the PSIS Participant Questionnaire
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the PSIS Participant Questionnaire

There are 39 questions in this survey.
ConsentForm知情同意書
(This question is mandatory)

The neurocognition of typical and atypical language development: Towards developing early biomarkers
You are cordially invited to participate in the above titled project conducted by Dr. Zhang Caicai (Primary Investigator), who is Assistant Professor at the Department of Chinese and Bilingual Studies in The Hong Kong Polytechnic University (PolyU). Co-Investigators on this project include Dr. Mehdi Bakhtiar (Research Assistant Professor, PolyU), Dr. Angel Wing Shan Chan (Associate Professor, PolyU), Dr. Dustin Kai Yan Lau (Associate Professor, PolyU), Dr. Man Tak Leung (Associate Professor, PolyU), Prof. William Shi Yuan Wang (Chair Professor, PolyU), Dr. Min Ney Wong (Assistant Professor, PolyU) and Prof. Michael Ullman (Professor, Georgetown University). The project has been approved by the Human Subjects Ethics Sub-committee (HSESC) (or its Delegate) of The Hong Kong Polytechnic University (HSESC Reference Number: HSEARS20200214002).
 

The project aims to examine the neurocognitive mechanisms of typical and atypical speech, language and reading development, by testing a recently proposed neurocognitive hypothesis that has garnered increasing support—the Procedural circuit Deficit Hypothesis (PDH)—for the first time in the Chinese population.

All information related to you will remain confidential and will be identifiable by codes only known to the researcher. You have every right to withdraw from the study before or during the measurement without penalty of any kind.

I hereby consent to participate in the captioned project conducted by Dr. Zhang Caicai, Dr. Mehdi Bakhtiar, Dr. Angel Wing Shan Chan, Dr. Dustin Kai Yan Lau, Dr. Man Tak Leung, Prof. William Shi Yuan Wang, Dr. Min Ney Wong and Prof. Michael Ullman
 

典型與非典型語言發展的神經認知機制
我們誠摯邀請您參加一項由香港理工大學（理大） 中文及雙語學系助理教授張偲偲博士主持的合作研究。 其他合作參與研究者包括 Mehdi Bakhtiar 博士（理大研究助理教授） 、陳詠珊博士（理大副教授） 、劉啟欣博士（理大副教授） 、梁文德博士（理大副教授） 、王士元教授（理大講座教授） 、黃敏妮博士（理大助理教授） 及 Michael Ullman 教授（美國 Georgetown 大學教授）。本研究已獲香港理工大學人類研究倫理委 員會（HSFC）批準（HSESC 參考號： HSEARS20200214002）。

本項研究的目的在於揭示典型與非典型言語、語言和閱讀發展的神經認知機制。 我們將測試一個近來獲得諸多支持的新假說──程序記憶神經回路障礙假說。

本項研究沒有涉及任何商業目的。參與純屬自願性質，參與者亦可隨時終止參與此項研究計劃。所收集的資料只作研究用途，供本計劃研究者撰寫及發表論文之用。參與者的個人資料亦將完全保密 。 完成是項測試後，我們會把研究結果回饋予家長。

本人同意參與由 張偲偲博士、Mehdi Bakhtiar 博士、陳詠珊博士、劉啟欣博士、梁文德博士、王士元教授、黃敏妮博士及 Michael Ullman 教授 開展的上述研究。

General Information/一般信息

You can save your progress by the "Resume later" button at the upper corner to create your own account for this survey. To reload the saved survey next time, please press the "Load unfinished survey" button to log in with your account. 

您可以通過點擊右上角的"Resume later"鍵，創建個人賬號並保存您的問卷進度。下次訪問問卷鏈接時，您可通過點擊“Load unfinished survey”鍵，登錄個人賬戶並載入未完成的問卷。

(This question is mandatory)

Participant Name in Chinese and English/兒童姓名（中文及其英文拼寫）

(This question is mandatory)
Age/年齡
(This question is mandatory)
Date of birth/出生日期
Open date/time selector
(This question is mandatory)
Gender/性別
(This question is mandatory)
Education level/教育程度

For example, the first grade of primary school

例如，小學一年級

(This question is mandatory)

Contact

家長/ 監護人姓名及聯絡電話/郵箱

Phone/Email
(This question is mandatory)

What is the child's dominant hand(s)?

貴子女的慣用手是？

(This question is mandatory)
Place of birth/出生地

e.g., Hong Kong, mainland China, Japan...

例如，香港，中國內地，日本

Language background/語言背景
(This question is mandatory)

Is your child a native speaker of Cantonese?

