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

 General Details

Title:
NIH Toolbox Emotion Domain Fear Survey Short/Fixed Form Ages 8-17 version 1.1
Short Name:
NIHTBFearSurveyAges8to17
Description:
This is a self-report measure for ages 8-17 as well as a parent-report measure for ages 8-12. It assesses fear, anxious misery and hyperarousal. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx The self-report version is an 8-item fixed-length form.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-24
Owner:
Number of Data Elements:
38
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 Survey SF/FF Ages 8-17 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Fear Short Form 8-17 - Scared scale  Scale of participant report of statement: I felt scared, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17ScaredScl Recommended CDE
2 NIH Toolbox Emotion Fear Short Form 8-17 - Worried what could happen scale  Scale of participant report of statement: I worried about what could happen to me, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17WrrdCldHppnScl Recommended CDE
3 NIH Toolbox Emotion Fear Short Form 8-17 - Worried scale  Scale of participant report of statement: I felt worried, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17WorriedScl Recommended CDE
4 NIH Toolbox Emotion Fear Short Form 8-17 - Something awful scale  Scale of participant report of statement: I felt like something awful might happen, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17SmthgAwflScl Recommended CDE
5 NIH Toolbox Emotion Fear Short Form 8-17 - Worried at night scale  Scale of participant report of statement: I worried when I went to bed at night, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17WrrdAtNightScl Recommended CDE
6 NIH Toolbox Emotion Fear Short Form 8-17 - Nervous scale  Scale of participant report of statement: I felt nervous, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17NervousScl Recommended CDE
7 NIH Toolbox Emotion Fear Short Form 8-17 - Worried at home scale  Scale of participant report of statement: I worried when I was at home, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17WrrdAtHomeScl Recommended CDE
8 NIH Toolbox Emotion Fear Short Form 8-17 - Scared easily scale  Scale of participant report of statement: I got scared really easily, in the past 7 days, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17ScaredEasilyScl Recommended CDE

NIH Toolbox Fear Survey SF/FF Ages 8-17 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Fear Short Form 8-17 - Raw score  Raw score, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17RawScore Recommended CDE
2 NIH Toolbox Emotion Fear Short Form 8-17 - Theta score  Theta score, for ages 8-17 as part of the NIH Toolbox Emotion Fear Survey Short Form NIHTBFSF8to17ThetaScore 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