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

 General Details

Title:
NIH ToolBox Emotion Domain Fear Survey Parent Report CAT Ages 8-12
Short Name:
NIHTBFearSvyPrtRptCAT8to12
Description:
The parent-report version for ages 8-12 uses a CAT format. 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
Disease:
Traumatic Brain Injury , 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:
2016-06-23
Owner:
Number of Data Elements:
40
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 Parent Report CAT Ages 8-12 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Liking scale  Scale of parent report of statement: My child worries about other people liking him/her, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12LikingScl Recommended CDE
2 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worry already scale  Scale of parent report of statement: My child worries about things that have already happened, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrryAlrdyScl Recommended CDE
3 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - nervous scale  Scale of parent report of statement: My child is nervous, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12NervousScl Recommended CDE
4 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worry other kids scale  Scale of parent report of statement: My child worries about being as good as other kids, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrryOthrKdsScl Recommended CDE
5 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worry school scale  Scale of parent report of statement: My child worries about going to school, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrrySchoolScl Recommended CDE
6 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worry working scale  Scale of parent report of statement: My child worries about things working out for him/her, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrryWrkngScl Recommended CDE
7 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worrier scale  Scale of parent report of statement: My child is a worrier, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WorrierScl Recommended CDE
8 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worries scale  Scale of parent report of statement People tell me that my child worries too much, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WorriesScl Recommended CDE
9 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worries furture scale  Scale of parent report of statement: My chid worries about what is going to happen in the future, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrrsFtrScl Recommended CDE
10 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Worries well scale  Scale of parent report of statement: My chid worries about how well he/she does things, for children ages 8-12, as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12WrrsWellScl Recommended CDE

NIH Toolbox Fear Parent Report CAT Ages 8-12 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Raw score  Raw Score, for children ages 8 to 12 as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12RawScore Recommended CDE
2 NIH Toolbox Emotion Domain Fear Parent Report CAT 8 to 12 - Theta score  Theta Score, for children ages 8 to 12 as part of the NIH Toolbox Emotion Fear Parent Report CAT NIHTBFPRCAT8to12ThetaScore 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