Form Structure: Beery-Buktenica Developmental Test
This form structure is an organized set of data definitions for a copyrighted form
Title:
Beery-Buktenica Developmental Test
Short Name:
BBDT
Description:
The Beery-Buktenica Developmental Test (of Visual-Motor Integration, Visual Perception, and/or Motor Coordinatio) is a developmental sequence of geometric forms to be copied with paper and pencil. The BBDT is designed to assess the extent to which individuals can integrate their visual and motor abilities (eye-hand coordination). Copyright 1967, 1982, 1989, 1997, 2004, 2006 (Adults), 2010 Keith E. Beery and Natasha A. Beery. All rights reserved. Published and distributed exclusively by NCS Pearson, Inc.
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:
2016-12-21
Owner:
Number of Data Elements:
69
eForms:
N
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 |
BBDTVMI Chronological Age (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Age derived value | The calculation of age based on the equation of Date of Event-Date of Birth. | AgeDerivedVal | Recommended | UDE |
BBDTVMI Items 1-3 (Appears Up To 4 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test-Task or form text | Task or form text , as part of Beery-Buktenica Developmental Test | BBDTTaskOrFormTxt | Recommended | CDE |
| 3 | Image response file | The image used to obtain the subject response. | ImageResponse | Recommended | CDE |
| 4 |
Beery-Buktenica Developmental Test-Item score
(Draft) |
Item score , as part of Beery-Buktenica Developmental Test | BBDTItmScore | Recommended | UDE |
| 5 | Beery-Buktenica Developmental Test-Marked box type | Marked box type , as part of Beery-Buktenica Developmental Test | BBDTMarkedBoxTyp | Recommended | CDE |
| 6 |
Beery-Buktenica Developmental Test-Mark spontaneity type
(Draft) |
Mark spontaneity type , as part of Beery-Buktenica Developmental Test | BBDTMarkSponTyp | Recommended | UDE |
| 7 | Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value | Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration | BBDTVMIAgeNormVal | Recommended | CDE |
| 8 |
Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text
(Draft) |
Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMIObsTxt | Recommended | UDE |
| 9 | Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMITotalRawScore | Recommended | CDE |
BBDTVMI Items 1-6 (Appears Up To 7 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test-Task or form text | Task or form text , as part of Beery-Buktenica Developmental Test | BBDTTaskOrFormTxt | Recommended | CDE |
| 3 |
Beery-Buktenica Developmental Test-Item score
(Draft) |
Item score , as part of Beery-Buktenica Developmental Test | BBDTItmScore | Recommended | UDE |
| 4 | Image response file | The image used to obtain the subject response. | ImageResponse | Recommended | CDE |
| 5 | Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value | Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration | BBDTVMIAgeNormVal | Recommended | CDE |
| 6 |
Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text
(Draft) |
Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMIObsTxt | Recommended | UDE |
| 7 | Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMITotalRawScore | Recommended | CDE |
BBDTVMI Items 7-30 (Appears Up To 24 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test-Task or form text | Task or form text , as part of Beery-Buktenica Developmental Test | BBDTTaskOrFormTxt | Recommended | CDE |
| 3 |
Beery-Buktenica Developmental Test-Item score
(Draft) |
Item score , as part of Beery-Buktenica Developmental Test | BBDTItmScore | Recommended | UDE |
| 4 | Image response file | The image used to obtain the subject response. | ImageResponse | Recommended | CDE |
| 5 | Beery-Buktenica Developmental Test of Visual-Motor Integration-Age norm value | Age norm value , as part of Beery-Buktenica Developmental Test of Visual-Motor Integration | BBDTVMIAgeNormVal | Recommended | CDE |
| 6 |
Beery-Buktenica Developmental Test of Visual Motor Integration-Observation text
(Draft) |
Observation text , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMIObsTxt | Recommended | UDE |
| 7 | Beery-Buktenica Developmental Test of Visual Motor Integration-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Visual Motor Integration | BBDTVMITotalRawScore | Recommended | CDE |
BBDTVP (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 |
Beery-Buktenica Developmental Test of Visual Perception-Item 1 type
(Draft) |
Item 1 type , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPItm1Typ | Recommended | UDE |
| 2 |
Beery-Buktenica Developmental Test of Visual Perception-Item 2 type
(Draft) |
Item 2 type , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPItm2Typ | Recommended | UDE |
| 3 |
Beery-Buktenica Developmental Test of Visual Perception-Item 3 type
(Draft) |
Item 3 type , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPItm3Typ | Recommended | UDE |
| 4 | Beery-Buktenica Developmental Test of Visual Perception-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPTotalRawScore | Recommended | CDE |
