Form Structure: NIH Toolbox Emotion Domain Sibling Rejection Survey Ages 3-12
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Emotion Domain Sibling Rejection Survey Ages 3-12
Short Name:
NIHTBSiblingRejection3to12
Description:
As an analogue to the NIH Toolbox Perceived Rejection Survey, the NIH Toolbox Sibling Rejection Survey is a supplemental parent-report measure for children ages 3-12. It is a 9-item fixed-length form that assesses how often a child is left out, avoided, or teased by siblings. 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:
2016-07-15
Owner:
Number of Data Elements:
39
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 Sibling Rejection Survey Ages 3-12 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Left out by siblings scale | Scale for when the participant is left out by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSLeftOutBySibsScl | Recommended | CDE |
| 2 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Siblings refuse to play with them scale | Scale for when the siblings refuse to play with the participant, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSSibsRefusePlayChldScl | Recommended | CDE |
| 3 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Not chosen as a playmate by siblings scale | Scale for when the participant is not chosen as a playmate by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSNoChosenPlaymtSibsScl | Recommended | CDE |
| 4 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Rejected by siblings scale | Scale for when the participant is actively rejected by siblings who refuse to play with them, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSRejectBySibsScl | Recommended | CDE |
| 5 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Avoided by siblings scale | Scale for when the participant is avoided by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSAvoidBySibsScl | Recommended | CDE |
| 6 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Not liked by siblings scale | Scale for when the participant is not well liked by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSNoLikedBySibsScl | Recommended | CDE |
| 7 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Picked on by siblings scale | Scale for when the participant is picked on by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSPickOnBySibsScl | Recommended | CDE |
| 8 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Teased by siblings scale | Scale for when the participant is teased and made fun of by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSTeasedBySibsScl | Recommended | CDE |
| 9 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Pushed by siblings scale | Scale for when the participant is pushed or shoved around by siblings, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSPushedBySibsScl | Recommended | CDE |
NIH Toolbox Sibling Rejection Survey Ages 3-12 Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey - Raw score | Raw score, as part of the NIH Toolbox Emotion Domain Social Relationships Subdomain Social Distress Measure Sibling Rejection Survey | NIHTBSRSRawScore | 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