貴子女的母語是廣東話嗎？

Please provide any special information about the background in which your child learnt her/his native language. 

For example, there is a language switch during early childhood from English to Cantonese.

請提供有關貴子女母語習得背景的特殊信息。

例如，在孩提時期，貴子女的母語從英語轉為廣東話。

(This question is mandatory)

Is your child bilingual or multilingual?

貴子女是雙語或多語使用者嗎？

(This question is mandatory)

Please list the languages your child speaks in the order of learning. If not applicable, leave NA there. 

請按照學習時間的先後順序列出, 不適用者請填寫NA

(This question is mandatory)

Score your child language ability on each language s/he speaks (1= not good at, 10 = very good at )

請為貴子女認識的每種語言的聽說能力打分 (1 很不熟練 – 10 很熟練, NA 不適用)

Language 1 Listening/語言1 聆聽能力
Language 1 Speaking/語言1 表達能力
Language 2 Listening/語言2 聆聽能力
Language 2 Speaking/語言2 表達能力
Language 3 Listening/語言3 聆聽能力
Language 3 Speaking/語言3 表達能力
(This question is mandatory)

What is the primary language your child uses in the school？

在學校時，貴子女的主要用語是？

For example, Cantonese, English

例如, 廣東話, 英語

(This question is mandatory)

What is the primary language your child uses at home?

在家時， 貴子女的主要用語是？

For example, Cantonese, English

例如, 廣東話，英語

(This question is mandatory)

Has your child lived in countries/area besides HK?

貴子女是否曾在海外生活超過兩個月？

For example, two months in Japan during 3-4 years old

例如，在3-4歲時，曾在日本生活兩個月。

(This question is mandatory)

Please list the places that your child has lived in besides Hong Kong

請列出貴子女的海外居住地。

 

Please write down the period and the places. For example, "3-4 years old in Japan"

請寫下對應的時間和地點。例如，“3-4歲，日本”

(This question is mandatory)

When did you child speak her/his first word(s) in her/his native language?

貴子女在何時能用母語說出第一個單詞？

(This question is mandatory)

Does your child have any musical training?

貴子女是否接受過音樂相關的訓練？

For example, piano

例如, 鋼琴

(This question is mandatory)
Please list what kinds of musical training your child has and how long the training is.

請列明音樂訓練的類型和訓練時長。

 

Please write down the period and the training type. For example, "5-7 years old, piano" or "7 years old to now, violin"

例如，“5-7歲，鋼琴” 或 “7歲至今，小提琴”

FamilyBackground/家庭背景
(This question is mandatory)

Choose the family members that live with the child

請選出與貴子女一起生活的家庭成員

The following questions are about the family language background. Only the family members who live with the child need to be filled in. If not applicable, please leave them blank there. 

請回答下列關於家庭語言背景的提問。只需填寫與貴子女一同居住的家庭成員即可。可略去不適用者。

Mother/母親
Father/父親
Maternal Grandmother/外祖母
Maternal Grandfather/外祖父
Paternal Grandmother/祖母
Paternal Grandfather/祖父
Domestic helper(s) /外籍傭工
(This question is mandatory)

Only fill in numbers

只需填入數字

(This question is mandatory)
Does your child have a twin?/貴子女是雙胞胎中的一個嗎？
Medical/Developmental history/ 用藥/發育史
(This question is mandatory)

Did the mother have any health or medical condition during pregnancy and birth history?

媽媽在懷孕期間是否出現任何身體狀況?

(This question is mandatory)

Describe the mother's health or medical condition during pregnancy and birth history

請描述媽媽在懷孕期間的身體狀況

(This question is mandatory)

Do you/your child have/have had any illness or medical condition?

您/貴子女是否有或曾有任何身體狀況？

(This question is mandatory)

Specify the illness or medical condition you or your child have/had

請描述具體病症/狀況

(This question is mandatory)

Did your child take any medications in the past?

過去貴子女是否接受過藥物治療？

(This question is mandatory)

Please specify the medication your child took before

請列明貴子女此前服用的具體藥物

(This question is mandatory)

Does the child show any developmental complications, e.g. learning difficulties, ADHD, ASD, late to talk or late to walk?

貴子女是否被確診或懷疑有任何發展障礙？例如：學習困難，專注力不足/過度活躍症，自閉症譜系障礙，太遲開始說話/走路

(This question is mandatory)

Please indicate whether your child has ever been diagnosed with any of the following conditions.

