|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
Query
|
fs_v1_q50b_nr_bioparent_race_ |
String |
80
|
Recommended |
Full Screener (Visit 1): Q50b nonrespondent biological parent race (Choices are - American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided) |
|
American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided
|
FullScreen_V1_Q50b_NonRespondent_BioParent_Race |
Query
|
mother_race_ |
String |
80
|
Recommended |
Mother race (choices are American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided) |
|
American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided
|
Mother_Race |
Query
|
father_race_ |
String |
80
|
Recommended |
Father race (choices are American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided) |
|
American Indian/Alaskan Native; African American/Black; Asian; Native Hawaiian/other Pacific Islander; White; Not provided
|
Father_Race |
Query
|
subject_gender |
String |
10
|
Recommended |
Subject: gender |
Male;Female
|
|
|
Query
|
mother_ethnicity |
String |
30
|
Recommended |
Mother ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) |
Hispanic or Latino;Not Hispanic or Latino;Not Provided
|
|
|
Query
|
mother_education |
String |
30
|
Recommended |
Mother education level |
Less Than 6th Grade;Less Than High School;High School;Some College;College;Some Graduate Level;Graduate Level;NA
|
NA = Not available
|
|
Query
|
hand_used_to_write_with |
String |
1
|
Recommended |
Hand used to write with. |
R;L;B
|
R = Right; L = Left; B = Both/bimanual
|
|
Query
|
fs_v1_household_income |
String |
20
|
Recommended |
Full Screener (Visit 1): Q52 combined income all adults in home |
Zero to 5000;5001 to 10000;10001 to 15000;15001 to 25000;25001 to 35000;35001 to 50000;50001 to 75000;75001 to 100000;100001 to 150000;over 150000;No Answer
|
In dollars
|
FullScreen_V1_Household_Income |
Query
|
child_race_ |
String |
80
|
Recommended |
Child race derived from both parent races |
|
African American or Black; American Indian or Alaskan Native; Asian; Native Hawaiian or Other Pacific Islander; White; Not Provided. Multiple races may be listed.
|
|
Query
|
father_ethnicity |
String |
30
|
Recommended |
Father ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) |
Hispanic or Latino;Not Hispanic or Latino;Not Provided
|
|
|
Query
|
father_education |
String |
30
|
Recommended |
Father education level |
Less Than 6th Grade;Less Than High School;High School;Some College;College;Some Graduate Level;Graduate Level;NA
|
NA = Not available
|
|
Query
|
child_ethnicity_ |
String |
30
|
Recommended |
Child ethnicity derived from both parent ethnicities |
Hispanic or Latino;Part Hispanic or Latino;Not Hispanic or Latino
|
|
|
Query
|
family_bio_coi_total_house_inc |
String |
30
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question ID2 Total Income for Child of Interest (COI) Household at brain scan timepoint |
Zero to 5000;5001 to 10000;10001 to 15000;15001 to 25000;25001 to 35000;35001 to 50000;50001 to 75000;75001 to 100000;100001 to 150000;over 150000;No Answer
|
In dollars
|
Family_Bio_ID2_COI_Family_Total_Household_Income |
Query
|
family_bio_coi_biol_father_ed |
String |
30
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IB6 Child of Interest (COI) Biological Father education at brain scan timepoint |
Less than High School;High School Degree;Some College;College Degree;Some Graduate Work;Graduate Degree;No Answer
|
|
Family_Bio_IB6_COI_Biol_Father_Education |
Query
|
family_bio_coi_biol_fathr_race |
String |
50
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IB5 Child of Interest (COI) Biological Father Race (American Indian or Alaska Native, African American or Black, Asian, Native Hawaiian or Other Pacific Islander, White, No Answer) |
