Form Structure: Tests for Auditory Processing Disorders for Children (SCAN-3:C)-Screening
This form structure is an organized set of data definitions for a copyrighted form
Title:
Tests for Auditory Processing Disorders for Children (SCAN-3:C)-Screening
Short Name:
SCAN3CScreening
Description:
SCAN3-C is designed to identify auditory processing disorders in children. Use this table to record and compare scores to pass criteria for Gap Detection, Auditory Figure-Ground +8 dB, and Competing Words–Free Recall. Keith, R. W. (2009). SCAN-3 for Children: Test for Auditory Processing Disorders. Pearson. Copyright 2009, 2000 NCS Pearson, Inc. http://www.pearsonclinical.com/
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-08-25
Owner:
Number of Data Elements:
22
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 (Repeat Infinitely)
| # | 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 |
SCAN-3C Pure Tone Results (Appears Up To 6 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type | Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTEarTyp | Recommended | CDE |
| 2 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Pure tone frequency | Pure tone frequency in Hz used to check both ears' status regarding sensing pure tone with different frequencies, as part of SCAN-3 for children (SCAN-3C) | SCAN3CPureToneFreq | Recommended | CDE |
| 3 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Pure tone results status | Status regarding pure tone results, as part of SCAN-3 for children (SCAN-3C) | SCAN3CPureToneResultsStat | Recommended | CDE |
SCAN-3C Screening Criteria (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Gap detection meets criterion indicator | Indicates whether the subject meets pass criterion for Gap Detection, as part of SCAN-3 for children (SCAN-3C) | SCAN3CGapDetectionMeetsCritInd | Recommended | CDE |
| 2 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Auditory Figure - Ground +8 meets criterion indicator | Indicates whether the subject meets pass criterion for Auditory Figure-Ground +8, as part of SCAN-3 for children (SCAN-3C) | SCAN3CAFG8MeetsCritInd | Recommended | CDE |
| 3 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Competing Words-Free Recall meets criterion indicator | Indicates whether the subject meets pass criterion for Competing Words-Free Recall, as part of SCAN-3 for children (SCAN-3C) | SCAN3CCWFRMeetsCritInd | Recommended | CDE |
| 4 | SCAN-3:C Tests for Auditory Processing Disorders for Children - Screening criterion status | Status regarding whether or not the scores pass criteria for Gap Detection, Auditory Figure-Ground plus 8 dB and Competing Words-Free Recall, as part of SCAN-3 for children (SCAN-3C) | SCAN3CScreeningCritStat | Recommended | CDE |
Keywords
