Form Structure: Wechsler Intelligence Scale for Children -Fourth edition (WISC-IV) Block design section
This form structure is an organized set of data definitions for a copyrighted form
Title:
Wechsler Intelligence Scale for Children -Fourth edition (WISC-IV) Block design section
Short Name:
WISCIVBD
Description:
WISC-IV measures a child's intellectual ability. Block Design measures visual-motor coordination. Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition: Technical and interpretive manual. San Antonio, TX: Psychological Corporation. Copyright 2003 by The Psychological Corporation, a Harcourt Assessment Company 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:
2016-06-30
Owner:
Number of Data Elements:
36
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 |
WISC-IV-Block Design 1 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Design 1 score | Score for Design 1, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn1Score | Recommended | CDE |
| 4 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV-Block Designs 2-3 (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 2-3 score | Score for Designs 2-5, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn2to3Score | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV-Block Designs 4-5 (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 4-5 score | Score for Designs 2-5, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn4to5Score | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV-Block Designs 6-8 (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 6-8 score | Score for Design 6-10, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn6to8Score | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV-Block Designs 9-10 (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 9-10 score | Score for Design 6-10, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn9to10Score | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV-Block Designs 11-14 (Appears Up To 4 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Correct block design indicator | Correct design number indicator, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCorrInd | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Designs 11-14 score | Score for Designs 11-14, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgn11to14Score | Recommended | CDE |
| 3 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Completion time | Time to complete, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnCompltTime | Recommended | CDE |
WISC-IV Block Design Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Total raw score | Total raw score, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBlockDesgnTotalRawScore | Recommended | CDE |
| 2 | Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) Block Design Section - Block Design No Time Bonus (BDN) raw score | Block Design No Time Bonus (BDN) raw score, as part of the Wechsler Intelligence Scale For Children- Fourth Edition (WISC-IV) | WISCIVBDNRawScore | Recommended | CDE |
Keywords
