|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
subnum |
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
idate, sdate |
|
interview_age |
Integer |
|
Required |
Age in months at the time of the interview/test/sampling/imaging. |
0::1440
|
Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
|
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
|
prompt |
Integer |
|
Recommended |
Has the child received or is he/she currently receiving any non-medical treatments such as therapy, behavior modification, early intervention, etc. (that have not already reported to study staff)? |
0;1
|
0= No; 1= Yes
|
|
|
treat_num |
Integer |
|
Recommended |
Number of Treatments used during study participation |
|
|
|
|
treatment_type |
Integer |
|
Recommended |
Type of Treatment |
1::15; 97
|
1 = Counseling: family, child, or parent; 2 = Parent Training; 3 = ABA school; 4 = Tutoring; 5 = Neurofeedback; 6 = Music/Audio Therapy; 7 = Sensory Integration Therapy; 8 = Play Therapy/Floor time (DIR); 9 = Animal Therapy; 10 = Gluten Free/Cassein Free Diet; 11 = Hyperbaric Oxygen Treatment; 12 = Relationship Development; 13 = Speech Therapy; 14 = Occupational Therapy; 15 = Physical Therapy; 97 = Other
|
|
|
freq_treat |
Integer |
|
Recommended |
Frequency of Treatment |
1::5; 97
|
1 = Daily; 2 = Weekly; 3 = Twice a Month; 4 = Monthly; 5 = Every Other Month; 97 = Other (Please Specific in Comments Section)
|
|
|
discontinuation |
Integer |
|
Recommended |
Reason treatment discontinued |
1::6;97
|
1 = Lack of Efficacy; 2 = Intervention Completed Successfully; 3 = Financial Impediments; 4 = Accessibility Impediments; 5 = Dislike of Therapist/Therapy; 6 = No Longer Needed; 97 = Other (Please Specify in Comments Section)
|
|
|
tx_start_date |
Date |
|
Recommended |
Treatment start date |
|
|
|
|
tx_end_date |
Date |
|
Recommended |
Treatment end date |
|
|
|
|
continuing |
Integer |
|
Recommended |
Treatment not ended? |
0;1
|
0= Unchecked; 1= Checked
|
|
|
comments_misc |
String |
4,000
|
Recommended |
Miscellaneous comments on study, interview, methodology relevant to this form data |
|
|
|
|
session |
Integer |
|
Recommended |
Session |
|
|
|
|
validity |
String |
13
|
Recommended |
Validity rating |
Yes;No;Questionnable
|
|
|
|
site |
String |
101
|
Recommended |
Site |
|
Study Site
|
|
|
resp_source |
Integer |
|
Recommended |
Respondent Source |
1::6
|
1= subject; 2= parent; 3= clinician; 4= teacher; 5= trainer; 6= fidelity reviewer
|
source |
|
c_oth_cond_02 |
Integer |
|
Recommended |
Does this child have any of the following? Serious difficulty walking or climbing stairs. |
0;1
|
0= No; 1= Yes
|
other_cond_02 |
|
c_school_type_01 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Public school |
0;1
|
0= No; 1= Yes
|
school_type_01 |
|
c_school_type_02 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Charter school |
0;1
|
0= No; 1= Yes
|
school_type_02 |
|
c_school_type_03 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Private school |
0;1
|
0= No; 1= Yes
|
school_type_03 |
|
c_school_type_04 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) In-home schooling/home-school |
0;1
|
0= No; 1= Yes
|
school_type_04 |
|
c_school_type_05 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Residential school |
0;1
|
0= No; 1= Yes
|
school_type_05 |
|
c_school_type_06 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Institutional setting (e.g., hospital) |
0;1
|
0= No; 1= Yes
|
school_type_06 |
|
c_school_type_07 |
Integer |
|
Recommended |
What kind of school is this? (Childs Current Educational Setting) Other (describe) |
0;1
|
0= No; 1= Yes
|
school_type_07 |
|
c_school_type_oth |
Integer |
|
Recommended |
Other, Kind of School, please describe |
|
|
school_type_other |
|
c_class_size |
Integer |
|
Recommended |
How many children are in the classroom?? |
|
Number of Children
