National Database for Autism Research
Short Name: csbs_dp
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CSBS DP Caregiver Questionnaire

CSBS DP Caregiver Questionnaire. Provided by Dr. A.Thurm

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ElementName DataType Size Required Condition ElementDescription ValueRange Notes
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for subjects which identifies a subject in NDAR NDAR*
src_subject_id String 20 Required The site or study's subject identification
interview_date Date Required Date on which the interview/genetic test/sampling/imaging was completed Required field
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0 :: 1200 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
gender String 50 Required Gender M; F
birth_premature String 20 Recommended Was birth premature? Yes; No
premature_weeks Integer Conditional #birth_premature=Yes Weeks premature 0 is full term
respond_detail Integer Recommended Respondent detail (if available on form version) Options include "1 = Mother; 2 = Father; 3 = Other Relative or custodial adult; 4 = Teacher or caregiver; 5 = Other specialist; 6 = Other; 7 = Child; 999 = Not Available 1; 2; 3; 4; 5; 6; 7; 999
emotion_eyegaze_q2 String 50 Recommended When your child is playing with a toy, does he/she look at you and then back at the toy? Not yet; Sometimes; Often
emotion_eyegaze_q3 String 50 Recommended If you look at and point to a toy out of your child's reach, does your child look at the toy? Not yet; Sometimes; Often
emotion_eyegaze_q1 String 50 Recommended When your child is happy, does he/she smile or laugh and look at you at the same time? Not yet; Sometimes; Often
emotion_eyegaze_q4 String 50 Recommended When your child is upset or frustrated, does he/she express this clearly with facial expression, sounds, or words? Not yet; Sometimes; Often
emotion_eyegaze_q5 String 50 Recommended How often does your child get upset or frustrated each day? Not yet; Sometimes; Often
emotion_eyegaze_q6 String 50 Recommended When your child is upset, does he/she calm down easily (within a few minutes)? Not yet; Sometimes; Often
emotion_eyegaze_q7 String 50 Recommended When you are with your child, is your child comfortable interacting with unfamiliar people or new situations? Not yet; Sometimes; Often
emotion_eyegaze_q8 String 50 Recommended When your child is afraid, does he/she seek comfort from you? Not yet; Sometimes; Often
communicat_q9 String 50 Recommended Does your child clearly let you know when he/she needs help (for example, wants you to open a container)? Not yet; Sometimes; Often
communicat_q10 String 50 Recommended Does your child clearly let you know when he/she wants an object that is out of reach? Not yet; Sometimes; Often
communicat_q11 String 50 Recommended Does your child let you know that he/she does not want something that you are offering him/her? Not yet; Sometimes; Often
communicat_q12 String 50 Recommended Does your child greet you when you come in the room or leave? Not yet; Sometimes; Often
communicat_q13 String 50 Recommended Does your child reach out to give you a hug or kiss? Not yet; Sometimes; Often
communicat_q14 String 50 Recommended Does your child try to get your attention when you are busy doing something, such as when you are talking with an adult or preparing a meal? Not yet; Sometimes; Often
communicat_q15 String 50 Recommended If your child does something that is funny and you laugh, does your child do it again for the attention? Not yet; Sometimes; Often
communicat_q16 String 50 Recommended Does your child try to get you to notice interesting objects, not to get you to do anything with them, but just to get you to look at them (for example, show you an object or point to a picture in a book)? Not yet; Sometimes; Often
communicat_q17 String 50 Recommended Does your child try to draw your attention to exciting or unexpected things, such as a pop-up toy or something falling down? Not yet; Sometimes; Often
communicat_q18 String 50 Recommended If you can't figure out what your child is trying to communicate, does your child try again or use a different way to get his/her meaning across? Not yet; Sometimes; Often
gestures_q19 String 50 Recommended Does your child use gestures that are easily understood by others, such as giving objects, showing objects, pointing, and waving? Not yet; Sometimes; Often