American Indian or Alaska Native;African American or Black;Asian;Native Hawaiian or Other Pacific Islander;White;No Answer
|
|
Family_Bio_IB5_COI_Biol_Father_Race |
Query
|
family_bio_coi_biol_fathr_ethn |
String |
30
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IB4 Child of Interest (COI) Biological Father ethnicity (Hispanic or Latino, Not Hispanic or Latino, No Answer) |
Hispanic or Latino;Not Hispanic or Latino;No Answer
|
|
Family_Bio_IB4_COI_Biol_Father_Ethnicity |
Query
|
family_bio_coi_biol_mother_ed |
String |
30
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IA5 Child of Interest (COI) Biological Mother education at brain scan timepoint |
Less than High School;High School Degree;Some College;College Degree;Some Graduate Work;Graduate Degree;No Answer
|
|
Family_Bio_IA5_COI_Biol_Mother_Education |
Query
|
family_bio_coi_biol_mothr_race |
String |
50
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IA4 Child of Interest (COI) Biological Mother Race (American Indian or Alaska Native, African American or Black, Asian, Native Hawaiian or Other Pacific Islander, White, No Answer) |
American Indian or Alaska Native;African American or Black;Asian;Native Hawaiian or Other Pacific Islander;White;No Answer
|
|
Family_Bio_IA4_COI_Biol_Mother_Race |
Query
|
family_bio_coi_biol_mothr_ethn |
String |
30
|
Recommended |
Family Biographical History Form (0:0 to 4:5 y:m) Question IA3 Child of Interest (COI) Biological Mother Ethnicity (Hispanic or Latino, Not Hispanic or Latino, No Answer) |
Hispanic or Latino;Not Hispanic or Latino;No Answer
|
|
Family_Bio_IA3_COI_Biol_Mother_Ethnicity |
Query
|
adjusted_family_income |
Integer |
|
Recommended |
Income adjusted for family size and geographical region using HUD data |
|
In dollars
|
|
Query
|
timepoint_label |
String |
50
|
Recommended |
Timepoint/visit label |
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
Subject_ID |
Query
|
site_id |
Integer |
|
Recommended |
Number assigned to site |
|
|
Site_Location |
Query
|
household_income_level |
Integer |
|
Recommended |
Combined income all adults in home |
1::26;77
|
1 = $0-$5,000; 2 = $5,001-$10,000; 3 = $10,001-$15,000; 4 = $15,001-$25,000; 5 = $25,001-$35,000; 6 = $35,001-$50,000; 7 = $50,001-$75,000; 8 = $75,001-$100,000; 9 = $100,001-$150,000; 10 = Over $150,000; 11 = Less than $10,000; 12 = $15,000-$20,000; 13 = $20,000-$25,000; 14 = $25,000-$30,000; 15 = $30,000-$35,000; 16 = $35,000-$40,000; 17 = $40,000-$45,000; 18 = $45,000-$50,000; 19 = $50,000-$55,000; 20 = $55,000-$60,000; 21 = Above $60,000; 23=$60, 001 - $65, 000;
24=65, 001 - $70, 000 ;25=$70, 001 - $75, 000; 26=More than $75, 000; 77=Rather not say
|
|
Query
|
age_years_dov_to_dob |
Integer |
|
Recommended |
Age in years obtained by subtracting the date of birth from the date of visit (Calculation is based on 1 year = 365.25 days). |
|
|
Age_Years_Date_of_Visit_to_DOB |
Query
|
age_months_dov_to_dob |
Integer |
|
Recommended |
Age in months obtained by subtracting the date of birth from the date of visit (Calculation is based on 1 month = 30 days). |
|
|
Age_Months_Date_of_Visit_to_DOB |
Query
|
age_days_dov_to_dob |
Integer |
|
Recommended |
Age in days at Visit (DoV-DoB), same as age of scan if obtained |
|
|
Age_Days_Date_of_Visit_to_DOB |
|
ac_info02 |
String |
20
|
Recommended |
Alternative Caregiver (AC) Gender: |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
tc_service04 |
Integer |
|
Recommended |
Speech Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service05 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Occupational Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service06 |
Integer |
|
Recommended |
Occupational Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service07 |
Integer |
|
Recommended |