|
class_size |
|
c_class_type_01 |
Integer |
|
Recommended |
What kind of classroom is your child in? Full inclusion/general education/regular classroom (same classroom all day) |
0;1
|
0= No; 1= Yes
|
class_type_01 |
|
c_oth_cond_03 |
Integer |
|
Recommended |
Does this child have any of the following? Difficulty dressing or bathing. |
0;1
|
0= No; 1= Yes
|
other_cond_03 |
|
c_class_type_02 |
Integer |
|
Recommended |
What kind of classroom is your child in? Partial inclusion- in a regular classroom but is sometimes pulled out for special learning opportunities (e.g., resource room) |
0;1
|
0= No; 1= Yes
|
class_type_02 |
|
c_class_type_03 |
Integer |
|
Recommended |
What kind of classroom is your child in? Self-contained or substantially separate classroom with special education students |
0;1
|
0= No; 1= Yes
|
class_type_03 |
|
c_class_type_04 |
Integer |
|
Recommended |
What kind of classroom is your child in? Autism classroom or ABA classroom-special education classroom with children who require services for autism or require ABA |
0;1
|
0= No; 1= Yes
|
class_type_04 |
|
c_class_type_05 |
Integer |
|
Recommended |
What kind of classroom is your child in? Language-based classroom (smaller ratio of students in the class) |
0;1
|
0= No; 1= Yes
|
class_type_05 |
|
c_class_type_06 |
Integer |
|
Recommended |
What kind of classroom is your child in? Other |
0;1
|
0= No; 1= Yes
|
class_type_06 |
|
c_class_type_oth |
String |
250
|
Recommended |
Other class type, please describe:? |
|
|
class_type_other |
|
c_para_prof |
Integer |
|
Recommended |
Does your child have a 1-1 aide or paraprofessional? |
0 :: 2
|
0= No; 1= Yes; 2= Other
|
para_prof |
|
c_para_prof_oth |
String |
250
|
Recommended |
Other, paraprofessional, please describe |
|
|
para_prof_other |
|
c_out_special_serv |
Integer |
|
Recommended |
Does your child leave the classroom to receive any special services? |
0;1
|
0= No; 1= Yes
|
out_special_serv |
|
c_special_serv_out_class |
String |
250
|
Recommended |
If yes, specify special services? |
|
|
special_serv_out_class |
|
c_oth_cond_04 |
Integer |
|
Recommended |
Does this child have any of the following? Deafness or problems with hearing. |
0;1
|
0= No; 1= Yes
|
other_cond_04 |
|
c_com_serv |
Integer |
|
Recommended |
Since your child turned 3, have they EVER received any home-based or community services, not including school services? |
0;1
|
0= No; 1= Yes
|
comm_serv |
|
c_com_serv_desc |
String |
250
|
Recommended |
If yes, to any home-based or community services, please list them |
|
|
comm_serv_desc |
|
c_com_serv_now |
Integer |
|
Recommended |
Are they currently receiving this/these service(s)? |
0;1
|
0= No; 1= Yes
|
comm_serv_now |
|
c_pa_com_serv |
Integer |
|
Recommended |
Did your child receive these services in (current state)? |
0;1
|
0= No; 1= Yes
|
pa_comm_serv |
|
c_aba |
Integer |
|
Recommended |
Ever receive Insurance-funded Applied Behavior Analysis (ABA) |
0;1
|
0= No; 1= Yes
|
aba |
|
c_pa_aba |
Integer |
|
Recommended |
Ever receive Insurance-funded Applied Behavior Analysis (ABA) in (current state) |
0;1
|
0= No; 1= Yes
|
pa_aba |
|
c_aba_now |
Integer |
|
Recommended |
Currently receive Insurance-funded Applied Behavior Analysis (ABA) |
0;1
|
0= No; 1= Yes
|
aba_now |
|
c_pa_aba_now |
Integer |
|
Recommended |
Currently receive Insurance-funded Applied Behavior Analysis (ABA) in (current state) |
0;1
|
0= No; 1= Yes
|
pa_aba_now |
|
c_waiver |
Integer |
|
Recommended |
Ever receive Autism Waiver |
0;1
|
0= No; 1= Yes
|
waiver |
|
c_waiver_now |
Integer |
|
Recommended |
Currently receive Autism Waiver |
0;1
|
0= No; 1= Yes
|
waiver_now |
|
c_oth_cond_05 |
Integer |
|
Recommended |
Does this child have any of the following? Blindness or problems with seeing, even when wearing glasses. |
0;1
|
0= No; 1= Yes
|
other_cond_05 |
|
c_cbhi |
Integer |