gestures_q20a String 50 Recommended Which of the following gestures have you seen your child use? give an object to you Yes; No
gestures_q20b String 50 Recommended Which of the following gestures have you seen your child use? show an object to you {i.e., by extending arm but not releasing object) Yes; No
gestures_q20c String 50 Recommended Which of the following gestures have you seen your child use? push an object away Yes; No
gestures_q20d String 50 Recommended Which of the following gestures have you seen your child use? raise arms to be picked up Yes; No
gestures_q20e String 50 Recommended Which of the following gestures have you seen your child use? reach with an open hand toward an object Yes; No
gestures_q20f String 50 Recommended Which of the following gestures have you seen your child use? wave "hi" or "bye bye Yes; No
gestures_q20g String 50 Recommended Which of the following gestures have you seen your child use? point to an object or a picture that is within reach Yes; No
gestures_q20h String 50 Recommended Which of the following gestures have you seen your child use? point to an object or a picture out of reach Yes; No
gestures_q20i String 50 Recommended Which of the following gestures have you seen your child use? shake head to indicate "no Yes; No
gestures_q20k String 50 Recommended Which of the following gestures have you seen your child use? nod head to indicate "yes Yes; No
sounds_q21 String 50 Recommended Does your child use sounds to communicate both pleasure and discomfort? Not yet; Sometimes; Often
sounds_q22 String 50 Recommended Children use sounds to communicate in vocal play before they use sounds in words. Does your child use a variety of different consonant sounds, such as ba, ga ta and da either in vocal play or in words? Not yet; Sometimes; Often
sounds_q23 String 50 Conditional sounds_q22!=Not yet If so, which of the following sounds have you heard your child use, either in vocal play or in words? m; n; b; d; g; w; l; y; s; sh /m/as in "mamamama" or "mama" or "moo" /n/ as in "nununu" or "no no" /b/ as in "babababa" or "bibo" or "boo" or "bye bye" /d/as in "dodododo" or "daddy" /g/ as in "googoo" or "gone gone" /w/ as in "woowoo" or "weewee" or "wagon" /I/ as in "lalala" or "balloon" or "little" /y/ as in "yayaya" or "yum yum" or "you" /s/as in "sasasa" or "sock" or "kiss" /sh/ as in "shashasha" or "hush" or "shoe"
sounds_q24 String 50 Recommended Does your child put sounds together, either in vocal play or words (for example, "baba", "mamama", "dada","bye bye")? Not yet; Sometimes; Often
words_q25 String 50 Recommended Does your child use words to communicate that are understandable to you? Not yet; Sometimes; Often
words_q26 String 50 Conditional #words_q25!=Not yet If so, which of the following words have you heard your child use (include approximations that you recognize, such as "nana" for banana or "baba" for bottle)? mommy; daddy; baby; dog; kitty; bird; duck; eye; nose; moo; woof; grr; peekaboo; bye bye; no; hi; all gone; uhoh; night night; outside; yum yum; vroom; ouch; up; bottle; banana; ball; bath; book; car; cookie; juice; sock; keys; balloon; truck mommy;daddy;baby;dog;kitty;bird;duck;eye;nose;moo;woof;grr (animal noise);peekaboo;bye bye;no;hi;all gone;uhoh;night night;outside;yum yum;vroom;ouch;up;bottle;banana;ball;bath;book;car;cookie;juice;sock;keys;balloon;truck
words_q27 String 50 Recommended Does your child use words that are understandable to unfamiliar adults? Not yet; Sometimes; Often
words_q28 String 50 Recommended Does your child put two or more words together (for example, more cookie, daddy car, bye bye kitty)? Not yet; Sometimes; Often
understanding_q29 String 50 Recommended Does your child respond when you call his/her name (for example, by looking/turning head)? Not yet; Sometimes; Often
understanding_q30 String 50 Recommended Does your child respond appropriately to gestures (for example, giving you an object when you say "give it to me" while holding out your hand or while pointing to the object)? Not yet; Sometimes; Often
understanding_q31 String 50 Recommended Does your child understand words or short phrases when you use only words and do not use gestures? Not yet; Sometimes; Often