BBDTVP Items 4 to 6 (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test-Task or form text | Task or form text , as part of Beery-Buktenica Developmental Test | BBDTTaskOrFormTxt | Recommended | CDE |
| 2 |
Beery-Buktenica Developmental Test of Visual Perception-Correct indicator
(Draft) |
Correct indicator , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPCrrctInd | Recommended | UDE |
| 3 |
Beery-Buktenica Developmental Test of Visual Perception-Item figure score
(Draft) |
Item figure score , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPItmFigScore | Recommended | UDE |
BBDTVP Items 7 to 30 (Appears Up To 24 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test-Task or form text | Task or form text , as part of Beery-Buktenica Developmental Test | BBDTTaskOrFormTxt | Recommended | CDE |
| 2 |
Beery-Buktenica Developmental Test of Visual Perception-Correct indicator
(Draft) |
Correct indicator , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPCrrctInd | Recommended | UDE |
| 3 |
Beery-Buktenica Developmental Test of Visual Perception-Item figure score
(Draft) |
Item figure score , as part of Beery-Buktenica Developmental Test of Visual Perception | BBDTVPItmFigScore | Recommended | UDE |
BBDTMC Items 1-3 (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test of Motor Coordination-Item text | Item text , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCItmTxt | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator | Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCCrrctInd | Recommended | CDE |
| 3 | Beery-Buktenica Developmental Test of Motor Coordination-Item score | Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCItmScore | Recommended | CDE |
| 4 | Beery-Buktenica Developmental Test of Motor Coordination-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCTotalRawScore | Recommended | CDE |
BBDTMC Items 4A-6B (Appears Up To 6 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator | Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCCrrctInd | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test of Motor Coordination-Item score | Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCItmScore | Recommended | CDE |
| 3 | Beery-Buktenica Developmental Test of Motor Coordination-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCTotalRawScore | Recommended | CDE |
BBDTMC Items 7-30 (Appears Up To 24 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test of Motor Coordination-Correct indicator | Correct indicator , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCCrrctInd | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test of Motor Coordination-Item score | Item score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCItmScore | Recommended | CDE |
| 3 | Beery-Buktenica Developmental Test of Motor Coordination-Total raw score | Total raw score , as part of Beery-Buktenica Developmental Test of Motor Coordination | BBDTMCTotalRawScore | Recommended | CDE |
BBDT Summary Comments and Recommendations (Appears Up To 5 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test-Abilities type | Abilities type , as part of Beery-Buktenica Developmental Test | BBDTAbilitiesTyp | Recommended | CDE |
| 2 |
Beery-Buktenica Developmental Test-Summary comments and recommendations text
(Draft) |
Summary comments and recommendations text , as part of Beery-Buktenica Developmental Test | BBDTSummCommentsAndRecTxt | Recommended | UDE |
BBDT Actions Taken and Progress Text (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test-Actions taken text | Actions taken text , as part of Beery-Buktenica Developmental Test | BBDTActionsTakenTxt | Recommended | CDE |
| 2 | Beery-Buktenica Developmental Test-Progress text | Progress text , as part of Beery-Buktenica Developmental Test | BBDTProgressTxt | Recommended | CDE |
BBDT Summary Scoring (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Beery-Buktenica Developmental Test-Summary score type | Summary score type , as part of Beery-Buktenica Developmental Test | BBDTSummScoreTyp | Recommended | CDE |
| 2 |
Beery-Buktenica Developmental Test-Standard score
(Draft) |
Standard score , as part of Beery-Buktenica Developmental Test | BBDTStandardScore | Recommended | UDE |
| 3 |
Beery-Buktenica Developmental Test-Scaled score
(Draft) |
Scaled score , as part of Beery-Buktenica Developmental Test | BBDTScaledScore | Recommended | UDE |
| 4 | Beery-Buktenica Developmental Test-Percentiles value | Percentiles value , as part of Beery-Buktenica Developmental Test | BBDTPercentilesVal | Recommended | CDE |
| 5 | Beery-Buktenica Developmental Test-Other scaling score | Other scaling score , as part of Beery-Buktenica Developmental Test | BBDTOTHScalingScore | Recommended | CDE |
| 6 |
Beery-Buktenica Developmental Test-Comments and recommendations text
(Draft) |
Comments and recommendations text , as part of Beery-Buktenica Developmental Test | BBDTCommentsAndRecTxt | Recommended | UDE |
Keywords
