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56

Lampiran 1. Ethical Clearance

57

Lampiran 2. Lembar Informed Concent

58

59

60

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

61

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

62

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 :

63

64

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 :

65

13

66

Lampiran 7. Dokumentasi Penelitian

67

68

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

69

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%

70

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.

71

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.

72

Lampiran 9. Lampiran Kuesioner

1.HOME SF

73

74

2.Conner ADHD

75

76

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

77

4. Menteri Informasi dan Komunikasi BEM FK UNDIP Tahun 2014

5. Konselor Lembaga Pers Mahasiswa Impuls FK UNDIP Tahun 2015