貴子女是否被確診患有以下障礙

(This question is mandatory)

Is your child receiving any behavioural or pharmaceutical treatment now?

貴子女目前是否正在接受任何行為或藥物治療？

(This question is mandatory)

Please specify the treatment(s) your child is receiving

請列明貴子女正在進行的具體治療

e.g., treatment type, how long it has been receiving, what institution provides the treatment

例如，治療類型（行為/藥物），治療已經進行了多久，提供治療的機構

ASD screening/自閉症譜系障礙篩查
(This question is mandatory)

Please answer each of the following questions about your child or the person who is under your care by choosing the point that reflects your answer to the question most appropriately.  If there is any question that you feel not able to comment, please ask your son, daughter, partner or the child to answer. In case the question is still hard to answer, please make an estimation.

以下問題與貴子女或你照顧的孩子有關。請回答每條問題，選擇最切合貴子女的答案。如果你感到難以回答某些問題，可請你的兒子、女兒、配偶或該兒童作答。若問題仍難以回答，請酌情做出估計。
 

1. S/he prefers to do things with others rather than on her/his own. 他/她喜歡和別人一起做事多於單獨處事。
2. S/he prefers to do things the same way over and over again. 他/她較喜歡以相同方式重複做事。
3. If s/he tries to imagine something, s/he finds it very easy to create a picture in her/his mind. 如要想像事情，他/她覺得在腦海中構想該事情的畫面是容易的。
4. S/he frequently gets so strongly absorbed in one thing that s/he loses sight of other things. 他/她常常太沉醉於某事情，以致忽略了其他東西。
5. S/he often notices small sounds when others do not. 他/她常常留意到一些別人不為意的細微聲音。
6. S/he usually notices house numbers or similar strings of information. 他/她常常留意車牌號碼或類似的數列資料。
7. S/he has difficulty understanding rules for polite behaviour. 他/她較難理解怎樣才是有禮貌的應有表現。
8. When s/he is read a story, s/he can easily imagine what the characters might look like. 在閱讀故事時，他/她能輕易地想像出角色的模樣。
9. S/he is fascinated by dates. 他/她對日期很著迷。
10. In a social group, s/he can easily keep track of several different people’s conversations. 在社交場合中，他/她能輕易聽懂不同人的對話。
11. S/he finds social situations easy. 他/她覺得身處社交場合是輕鬆自在的事。
12. S/he tends to notice details that others do not. 他/她傾向留意一些別人不為意的細節。
13. S/he would rather go to a library than a birthday party. 他/她喜歡去圖書館多於生日會。
14. S/he finds making up stories easy. 他/她覺得虛構故事是容易的。
15. S/he is drawn more strongly to people than to things. 相對於物件，他/她對人有更大興趣。
16. S/he tends to have very strong interests, which s/he gets upset about if s/he can’t pursue. 他/她容易有強烈的喜好，如不能從事這些喜好，他/她會感到不開心。
17. S/he enjoys social chit-chat. 他/她喜歡與別人閒談。
18. When s/he talks, it isn’t always easy for others to get a word in edgeways. 他/她說話時別人不容易插嘴。
19. S/he is fascinated by numbers. 他/她對數字很著迷。
20. When s/he is read a story, s/he finds it difficult to work out the characters’ intentions or feelings. 在閱讀故事時，他/她覺得很難明白故事人物的意圖或感受。
21. S/he doesn’t particularly enjoy fictional stories. 他/她並不特別喜歡閱讀虛構小說。
22. S/he finds it hard to make new friends. 他/她覺得很難結識新朋友。
23. S/he notices patterns in things all the time. 他/她常常留意事物的規律模式。
24. S/he would rather go to the cinema than a museum. 他/她喜歡去戲院多於博物館。
25. It does not upset him/her if his/her daily routine is disturbed. 如他/她的日常生活程序被擾亂，他 /她不會感到不開心。
26. S/he doesn’t know how to keep a conversation going with her/his peers. 他/她不懂得怎樣與同輩持續一段對話。
27. S/he finds it easy to “read between the lines” when someone is talking to her/him. 他/她覺得理解對方說話的背後含意是容易的。
28. S/he usually concentrates more on the whole picture, rather than the small details. 他/她通常留意事情的整體多於其細節。
29. S/he is not very good at remembering phone numbers. 他/她不善於牢記電話號碼。
30. S/he doesn’t usually notice small changes in a situation, or a person’s appearance. 他/她很少留意身處境地或別人外表的細微轉變。
31. S/he knows how to tell if someone listening to him/her is getting bored. 如別人對他/她的說話感厭煩，他/ 她會知道。
32. S/he finds it easy to go back and forth between different activities. 他/她覺得同時處理不同的事情是容易的。
33. When s/he talk on the phone, s/he is not sure when it’s her/his turn to speak. 在電話對談中，他/她不肯定應該何時發言。
34. S/he enjoys doing things spontaneously. 他/她喜愛自發地做事。
35. S/he is often the last to understand the point of a joke. 他/她常常是最後一個才明白笑話意思的人。
36. S/he finds it easy to work out what someone is thinking or feeling just by looking at their face. 他/她覺得從察看別人表情去了解他們的想法或感受是容易的。
37. If there is an interruption, s/he can switch back to what s/he was doing very quickly. 若正進行的活動被打斷，他/她可以很快恢復進行該事情。
38. S/he is good at social chit-chat. 他/她善於與別人閒談。
39. People often tell her/him that s/he keeps going on and on about the same thing. 別人常常告知他/她，他/她不斷重複做或說同一件事情。
40. When s/he was in preschool, s/he used to enjoy playing games involving pretending with other children. 當他/她在幼稚園時，他/她喜歡和小朋友玩假裝遊戲 (例如, 煮飯仔)。
41. S/he likes to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant, etc.). 他/她喜歡收集某個種類的資料(如車類、雀鳥類、火車類、植物類等)。
42. S/he finds it difficult to imagine what it would be like to be someone else. 他/她很難想像自己成為別人會是怎樣的。
43. S/he likes to plan any activities s/he participates in carefully. 他/她喜歡仔細計劃自己參與的每一 項活動。
44. S/he enjoys social occasions. 他/她喜歡社交場合。
45. S/he finds it difficult to work out people’s intentions. 他/她覺得理解別人意圖是困難的。
46. New situations make him/her anxious. 新環境令他/她緊張。
47. S/he enjoys meeting new people. 他/她喜歡認識新朋友。
48. S/he is good at taking care not to hurt other people’s feelings. 他/她善於關顧而不會傷害別人的感受。
49. S/he is not very good at remembering people’s date of birth. 他/她不善於牢記別人的出生日期。
50. S/he finds it very to easy to play games with children that involve pretending. 他/她覺得和小朋友玩假裝遊戲是容易的 (例如, 煮飯仔)。