|
Recommended |
Ever receive Children's Behavior Health Initiative (CBHI): |
0;1
|
0= No; 1= Yes
|
cbhi |
|
c_cbhi_now |
Integer |
|
Recommended |
Currently receive Children's Behavior Health Initiative (CBHI): |
0;1
|
0= No; 1= Yes
|
cbhi_now |
|
c_iht |
Integer |
|
Recommended |
Ever receive In-home therapy (IHT), (family therapy at home) |
0;1
|
0= No; 1= Yes
|
iht |
|
c_iht_now |
Integer |
|
Recommended |
Currently receive In-home therapy (IHT), (family therapy at home) |
0;1
|
0= No; 1= Yes
|
iht_now |
|
c_outpt |
Integer |
|
Recommended |
Ever receive Outpatient therapy (individual therapy in an office or virtual) |
0;1
|
0= No; 1= Yes
|
outpt |
|
c_outpt_now |
Integer |
|
Recommended |
Currently receive Outpatient therapy (individual therapy in an office or virtual) |
0;1
|
0= No; 1= Yes
|
outpt_now |
|
c_icc |
Integer |
|
Recommended |
Ever receive Intensive Care Coordination (ICC) |
0;1
|
0= No; 1= Yes
|
icc |
|
c_icc_now |
Integer |
|
Recommended |
Currently receive Intensive Care Coordination (ICC) |
0;1
|
0= No; 1= Yes
|
icc_now |
|
c_tm |
Integer |
|
Recommended |
Ever receive Therapeutic Mentoring (TM) |
0;1
|
0= No; 1= Yes
|
tm |
|
c_tm_now |
Integer |
|
Recommended |
Currently Therapeutic Mentoring (TM) |
0;1
|
0= No; 1= Yes
|
tm_now |
|
c_beh_prob |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has behavioral or conduct problems?? |
0;1
|
0= No; 1= Yes
|
beh_prob |
|
c_fp |
Integer |
|
Recommended |
Ever receive Family Support and Training (Family Partners) |
0;1
|
0= No; 1= Yes
|
fp |
|
c_fp_now |
Integer |
|
Recommended |
Currently receive Family Support and Training (Family Partners) |
0;1
|
0= No; 1= Yes
|
fp_now |
|
c_ihbs |
Integer |
|
Recommended |
Ever receive In-Home Behavior Health Services (IHBS) |
0;1
|
0= No; 1= Yes
|
ihbs |
|
c_ihbs_now |
Integer |
|
Recommended |
Currently receive In-Home Behavior Health Services (IHBS) |
0;1
|
0= No; 1= Yes
|
ihbs_now |
|
c_mci |
Integer |
|
Recommended |
Ever receive Have you had to access Mobile Crisis Intervention (MCI) |
0;1
|
0= No; 1= Yes
|
mci |
|
c_mci_now |
Integer |
|
Recommended |
Currently receive Have you had to access Mobile Crisis Intervention (MCI) |
0;1
|
0= No; 1= Yes
|
mci_now |
|
c_dds |
Integer |
|
Recommended |
Ever receive Department of Developmental Services (DDS)? |
0;1
|
0= No; 1= Yes
|
dds |
|
c_dds_now |
Integer |
|
Recommended |
Currently receive Department of Developmental Services (DDS) |
0;1
|
0= No; 1= Yes
|
dds_now |
|
c_skills_group |
Integer |
|
Recommended |
Ever receive Social skills group |
0;1
|
0= No; 1= Yes
|
skills_group |
|
c_skills_group_now |
Integer |
|
Recommended |
Currently receive Social skills group |
0;1
|
0= No; 1= Yes
|
skills_group_now |
|
c_beh_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (behavioral or conduct problems)? |
0;1
|
0= No; 1= Yes
|
beh_now |
|
c_speech_thrpy |
Integer |
|
Recommended |
Ever receive Speech therapy ? |
0;1
|
0= No; 1= Yes
|
speech_therapy |
|
c_speech_thrpy_now |
Integer |
|
Recommended |
Currently receive Speech therapy ? |
0;1
|
0= No; 1= Yes
|
speech_therapy_now |
|
c_ot |
Integer |
|
Recommended |
Ever receive Occupational Therapy ? |
0;1
|
0= No; 1= Yes
|
ot |
|
c_ot_now |
Integer |
|
Recommended |
Currently receive Occupational Therapy ? |
0;1
|
0= No; 1= Yes
|
ot_now |
|
c_pt |
Integer |
|
Recommended |
Ever receive Physical Therapy |
0;1
|
0= No; 1= Yes
|
pt |
|
c_pt_now |
Integer |
|
Recommended |
Currently receive Physical Therapy |
0;1
|
0= No; 1= Yes
|
pt_now |
|
c_oth_com_serv_yes |
Integer |
|
Recommended |
Ever receive Other community service |
0;1
|
0= No; 1= Yes
|
other_comm_serv_yes |
|
c_pa_oth_com_serv_yes |
Integer |
|
Recommended |
Ever receive Other community service in (current state). |
0;1
|
0= No; 1= Yes
|
pa_other_comm_serv_yes |
|
c_oth_com_serv_now |
Integer |
|
Recommended |
