Fetal Alcohol Syndrome Questionnaire



Fetal Alcohol Syndrome Questionnaire

School Staff Survey (Post-Workshop Assessment)

This is a survey about fetal alcohol syndrome. Your answers will help improve training programs for other school staff and parents. Do NOT write your name on this survey. All your answers will be kept private and will never be seen by anyone who knows you. If there is any question that you do not want to answer, just leave it blank. Please write your answers directly on the survey. You can use either a pen or pencil.

You may have heard of various terms used to describe the conditions that can result from prenatal exposure to alcohol. These terms include: Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE), Alcohol-Related Neurodevelopmental Disorder (ARND), and Alcohol-Related Birth Defects (ARBD). For the purpose of this survey, FAS and ARND will be used together (FAS/ARND) to mean FAS or ARND or other prenatal alcohol-related disorders. In some questions, FAS or ARND will be used alone. Thank you for your participation in this survey. If you have any questions, feel free to ask the facilitator.

At the beginning of the course, we asked you to fill out a survey like this one. Please fill in the same matching code you used earlier below so we can compare surveys. Remember, your answers are private – you CANNOT be identified by your code. Thank you!

Month in which you were born ______________________

First letter of your mother’s first name ______________________

Last letter of your last name ______________________

First letter of the street you live on ______________________

1. How would you rate your current knowledge level of Fetal Alcohol Syndrome (FAS)? (check one)

|1 |None |

|2 |A Little |

|3 |Moderate Amount |

|4 |A Great Deal |

2. How would you rate your current knowledge level of Alcohol Related Neurodevelopmental Disorder (ARND)? (check one)

|1 |None |

|2 |A Little |

|3 |Moderate Amount |

|4 |A Great Deal |

3. FAS/ARND is…? (check one)

|1 |Present only at birth |

|2 |Usually outgrown by age two |

|3 |Usually outgrown by puberty |

|4 |Cured with the right treatment |

|5 |Lifelong |

4. Please state your opinion on these issues regarding FAS/ARND ranging from Strongly Disagree to Strongly Agree. (check one on each line)

| |Strongly |Somewhat |Somewhat |Strongly |

| |Disagree |Disagree |Agree |Agree |

|Children with FAS/ARND are often misdiagnosed as only having other conditions (i.e., |1 |2 |3 |4 |

|Attention-Deficit/Hyperactivity Disorder). | | | | |

|I can tell if a child has FAS/ARND by looking at him/her. |1 |2 |3 |4 |

5. Please state your opinion on the following issues. (check one on each line)

| |Strongly |Somewhat |Somewhat |Strongly Agree|

| |Disagree |Disagree |Agree | |

|I know where to go if I want more information on FAS/ARND. |1 |2 |3 |4 |

|I know some classroom strategies that would be helpful for children with FAS/ARND. |1 |2 |3 |4 |

|I would feel able to discuss FAS/ARND with a parent. |1 |2 |3 |4 |

|I would feel able to discuss FAS/ARND with a colleague. |1 |2 |3 |4 |

|With early and ongoing support and services, children with FAS/ARND are less likely to |1 |2 |3 |4 |

|develop secondary conditions. | | | | |

6. Please indicate whether each of the following statements is true or false. (check one box in each line)

| |Definitely False |Probably False |Probably True |Definitely True |

|Alcohol has a much greater potential than cocaine to disrupt brain |1 |2 |3 |4 |

|growth in the fetus. | | | | |

|While research has helped us understand alcohol’s effects, parents |1 |2 |3 |4 |

|have developed many of the interventions that help children with | | | | |

|FAS/ARND. | | | | |

|Facial abnormalities are an essential feature in the diagnosis of FAS.|1 |2 |3 |4 |

|Alcohol abuse during pregnancy does not always result in the birth of |1 |2 |3 |4 |

|a child with FAS. | | | | |

|The most serious effect of prenatal alcohol exposure is growth |1 |2 |3 |4 |

|retardation. | | | | |

|All children with FAS are mentally retarded. |1 |2 |3 |4 |

|Early diagnosis and intervention can improve the outlook of a child |1 |2 |3 |4 |

|with FAS. | | | | |

|Diagnosis of FAS/ARND is made on the basis of a specific set of |1 |2 |3 |4 |

|laboratory tests administered by a doctor. | | | | |

|Many of the simple classroom adaptations that can help children with |1 |2 |3 |4 |

|FAS/ARND help all children in the classroom. | | | | |

|Many techniques used for children with learning disabilities work for |1 |2 |3 |4 |

|children affected by FAS/ARND. | | | | |

|Children with FAS/ARND often have problems with sustained attention |1 |2 |3 |4 |

|and focus. | | | | |

|There is a specific set of classroom strategies that work for every |1 |2 |3 |4 |

|child affected by FAS/ARND. | | | | |

7. Overall, how satisfied are you with the workshop? (check one)

|1 |Very Dissatisfied |

|2 |Somewhat Dissatisfied |

|3 |Somewhat Satisfied |

|4 |Very Satisfied |

8. Overall, how useful did you find the workshop? (check one)

|1 |Not Very Useful |

|2 |Somewhat Useful |

|3 |Fairly Useful |

|4 |Very Useful |

Fetal Alcohol Syndrome Questionnaire

Parent Survey (Post-Workshop Assessment)

This is a survey about fetal alcohol syndrome. Your answers will help improve training programs for other parents and school staff. Do NOT write your name on this survey. All your answers will be kept private and will never be seen by anyone who knows you. If there is any question that you do not want to answer, just leave it blank. Please write your answers directly on the survey. You can use either a pen or pencil.

