SURVEY Began: PM Survey No. 4118 (Phys. ID Number) INDUCTION INTERVIEW As 1 said on the phone the other day, Dr. , I have a few questions to ask before we discuss the reporting procedures. First, about your practice . . . lL. You are a . 1s that right? (ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.) Yas . 2 i 4 2 2 0 vo» os + ) No . «. +... C(ASKA) . . + « + 2 A. IF NO: What is your specialty, (including general practice)? (Name of Specialty) 2. Do you practice solo, or are you associated with other physicians in a partnership, in a group practice, or in some other way? SOLE + 4 vw » + + vw 5% 2 2.4 5 8 ® v bv wwe} Partnership (ASK AY . + + + + # o 3 » » % # # 2 Group . +» « ASK A) uw vw ¢ «5 5 vw ow v » = =» 3 Other (SPECIFY AND ASK A) +. + 4 + + +» » ss » =» 4 A. IF PARTNERSHIP, GROUP, OR OTHER: How many other physicians are associ- ated with you? (# of Physicians) be “All information which would permit identification of an individual or an establishment will be held confidential, will be used only by persons engaged in and for the purposes of the survey, and will not be disclosed or released to other persons or used for any other purpose. 65 wD Now I'll take a few minutes to discuss with you the physician's role in the National Ambulatory Medical Care Survey. To understand this better, I should give you a little background about the origin of this survey. There is a general lack of any systematic information about the characteristics and complaints of people who consult physicians in their offices. Such information is bad- ly needed by medical educators and persons concerned with medical manpower needs. In response to this need, NCHS (National Center for Health Statistics), in coopera- tion with representative of the medical profession has developed this survey of Ambulatory Medical Care. The information for this survey can be provided only by office-based physicians who provide care for ambulatory patients. The task is simple, carefully designed, and should not take much of your time. Es- sentially it consists of your participation on two randomly selected consecutive days in each of four quarters. Your participation consists of filling out a minimal amount of information for each patient seen by you during that two-day period. Let me show you the form(s) involved now. TAKE OUT FOLIO AND SHOW FORM(S) TO THE DOCTOR. EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHOW DOCTOR THE INSTRUCTIONS ON POCKET OF FOLIO TO WHICH HE CAN REFER AFTER YOU LEAVE, RECORD VERBATIM ANY CONCERNS, PROBLEMS, OR QUESTIONS THE DOCTOR RAISES IN CONNECTION WITH THE EXPLANATION OF THE SURVEY OR THE COMMITMENT FOR FOUR QUARTERS. Doctor, now that you know what the task is, let me tell you that your reporting days for this quarter are: READ DAYS OF WEEK AND DATES WHICH YOU CIRCLED FROM PAGE 3 OF CONTROL FOLDER. M T W Th F Sa M T W Th F Sa, March and 3. Are you likely to see any ambulatory patients on those days? Yes : o 5% & % 2 # o 3» i } No... (ASKA&B) ...2 IF NO: A. Why is that? 66 =3« 3. Continued IF NO TO 3: B. Your alternate days would be (READ NEXT PAIR OF DAYS). Are you at all likely to see any ambulatory patients on those two days? ¥e8 uu « + 4 ww » uw » u » «ww Mo woo TASK (LY) 4 ui 5° uw 2 (1) IF NO TOB : Would you please select any two consecutive days between / March 8 and March 20 on which you would be likely to see any ambulatory i ? patients: Yes (RECORD SELECTED DAYS AND Eo enor ca~="axs DATES IN BOX) . . . . . . . . 1 ELECTED REPORTING DAY : No (OFFER CHOICE OF ANY 2 DAYS M T W Th F Sa BETWEEN MARCH 22 AND APRIL 2 and AND RECORD SELECTED DAYS AND M T W Th F Sa, March/April and DATES INBOX) o's w 4 ww » » » 2 RECORD VERBATIM ANY COMMENTS DOCTOR MAKES WITH REFERENCE TO THE SELECTION OF RE- PORTING DAYS. IF REPORTING DAYS ARE UNACCEPTABLE FOR OTHER REASONS THAN ABOVE, RECORD VERBATIM HERE. 4, A. At which office location will you be seeing ambulatory patients during the 2-day reporting period? RECORD UNDER A BELOW AND ASK B WHEN INDICATED. B. IF HOSPITAL EMERGENCY ROOM, OUT-PATIENT CLINIC, OR OTHER INSTITUTIONAL LO- CATION IN A: Thinking about the ambulatory patients you see in (PLACE IN A), do you, yourself, have primary responsibility for their care over time, or does (INSTITUTION IN A) have primary responsibility for their care over time? A, B. Dr. has prime |Inst. has prime responsibility [responsibility Office Location (in-scope) (out-of-scope) (1) 1 0 2) 1 0 (3) 1 0 67 A= 5. During your 2-day reporting period (REPEAT EXACT DATES), will anyone be available to help in the survey reporting process (at each IN-SCOPE location)? Yes . . . (ASK A) . . 