Currently receiving Other community service |
0;1
|
0= No; 1= Yes
|
other_comm_serv_now |
|
c_pa_oth_com_serv_now |
Integer |
|
Recommended |
Currently receiving Other community service in (current state). |
0;1
|
0= No; 1= Yes
|
pa_other_comm_serv_now |
|
c_beh_severity |
Integer |
|
Recommended |
If yes, is it (behavioral or conduct problems): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
beh_severity |
|
c_oth_com_serv_hrs |
Integer |
|
Recommended |
Number of hrs received of other community service |
|
Number of Hours
|
other_comm_serv_hrs |
|
c_pa_oth_com_serv_hrs |
Integer |
|
Recommended |
Number of hrs received of other community service in (current state). |
|
Number of Hours
|
pa_other_comm_serv_hrs |
|
c_aba_hrs |
Integer |
|
Recommended |
ABA; Number of hours |
|
Number of Hours
|
aba_hrs |
|
c_pa_aba_hrs |
Integer |
|
Recommended |
ABA; Number of hours in (current state) |
|
Number of Hours
|
pa_aba_hrs |
|
c_waiver_hrs |
Integer |
|
Recommended |
Autism waiver; Number of hours |
|
Number of Hours
|
waiver_hrs |
|
c_iht_hrs |
String |
50
|
Recommended |
In-home therapy (IHT), (family therapy at home) how often? |
|
|
iht_hrs |
|
c_outpt_hrs |
String |
50
|
Recommended |
Outpatient therapy (individual therapy in an office or virtual), how often? |
|
|
outpt_hrs |
|
c_ihbs_hrs |
Integer |
|
Recommended |
In-Home Behavior Health Services (IHBS), Number of hours. |
|
Number of Hours
|
ihbs_hrs |
|
c_mci_when |
String |
50
|
Recommended |
Access Mobile Crisis Intervention (MCI)??When? |
|
Date
|
mci_when |
|
c_pa_med |
Integer |
|
Recommended |
Ever received Medical Assistance/Medicaid Insurance in (current state). |
0;1
|
0= No; 1= Yes
|
pa_med |
|
c_dd |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has developmental delay?? |
0;1
|
0= No; 1= Yes
|
dd |
|
c_pa_med_now |
Integer |
|
Recommended |
Currently receive Medical Assistance/Medicaid Insurance in (current state). |
0;1
|
0= No; 1= Yes
|
pa_med_now |
|
c_pa_wrap |
Integer |
|
Recommended |
Ever receive Wraparound Services (BSC, TSS, Mobile Therapy) in (current state). |
0;1
|
0= No; 1= Yes
|
pa_wrap |
|
c_pa_wrap_now |
Integer |
|
Recommended |
Currently receive Wraparound Services (BSC, TSS, Mobile Therapy) in (current state). |
0;1
|
0= No; 1= Yes
|
pa_wrap_now |
|
c_pa_wrap_hrs |
Integer |
|
Recommended |
Wraparound Services (BSC, TSS, Mobile Therapy) Number of hours in (current state). |
|
Number of Hours
|
pa_wrap_hrs |
|
c_pa_ibhs |
Integer |
|
Recommended |
Ever receive Intensive Behavioral Health Services (IBHS) in (current state). |
0;1
|
0= No; 1= Yes
|
pa_ibhs |
|
c_pa_ibhs_now |
Integer |
|
Recommended |
Currently receive Intensive Behavioral Health Services (IBHS) in (current state). |
0;1
|
0= No; 1= Yes
|
pa_ibhs_now |
|
c_pa_ibhs_hrs |
Integer |
|
Recommended |
Intensive Behavioral Health Services (IBHS) Number of hours in (current state). |
|
Number of Hours
|
pa_ibhs_hrs |
|
c_pa_casemgt |
Integer |
|
Recommended |
Ever receive Case Management Services in (current state). |
0;1
|
0= No; 1= Yes
|
pa_casemgt |
|
c_pa_casemgt_now |
Integer |
|
Recommended |
Currently receive Case Management Services in (current state). |
0;1
|
0= No; 1= Yes
|
pa_casemgt_now |
|
c_pa_casemgt_hrs |
Integer |
|
Recommended |
Case Management Services Number of hours in (current state). |
|
Number of Hours
|
pa_casemgt_hrs |
|
c_dd_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (developmental delay)? |
0;1
|
0= No; 1= Yes
|
dd_now |
|
c_com_serv_sat |
Integer |
|
Recommended |
How satisfied are you with these outside-of-school services? |
1 :: 5
|
1= Very unsatisfied; 2= Unsatisfied; 3= Neutral; 4= Satisfied; 5= Very satisfied
|
comm_serv_sat |
|
c_covid_serv |
Integer |
|
Recommended |
How were your childs services affected by COVID-19? |
1 :: 4
|