Please leave your comments here for any uncertainties or difficulties you feel when answering the questions.

關於回答時感到任何困難或不確定答案，請在此處留下您的評論。

ADHD Screening/專注力不足/過度活躍症篩查
(This question is mandatory)

Each rating should be considered in the context of what is appropriate for the age of your child.  As you answer each question, choose the point that best describes how you have felt over the past 6 months.

評級時請參考貴子女的年齡背景，做適切的判斷。回答每項問題時，請選擇最能描述貴子女過去六個月行為的選項。


 

1. Does not pay attention to details or makes careless mistakes with, for example, homework. 難於注意細節或犯粗心的錯誤, 例如:家課
2. Has difficulty keeping attention to what needs to be done. 對應該做的事難於保持注意力
3. Does not seem to listen when spoken to directly. 當對其說話時似乎沒聽見
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand). 不能完整地執行指令或不能完成作業 (並非由於聽不懂指令或由於對抗行為所致)
5. Has difficulty organizing tasks and activities. 對進行任務或活動時缺乏整體組織能力
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort. 迴避, 不喜歡或不願參與需集中注意力的工作
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books). 丟失對學習或活動所必需的東西 (如作業本,鉛筆或書)
8. Is easily distracted by noises or other stimuli. 容易被外界刺激分散注意力, 例如: 聲音或其他
9. Is forgetful in daily activities. 在日常活動中容易忘事
10. Fidgets with hands or feet or squirms in seat. 在座位上手腳不停的震動或不能坐定
11. Leaves seat when remaining seated is expected. 在需坐著的場合中擅自離開坐位
12. Runs about or climbs too much when remaining seated is expected. 在需保持坐位的環境中過多地走動或攀爬
13. Has difficulty playing or beginning quiet play activities. 在課餘活動中難於保持安靜
14. Is “on the go” or often acts as if “driven by a motor”. 總是活動力很強或像“被馬達駒使著一樣”
15. Talks too much. 過份愛講話
16. Blurts out answers before questions have been completed. 未等問題被問完即搶先說出答案
17. Has difficulty waiting his or her turn. 不能耐心排隊等待
18. Interrupts in or intrudes on others’ conversations and/activities. 打斷別人談話
 
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