Form Structure: NIH Toolbox Emotion Domain Emotion Control Survey Parent Report Ages 8-12
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Emotion Domain Emotion Control Survey Parent Report Ages 8-12
Short Name:
NIHTBEmotinCtrlPrtRpt8to12
Description:
The NIH Toolbox Emotion Control Survey is a supplemental measure that includes self-report versions for ages 8-17 as well as a parent-report version for ages 8-12. It is a 10-item fixed-length form that assesses the ability to control the frequency and intensity of both positive and negative emotion when it occurs. 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)
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:
2016-07-21
Owner:
Number of Data Elements:
40
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 |
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 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 Emotion Control Survey Prt Rpt 8-12 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could control frequency of feeling excited scale | Scale for parent report of child being in control of how often they felt excited in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12CtrlFreqFelExctScl | Recommended | CDE |
| 2 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could control frequency of feeling happy scale | Scale for parent report of child being in control of how often they felt happy in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12CtrlFreqFelHapyScl | Recommended | CDE |
| 3 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could control frequency of feeling mad scale | Scale for parent report of child being in control of how often they felt mad in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12CtrlFreqFeelMadScl | Recommended | CDE |
| 4 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could control frequency of feeling sad scale | Scale for parent report of child being in control of how often they felt sad in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12CtrlFreqFeelSadScl | Recommended | CDE |
| 5 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could control frequency of feeling scared scale | Scale for parent report of child being in control of how often they felt scared in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12CtrlFreqFelScarScl | Recommended | CDE |
| 6 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could change or control excitement scale | Scale for parent report of child being able to control or change how excited they felt, when they were excited in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12ChngCtrlExciteScl | Recommended | CDE |
| 7 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could change or control happiness scale | Scale for parent report of child being able to control or change how happy they felt, when they were happy in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12ChngCtrlHappyScl | Recommended | CDE |
| 8 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could change or control anger scale | Scale for parent report of child being able to control or change how mad they felt, when they were mad in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12ChngCtrlMadScl | Recommended | CDE |
| 9 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could change or control sadness scale | Scale for parent report of child being able to control or change how sad they felt, when they were sad in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12ChngCtrlSadScl | Recommended | CDE |
| 10 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Child could change or control fright scale | Scale for parent report of child being able to control or change how scared they felt, when they were scared in the past 3 months, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12ChngCtrlFrightScl | Recommended | CDE |
NIH Toolbox Emotion Control Survey Prt Rpt 8-12 Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) - Raw score | Raw score, as part of the NIH Toolbox Emotion Domain Emotion Control Survey (Age 8-12) | NIHTBEC8to12RawScore | Recommended | CDE |
| 2 | 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, including iPad app | NIHTBPROAgeAdjSclScore | Recommended | CDE |
| 3 | 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, including iPad app | NIHTBPROAgeAdjNationalPctVal | Recommended | CDE |
| 4 | 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, including iPad app | NIHTBPROFullyAdjSclScore | Recommended | CDE |
| 5 | NIH Toolbox Patient Reported Outcome (PRO) Measures - Unadjusted scale score | Unadjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures, including iPad app | NIHTBPROUnadjSclScore | Recommended | CDE |
| 6 | NIH Toolbox - Standard error | Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. | NIHTBStandardError | Optional | CDE |
Keywords