1= They were Not affected at all; 2= They were affected a little bit (stopped briefly, or modified a bit); 3= They were moderately affected; 4= They were severely affected (they were very limited or were stopped for a long time, etc.)
|
covid_serv |
|
c_covid_learn |
Integer |
|
Recommended |
How was your childs learning and development affected by COVID-19? |
1 :: 4
|
1= Not at all - my childs learning was about the same during COVID-19 as it was before.; 2= A little; 3= Somewhat; 4= Very Much
|
covid_learn |
|
c_dd_severity |
Integer |
|
Recommended |
If yes, is it (developmental delay): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
dd_severity |
|
c_int_dis |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has intellectual disability?? |
0;1
|
0= No; 1= Yes
|
int_dis |
|
c_int_dis_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (intellectual disability)? |
0;1
|
0= No; 1= Yes
|
int_dis_now |
|
c_int_dis_severity |
Integer |
|
Recommended |
If yes, is it (intellectual disability): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
int_dis_severity |
|
c_speech |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has speech or other language disorder?? |
0;1
|
0= No; 1= Yes
|
speech |
|
c_speech_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (speech or other language disorder)? |
0;1
|
0= No; 1= Yes
|
speech_now |
|
c_speech_severity |
Integer |
|
Recommended |
If yes, is it (speech or other language disorder): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
speech_severity |
|
c_learn_dis |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has a learning disability? ? |
0;1
|
0= No; 1= Yes
|
learn_dis |
|
c_learn_dis_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (learning disability)? |
0;1
|
0= No; 1= Yes
|
learn_dis_now |
|
c_learn_dis_severity |
Integer |
|
Recommended |
If yes, is it (learning disability): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
learn_dis_severity |
|
c_asd |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has Autism or Autism Spectrum Disorder (ASD)? Include diagnoses of Aspergers Disorder or Pervasive Developmental Disorder (PDD).? |
0;1
|
0= No; 1= Yes
|
asd |
|
state_services |
String |
50
|
Recommended |
State/Territory Services are being provided |
|
|
|
|
c_asd_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (Autism Spectrum Disorder (ASD), Aspergers Disorder or Pervasive Developmental Disorder (PDD))? |
0;1
|
0= No; 1= Yes
|
asd_now |
|
c_asd_severity |
Integer |
|
Recommended |
If yes, is it (Autism Spectrum Disorder (ASD), Aspergers Disorder or Pervasive Developmental Disorder (PDD)): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
asd_severity |
|
c_asd_age |
Integer |
|
Recommended |
How old was this child when a doctor or other health care provider FIRST told you that they had Autism, ASD, Aspergers Disorder or PDD?? |
|
Age in Years
|
asd_age |
|
c_who_diagnosed |
Integer |
|
Recommended |
What type of doctor or other health care provider was the FIRST to tell you that this child had Autism, ASD, Aspergers Disorder or PDD? Select one option |
1::6
|
1= Primary Care Physician; 2= Specialist; 3= School Psychologist/Counselor; 4= Other Psychologist (Non-School); 5= Psychiatrist; 6= Other:
|
who_diagnosed |
|
c_oth_diagnosed |
String |
100
|
Recommended |
Other diagnosed, please specify |
|
|
other_diagnosed |
|
c_asd_meds |
Integer |
|
Recommended |
Is this child CURRENTLY taking medication for Autism, ASD, Aspergers Disorder or PDD?? |
0;1
|
0= No; 1= Yes
|
asd_meds |
|
c_asd_beh_tx |
Integer |
|
Recommended |
At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for Autism, ASD, Aspergers Disorder or PDD, such as training or an intervention that you or this child received to help with their behavior? |
0;1
|
0= No; 1= Yes
|
asd_beh_tx |
|
c_adhd |
Integer |
|
Recommended |
