AUSTRALIAN INDEX OF ADOLESCENT DEVELOPMENT The Australian Index of Adolescent Development (AIAD) is a survey that asks some questions about you and your life and relationships at home, at school and outside of school. Your answers to various questions will be treated in strict confidence. A few questions might seem a little personal, but please have the confidence to answer honestly. Student Name: First Name Date of Birth: DD / MM / Surname YYYY Name of School: Before you complete this survey please read the information sheet handed out along with the survey. This information explains what the purpose of the AIAD is, and runs through some points to check that you understand what is involved. I ....................................................................................................................................... (Your full name): Date: / / . When doing the AIAD survey it is important to answer all the questions. Questions are added up to compile scores and these scores indicate the level of need for extra support. The answers for questions do vary. Some are Yes / No answers; others are: Strongly Agree / Agree / Unsure / Disagree / Strongly Disagree or Not true at all / Not really true / Sort of true / Very true. Be aware of this. Read each question carefully! If you have any difficulty understanding a question please ask the teacher or youth worker, who is administering the survey to your class for help. Please note that completion of the AIAD survey will be taken as your agreement to do the survey. Before you start completing the survey read the completion instructions overleaf then start to complete the survey as carefully and as honestly as possible. This survey asks some questions about you and your life and relationship at home, at school and outside of school. Your answers to various questions will be treated in strict confidence. A few questions might seem a little personal, but please have the confidence to answer honestly. SURVEY COMPLETION INSTRUCTIONS It is very important that you read these survey instructions to make sure your answers to the questions are correctly interpreted. . Completely fill in the oval of your choice . Use a black or blue pen or pencil. . Do not use a red pen . Erase any mistakes or stray marks. Where there is a WRITE-IN box please complete as neatly as posible. MARK OVALS LIKE THIS: NOT LIKE THIS: $ D $ D $ D $ D $ D 1 2 3 4 5 $ D $ D $ $ D $ 1 3 5 04 D 2 D 1. Gender: 2. Age: D $ $ D $ D Male D $ $ D $ D $ D $ D $ D $ D $ D $ D Less than 12 years A B C D or 1 2 3 4 like this: Female Another gender 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years or over 3. Cultural Background: $ D Yes $ D No (b) Are one or both your parents an Aboriginal or Torres Strait islander? $ D Yes $ D No (c) Were one or both your parents born overseas in an non-English speaking country: $ D One (a) Were you born in a non-English speaking country? If YES, which country: Page: 2 $ D Both $ D Neither Parent 4. Youth Allowance (answer if you are 16 years or older) Are you in receipt of a Youth Allowance payment from Centrelink? D $ 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 No No, but I get Abstudy Yes, at a standard at home rate Yes, at the away from home rate Yes, at the independent rate Yes, at the "unreasonable to live at home" rate Don't know 5. Living situation: (Mark one only) (a) Which residential setting best describes where you stayedlast night? D $ 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 $ D 8 $ D 9 $ D 10 Family owned house / apartment A privately rented house or apartment A social/ public housing house / apartment in a caravan / caravan park cabin Supported Accommodation (e.g. a youth shelter,family shelter, transitional housing etc) Stayed temporarily with friends or relatives - just visiting: everything is normal and OK Stayed temporarily with friends or relatives - really didn't want to be at home with my parent(s) / guardian(s) / family Boarding with another family Stayed outside (e.g. bus shelter, park, under a bridge, abandoned building, all-night coffee shop, etc.) Some other setting: (b) Over the past 3 months, at any time, have you ever gone and stayed with friends or relatives because you did not want to be at home with your parent(s) / guardian(s) / family? $ D Yes $ D No (c) Over the past 12 months, at any time, have you ever gone and stayed with friends or relatives because you did not want to be at home with your parent(s) / guardian(s) / family? $ D Yes $ D No (d) Have you ever, at any time in your life, gone and stayed with friends or relatives because you did not want to be at home with your parent(s) / guardian(s) / family? $ D Yes $ D No 6. Your Family (mark one only) Which adult(s) do you live with all/most of the time currently? D $ 1 $ D 2 $ D 3 $ D 4 $ D 5 Both parents together Shared or joint custody - both parent but at different times One parent One parent and a step-parent / live-in partner Sometimes with parent(s), sometimes with another relative Neither parent but with: D $ 6 $ D 7 $ D 8 $ D 9 $ D 10 $ D 11 Foster parent(s) Relative(s) (e.g. grandparents, aunts, uncles) Brother(s) / Sister(s) / sibling(s) Friend(s) Other non-related person(s) No-one - I live alone Page: 3 7. The following