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Lampiran 1. Ethical Clearance
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Lampiran 2. Lembar Informed Concent
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59
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Lampiran 3. Wawancara dan pemeriksaan fisik
Nomor urut sampel :
Sekolah Dasar :
Kelas :
Tanggal :
Pewawancara :
IDENTITAS SAMPEL PENELITIAN
1. NAMA :
2. TANGGAL LAHIR/UMUR :
3. JENIS KELAMIN :
4. ALAMAT :
5. BERAT BADAN : kg
6. TINGGI BADAN : cm
RIWAYAT KESEHATAN DAN PEKERJAAN
1. Apakah anak menderita sindrom down atau kelainan kongenital lainnya ?
( ) Ya ( ) Tidak
2. Apakah anak memiliki riwayat gangguan pendengaran dan penglihatan ?
( ) Ya ( ) Tidak
3. Apakah anak menderita penyakit neurologis ?
( ) Ya ( ) Tidak
4. Apakah anak bekerja lebih dari 2 jam per hari ?
( ) Ya ( ) Tidak
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Lampiran 4. Kuesioner deteksi dini GPPH
KUESIONER DETEKSI DINI
GANGGUAN PEMUSATAN PERHATIAN DAN HIPERAKTIVITAS
(Abbreviated Conner Rating Scale)
NAMA ANAK: NO :
No Kegiatan yang diamati Tidak
pernah
Kadang
-kadang
Sering Selalu
1 Tidak kenal lelah, atau aktivitas berlebihan
2 Mudah menjadi gembira
3 Mengganggu anak-anak lain
4 Gagal menyelesaikan kegiatan yang telah
dimulai, rentang perhatian pendek
5 Menggerak-gerakan anggota badan atau
kepala secara terus-menerus
6 Kurang perhatian, mudah teralihkan
7 Permintaannya harus segera dipenuhi
8 Sering dan mudah menangis
9 Suasana hatinya mudah berubah dengan cepat
dan drastis
10 Ledakan kekesalan, tingkah laku eksplosif dan
tak terduga
JUMLAH
PENILAIAN :
- Tidak pernah, nilai 0
- Kadang-kadang, nilai 1
- Sering, nilai 2
- Selalu, nilai 3
Interpretasi :
Anak kemungkinan dengan GPPH bila jumlah nilai total ≥ 13
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Lampiran 5 . Home Observation for Measurement of the Environment-Short
Form (HOME-SF) untuk usia 6-9 tahun
Kuisioner Stimulasi Kognitif HOME-SF 6-9 Tahun
Berilah tanda centang () di kotak pada jawaban yang sesuai menurut Anda
NAMA ANAK : NO :
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Lampiran 6 . Home Observation for Measurement of the Environment-Short
Form (HOME-SF) untuk usia 10-14 tahun
Kuisioner Stimulasi Kognitif HOME-SF 6-9 Tahun
Berilah tanda centang () di kotak pada jawaban yang sesuai menurut Anda
NAMA ANAK : NO :
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13
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Lampiran 7. Dokumentasi Penelitian
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Lampiran 8. Hasil Analisis Statistik
Karakteristik Sampel
Jenis_kelamin
Frequency Percent Valid
Percent
Cumulative
Percent
Valid
laki-laki 31 44.3 44.3 44.3
perempuan 39 55.7 55.7 100.0
Total 70 100.0 100.0
usia
Frequency Percent Valid
Percent
Cumulative
Percent
Valid
9.0 5 7.1 7.1 7.1
10.0 42 60.0 60.0 67.1
11.0 23 32.9 32.9 100.0
Total 70 100.0 100.0
Kategori IQ
Frequency Percent Valid
Percent
Cumulative
Percent
Valid
dibawah rata-
rata 18 25.7 25.7 25.7
rata-rata 47 67.1 67.1 92.9
diatas rata-rata 5 7.1 7.1 100.0
Total 70 100.0 100.0
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Prestasi Belajar
Frequenc
y
Percent Valid
Percent
Cumulative
Percent
Valid
prestasi tinggi 23 32.9 32.9 32.9
prestasi sedang 28 40.0 40.0 72.9
prestasi rendah 19 27.1 27.1 100.0
Total 70 100.0 100.0
Uji Bivariat Inteligensi dengan Prestasi Belajar
Kategori IQ * Prestasi Belajar Crosstabulation
Prestasi Belajar Total
prestasi
tinggi
prestasi
sedang
prestasi
rendah
kategori
IQ
Di atas rata-rata
Count 4 1 0 5
Expected
Count 1.6 2.0 1.4 5.0
% of Total 5.7% 1.4% 0.0% 7.1%
Rata-rata
Count 19 22 6 47
Expected
Count 15.4 18.8 12.8 47.0
% of Total 27.1% 31.4% 8.6% 67.1%
Dibawah rata-
rata
Count 0 5 13 18
Expected
Count 5.9 7.2 4.9 18.0
% of Total 0.0% 7.1% 18.6% 25.7%
Total
Count 23 28 19 70
Expected
Count 23.0 28.0 19.0 70.0
% of Total 32.9% 40.0% 27.1% 100.0%
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Chi-Square Tests
Value df Asymp. Sig.
