The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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Screener Survey

Please complete the survey below.

Thank you!

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Thank you for your interest!

We are contacting you because you have a child or adolescent who is on the waitlist for evaluation, or has recently been evaluated, for ADHD. The goal of this study is to learn about how Canadian parents and children perceive ADHD behaviours and common treatments for ADHD, and to compare these perceptions between families of Asian descent and families of Western European descent.

We would like to ask you a few questions to determine whether you are eligible for participating in this study.

如果您希望以簡體中文或繁體中文完成問卷，請點擊右上角"English"的按鈕。
如果您希望以简体中文或繁体中文完成问卷，请点击右上角"English"的按钮。

Are you the parent/guardian of a child on the waitlist for evaluation at the BC Children's Hospital ADHD Clinic?

* must provide value

Yes

No

How did you learn about our study? Please select the most suitable referral source from the following options:

* must provide value

BC Children's Hospital ADHD Clinic

Child and Youth Mental Health (CYMH)

Primary Care Physician

Other (specify)

Please specify:

* must provide value

Which of the following options most accurately reflects your child/teenager's current assessment status at BC Children's Hospital ADHD Clinic:

* must provide value

My child/teenager is on the waitlist.

My child/teenager has already been assessed.

None of the above options apply to my child/teenager.

Specify the date:

* must provide value

D-M-Y

Have you received your feedback session from BCCH?

* must provide value

Yes

No, it hasn't occurred yet

Specify the date:

* must provide value

D-M-Y

What is the name of the CYMH clinician who referred you to our study:

* must provide value

Please enter the contact information of this clinician (phone number and email address) :

* must provide value

Expand

Please specify the program that your family was enrolled at CYMH:

* must provide value

Has your child/teenager been diagnosed with ADHD?

* must provide value

Yes

No

When did you receive the diagnosis for your child/teenager's diagnosis (specify the date)

* must provide value

D-M-Y

Where did the assessment take place (location):

* must provide value

Who was the clinician responsible for making the diagnosis:

* must provide value

Is this clinician the same person who referred you to our study?

* must provide value

Yes

No (please enter the contact information of the clinician who provided the diagnosis)

Contact information of clinician who provided the diagnosis (phone number and email address):

* must provide value

Expand

Is the assessment currently in progress?

* must provide value

Yes

No

Where will the assessment take place (location):

* must provide value

Who is the clinician responsible for making the diagnosis:

* must provide value

Is this clinician the same person who referred you to our study?

* must provide value

Yes

No (please enter the contact information of the clinician who provided the diagnosis)

Contact information of clinician who provided the diagnosis (phone number and email address):

* must provide value

Expand

What is the name of your physician:

* must provide value

Please enter the contact information of this physician:

* must provide value

Expand

Has your child/teenager been diagnosed with ADHD?

* must provide value

Yes

No

When did you receive the diagnosis for your child/teenager's diagnosis (specify the date)

* must provide value

D-M-Y

Where did the assessment take place (location):

* must provide value

Who was physician responsible for making the diagnosis:

* must provide value

Is this physician the same person who referred you to our study?

* must provide value

Yes

No

Please enter the contact information of the physician who provided the diagnosis

* must provide value

Expand

Is the assessment currently in progress?

* must provide value

Yes

No

Where will the assessment take place (location):

* must provide value

Who is the physician responsible for making the diagnosis:

* must provide value

Is this physician the same person who referred you to our study?

* must provide value

Yes

No

Please enter the contact information of the clinician who provided the diagnosis

* must provide value

Expand

Has your child/teenager been diagnosed with ADHD?

* must provide value

Yes

No

When did you receive the diagnosis for your child/teenager's diagnosis (specify the date):

* must provide value

D-M-Y

Where did the assessment take place (location):

* must provide value

Who is responsible for making the diagnosis (name):

* must provide value

Please enter the contact information of this clinican (phone number and email address):

Expand

Is the assessment currently in progress?

* must provide value

Yes

No

Are you currently considering having your child or teenager receive an assessment?

Yes

No

Where will the assessment take place (location):

* must provide value

Who is responsible for making the diagnosis (name):

* must provide value

Please enter the contact information of this clinican (phone number and email address):

* must provide value

Expand

What is your child's age?

* must provide value

6

7

8

9

10

11

12

13

14

15

16

17

18

other

We are recruiting families who are of Western European descent or Asian descent. We would like to ask you some specific questions about you and your child's racial/ethnic backgrounds. Please choose all options that apply to you (the parent).

* must provide value

I am East Asian - Chinese

I am East Asian - Japanese

I am East Asian - Korean

I am South Asian (East Indian, Pakistani, Sri Lankan, etc)

I am Southeast Asian - Filipino

I am Southeast Asian - Others (Vietnamese, Cambodian, Malaysian, Laotian)

I am Western European (for example, English, German, French)

I am West Asian (for example, Irani, Iraqi)

I also identify with other racial/ethnic groups (write in)

Where were you born (the parent)?

* must provide value

If you were not born in Canada, when did you move to Canada (skip this question if you were born in Canada)?

D-M-Y

We would like to know more about your child's racial/ethnic background. Please choose all options that apply to your child.

* must provide value

My child is East Asian - Chinese

My child is East Asian - Japanese

My child is East Asian - Korean

My child is South Asian (East Indian, Pakistani, Sri Lankan, etc)

My child is Southeast Asian - Filipino

My child is Southeast Asian - Others (Vietnamese, Cambodian, Malaysian, Laotian)

My child is West Asian (for example, Irani, Iraqi)

My child is Western European (for example, English, German, French)

My child also identifies with other racial/ethnic groups (write in):

Where was your child born?

* must provide value

If your child was not born in Canada, when did your child move to Canada (skip this question if your child was born in Canada)?

D-M-Y

Parent name:

* must provide value

Child Name:

* must provide value

You may use email to communicate about this research study. The research team will use best efforts to keep your information confidential. However, there are always some risks of disclosure when using email and you should be aware that some email services may store the contents of your email account outside of Canada, where privacy and data security standards may be different than they are in Canada. If you have questions or would like to stop receiving research communication via email, please contact the Principal Investigator Dr. Mikami at 604-822-3245 or mikami@psych.ubc.ca.

Best email to contact parent:

* must provide value

Preferred phone number to reach parent:

* must provide value

Preferred language for completing this study (e.g., child interviews, consent forms):

* must provide value

English

Cantonese (Traditional Chinese)

Mandarin (Simplified Chinese)

Thank you for your time. We will contact you soon!

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.