statements are about you. Indicate what you think are the best answers to describe yourself - on a scale from 1 to 7 from Strongly Disagree-1 Strongly Disagree to Strongly Agree-7 . Strongly Agree (a) I usually manage one way or another $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (b) I feel proud that I have accomplished things in life $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (d) I am friends with myself $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (e) I feel that I can handle many things at a time $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (f) I am determined $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (g) I can get through difficult times because I've experienced difficulty before $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (h) I have self-discipline $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (i) I keep interested in things $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (j) I can usually find something to laugh about $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (k) My belief in myself gets me through hard times $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (l) In an emergency, I'm someone people can generally rely on $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (m) My life has meaning $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (n) When I'm in a difficult situation, I can usually find my way out of it $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 $ D 6 $ D 7 (c) I usually take things in my stride. (This means: I deal with things calmly and I don't let things bother me too much) 8. The following are some statements about your home life. Indicate what you think is the best answer to describe your home life - from Strongly Agree-1, Agree-2, Unsure-3, Disagree-4 and Strongly Disagree-5. Strongly Agree Agree Unsure Disagree Strongly Disagree (a) I feel happy at home $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (b) I would like to move out of home soon $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (c) I get into lots of conflict with my parent(s) / guardian(s) $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (d) Do you feel safe at home? D Yes, definitely $ (e) Have you moved out of home for any period in the past 12 months? 9. The following are statements about life at school. Indicate what you think are the best answers to describe your school life on a scale from: - Strongly Agree-1, Agree-2, Unsure-3, Disagree-4 or Strongly Disagree-5. $ Sometimes not safe D $ Yes D $ Often not safe D $ No D Strongly Agree Agree Unsure Disagree Strongly Disagree (a) I enjoy going to school everyday $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (b) If I was able to get a job, I would leave school now $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (c) I regularly 'wag' school (i.e. miss school without permission) $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (d) I get on well with most of my teachers $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (e) I get into a lot of trouble at school $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 Page: 4 10. Here are some things you may or may not have done. (a) Do you regularly smoke cigarettes? $ Yes D $ No D (b) Do you regularly drink alcohol? $ D Yes $ D No (c) Have you ever used marijuana or other drugs? $ D Yes $ D No (d) Have you ever been in trouble with the police (ranging from being stopped and questioned, or being arrested and appearing in court on some matter)? $ Yes D $ No D (e) Have you ever been involved in a violent incident (i.e. a fist-fight or assault) in a public space (but not at school)? $ Yes D $ No D (f) Have you ever been to see a doctor or a psychologist about a psychological or psychiatric problem (for example, anxiety, depression anger, self-harming, etc., whether the symptons you experienced were mild or severe? $ Yes D $ No D 11. Here are some more things you may or may not have done. You are asked about some things you may or may not have done over the previous five months. Please answer honestly – there is no way you will get into trouble if you say you have done any of these things. The scale is: 2 - Yes, during the previous five months 1 - Yes, but in the past, but not in the previous five months 0 - No never Mark the number which is your answer. Yes Yes in the past No Never $ D 2 $ D 1 $ D 0 Scribbled something on a school building, outside or inside or on things belonging to your school $ D 2 $ D 1 $ D 0 3. Stolen money or other things from a member of your family. $ D 2 $ D 1 $ D 0 4. Sworn at one of your teacher at school $ D 2 $ D 1 $ D 0 5. Taken something worth less than $30 from a shop without paying. $ D 2 $ D 1 $ D 0 6. Skipped one or two classes at school during the day. $ D 2 $ D 1 $ D 0 $ D 2 $ D 1 $ D 0 8. Without permission taken a bicycle that did not belong to you $ D 2 $ D 1 $ D 0 9. Skipped a whole day of school when you shouldn’t have. $ D 2 $ D 1 $ D 0 10. Had a violent quarrel with one of your teachers. $ D 2 $ D 1 $ D 0 1. Avoided paying for a movie, a bus, tram or train ride, or food. 2. 