1 No uo wo we v9 a2 A, IF YES: Who would that be? B. INTERVIEWER: WAS RECORD NAME, POSITION, AND LOCATION. Ta BRIEFED BY Name Position Location Yes No Now I have just a few more questions about your practice during a typical week. 6. A. During a typical week, approximately how many hours do you spend each day caring for ambulatory patients? RECORD IN COLUMN A. B. And about how many ambulatory patient visits do you have each day, during a typical week? RECORD IN COLUMN B. A. Estimated hours | Estimated No. of patients Day of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday BEFORE YOU LEAVE, STRESS THAT EACH AMBULATORY PATIENT SEEN BY THE DOCTOR DURING THE 2- DAY PERIOD AT ALL IN-SCOPE LOCATIONS (REPEAT THEM) IS TO BE INCLUDED IN THE SURVEY. Thank you for your time, Dr. . If you have any (more) questions, please feel free to call me. My phone number is written in on the folio. I'll call you the day before your reporting days just to remind you. [Time AM o] T 11 Lessee Mont ate ITEMS I & II ARE TO BE COMPLETED BY THE INTERVIEWER AFTER THE INTERVIEW. I. How much interest do you think the doctor II. How confident are you that the has in the survey? doctor will complete the forms? Definitely will . . . 1 Probably will . . . . 2 Doubtful ,. + v» » +» » 3 Great interest . . . Some interest . . . Little interest . . No interest . so. Can't tell « « + + + bw pr N= Interviewer # | Interviewer's Signature: 68 EVALUATION INTERVIEW SCHEDULE CONFIDENTIAL* NATIONAL OPINION RESEARCH CENTER orm approved. University of Chicago Budget Bureau No. : 68-870065 NATIONAL AMBULATORY MEDICAL CARE SURVEY Feb. 1971 Survey No. 4118 Time ____ AM Began: PM SURVEY EVALUATION INTERVIEW (Phys. ID Number) Hello, Dr. . This is (YOUR NAME) from the National Opinion Re- search Center (of the University of Chicago). I called to thank you very much for your cooperation in the National Ambulatory Medical Care Survey. To com- plete your participation, I hope you will answer a few questions now to help us evaluate the survey. NOTE: IF PROCEDURE V WAS USED BY THIS DOCTOR, BEGIN THIS INTERVIEW WITH Q. 2. 1. You will recall that two forms were used--the Patient Log and the Patient Record. A. First, tell me about the Patient Log--who, in your office, completed the Patient Log (for the most part)? Doctor himself . . . . . . 1 Assistant who was briefed by interviewer . 2 Someone else (SPECIFY) . . 3 B. At what point were the patients' names (usually) entered on the log? DO NOT READ CATEGORIES. When patients checked in with re- ceptionist or nurse . . . . . . . 1 When patients saw doctor . . . . . . 2 Other (SPECIFY) . . . « + o « + « « 3 2. Now, tell me about the Patient Record. You may recall that there were two kinds of information requested on the Patient Record--personal and clinical. A. Who usually completed the items asking for clinical information? Doctor himself . . . . . . 1 Assistant who was briefed by interviewer . 2 Someone else (SPECIFY) . . 3 B. Who usually completed the items asking for personal information? Doctor himself . . . . . . 1 Assistant who was briefed by interviewer . 2 Someone else (SPECIFY) . . 3 *A1l information which would permit identification of an individual or an establishment will be held confidential, will be used only by persons en- gaged in and for the purposes of the survey, and will not be disclosed or re- leased to other persons or used for any other purpose. li 69 2. Continued C. Was anyone else involved in completing any part of the Patient Records? Yes . [ASR (1) & (2)) . «. . 1 No (GOTO 3) v.20 # = « 2 IF YES TO C: (1) Who was that? (Name) (Position) (2) What part of the forms did (you/he/she/they) complete? Clinical items « + + + + » Personal items . . . . . Other (SPECIFY) . . . . « « 3 3. At what point in the process was the clinical information on the Patient Record filled out? DO NOT READ CATEGORIES At the time patient saw doctor . . . 1 At the end of each day (ASK A) . . . 2 At the end of reporting period (ASK A) . 3 Other (SPECIFY AND ASK A) . . . . . . . . 4 A. IF NOT AT TIME PATIENT SAW DOCTOR: Was the clinical information entered mostly from memory, mostly from the patient's medical record, or mostly from something else? Mostly memory . +. « + + « + + os o os + » Mostly patient's medical record . . . . . 2 Mostly something else (SPECIFY) . . . . . 3 4, How long did it usually take to complete a Patient Record? minutes or seconds 5. When filling out the Patient Records, were there any items or instructions that you had trouble with? Yes . (ASKA) . .....1 NO cui 0 vam eww 2 A. IF YES: What were they? 70 «3 ASK Q'S 6 AND 7 ONLY OF DOCTORS ASSIGNED PROCEDURES II OR IV; FOR OTHERS SKIP TO Q. 8. 6. Did you (OR PERSON) have any trouble filling out Yes (ASK A) 1 the Patient Log? . oo. Boe wo vw 9 ow w = 2 A. IF YES: What was the trouble? 