|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
|
|
interview_age |
Integer |
|
Required |
Age in months at the time of the interview/test/sampling/imaging. |
0::1440
|
Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
|
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
|
date_last_visit |
Date |
|
Recommended |
Date of last visit |
|
|
|
Query
|
prof_refer |
Integer |
|
Recommended |
Did a professional refer your child to an "early intervention" or "birth-to-three" program? |
0;1
|
0 = No; 1 = Yes
|
refer_birth_to_three |
Query
|
early_therapy |
Integer |
|
Recommended |
Did your child receive any "early intervention" or "birth to three" program service? |
0;1
|
0 = No; 1 = Yes
|
receive_birth_to_three |
Query
|
community_class |
Integer |
|
Recommended |
Did a professional recommend that your child attend any community based classes/activities? |
0;1
|
0 = No; 1 = Yes
|
recommend_community_classes |
Query
|
participate_class |
Integer |
|
Recommended |
Did your child participate in any classes/activities whether or not recommended by a professional? |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
dev_services |
Integer |
|
Recommended |
Did your child receive services for developmental delays of any kind or concerns about delay? |
0;1
|
0 = No; 1 = Yes
|
receive_services_dev_delays |
Query
|
txhx1occtx1 |
Integer |
|
Recommended |
Did child participate in occupational therapy |
|
0 = No; 1 = Yes
|
occupational_therapy |
|
txhxocctx1start |
Date |
|
Recommended |
occupational therapy start date |
|
|
date_started_occupational_therapy |
Query
|
txhxocctx1ong |
Integer |
|
Recommended |
occupational therapy ongoing? |
|
0 = No; 1 = Yes
|
still_receiving_occupational_therapy |
|
txhxocctx1end |
Date |
|
Recommended |
occupational therapy end date |
|
|
if_no_date_stopped_occupational_therapy |
Query
|
txhxocctx1type |
String |
10
|
Recommended |
occupational therapy type |
Individual; Group
|
|
individual_or_group_occupational_therapy |
Query
|
ot_setting |
String |
200
|
Recommended |
setting of OT |
|
|
setting_occupational_therapy |
|
ot_other |
String |
25
|
Recommended |
Other setting of Occupational Therapy |
|
|
other_setting_occupational_therapy |
Query
|
ot1_week_hrs |
Float |
|
Recommended |
Occupational Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
hours_per_week_occupational_therapy |
Query
|
service_physical |
String |
5
|
Recommended |
Physical Therapy |
Yes; No
|
|
physical_therapy |
|
pt_start |
Date |
|
Recommended |
Date started Physical Therapy: |
|
|
date_started_physical_therapy |
Query
|
pt_ongoing |
Integer |
|
Recommended |
Still receiving Physical Therapy? |
0;1
|
0 = No; 1 = Yes
|
still_receiving_physical_therapy |
|
pt_end |
Date |
|
Recommended |
date subject ended PT |
|
|
date_stopped_physical_therapy |
Query
|
pt_type |
Integer |
|
Recommended |
Individual or Group Physical Therapy? |
0;1
|
0 = Group; 1 = Individual
|
individual_group_physical_therapy |
Query
|
pt_setting |
String |
200
|
Recommended |
setting of PT |
|
|
setting_physical_therapy |
|
pt_other |
String |
25
|
Recommended |
Other setting of Physical Therapy: |
|
|
other_setting_physical_therapy |
Query
|
pt_week_hrs |
Float |
|
Recommended |
Average hours per week at Physical Therapy: |
|
|
hours_per_week_physical_therapy |
Query
|
txhx1speechtx1 |
Integer |
|
Recommended |
Did child participate in speech therapy |
|
0 = No; 1 = Yes
|
speech_language_therapy |
|
txhxspeechtx1start |
Date |
|
Recommended |
speech therapy start date |
|
|
date_started_speech_language |
Query
|
txhxspeechtx1ong |
Integer |
|
Recommended |
speech therapy ongoing? |
|
0 = No; 1 = Yes
|
still_receiving_speech_language_therapy |
|
txhxspeechtx1end |
Date |
|
Recommended |
speech therapy end date |
|
|
date_stopped_speech_language |
Query
|
txhxspeechtx1type |
String |
10
|
Recommended |
speech therapy type |
Individual; Group
|
|
individual_or_group_speech_language |
Query
|
speech_setting |
Integer |
|
Recommended |
Setting of Speech-Lanugage Therapy: |
0::3
|
0 = Daycare/preschool; 1 = Home; 2 = Office/Clinic; 3= Other
|
setting_speech_lanugage_therapy |
|
speech_other |
String |
25
|
Recommended |
Other setting of Speech-Lanugage Therapy |
|
|
other_setting_speech_lanugage_therapy |
Query
|
speech_week_hrs |
Float |
|
Recommended |
Average hours per week at Speech-Language Therapy: |
|
|
hours_per_week_speech_language |
Query
|
cbe_interv |
Integer |
|
Recommended |