Has a doctor or other health care provider EVER told you that this child has Attention Deficit Disorder or Attention Deficit/Hyperactivity Disorder, that is, ADD or ADHD?? |
0;1
|
0= No; 1= Yes
|
adhd |
|
c_adhd_now |
Integer |
|
Recommended |
If yes, does this child CURRENTLY have the condition (ADD or ADHD)? |
0;1
|
0= No; 1= Yes
|
adhd_now |
|
c_adhd_severity |
Integer |
|
Recommended |
If yes, is it (ADD or ADHD): |
1 :: 3
|
1= Mild; 2= Moderate; 3= Severe
|
adhd_severity |
|
child_health |
Integer |
|
Recommended |
In general, how would you describe this childs health?? |
1 :: 5
|
1= Excellent; 2= Very good; 3= Good; 4= Fair; 5= Poor
|
|
|
c_adhd_tx |
Integer |
|
Recommended |
At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for ADD or ADHD, such as training or an intervention that you or this child received to help with their behavior? |
0;1
|
0= No; 1= Yes
|
adhd_tx |
|
c_adhd_meds |
Integer |
|
Recommended |
Is this child CURRENTLY taking medication for ADD or ADHD?? |
0;1
|
0= No; 1= Yes
|
adhd_meds |
|
c_mh |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, has this child received any treatment or counseling from a mental health professional? Mental health professionals include psychiatrists, psychologists, psychiatric nurses, and clinical social workers. |
1 :: 3
|
1= No, but this child needed to see a mental health professional; 2= No, but this child did Not need to see a mental health professional; 3= Yes, specify services:
|
mh |
|
c_mh_services |
String |
500
|
Recommended |
Please specify services?(if your child is receiving any treatment or counseling from a mental health professional) |
|
|
mh_services |
|
c_mh_tx_access |
Integer |
|
Recommended |
How difficult was it to get the mental health treatment or counseling that this child needed?? |
1 :: 4
|
1= Not difficult; 2= Somewhat difficult; 3= Very difficult; 4= It was Not possible to obtain care
|
mh_tx_access |
|
c_oth_meds |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, has this child taken any medication because of difficulties with their emotions, concentration, or behavior? |
0;1
|
0= No; 1= Yes
|
other_meds |
|
c_alt_med |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, did this child use any type of alternative health care or treatment? Alternative health care can include acupuncture, chiropractic care, relaxation therapies, herbal supplements, and others. Some therapies involve seeing a health care provider, while others can be done on your own. |
0;1
|
0= No; 1= Yes
|
alt_med |
|
c_alt_med_specify |
String |
500
|
Recommended |
Please specify alternative treatments |
|
|
alt_med_specify |
|
c_frustration_services |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, how often were you frustrated in your efforts to get services for this child? |
1 :: 4
|
1= Never; 2= Sometimes; 3= Usually; 4= Always
|
frustration_services |
|
c_services_elig |
Integer |
|
Recommended |
1. This child was not eligible for the services |
0;1
|
0= No; 1= Yes
|
services_elig |
|
c_height_ft_in |
String |
25
|
Recommended |
What is this childs CURRENT height? ? |
|
Feet and Inches
|
height_ft_in |
|
c_services_avai |
Integer |
|
Recommended |
2. The services this child needed were not available in your area |
0;1
|
0= No; 1= Yes
|
services_avai |
|
c_services_appt |
Integer |
|
Recommended |
3. There were problems getting an appointment when this child needed one |
0;1
|
0= No; 1= Yes
|
services_appt |
|
c_services_tran |
Integer |
|
Recommended |
4. There were problems with getting transportation or child care |
0;1
|
0= No; 1= Yes
|
services_tran |
|
c_services_sched |
Integer |
|
Recommended |
5. The clinic or doctors office was not open when this child needed care |
0;1
|
0= No; 1= Yes
|
services_sched |
|
c_services_cost |
Integer |
|
Recommended |
6. There were issues related to cost |
0;1
|
0= No; 1= Yes
|
services_cost |
|
c_dev_services |
Integer |
|
Recommended |