7. Did you (or the person filling out the forms) have any difficulty follow- ing the survey procedures because a Patient Record was completed for only every third patient? Yes (ASK A) 1 NO oo v0 wu 5 0 % 2 A. IF YES: What difficulties? ASK EVERYONE: 8. We are trying to get some notion of how complete the information is which we have collected. We know that many things could have occurred to pre- vent you from keeping records on the two reporting days. How confident are you that the records you sent to us include every ambulatory patient seen by you during the 2-day reporting period--would you say you are con- fident that every patient was included, or that you got all except one or two, or that more than that were missed, for one reason or another? Every patient was included . . . Got all except one or two . . . Missed more than that (ASK A) . Ss WN = Can't recall , « « vw ¢ = + # © =» A. IF MISSED MORE THAN TWO: Why was that? 71 dy 9. What changes do you suggest in order to make any of the forms more useful or easier to complete? RECORD IN APPROPRIATE COLUMN. Patient Records Patient Log ASK Q. 10 ONLY IF ''NO CHANGES' SUGGESTED IN Q. 9. 10. Are you generally satisfied with the forms as they are? YEE « 4 o o 0 9 ¢ oo 5 oo » Noo (ASK A) ¢ vo so + » = » A, IF NO: Why not? 11. With regard to the overall survey operation in your office, did you find that the procedures we asked you to follow were reasonable and easily adaptable to your office routine? Yes uo ox x wv ow ow 3d No . (ASK A) . . . . 2 A. IF NO: What changes in procedures do you suggest that would make your participation easier? 72 -5- Now, about your practice. wp ; oe 12. Was your practice during the 2-day reporting period (GIVE DATES) unusual in any way? Yes . . (ASK A-C) . 1 FO 4 vw ov oo 7 » & 2 IF YES: A. Was your patient load lighter than Lighter than usual . usual, heavier than usual, or about Heavier than usual . 2 the same? About the same . . . B. How about the amount of time spent in caring for ambulatory patients--was that less than usual, more than usual, or About the same . . . 3 about the same? Less than usual . . More than usual . . 2 C. In what (other) ways was your practice unusual during your reporting period? 13. Doctor, we would like to get an idea of your total ambulatory patient load during the two-day reporting period, including telephone calls and patient contacts made outside of your office. A. First, how many ambulatory patient contacts would you estimate took place by telephone during the two- Number of patient day period--not including calls contacts by for appointments? telephone: B. How many ambulatory patient con- tacts were not included in the survey because they took place outside of your office during the two-day period, such as in a hos- pital emergency room, in a patient's home, in an out-patient clinic, at the scene of an accident, or elsewhere? Number of outside patient contacts: 14. What suggestions do you have for us to encourage participation in this sur- vey by other physicians? (IF MONEY IS MENTIONED, PROBE FOR AMOUNT.) 73 l= 15. A letter was sent to you by Mr. Theodore Woolsey of the National Center for Health Statistics (NCHS) urging you to participate. Did you receive that letter? Yes . (ASR AY « « « + + + 1 NO «0 6 was ow « « » 2 A. IF YES: Did it influence your decision to participate? Yes . « « ¢ 4% 5 w © ® a X NO 2 vo vo 0 #0 » « 9 2 16. There was also a letter from Dr. Howard, Executive Director of AMA urging you to take part in the study. Did you receive that letter? Yes . (ASK A) © » # 4 w o 1 NO io v vw 8 8 ww 0» » 2 A. IF YES: Did it influence your decision to participate? Yes . 4 ov ¢ wo ow =» 4 NO wie 889 9% awe 2 17. Did you happen to discuss the survey with anyone from your (local or) state medical society or one of your colleagues before you participated? Yes, local or state medical society (ASK A) . . 1 Yes, colleague . . . . . . . . . . (ASKA) . . 2 No, neither a « + « « s + » # + + ® & + & © « 3 A. IF YES: Did (that/those) discussion(s) influence your decision to par- ticipate? Yes , « « = + = © ¢ 5 = © & No woo 5 om @ 0 @ 6 uo 18. Were there any (other) specific factors which influenced your decision to participate? Yes . (ASK AY « « » 0 +» « 1 NO wmv o 982% 2% 2 A. IF YES: What were they? 74 19. We initially requested your participation in this survey during four quarter- ly 2-day periods. After having participated for the first period, how do you feel about participating during the other 2-day periods--would ynru defi- nitely participate, probably participate, probably not participate, or defi- nitely not participate? Definitely would i & aX Probably would . . . . . . . . . 2 Don't care one way or the other . 3 Probably would not (ASK A-D) . . 