You may have heard of various terms used to describe the conditions that can result from prenatal exposure to alcohol. These terms include: Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE), Alcohol-Related Neurodevelopmental Disorder (ARND), and Alcohol-Related Birth Defects (ARBD). For the purpose of this survey, FAS and ARND will be used together (FAS/ARND) to mean FAS or ARND or other prenatal alcohol-related disorders. In some questions, FAS or ARND will be used alone. Thank you for your participation in this survey. If you have any questions, feel free to ask the instructor.

At the beginning of the workshop, we asked you to fill out a survey like this. Please fill-in the same matching code you used earlier below so we can compare surveys. Remember, your answers are private – you CANNOT be identified by your code. Thank you!

Month in which you were born ______________________

First letter of your mother’s first name ______________________

Last letter of your last name ______________________

First letter of the street you live on ______________________

1. How would you rate your current knowledge level of Fetal Alcohol Syndrome (FAS)? (check one)

|1 |None |

|2 |A Little |

|3 |Moderate Amount |

|4 |A Great Deal |

2. How would you rate your current knowledge level of Alcohol Related Neurodevelopmental Disorder (ARND)? (check one)

|1 |None |

|2 |A Little |

|3 |Moderate Amount |

|4 |A Great Deal |

3. FAS/ARND is…? (check one)

|1 |Present only at birth |

|2 |Usually outgrown by age two |

|3 |Usually outgrown by puberty |

|4 |Cured with the right treatment |

|5 |Lifelong |

4. Please state your opinion on these issues regarding FAS/ARND ranging from Strongly Disagree to Strongly Agree. (check one on each line)

| |Strongly |Somewhat |Somewhat |Strongly |

| |Disagree |Disagree |Agree |Agree |

|Children with FAS/ARND are often misdiagnosed as only having other conditions (i.e., |1 |2 |3 |4 |

|Attention-Deficit/Hyperactivity Disorder). | | | | |

|I can tell if a child has FAS/ARND by looking at him/her. |1 |2 |3 |4 |

|It is important to diagnose people with FAS/ARND. |1 |2 |3 |4 |

|Different types of alcohol (wine, beer, liquor) have different risks for the baby. |1 |2 |3 |4 |

5. Please state your opinion on the following issues. (check one on each line)

| |Strongly |Somewhat |Somewhat |Strongly Agree|

| |Disagree |Disagree |Agree | |

|I know where to go to get a child evaluated for FAS/ARND. |1 |2 |3 |4 |

|I know where to go if I want more information about FAS/ARND. |1 |2 |3 |4 |

|I know some parenting strategies that would be helpful for children with FAS/ARND. |1 |2 |3 |4 |

|I would feel able to discuss FAS/ARND with my child’s teacher or other school personnel. |1 |2 |3 |4 |

|With early and ongoing support and services, children with FAS/ARND are less likely to |1 |2 |3 |4 |

|develop secondary conditions. | | | | |

6. Please indicate whether each of the following statements is true or false. (check one box in each line)

| |Definitely |Probably False |Probably True |Definitely True|

| |False | | | |

|Alcohol has a much greater potential than cocaine to disrupt brain growth in the |1 |2 |3 |4 |

|fetus. | | | | |

|While research has helped us understand alcohol’s effects, parents have developed |1 |2 |3 |4 |

|many of the interventions that help children with FAS/ARND. | | | | |

|Facial abnormalities are an essential feature in the diagnosis of FAS. |1 |2 |3 |4 |

|Alcohol abuse during pregnancy does not always result in the birth of a child with |1 |2 |3 |4 |

|FAS. | | | | |

|The most serious effect of prenatal alcohol exposure is growth retardation. |1 |2 |3 |4 |

|All children with FAS are mentally retarded. |1 |2 |3 |4 |

|Early diagnosis and intervention can improve the outlook of a child with FAS. |1 |2 |3 |4 |

|Diagnosis of FAS/ARND is made on the basis of a specific set of laboratory tests |1 |2 |3 |4 |

|administered by a doctor. | | | | |

|Many of the simple classroom adaptations that can help children with FAS/ARND help |1 |2 |3 |4 |

|all children in the classroom. | | | | |

|Many techniques used for children with learning disabilities work for children |1 |2 |3 |4 |

|affected by FAS/ARND. | | | | |

|Children with FAS/ARND often have problems with sustained attention and focus. |1 |2 |3 |4 |

|There is a specific set of classroom strategies that work for every child affected by|1 |2 |3 |4 |

|FAS/ARND. | | | | |

7. Overall, how satisfied are you with the workshop? (check one)

|1 |Very Dissatisfied |

|2 |Somewhat Dissatisfied |

|3 |Somewhat Satisfied |

|4 |Very Satisfied |

8. Overall, how useful did you find the workshop? (check one)

|1 |Not Very Useful |

|2 |Somewhat Useful |

|3 |Fairly Useful |

|4 |Very Useful |

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