Occupational Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service08 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Sensory Integration |
0;1
|
0= No; 1= Yes
|
|
|
tc_service09 |
Integer |
|
Recommended |
Sensory Integration: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service10 |
Integer |
|
Recommended |
Sensory Integration: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service11 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Physical Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service12 |
Integer |
|
Recommended |
Physical Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service13 |
Integer |
|
Recommended |
Physical Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
ac_info03 |
String |
20
|
Recommended |
Alternative Caregiver (AC) Relationship to child (TC): |
|
ie mother father legal guardian sibling aunt uncle etc
|
|
|
tc_service14 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Clinic to Based Behavior Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service15 |
Integer |
|
Recommended |
Clinic to Based Behavior Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service16 |
Integer |
|
Recommended |
Clinic to Based Behavior Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service17 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Adaptive PE |
0;1
|
0= No; 1= Yes
|
|
|
tc_service18 |
Integer |
|
Recommended |
Adaptive PE: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service19 |
Integer |
|
Recommended |
Adaptive PE: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service20 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Play Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service21 |
Integer |
|
Recommended |
Play Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service22 |
Integer |
|
Recommended |
Play Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service23 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Psychotherapy |
0;1
|
0= No; 1= Yes
|
|
|
ac_info04 |
Integer |
|
Recommended |
How long has child (TC) lived with Alternative Caregiver (AC): |
|
Number of years; Number of months
|
|
|
tc_service24 |
Integer |
|
Recommended |
Psychotherapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service25 |
Integer |
|
Recommended |
Psychotherapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service26 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive In to home Behavior Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service27 |
Integer |
|
Recommended |
In to home Behavior Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service28 |
Integer |
|
Recommended |
In to home Behavior Therapy: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
tc_service29 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Other |
0;1
|
0= No; 1= Yes
|
|
|
tc_service30 |
String |
500
|
Recommended |
Please specify what other services are received: |
|
|
|
|
tc_service31 |
Integer |
|
Recommended |
Other: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
tc_service32 |
Integer |
|
Recommended |
Other: Number of Months of Services (only within the last 6 months) |
|
Number of Months of Services
|
|
|
ser_satis_01 |
Integer |
|
Recommended |
Overall, how satisfied are you with the services you and your child receives? |
0 :: 4;9
|
0= Very Dissatisfied; 1= Dissatisfied; 2= Neutral; 3= Satisfied; 4= Very Satisfied; 9= NA
|
|
|
ac_info05 |
Integer |
|
Recommended |
Is the Alternative Caregiver (AC) currently living in the home? |
0;1
|
0= No; 1= Yes
|
|
|
ser_satis_02 |
Integer |
|
Recommended |
How satisfied are you with the number of hours of services you receive? |
0 :: 4;9
|
0= Very Dissatisfied; 1= Dissatisfied; 2= Neutral; 3= Satisfied; 4= Very Satisfied; 9= NA
|
|
|
ser_satis_03 |
Integer |
|
Recommended |
How satisfied are you with your service providers? |
