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

 General Details

Title:
NIH Toolbox Emotion Domain Fear Over-Anxious Parent Report SF Ages 3-7
Short Name:
NIHTBFearOverAnxsPrtRpt
Description:
The NIH Toolbox Fear- Over Anxious Survey is a parent-report measure for ages 3-7, assessing fear, worry, and hyperarousal. It is a 6-item fixed-length form. Each item administered has a 3-point scale, ranging from 'never or not true' to 'often or very true.' Higher scores are indicative of more parent-reported child fear, worry, and hyperarousal. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases)
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-27
Owner:
Number of Data Elements:
36
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

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test domain battery type  Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBatteryTyp Recommended CDE
2 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
3 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
4 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
5 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
6 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
8 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE
9 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE

NIH Toolbox Fear Over Anxious Parent Report 3-7 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Future scale  Scale of parent reported truth of statement: Worries about things in future, for the parent report for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7FutureScl Recommended CDE
2 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Past behavior scale  Scale of parent reported truth of statement: Worries about past behavior, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7PstBhvrScl Recommended CDE
3 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Better scale  Scale of parent reported truth of statement: Worries about doing better at things, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7BetterScl Recommended CDE
4 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Self conscious scale  Scale of parent reported truth of statement: Is self-conscious or easily embarrassed, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7SlfCnscsScl Recommended CDE
5 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Okay scale  Scale of parent reported truth of statement: Needs to be told over and over that things are okay, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7OkayScl Recommended CDE
6 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - High strung scale  Scale of parent reported truth of statement: Is nervous, high strung or tense, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7HighStrngScl Recommended CDE

NIH Toolbox Fear Over Anxious Parent Rpt 3-7 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Raw Score  Raw score, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7RawScore Recommended CDE
2 NIH Toolbox Emotion Fear Over Anxious Parent Report Short Form 3 to 7 - Theta Score  Theta score, for the parent report, for children ages 3 to 7 as part of the NIH Toolbox Emotion Fear Over Anxious Short Form NIHTBFOAPRSF3to7ThetaScore Recommended CDE
3 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjSclScore Recommended CDE
4 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjNationalPctVal Recommended CDE
5 NIH Toolbox Patient Reported Outcome (PRO) Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROFullyAdjSclScore Recommended CDE
6 NIH Toolbox Patient Reported Outcome (PRO) Measures - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROUnadjSclScore Recommended CDE

 Change History

 Administrative Change History