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Form Structure: NIH Toolbox Emotion Domain Specific Life Satisfaction Survey Parent Report Ages 3-7

This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Emotion Domain Specific Life Satisfaction Survey Parent Report Ages 3-7
Short Name:
NIHTBDomnSpfcLFStsfnPR3to7
Description:
The NIH Toolbox Domain­-Specific Life Satisfaction Survey is a supplemental self­-report measure that assesses feelings and attitudes about specific domains of one's life (e.g., family, health, work, leisure). A 13-item fixed-length form is used for adults, and 7­‐item fixed-­length forms are used for ages 8-12 and 13-17, as well as for the Parent-Report versions for ages 3-7 and 8-12. 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:
2016-08-02
Owner:
Number of Data Elements:
31
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.

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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 NIHTBTestDomainBattryTyp 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 type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE
9 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

NIH Toolbox Domain Specific Life Satifn Parent Rpt 3-7 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Hobbies score  Score for parent's report of child's satisfaction with their hobbies and free time activities, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRHobbiesScore Recommended CDE
2 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Clothes score  Score for parent's report of child's satisfaction with their clothes, games, toys, and other things they have, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRClothesScore Recommended CDE
3 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Attention from parent score  Score for parent's report of child's satisfaction with the attention they get from their parents, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRAttentnParentScore Recommended CDE
4 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Friends score  Score for parent's report of child's satisfaction with the friends they have, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRFriendsScore Recommended CDE
5 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Size and appearance score  Score for parent's report of child's satisfaction with their size and appearance, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRSizeAppearncScore Recommended CDE
6 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Skills and talents score  Score for parent's report of child's satisfaction with their skills and talents, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRSkillsTalentsScore Recommended CDE
7 NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report - Neighborhood score  Score for parent's report of child's satisfaction with the neighborhood and community they live in, as part of the NIH Toolbox Emotion Domain Psychological Well-Being Subdomain Domain-Specific Life Satisfaction Survey Parent Report NIHTBDSLSSPRNeighborhoodScore Recommended CDE
Keywords

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