Questionnaires

Treatment of Lead-Exposed Children Trial (TLC)

For more information about Treatment of Lead-Exposed Children Trial questionnaires, contact Walter Rogan, M.D.

Screening

• Parent/Guardian Interview: Pre-Randomization Eligibility Review (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/screen/screen03.pdf)   (189K)
• Participant Referral Sheet (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/screen/scrnlog03.pdf)   (237K)
• Pre-Randomization Eligibility Review (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/screen/scrnrvw03.pdf)   (239K)
• Residence Information: Pre-Randomization Visit 1 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/screen/houses04.pdf)   (243K)

First Visit

• Participant Tracking Form (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit1/v1log03.pdf)   (238K)
• Review of Eligibility Lab Results: Pre-Randomization Visit 1 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit1/v1review04.pdf)   (237K)
• Pre-Randomization Visit 1 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit1/visit1a_04.pdf)   (238K)
• Repeat Eligibility Lab Work: Pre-Randomization Visit 1A (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit1/visit1a_04.pdf)   (238K)

Diaries

• Medicine Diary (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/diary/TLC_Diaries_medicine.pdf)   (222K)
• Vitamin Diary (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/diary/TLC_Diaries_vitamin.pdf)   (220K)

Home Assessment, Inspection & Clean-up

• Home Characteristics (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/homechar03.pdf)   (239K)
• Home Assessment Log (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/homelog03.pdf)   (268K)
• Home Visual Inspection (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/inspect01.pdf)   (240K)
• Home Floor Plans (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/floorpln03.pdf)   (189K)
• Dust Wipe Collection (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/dustwipe03.pdf)   (385K)
• Home Cleanup (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/cleanup03.pdf)   (235K)
• Environmental Eligibility Review (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/home/envrvw03.pdf)   (234K)

Second Visit

• Family Characteristics Interview (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit2/famchar03.pdf)   (240K)
• Report of Ineligibility: Visit Non-Compliance (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit2/noncmply03.pdf)   (185K)
• Report of Non-Enrollment (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit2/refuse03.pdf)   (234K)
• Pre-Randomization Visit 2 or 2A (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/visit2/visit2_04.pdf)   (241K)

Initial Psychometric Assessment

• Psychometric Assessment for Younger Children (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/psych1_03.pdf)   (242K)
• Review of Tapes of Psychometric Assessment for Younger Children (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/psych1qa_01.pdf)   (242K)
• Wechsler Adult Intelligence Scale for Parents (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/wais04.pdf)   (234K)

Randomization and Treatment

• Randomization (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/rando04.pdf)   (237K)
• Local Lab Review (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/labrvw04.pdf)   (237K)
• Initiation of Treatment (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/tx0_04.pdf)   (234K)
• Review of Medications and Physical Exam: Treatment Day 7 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/tx1_05.pdf)   (244K)
• Review of Medications and Physical Exam: Treatment Day 28 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/tx2_05.pdf)   (243K)
• Treatment Day 42 (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/tx3_05.pdf)   (239K)
• Retreatment (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/retreat05.pdf)   (234K)
• Adverse Drug Experience Case Report Form (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/treat/ade04.pdf)   (239K)

Follow-up

Medical Follow-up

• Annual Follow-up Visit (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/fu/big_fup04.pdf)   (242K)
• Midyear Follow-up Visit (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/fu/ltl_fup03.pdf)   (239K)

Psychometric Assessment Follow-up Visits

• Psychometric Assessment for Older Children (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/psych2_03.pdf)   (241K)
• Review of Tapes of Psychometric Assessment for Older Children (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/psych2qa_01.pdf)   (237K)
• NEPSY Session Data for TLC Children (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/tlc/docs/psych/psych3_01.pdf)   (239K)

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