(2-sided)
Pearson Chi-Square 30.245a 4 .000
Likelihood Ratio 33.272 4 .000
Linear-by-Linear
Association 25.261 1 .000
N of Valid Cases 70
a. 4 cells (44.4%) have expected count less than 5. The
minimum expected count is 1.36.
Penggabungan Kategori IQ * Prestasi Belajar Crosstabulation
Prestasi Belajar
prestasi
tinggi
prestasi
sedang
prestasi
rendah
Penggabun
gan
Kategori
IQ
di atas rata-rata +
rata-rata
Count 23 23 6
Expected Count 17.1 20.8 14.1
di bawah rata-rata Count 0 5 13
Expected Count 5.9 7.2 4.9
Total Count 23 28 19
Expected Count 23.0 28.0 19.0
Chi-Square Tests
Value df Asymp. Sig.
(2-sided)
Pearson Chi-Square 27.008a 2 .000
Likelihood Ratio 29.831 2 .000
Linear-by-Linear
Association 24.312 1 .000
N of Valid Cases 70
a. 1 cells (16.7%) have expected count less than 5. The
minimum expected count is 4.89.
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Uji Interclass Correlation Coefficient (ICC)
HOME-SF
Intraclass Correlation Coefficient
Intraclass
Correlatio
nb
95% Confidence
Interval
F Test with True Value 0
Lower
Bound
Upper
Bound
Value df1 df2 Sig
Single Measures .898a .735 .971 27.324 9 18 .000
Average Measures .963c .893 .990 27.324 9 18 .000
Two-way mixed effects model where people effects are random and measures effects are fixed.
a. The estimator is the same, whether the interaction effect is present or not.
b. Type C intraclass correlation coefficients using a consistency definition-the between-measure
variance is excluded from the denominator variance.
Conner ADHD
Intraclass Correlation Coefficient
Intraclass
Correlatio
nb
95% Confidence
Interval
F Test with True Value 0
Lower
Bound
Upper
Bound
Value df1 df2 Sig
Single Measures .920a .787 .977 35.394 9 18 .000
Average Measures .972c .917 .992 35.394 9 18 .000
Two-way mixed effects model where people effects are random and measures effects are fixed.
a. The estimator is the same, whether the interaction effect is present or not.
b. Type C intraclass correlation coefficients using a consistency definition-the between-measure
variance is excluded from the denominator variance.
c. This estimate is computed assuming the interaction effect is absent, because it is not estimable
otherwise.
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Lampiran 9. Lampiran Kuesioner
1.HOME SF
73
74
2.Conner ADHD
75
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Lampiran 10. Biodata mahasiswa
Identitas
Nama : Muhamad Tri Sutrisno
NIM : 22010111120055
Tempat Lahir : Demak
Tanggal Lahir : 20 April 1992
Jenis Kelamin : Laki-laki
Alamat : Sidokumpul RT 08/01 Kec Guntur, Demak
Nomor HP : 085641995440
Email : tri.fkundip@gmail.com
Riwayat Pendidikan Formal
1. SD : SD Negeri 1 Sidokumpul Lulus tahun : 2005
2. SMP : SMP Negeri 34 Semarang Lulus tahun : 2008
3. SMA : SMA Negeri 2 Semarang Lulus tahun : 2011
4. S1 : Pendidikan Dokter Fakultas Kedokteran
Universitas Diponegoro Masuk tahun : 2011
Pengalaman Organisasi
1. Staff Ahli Bidang Informasi dan Komunikasi HIMA KU Universitas
Diponegoro Tahun 2013
2. Kepala Departemen Syiar ROHIS Fakultas Kedokteran Universitas
Diponegoro Tahun 2013
3. Anggota Divisi External Kelompok Studi Mahasiswa FK UNDIP 2013
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4. Menteri Informasi dan Komunikasi BEM FK UNDIP Tahun 2014
5. Konselor Lembaga Pers Mahasiswa Impuls FK UNDIP Tahun 2015