4 Definitely would not (ASK A-D) . 5 Don't know . . . +. « +. « « « « . 6 IF PROBABLY NOT OR DEFINITELY NOT: A. Why would you (probably) not participate? B. (PROCEDURES I AND II ONLY): Would you be willing to participate if the Patient Record was different? C. (PROCEDURES I, III, AND V): Would you be willing to participate if you were asked to complete only about ten Patient Records for each of the two days? D. Are there any (other) conditions under which you would participate again? Yes [ASK (1)] . . 1 (1) IF YES TO D: Under what conditions? That's all the questions I have, Doctor. The information you have given us to- day will be most useful in evaluating our survey procedures. Thank you very much for all your help and cooperation. Time AM Ended:™ pM FILL OUT ITEMS ON BACK COVER AFTER INTERVIEW. 75 =8= ITEMS BELOW ARE TO BE COMPLETED BY THE INTERVIEWER AFTER THE INTERVIEW 1. How do you think the doctor feels about participating during the other three quarters? Definitely would . . . . . Probably would . . . . Probably would not . . . . Definitely would not . . . 0m rN = Con't tell . + vv vw» = = II. Was doctor cooperative during this evaluation interview? YES vv vv ee eee 1 No . . (ANSWER A) . . . . 2 A. IF NO: Why do you think he wasn't cooperative? III. Was this interview conducted on the telephone? ¥Ye5 « « « ¢ « +» » 1 No (ANSWER A) . . 2 A, IF NO: Where was it conducted, and why were you not able to conduct it on the telephone? Please record here any other comments or insights of your own which might help us in the evaluation of this survey. fo Interviewer's Signature: (Interviewer # Date of Interview: lo] | | | Month Date 76 — —— i —— oo [E R——— ee mei eee, Pee Tt N . 1 3 el oy _ Series 1. Series 2. Series 3. Series 4. Series 10. Series 11. Series 12. Series 13. Series 14, Series 20. Series 21, Series 22, VITAL AND HEALTH STATISTICS PUBLICATION SERIES Formerly Public Health Services Publication No. 1000 Programs and collection procedures.— Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data. Data evaluation and methods research.— Studies of new statistical methodology including: experi- mental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory. Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series. Documents and committee reports.—Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birth and death certificates. Data from the Health Interview Survev.— Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey. Data from the Health Examination Survey.—Data from direct examination, testing, and measure- ment of national samples of the civilian, noninstitutional population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psycho- logical characteristics; and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons, Data from the Institutional Population Surveys. — Statistics relating tothe health characteristics of persons in institutions, and their medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients. Data from the Hospital Discharge Survey. — Statistics relating to discharged patients in short-stay hospitals, based on a sample of patient records in a national sample of hospitals. Data on health resources: manpower and facilities. —Statistics on the numbers, geographic distri- bution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities. Data on mortality,—Various statistics on mortality other than as included in regular annual or monthly reports—special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses. Data on natality, marriage, and divovce,—Various statistics on natality, marriage, and divorce other than as included in regular annual or monthly reports—special analyses by demographic variables, also geographic and time series analyses, studies of fertility. Data from the National Natality and Mortality Surveys.— Statistics on characteristics of births and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, hospital experience in the last year of life, medical care during pregnancy, health insurance coverage, etc. For a list of titles of reports published in these series, write to: Office of Information National Center for Health Statistics Public Health Service, HRA Rockville, Md. 20852 DHEW Publication No. (HRA) 74-1335 Series 2-No. 61 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE POSTAGE AND FEES PAID Public Health Service U.S. DEPARTMENT OF H.E.W, HEALTH RESOURCES ADMINISTRATION MEW 390 5600 Fishers Lane THIRD CLASS Rockville, Md. 20862 BLK. RATE OFFICIAL BUSINESS Penalty for Private Use, $300 U.C. BERKELEY LIBRARIES 021206089 F808 PON (05:20 0t0°0000 PP I3T003 0076s C0EENLIESIO DOLICRCeEsoI NT NOE IleEnSd GLI ate@ress TCaPe "OVERS s 9880S 80080 )00 230 ,04°0000003600 2005808 1009 _®08 03°93 1680938c00000908s __.70s0ns