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Form Structure: NIH Toolbox Emotion Domain Maternal Relationship Survey Ages 8-17

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
NIH Toolbox Emotion Domain Maternal Relationship Survey Ages 8-17
Short Name:
NIHTBMaternalReltnshp8to17
Description:
The NIH Toolbox Maternal Relationship Survey is a supplemental, self-report measure for children and adolescents ages 8-17. It is a 3-item fixed-length survey assessing the perceived quality of a child or adolescent's relationship with his/her mother in terms of an affective feeling of 'closeness' and meaningful time spent together. It may be administered with the parallel Paternal Relationship Survey. 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:
2016-07-15
Owner:
Number of Data Elements:
33
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 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
10 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

NIH Toolbox Maternal Relationship Survey Ages 8-17 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey - Do enjoyable things with mom scale  Scale of doing things together with their mother that they enjoy, for ages 8-17 as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey NIHTBMRSDoEnjoyThingsMomScl Recommended CDE
2 NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey - Share ideas with mom scale  Scale of sharing idea and talking about things that really matter with their mother, for ages 8-17 as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey NIHTBMRSShareIdeasMomScl Recommended CDE
3 NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey - Feel close to mom scale  Scale for how close they feel to their mother, for ages 8-17 as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey NIHTBMRSFeelCloseMomScl Recommended CDE

NIH Toolbox Maternal Relationship Survey 8-17 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey - Raw score  Raw score, for ages 8-17 as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Perceived Social Support Measure Maternal Relationship Survey NIHTBMRSRawScore 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
Keywords