Has this child EVER received special services to meet their developmental needs such as speech, occupational, or behavioral therapy? |
0;1
|
0= No; 1= Yes
|
dev_services |
|
c_services_now_01 |
Integer |
|
Recommended |
Check if currently receiving: Early Intervention |
0;1
|
0= No; 1= Yes
|
services_now_01 |
|
c_services_now_02 |
Integer |
|
Recommended |
Check if currently receiving: Occupational Therapy |
0;1
|
0= No; 1= Yes
|
services_now_02 |
|
c_services_now_03 |
Integer |
|
Recommended |
Check if currently receiving: Speech Therapy |
0;1
|
0= No; 1= Yes
|
services_now_03 |
|
c_services_now_04 |
Integer |
|
Recommended |
Check if currently receiving: Physical Therapy |
0;1
|
0= No; 1= Yes
|
services_now_04 |
|
c_weight_lb |
Float |
|
Recommended |
How much does this child CURRENTLY weigh? |
|
Lbs
|
weight_lb |
|
c_services_now_05 |
Integer |
|
Recommended |
Check if currently receiving: Group Therapy |
0;1
|
0= No; 1= Yes
|
services_now_05 |
|
c_services_now_06 |
Integer |
|
Recommended |
Check if currently receiving: Individual Therapy |
0;1
|
0= No; 1= Yes
|
services_now_06 |
|
c_services_now_07 |
Integer |
|
Recommended |
Check if currently receiving: Autism-specific services such as ABA, Floortime, etc |
0;1
|
0= No; 1= Yes
|
services_now_07 |
|
c_yr_dev_services |
Integer |
|
Recommended |
How old (years) was this child when they began receiving these special services? ? |
|
Age in Years
|
yr_dev_services |
|
c_mo_dev_services_2 |
Integer |
|
Recommended |
How old (months) was this child when they began receiving these special services? ? |
|
Age in Months
|
mo_dev_services_2 |
|
c_ei_referral |
String |
100
|
Recommended |
Who referred to Early Intervention? |
|
|
ei_referral |
|
c_ei_referral_date |
String |
50
|
Recommended |
When was the child referred to Early Intervention? |
|
|
ei_referral_date |
|
c_yr_ei_end |
Integer |
|
Recommended |
How old (years) was this child when their Early Intervention services ended? |
|
Age in Years
|
yr_ei_end |
|
c_mo_ei_end |
Integer |
|
Recommended |
How old (months) was this child when their Early Intervention services ended? |
|
Age in Months
|
mo_ei_end |
|
c_after_ei |
String |
500
|
Recommended |
What did your child do after Early Intervention services ended? |
|
|
after_ei |
|
c_vision |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, has this child had their vision tested, such as with pictures, shapes, or letters? |
0;1
|
0= No; 1= Yes
|
vision |
|
c_ei_pa |
Integer |
|
Recommended |
Did your child receive Early Intervention services in (current state)?? |
0;1
|
0= No; 1= Yes
|
ei_pa |
|
c_after_ei2_01 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. A full-day preschool program (specify public or private) |
0;1
|
0= No; 1= Yes
|
after_ei2_01 |
|
c_after_ei2_02 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Attended preschool program part-time |
0;1
|
0= No; 1= Yes
|
after_ei2_02 |
|
c_after_ei2_03 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. A head-start program |
0;1
|
0= No; 1= Yes
|
after_ei2_03 |
|
c_after_ei2_04 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Services through a public school less than 5 days/week - (e.g., specialized services - go to school to get speech but not enrolled in pre-K) |
0;1
|
0= No; 1= Yes
|
after_ei2_04 |
|
c_after_ei2_05 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Private therapies (e.g., speech, OT etc.) |
0;1
|
0= No; 1= Yes
|
after_ei2_05 |
|
c_after_ei2_06 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Home or center-based ASD services (e.g., ABA) |
0;1
|
0= No; 1= Yes
|
after_ei2_06 |
|
c_after_ei2_07 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Nothing |
0;1
|
0= No; 1= Yes
|
after_ei2_07 |
|
c_after_ei_pa_01 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Attended a typical child care setting |
0;1
|
0= No; 1= Yes
|