0 :: 4;9
|
0= Very Dissatisfied; 1= Dissatisfied; 2= Neutral; 3= Satisfied; 4= Very Satisfied; 9= NA
|
|
|
ser_satis_04 |
Integer |
|
Recommended |
How satisfied are you with your involvement in your childs services? |
0 :: 4;9
|
0= Very Dissatisfied; 1= Dissatisfied; 2= Neutral; 3= Satisfied; 4= Very Satisfied; 9= NA
|
|
|
ser_satis_05 |
Integer |
|
Recommended |
How satisfied are you with your access to services (eg, how easy of difficult was it to secure services)? |
0 :: 4;9
|
0= Very Dissatisfied; 1= Dissatisfied; 2= Neutral; 3= Satisfied; 4= Very Satisfied; 9= NA
|
|
|
ser_satis_06 |
Integer |
|
Recommended |
I would recommend the services I have to others |
0 :: 4;9
|
0= Definitely not recommend; 1= Probably not recommend; 2= Not sure if I would recommend; 3= Recommend; 4= Highly recommend; 9= NA
|
|
|
tc_lang01 |
String |
25
|
Recommended |
What is your childs first language? |
|
English; Spanish; Other (specify)
|
|
|
tc_lang02 |
String |
25
|
Recommended |
What language is primarily spoken in the home? |
|
English; Spanish; Other (specify)
|
|
|
tc_lang03 |
Integer |
|
Recommended |
Is your child bilingual? |
0;1
|
0= No; 1= Yes
|
|
|
tc_lang04 |
String |
25
|
Recommended |
If Yes, Specify other language spoken: |
|
|
|
|
tc_race |
Integer |
|
Recommended |
Childs (TC) Race |
1 :: 7
|
1= WhiteCaucasian; 2= BlackAfrican American; 3= HispanicLatino; 4= Asian; 5= Native American; 6= Pacific Islander; 7= Other
|
|
|
pc_race |
Integer |
|
Recommended |
Primary Caregivers (PC) Race |
1 :: 7
|
1= WhiteCaucasian; 2= BlackAfrican American; 3= HispanicLatino; 4= Asian; 5= Native American; 6= Pacific Islander; 7= Other
|
|
|
ac_race |
Integer |
|
Recommended |
Alternative Caregivers (AC) Race |
1 :: 7
|
1= WhiteCaucasian; 2= BlackAfrican American; 3= HispanicLatino; 4= Asian; 5= Native American; 6= Pacific Islander; 7= Other
|
|
|
pc_edu |
Integer |
|
Recommended |
Primary Caregiver (PC): What is the last level of formal education you completed? |
1 :: 10
|
1= No formal schooling; 2= 7th grade or less; 3= Junior high completed; 4= Partial high school (at least one year); 5= High school graduateGED certificate; 6= Partial college (at least one year); 7= Specialized training; 8= Junior collegeAssociates degree (2 years); 9= Standard college or university graduation (4 years); 10= Graduate professional training graduate degree
|
|
|
ac_edu |
Integer |
|
Recommended |
Alternative Caregiver (AC): What is the last level of formal education your partner (AC) completed? |
1 :: 10
|
1= No formal schooling; 2= 7th grade or less; 3= Junior high completed; 4= Partial high school (at least one year); 5= High school graduateGED certificate; 6= Partial college (at least one year); 7= Specialized training; 8= Junior collegeAssociates degree (2 years); 9= Standard college or university graduation (4 years); 10= Graduate professional training graduate degree
|
|
|
pc_job |
Integer |
|
Recommended |
Primary Caregiver (PC): What is your employment status? |
1 :: 11
|
1= Self to Employed; 2= Full Time; 3= Part Time; 4= Seasonal; 5= Unemployed; 6= Disabled; 7= Temporary Layoff; 8= Full to Time Homemaker; 9= Retired; 10= Student; 11= Other
|
|
|
pc_job_a |
String |
500
|
Recommended |
Primary Caregiver (PC): Job Title |
|
|
|
|
pc_job_b |
String |
4,000
|
Recommended |
Primary Caregiver (PC): Job Duties |
|
|
|
|
pc_job_c |
Integer |
|
Recommended |
Primary Caregiver (PC): How many hours per week: |
|
Time in Hours
|
|
|
pc_job_d |
Integer |
|
Recommended |
Primary Caregiver (PC): How long have you been at this job,profession? |
|
Length in Months
|
|
|
ac_job |
Integer |
|
Recommended |
Alternative Caregiver (AC): What is your partners (AC) employment status? |
1 :: 11
|
