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High School Student Disability Attitude Survey - C

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* Hello:
You are invited to participate in our High School Student Disability Attitude Survey. In this survey, approximately 100 people will be asked to complete a survey that asks questions about disability and quality of life. It will take approximately 10-12 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Sigmund Hough, Ph.D., ABPP by email at [email protected]

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
* What is your gender?
 
Male
 
Female
 
Transgender
 
Neutral
 
Other
 
 
 
* What is your sexual orientation?
 
Straight
 
Lesbian
 
Gay
 
Bisexual
 
Other
 
 
 
* What is your age?
 
Younger than 13
 
13 to 14
 
15 to 16
 
17 to 18
 
Older than 18
 
 
 
* What grade are you currently in?
 
Freshman 9th
 
Sophomore 10th
 
Junior 11th
 
Senior 12th
 
 
 
* What is your relationship status?
 
In a relationship
 
Looking for a relationship
 
Not looking for a relationship
 
 
 
* Do you work part-time during the school year or during the summer?
 
Yes
 
No
 
 
 
* Where do you live?
 
In a house
 
In an apartment
 
In a condo
 
In a shared place
 
In a trailer
 
In a shelter
 
Other
 
 
 
* How many hours per week do you watch TV?
 
0
 
1-3
 
4-8
 
9-14
 
15 or more
 
 
 
* How many hours per week do you play video-games?
 
0
 
1-3
 
4-8
 
9-14
 
15 or more
 
 
 
* How many hours per week do you exercise or play sports?
 
0
 
1-3
 
4-8
 
9-14
 
15 or more
 
 
 
* Ethnicity (how do you identify yourself?)
 
Hispanic or Latino
 
American Indian/Native American or Alaska Native
 
Asian
 
Black or African American
 
Native Hawaiian or Other Pacific Islander
 
White
 
Other
 
Mixed 2 ethnic groups
 
Mixed more than 2 ethnic groups
 
 
 
* Have you ever had or currently have a disability?
 
Yes
 
No
 
 
 
* If yes: My disability is: (Please check as many as apply)
 
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
 
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
 
Emotional (for example, anxiety, depression, bipolar, psychotic)
 
Learning (for example, learning or reading disability, attention deficit disability)
 
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
 
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
 
Other
 

 
 
 
* Have you ever had or currently have a family member with a disability?
 
Yes
 
No
 
 
 
* Have you ever had or currently have a friend with a disability?
 
Yes
 
No
 
 
 
* Have you ever been or currently are friendly with a person with a disability?
 
Yes
 
No
 
 
 
* On average, how many hours per week do you spend on homework?
   
 
 
 
* Your total cumulative grade point average in high school is
 
A
 
A-
 
B+
 
B
 
B-
 
C+
 
C
 
C-
 
Below C-
 
Non-Grading High School
 
 
 
* Have you ever participated in volunteer work with people with disabilities?
 
Yes
 
No
 
 
 
* Have you ever read a book or seen a movie on the topic of disability?
 
Yes
 
No
 
 
 
* I generally feel bad for people with disabilities.
 
Yes
 
No
 
 
 
* For Questions 23 to 36, please rank order (#1 to #7) your perception of the following disabilities/ impairments/ dysfunctions according to the significant impact upon quality of life for a specific age male or female. #1 has the least negative impact and consequence upon the person’s quality of life, and #7 has the most negative impact and consequence upon the person’s quality of life.

For a 15 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 15 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 21 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 21 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 30 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 30 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 45 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 45 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 65 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 65 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 75 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For a 75 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For an 85 year old male?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
 
 
* For an 85 year old female?
Behavioral (for example, drug or alcohol addiction, anger outbursts/bullying)
Cognitive (for example, memory loss from brain injury, reasoning and judgment impairment from dementia)
Emotional (for example, anxiety, depression, bipolar, psychotic)
Learning (for example, learning disability, attention deficit disability)
Physical (for example, unable to walk from spinal cord injury, unable to use hands)
Sensory (for example, vision loss, hearing loss, loss of touch feedback)
Sexual Reproduction (for example, infertility)
 
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