This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Brief Infant Toddler Social Emotional Assesment-Childcare provider form
Short Name:
BITSEAChildcareProvider
Description:
The Brief Infant Toddler Social Emotional Assesment (BITSEA) is a brief screener of children's social or emotional behavior problems and competencies based on the Infant Toddler Social Emotional Assessment (ITSEA). It was designed to identify children with deficits or delays in these areas, with positive screens to be followed by administration of the full ITSEA. The measure yields a Problem Total Score and a Competence Total Score. There are two versions, a Parent Form and a Childcare Provider Form. References: Briggs-Gowan, M. J., Carter, A. S., Irwin, J. R., Wachtel, K., & Cicchetti, D. V. (2002). Copyright 2006, 2016 Pearson Education, Inc or its affiliate(s). All rights reserved, http://www.pearsonclinical.com/. Copyright 2004, Society of Pediatric Psychology. All rights reserved. Copyright 2006 2002 by Yale University and the University of Massachusetts
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-01
Owner:
Number of Data Elements:
67
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

BITSEA (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Succeed pleasure scale  The scale of showing pleasure when the child succeeds, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEASucceedPleasScl Recommended CDE
2 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hurt often scale  The scale of getting hurt that the parent/guardian/caregiver cannot take eyes off the child, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHurtOftScl Recommended CDE
3 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Nervous tense fearful scale  The scale of being nervous, tense, or fearful, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEANervTensFearfulScl Recommended CDE
4 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Restlessness scale  The scale of being restless, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEARestlessScl Recommended CDE
5 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Rule follow scale  The scale of following rules, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAFollowRulesScl Recommended CDE
6 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Sleep difficulty scale  The scale of having difficulty in falling asleep again after waking up, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEASleepDiffScl Recommended CDE
7 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Cries tantrum exhaust scale  The scale of having cries or tantrums until the child is exhausted, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEACriesTantrumExhaustScl Recommended CDE
8 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Place animal thing fear scale  The scale of being afraid of certain places, animals or things, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAPlacAnimThingFearScl Recommended CDE
9 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Place animal thing fear text  An example that a child is afraid of, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAPlacAnimThingFearTxt Recommended CDE
10 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Less fun scale  The scale of having less fun than other children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEALessFunScl Recommended CDE
11 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Look for when upset scale  The scale of looking for parent/guardian/childcare provider, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEALookForWhenUpsetScl Recommended CDE
12 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Cries hang onto care giver scale  The scale of crying or hanging onto a care giver when he or she tries to leave, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEACriesHangOntoCrGiverScl Recommended CDE
13 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Worries a lot very serious scale  The scale of worrying a lot or being very serious, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAWorriesALotVySeriousScl Recommended CDE
14 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Look right name called scale  The scale of looking right at parent/guardian/childcare provider when his/her name is called, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEALookRightNameCalledScl Recommended CDE
15 Brief Infant Toddler Social Emotional Assessment (BITSEA) - No reaction when hurt scale  The scale of not reacting when hurting, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEANoReactnWhenHurtScl Recommended CDE
16 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Affectionate with loved ones scale  The scale of being affectionate with loved ones, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAAffectionateWLvdOnesScl Recommended CDE
17 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Won't touch some objects scale  The scale of not touching some objects because of how they feel, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAWontTouchSomeObjectsScl Recommended CDE
18 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Trouble fall stay asleep scale  The scale of having trouble falling or staying asleep, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAToubleFallStayAsleepScl Recommended CDE
19 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Run away public places scale  The scale of running away public places, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEARunAwayPublicPlcsScl Recommended CDE
20 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Play well with other children scale  The scale of playing well with other children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAPlayWellWOthrChldrnScl Recommended CDE
21 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Long time attention scale  The scale of paying attention for a long time, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEALongTimeAttnScl Recommended CDE
22 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Trouble adjusting to changes scale  The scale of having trouble adjusting to changes, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEATroubleAdjutToChangeScl Recommended CDE
23 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Help when someone hurt scale  The scale of trying to help when someone is hurt, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHelpWhenSomeoneHurtScl Recommended CDE
24 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Often get upset scale  The scale of often getting upset, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAOftenGetUpsetScl Recommended CDE