1= Self to Employed; 2= Full Time; 3= Part Time; 4= Seasonal; 5= Unemployed; 6= Disabled; 7= Temporary Layoff; 8= Full to Time Homemaker; 9= Retired; 10= Student; 11= Other
|
|
|
ac_job_a |
String |
500
|
Recommended |
Alternative Caregiver (AC): Job Title |
|
|
|
|
ac_job_b |
String |
4,000
|
Recommended |
Alternative Caregiver (AC): Job Duties |
|
|
|
|
ac_job_c |
Integer |
|
Recommended |
Alternative Caregiver (AC): How many hours per week: |
|
Time in Hours
|
|
|
ac_job_d |
Integer |
|
Recommended |
Alternative Caregiver (AC): How long have you been at this job,profession? |
|
Length in Months
|
|
|
grossinc |
Integer |
|
Recommended |
Gross Annual Household Income |
1 :: 13
|
1= 4999 or less; 2= 5000 to 9999; 3= 10000 to 14999; 4= 15000 to 19999; 5= 20000 to 24999; 6= 25000 to 29999; 7= 30000 to 39999; 8= 40000 to 49999; 9= 50000 to 59999; 10= 60000 to 69999; 11= 70000 to 79999; 12= 80000 to 89999; 13= 90000 or more
|
|
|
pc_info01 |
Integer |
|
Recommended |
Primary Caregiver (PC) Age: |
|
Age in Years
|
|
|
fam_services |
Integer |
|
Recommended |
Do you or your family receive any of the following? |
1 :: 12
|
1= Temporary Assistance for Needy Families (TANF)Welfare; 2= Social Security; 3= SSI (Supplemental Security Income); 4= Medi to Cal; 5= CalFresh SNAP Food Stamps; 6= Heating and Electric bill assistance; 7= Unemployment; 8= Child support; 9= WIC (Women Infants and Children); 10= Tribal Insurance; 11= Other; 12= None
|
|
|
sibs_01 |
Integer |
|
Recommended |
Do you have any other children living in the home? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_02 |
Integer |
|
Recommended |
How many other children live in the home? |
|
|
|
|
sibs_03 |
Integer |
|
Recommended |
How many children are you financially supporting? |
|
|
|
|
sibs_04 |
Integer |
|
Recommended |
Sibling 1: Siblings Age |
|
Age in Years
|
|
|
sibs_05 |
String |
2
|
Recommended |
Sibling 1: Siblings Gender |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
sibs_06 |
String |
25
|
Recommended |
Sibling 1: Siblings relationship to child (TC) |
|
|
|
|
sibs_07 |
String |
2
|
Recommended |
Sibling 1: relationship code |
|
|
|
|
sibs_08 |
Integer |
|
Recommended |
Sibling 1: Do they have a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_09 |
String |
500
|
Recommended |
Sibling 1: If yes, please list learning problems |
|
|
|
|
pc_info02 |
String |
20
|
Recommended |
Primary Caregiver (PC) Gender: |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
sibs_10 |
Integer |
|
Recommended |
Sibling 1: Do they have a behavior problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_11 |
Integer |
|
Recommended |
Sibling 1: Do they have a mental health problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_12 |
Integer |
|
Recommended |
Sibling 1: Do they live in the home? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_13 |
Integer |
|
Recommended |
Sibling 2: Siblings Age |
|
Age in Years
|
|
|
sibs_14 |
String |
2
|
Recommended |
Sibling 2: Siblings Gender |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
sibs_15 |
String |
25
|
Recommended |
Sibling 2: Siblings relationship to child (TC) |
|
|
|
|
sibs_16 |
String |
2
|
Recommended |
Sibling 2: relationship code |
|
|
|
|
sibs_17 |
Integer |
|
Recommended |
Sibling 2: Do they have a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_18 |
String |
500
|
Recommended |
Sibling 2: If yes, please list learning problems |
|
|
|
|
sibs_19 |
Integer |
|
Recommended |
Sibling 2: Do they have a behavior problem? |
0;1
|
0= No; 1= Yes
|
|
|
pc_info03 |
String |
20
|
Recommended |
Primary Caregiver (PC) Relationship to child (TC): |
|
ie mother father legal guardian sibling aunt uncle etc
|
|
|
sibs_20 |
Integer |
|
Recommended |
Sibling 2: Do they have a mental health problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_21 |
Integer |
|