7. Purposely destroyed or damaged public or private property such as a window, a seat, a public telephone or someone’s post box. Page: 5 12. The statements below ask about how you relate with your teacher, your friends, your parent(s) or guardian(s) and how you get on at your school. Indicate what you think is the best answers on a scale from 1 to 5: Not true at all - 1, Not really true - 2, Sort of true - 3, True - 4, or Very true - 5. Not true at all Not really true Sort of true True Very true (a) I care what my teachers think of me. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (b) I do not get along with some of my teachers. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (c) I want to be respected by my teachers. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (d) I try to get along with my teachers. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (e) I always try hard to earn my teachers trust. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (f) $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (g) I work hard at school. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (h) I enjoy being at school. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (i) I get bored in school a lot. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (j) I do well in school. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (k) I feel good about myself when I am at school. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (l) Doing well at school is important to me. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (m) Spending time with friends is not so important to me. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (n) I have friends I'm really close to and trust completely. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (o) Spending time with my friends is a big part of my life. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (p) My friends and I talk openly with each other about personal things. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (q) I spend as much time as I can with my friends. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (r) My friends and I spend a lot of time talking about things. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (s) My parent(s) / guardian(s) and I disagree about many things. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (t) My family has fun together. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (u) It is important that my parent(s) / guardian(s) trust me. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (v) I enjoy spending time with my parent(s) / guardian(s). $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (w) My parent(s) / guardian(s) and I get along well. $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (x) $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 I usually like my teachers. I care about my parent(s) / guardian(s) very much. Page: 6 13. The following statements are about how you see yourself. Indicate what you think is the best answer to describe yoursel Strongly from 1 to 4: Agree Strongly Agree - 1, Agree - 2, Disagree - 3 and Strongly Disagree - 4. Agree Disagree Strongly Disagree (a) On the whole I am satisfied with myself $ D 1 $ D 2 $ D 3 $ D 4 (b) At times, I think I am no good at all $ D 1 $ D 2 $ D 3 $ D 4 (c) I feel that I have a number of good qualities $ D 1 $ D 2 $ D 3 $ D 4 (d) I am able to do things as well as most people $ D 1 $ D 2 $ D 3 $ D 4 (e) I feel I do not have much to be proud of $ D 1 $ D 2 $ D 3 $ D 4 (f) $ D 1 $ D 2 $ D 3 $ D 4 (g) I feel I am a person of worth, at least on an equal plane with others $ D 1 $ D 2 $ D 3 $ D 4 (h) I wish I could have more respect for myself $ D 1 $ D 2 $ D 3 $ D 4 (i) All in all, I am inclined to feel that I am a failure $ D 1 $ D 2 $ D 3 $ D 4 (j) I take a positive attitude towards myself $ D 1 $ D 2 $ D 3 $ D 4 I certainly feel useless at times 14. The following questions concern how you have been feeling during the past month. Indicate the extent of your feelings over the past 30 days from 1 to 5: None of the time - 1, A Little of the time - 2 Some of the time - 3, Most of the time - 4, All of the time - 5 None of the time A little of the time Some of the time Most of the time All of the time (a) About how often did you feel tired out for no good reason? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (b) About how often did you feel nervous? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (c) About how often did you feel so nervous that nothing could calm you down? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (d) About how often did you feel hopeless? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (e) About how often did you feel restless or fidgety? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (f) $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (g) About how often did you feel depressed? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (h) About how often did you feel that everything was an effort? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 About how often did you feel so restless you could not sit still? (i) About how often did you feel so sad that nothing could cheer you up? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 (j) About how often did you feel worthless? $ D 1 $ D 2 $ D 3 $ D 4 $ D 5 Page: 7 D. J. MaCKenzie Printed in Australia by: Ducat Scanning Services D88 2805 - 1702 Page: 8