after_ei_pa_01 |
|
c_after_ei_pa_02 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Attended an autism specialized classroom |
0;1
|
0= No; 1= Yes
|
after_ei_pa_02 |
|
c_oral_health |
Integer |
|
Recommended |
DURING THE PAST 12 MONTHS, did this child see a dentist or other oral health care provider for any kind of dental or oral health care? |
0;1
|
0= No; 1= Yes
|
oral_health |
|
c_after_ei_pa_03 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Attended a non-specialized classroom |
0;1
|
0= No; 1= Yes
|
after_ei_pa_03 |
|
c_after_ei_pa_04 |
Integer |
|
Recommended |
Check all that apply based on above response to, what did your child do after Early Intervention. Received services in the home (e.g., speech) |
0;1
|
0= No; 1= Yes
|
after_ei_pa_04 |
|
c_ei_tran_satisfied |
Integer |
|
Recommended |
How satisfied were you with the transition process from Early Intervention to after Early Intervention services? |
1 :: 5
|
1= Very Unsatisfied; 2= Unsatisfied; 3= Neutral; 4= Satisfied; 5= Very Satisfied
|
ei_tran_satisfied |
|
c_iep_plan |
Integer |
|
Recommended |
Has this child EVER had a special education or early intervention plan? Children receiving these services often have an Individualized Education Plan (IEP). |
0;1
|
0= No; 1= Yes
|
iep_plan |
|
c_yr_iep_plan |
Integer |
|
Recommended |
If yes, how old was this child at the time of the FIRST IEP plan (i.e., preschool/kindergarten plan)?? |
|
Age in Years
|
yr_iep_plan |
|
c_iep_serv_now |
Integer |
|
Recommended |
Is this child CURRENTLY receiving services under one of these plans?? |
0;1
|
0= No; 1= Yes
|
iep_serv_now |
|
c_iep_know_why |
Integer |
|
Recommended |
Do you know what your child has an IEP/services for?? |
0;1
|
0= No; 1= Yes
|
iep_know_why |
|
c_iep_reason_01 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Autism |
0;1
|
0= No; 1= Yes
|
iep_reason_01 |
|
c_iep_reason_02 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Developmental Delay |
0;1
|
0= No; 1= Yes
|
iep_reason_02 |
|
c_iep_reason_03 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Intellectual Impairment |
0;1
|
0= No; 1= Yes
|
iep_reason_03 |
|
c_oth_cond_01 |
Integer |
|
Recommended |
Does this child have any of the following? Serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition. |
0;1
|
0= No; 1= Yes
|
other_cond_01 |
|
c_iep_reason_04 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Communication |
0;1
|
0= No; 1= Yes
|
iep_reason_04 |
|
c_iep_reason_05 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Neurological Impairment |
0;1
|
0= No; 1= Yes
|
iep_reason_05 |
|
c_iep_reason_06 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Sensory Impairment (hearing, vision impairment) |
0;1
|
0= No; 1= Yes
|
iep_reason_06 |
|
c_iep_reason_07 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Emotional Impairment |
0;1
|
0= No; 1= Yes
|
iep_reason_07 |
|
c_iep_reason_08 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Specific Learning Disability (SED) |
0;1
|
0= No; 1= Yes
|
iep_reason_08 |
|
c_iep_reason_09 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Physical Impairment (e.g., mobility etc.) |
0;1
|
0= No; 1= Yes
|
iep_reason_09 |
|
c_iep_reason_10 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Other Health Impairments |
0;1
|
0= No; 1= Yes
|
iep_reason_10 |
|
c_iep_reason_11 |
Integer |
|
Recommended |
Here are some categories why a child may qualify for an IEP. Other Classification |
0;1
|
0= No; 1= Yes
|
iep_reason_11 |
|
c_iep_reason_oth |
String |
250
|
Recommended |
Other classification, why a child may qualify for an IEP: (please describe) |
|
|
iep_reason_other |
|
c_iep_satisfy |
Integer |
|
Recommended |
How satisfied are you with the school services on your childs current IEP? |
1 :: 5
|
1= Very unsatisfied; 2= Unsatisfied; 3= Neutral; 4= Satisfied; 5= Very Satisfied
|
iep_satisfy |