25 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Gags chokes scale  The scale of having gags and chokes on food, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAGagsChokesScl Recommended CDE
26 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Imitates playful sounds scale  The scale of imitating playful sounds when you ask the child to, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAImitatesPlayfulSdsScl Recommended CDE
27 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Refuse to eat scale  The scale of refusing to eat, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEARefuseToEatScl Recommended CDE
28 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit shove kick bite children scale  The scale of hitting, shoving, kicking and biting children, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHitShoveKickBiteCdrnScl Recommended CDE
29 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Destructive scale  The scale of being destructive, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEADestructiveScl Recommended CDE
30 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Point to show things far away scale  The scale of pointing to show you something far away, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAPntToShowTgsFarAwayScl Recommended CDE
31 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick parent scale  The scale of hitting, biting, or kicking parents, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHitBiteKickParntScl Recommended CDE
32 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick parent scale  The scale of hitting, biting, or kicking parents, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHugFeedDollsScl Recommended CDE
33 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Unhappy sad depressed withdrawn scale  The scale of being unhappy, sad, depressed or withdrawn, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAUnhapySdDpresWithdrnScl Recommended CDE
34 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Hit bite kick you scale  The scale of hitting, kicking or biting you (or other childcare provider), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHitBiteKickUScl Recommended CDE
35 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Still freeze when upset scale  The scale of getting very still, freezing, or not moving when upset, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAStillFreezeWhenUpsetScl Recommended CDE
36 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Still freeze when upset scale  The scale of putting things in a special order over and over and getting upset if the child is interrupted, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAPutTnsInSpeclOrdersScl Recommended CDE
37 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat same actions without enjoyment scale  The scale of repeating the same action or phrase over and over without enjoyment, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAReptSmActnWtEnjymntScl Recommended CDE
38 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat same actions without enjoyment text  An example describing how a child repeats the same action or phrase over and over without enjoyment, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAReptSmActnWtEnjymntTxt Recommended CDE
39 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat particular movement scale  The scale of repeating a particular movement over and over ( like rocking, spinning), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAReptPrtcularMovemntScl Recommended CDE
40 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Repeat particular movement text  An example describing how a child repeats a particular movement over and over ( like rocking, spinning), as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAReptPrtcularMovemntTxt Recommended CDE
41 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Space out scale  The scale of spacing out, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEASpaceOutScl Recommended CDE
42 Brief Infant Toddler Social Emotional Assessment (BITSEA) - No eye contact scale  The scale of not making eye contact, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEANoEyeContactScl Recommended CDE
43 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Avoid physical contact scale  The scale of avoiding physical contact, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAAvoidPhysicalContactScl Recommended CDE
44 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Self hurt on purpose scale  The scale of hurting himself or herself on purpose, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEASelfHurtOnPurposeScl Recommended CDE
45 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Self hurt on purpose text  An example describing how a child hurts himself or herself on purpose, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEASelfHurtOnPurposeTxt Recommended CDE
46 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Eat drink things non edible scale  The scale of eating or drinking things that are not edible, like paper or paint, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAEatDrinkTnsNonEdibleScl Recommended CDE
47 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Eat drink things non edible text  An example describing how a child eats or drinks things that are not edible, like paper or paint, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAEatDrinkTnsNonEdibleTxt Recommended CDE
48 Brief Infant Toddler Social Emotional Assessment (BITSEA) -How worried about child behavior scale  The scale of worrying about the child's behavior, emotions, or relationships, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHwWorrdAbtCdBehvrScl Recommended CDE
49 Brief Infant Toddler Social Emotional Assessment (BITSEA) -How worried about child language development scale  The scale of worrying about the child's language development, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAHwWorrdAbtCdLangDevScl Recommended CDE

Score summary (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Brief Infant Toddler Social Emotional Assessment (BITSEA) -Problem total score  Problem total score, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEAProblemTtlScore Recommended CDE
2 Brief Infant Toddler Social Emotional Assessment (BITSEA) -Competence total score  Competence total score, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA) BITSEACompetenceTtlScore Recommended CDE
3 Brief Infant Toddler Social Emotional Assessment (BITSEA) - Follow up notes text  Description of follow-up notes, as part of the Brief Infant Toddler Social Emotional Assessment (BITSEA), Childcare Provider Form BITSEAFollowUpNotesTxt Recommended CDE

 Change History

 Administrative Change History