Recommended |
Sibling 2: Do they live in the home? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_22 |
Integer |
|
Recommended |
Sibling 3: Siblings Age |
|
Age in Years
|
|
|
sibs_23 |
String |
2
|
Recommended |
Sibling 3: Siblings Gender |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
sibs_24 |
String |
25
|
Recommended |
Sibling 3: Siblings relationship to child (TC) |
|
|
|
|
sibs_25 |
String |
2
|
Recommended |
Sibling 3: relationship code |
|
|
|
|
sibs_26 |
Integer |
|
Recommended |
Sibling 3: Do they have a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_27 |
String |
500
|
Recommended |
Sibling 3: If yes, please list learning problems |
|
|
|
|
sibs_28 |
Integer |
|
Recommended |
Sibling 3: Do they have a behavior problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_29 |
Integer |
|
Recommended |
Sibling 3: Do they have a mental health problem? |
0;1
|
0= No; 1= Yes
|
|
|
pc_info04 |
Integer |
|
Recommended |
How long has child (TC) lived with PC: |
|
Number of years; Number of months
|
|
|
sibs_30 |
Integer |
|
Recommended |
Sibling 3: Do they live in the home? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_31 |
Integer |
|
Recommended |
Sibling 4: Siblings Age |
|
Age in Years
|
|
|
sibs_32 |
String |
2
|
Recommended |
Sibling 4: Siblings Gender |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
|
|
sibs_33 |
String |
25
|
Recommended |
Sibling 4: Siblings relationship to child (TC) |
|
|
|
|
sibs_34 |
String |
2
|
Recommended |
Sibling 4: relationship code |
|
|
|
|
sibs_35 |
Integer |
|
Recommended |
Sibling 4: Do they have a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_36 |
String |
500
|
Recommended |
Sibling 4: If yes, please list learning problems |
|
|
|
|
sibs_37 |
Integer |
|
Recommended |
Sibling 4: Do they have a behavior problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_38 |
Integer |
|
Recommended |
Sibling 4: Do they have a mental health problem? |
0;1
|
0= No; 1= Yes
|
|
|
sibs_39 |
Integer |
|
Recommended |
Sibling 4: Do they live in the home? |
0;1
|
0= No; 1= Yes
|
|
|
pc_info05 |
Integer |
|
Recommended |
What is you martial status? |
1 :: 6
|
1= Married; 2= Living Together; 3= Seperated; 4=Divorced; 5= Widowed; 6= Single
|
|
|
famdis_01 |
Integer |
|
Recommended |
Immediate Family: Does anyone in your childs family have a history of a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
famdis_02 |
String |
500
|
Recommended |
Immediate Family: is Yes, who & what: |
|
|
|
|
famdis_03 |
Integer |
|
Recommended |
Extended Family: Does anyone in your childs family have a history of a learning problem? |
0;1
|
0= No; 1= Yes
|
|
|
famdis_04 |
String |
500
|
Recommended |
Extended Family: is Yes, who & what: |
|
|
|
|
famdis_05 |
Integer |
|
Recommended |
Immediate Family: Does anyone in your childs family have a history of mental health problems? |
0;1
|
0= No; 1= Yes
|
|
|
famdis_06 |
String |
500
|
Recommended |
Immediate Family: is Yes, who & what: |
|
|
|
|
famdis_07 |
Integer |
|
Recommended |
Extended Family: Does anyone in your childs family have a history of mental health problems? |
0;1
|
0= No; 1= Yes
|
|
|
famdis_08 |
String |
500
|
Recommended |
Extended Family: is Yes, who & what: |
|
|
|
|
tcdis_01 |
Integer |
|
Recommended |
Has child (TC) been identified as having autism spectrum disorder? |
0;1
|
0= No; 1= Yes
|
|
|
tcdis_02 |
Integer |
|
Recommended |
If No: Has child (TC) been identified as having a developmental delay or concern? |
0;1
|
0= No; 1= Yes
|
|
|
pc_info06 |
Integer |
|
Recommended |
Do you have a partner in the home? |
0;1
|
0= No; 1= Yes
|
|
|
tcdis_03 |
Integer |
|
Recommended |
TC: Primary Development Disability: |
1 :: 13
|