Comprehensive Behavioral/Educational Interventions |
0;1
|
0 = No; 1 = Yes
|
comp_behavioral_educational_interventions |
|
cbe_start |
Date |
|
Recommended |
Date Started Comprehensive Behavioral/Educational Interventions |
|
|
date_started_comprehensive_behavioral |
Query
|
cbe_ongoing |
Integer |
|
Recommended |
Still receiving Comprehensive Behavioral/Educational Interventions? |
0;1
|
0 = No; 1 = Yes
|
still_receiving_comprehensive_behavioral |
|
cbe_end |
Date |
|
Recommended |
If, No, date stopped Comprehensive Behavioral/Educational Interventions |
|
|
date_stopped_comprehensive |
Query
|
sbe_type |
Integer |
|
Recommended |
Individual or Group Comprehensive Behavioral/Educational Interventions? |
0;1
|
0 = Group; 1 = Individual
|
individual_or_group_comprehensive_behavioral |
Query
|
cbe_setting |
Integer |
|
Recommended |
Setting of Comprehensive Behavioral/Educational Interventions |
0::3
|
0 = Daycare/preschool; 1 = Home; 2 = Office/Clinic; 3= Other
|
setting_comprehensive_behavioral |
|
cbe_other |
String |
25
|
Recommended |
Other setting of Comprehensive Behavioral/Educational Interventions |
|
|
other_setting_comprehensive_behavioral |
Query
|
cbe_week_hrs |
Float |
|
Recommended |
Average hours per week at Comprehensive Behavioral/Educational Interventions: |
|
|
average_hours_per_week_comp_behavioral |
Query
|
other_intervention |
Integer |
|
Recommended |
Other Intervention |
0;1
|
0 = No; 1 = Yes
|
|
|
other_start |
Date |
|
Recommended |
date subject began other therapy |
|
|
date_started_other_intervention |
Query
|
other_ongoing |
Integer |
|
Recommended |
Still receiving Other Intervention? |
0;1
|
0 = No; 1 = Yes
|
still_receiving_other_intervention |
|
other_end |
Date |
|
Recommended |
date subject ended other therapy |
|
|
if_no_date_stopped_other_intervention |
Query
|
othertherapy1_group_ind |
String |
50
|
Recommended |
Other Therapy Occurrence 1: For the following intervention, how was it provided? |
Individual;Group;Both
|
|
individual_or_group_other_intervention |
|
other_setting |
String |
200
|
Recommended |
setting of other therapy |
|
|
setting_other_intervention |
|
other_other |
String |
50
|
Recommended |
Other Setting of Other Intervention: |
|
|
other_setting_other_intervention |
Query
|
othertherapy1_week_hrs |
Float |
|
Recommended |
Other Therapy Occurrence 1:For the following intervention, how many hours per week were provided? |
|
|
average_hours_per_week_other_intervention |
Query
|
intervention_average |
Float |
|
Recommended |
On average, how many hours per week has your child been in intervention since your last visit to our research program? |
|
|
hours_per_week_since_last_visit |
Query
|
intervention_average_year |
Float |
|
Recommended |
On average, how many hours per week has your child been in intervention in the past year? |
|
|
hours_per_week_in_past_year |
Query
|
alternative_therapies |
Integer |
|
Recommended |
Did your child receive complementory or alternative therapies used to treat symptoms of autism? |
0;1
|
0 = No; 1 = Yes
|
receive_alternative_therapies |
Query
|
alternative_specify |
String |
50
|
Recommended |
If Yes, please specify: |
|
|
please_specify_alternative_therapy |
Query
|
pharma_int |
Integer |
|
Recommended |
8. Did your child receive medical or pharmacological interventions? |
0;1
|
0 = No; 1 = Yes
|
medical_pharmacological_intervention |
|
pharma_specify |
String |
50
|
Recommended |
If, Yes, please specify: |
|
|
specify_pharm_intervention |
Query
|
assess_36m |
Integer |
|
Recommended |
Is this your child's 36-month assessment? |
0;1
|
0 = No; 1 = Yes
|
this_your_childs_36_month_assessment |
Query
|
intervention_plan |
Integer |
|
Recommended |
Do you plan to continue your child's enrollment in intervention during the next year? |
0;1
|
0 = No; 1 = Yes
|
plan_continue_childs_enrollment_intervention |
|
future_intervention |
String |
100
|
Recommended |
Plan to continue following interventions |
|
|
|
Query
|
program_week_hrs |
Float |
|
Recommended |
Average hours per week (of early intervention or birth to three programs). |
|
|
average_hours_per_week |
Query
|
total_hrs |
Float |
|
Recommended |
Total hours since last visit (of early intervention or birth to three programs). |
|
|
total_hours_since_last_visit |
|
comments_misc |
String |
4,000
|
Recommended |
Miscellaneous comments on study, interview, methodology relevant to this form data |
|
|
anything_tell_us_about_services |