1= Developmental Delay; 2= SpeechLanguage Delay; 3= Autism Spectrum Disorder; 4= Cerebral Palsy; 5= Chronic medical illness; 6= Genetic DisorderSyndrome; 7= Sensory Disorder; 8= Learning Disability; 9= Fetal Alcohol Syndrome; 10= Motor Delay; 11= Social to Emotional Delay; 12= DeafHearing; 13= Other
|
|
|
tcdis_04 |
String |
150
|
Recommended |
TC: Primary Development Disability (Specify): |
|
|
|
|
tcdis_05 |
Integer |
|
Recommended |
When was child (TC) identified with this condition? |
0 :: 5;9
|
0= At birth or infancy (0 to 11 months); 1= One to year old (12 to 23 months); 2= Two to years old (24 to 35 months); 3= Three to years old (36 to 47 months); 4= Four to years old (48 to 59 months); 5= Five to years old (60 to 71 months); 9= Unknown
|
|
|
tcdis_06 |
Integer |
|
Recommended |
Who identified child (TC) with this condition? |
1 :: 6;9
|
1= Primary Care PhysicianPediatrician; 2= Other PhysicianSpecialist (eg neurologist psychiatrist other specialist); 3= Psychologist (eg clinical psychologist school psychologist); 4= Social Worker; 5= Interdisciplinary Team; 6= Other; 9= Unknown
|
|
|
tcdis_07 |
Integer |
|
Recommended |
Does child (TC) have a secondary condition? |
0;1
|
0= No; 1= Yes
|
|
|
tcdis_08 |
Integer |
|
Recommended |
TC: Secondary Development Disability: |
1 :: 4;9
|
1= ADHD; 2= Disruptive behavior disorder; 3= Seizure disorder; 4= Other; 9= NA
|
|
|
tcdis_09 |
String |
150
|
Recommended |
TC: Secondary Development Disability (Specify): |
|
|
|
|
tcdis_10 |
Integer |
|
Recommended |
When was child (TC) identified with this secondary condition? |
0 :: 6;9
|
0= At birth or infancy (0 to 11 months); 1= One to year old (12 to 23 months); 2= Two to years old (24 to 35 months); 3= Three to years old (36 to 47 months); 4= Four to years old (48 to 59 months); 5= Five to years old (60 to 71 months); 6= Unknown; 9= NA
|
|
|
tcdis_11 |
Integer |
|
Recommended |
Who identified child (TC) with this secondary condition? |
1 :: 6;9
|
1= Primary Care PhysicianPediatrician; 2= Other PhysicianSpecialist (eg neurologist psychiatrist other specialist); 3= Psychologist (eg clinical psychologist school psychologist); 4= Social Worker; 5= Interdisciplinary Team; 6= Other; 9= Unknown
|
|
|
tcdis_12 |
Integer |
|
Recommended |
Does child (TC) have any medical,health problems? |
0 :: 2
|
0= No; 1= Yes; 2= Dont know
|
|
|
ac_info01 |
Integer |
|
Recommended |
Alternative Caregiver (AC) Age: |
|
Age in Years
|
|
|
tcdis_13 |
String |
4,000
|
Recommended |
If Yes, Specify Medical,Mental Health problems |
|
|
|
|
tcdis_14 |
Integer |
|
Recommended |
Is child (TC) seen regularly by a physician? |
0;1
|
0= No; 1= Yes
|
|
|
tcdis_15 |
Integer |
|
Recommended |
Is child (TC) currently taking any medications? |
0;1
|
0= No; 1= Yes
|
|
|
tcdis_16 |
String |
4,000
|
Recommended |
Medication List |
|
Note Medication Name; Dosage; and Reason
|
|
|
tc_edu01 |
Integer |
|
Recommended |
Is child (TC) currently enrolled in a school program? |
0;1
|
0= No; 1= Yes
|
|
|
tc_edu02 |
String |
50
|
Recommended |
If Yes, please provide name of school: |
|
|
|
|
tc_edu03 |
Integer |
|
Recommended |
Is child (TC) enrolled in school with special education eligibility? (ex IEP) |
0 :: 2
|
0= No; 1= Yes; 2= Dont know
|
|
|
tc_service01 |
Integer |
|
Recommended |
Does child (TC) receive related services for either the primary or secondary diagnosis? |
0;1
|
0= No; 1= Yes
|
|
|
tc_service02 |
Integer |
|
Recommended |
In the last 6 months: Did child (TC) receive Speech Therapy |
0;1
|
0= No; 1= Yes
|
|
|
tc_service03 |
Integer |
|
Recommended |
Speech Therapy: Number of Sessions per Month |
|
Number of Sessions per Month
|
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
|
|
interview_age |
Integer |
|
Required |
Age in months at the time of the interview/test/sampling/imaging. |
0 :: 1260
|
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
|
|