understanding_q32 String 50 Conditional #understanding_q31!=Not yet If so, which of the following words does your child understand without gestures (i.e., if you say the word, your child will find the object or carry out the action)? mommy; daddy; child's name; baby; kitty; dog; bird; nose; eyes; tummy; foot; hair; peekaboo; bye bye; no; hi; all gone; uh oh; night night; outside; eat; drink; hug; bite; bottle; bath; ball; book; diaper; car; juice; shoe; cup; keys; ballon; trucks mommy; daddy; child's name; baby; kitty; dog; bird; nose; eyes; tummy; foot; hair; peekaboo; bye bye; no; hi; all gone; uh oh; night night; outside; eat; drink; hug; bite; bottle; bath; ball; book; diaper; car; juice; shoe; cup; keys; ballon; trucks
object_use_q33 String 50 Recommended Does your child show interest in playing with a variety of objects? Not yet; Sometimes; Often
object_use_q34 String 50 Recommended Does your child use a variety of common objects appropriately (for example, comb, spoon, toothbrush)? Not yet; Sometimes; Often
object_use_q35a String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? drink with a cup or bottle Yes; No
object_use_q35b String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? comb or brush hair Yes; No
object_use_q35c String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? feed self with a spoon Yes; No
object_use_q35d String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? stir with a spoon Yes; No
object_use_q35e String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? pour with cup or bowl Yes; No
object_use_q35f String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? brush teeth Yes; No
object_use_q35g String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? wash or wipe face with cloth Yes; No
object_use_q35h String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? roll or throw a ball Yes; No
object_use_q35i String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? push a toy vehicle Yes; No
object_use_q35k String 50 Conditional #object_use_q34!=Not yet If so, which of the following actions have you seen your child do with objects? put toy telephone to ear Yes; No
object_use_q36 String 50 Recommended Does your child pretend to play with toys (for example, feed a stuffed animal, put a baby doll to sleep, put an animal figure in a vehicle)? Not yet; Sometimes; Often
object_use_q37a String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? feed with a spoon Yes; No
object_use_q37b String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? drink with a cup or bottle Yes; No
object_use_q37c String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? comb or brush hair Yes; No
object_use_q37d String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? cover with blanket Yes; No
object_use_q37e String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? wash or wipe face with cloth Yes; No
object_use_q37f String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? brush teeth with toothbrush Yes; No
object_use_q37g String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? put on diaper Yes; No
object_use_q37h String 50 Conditional #object_use_q36!=Not yet If so, which of the following actions have you seen your child do when playing with another person, a stuffed animal, or a doll? hug or kiss Yes; No
object_use_q38 String 50 Recommended Does your child pretend by putting two or more actions together in a sequence, such as stirring food and feeding doll or washing doll's face and covering doll with a blanket? Not yet; Sometimes; Often
object_use_q39 String 50 Recommended Does your child build or arrange toy objects (for example, build a tower of blocks, stack rings, put puzzle pieces together)? Not yet; Sometimes; Often
object_use_q40a String 50 Recommended Which of these actions have you seen your child do? take blocks out of container Yes; No
object_use_q40b String 50 Recommended Which of these actions have you seen your child do? put blocks in container Yes; No
object_use_q40c String 50 Recommended Which of these actions have you seen your child do? build a tower of blocks Yes; No
object_use_q40d String 50 Recommended Which of these actions have you seen your child do? put puzzle pieces together Yes; No
object_use_q40e String 50 Recommended Which of these actions have you seen your child do? stack rings on ring stacker without regard for order Yes; No
object_use_q40f String 50 Recommended Which of these actions have you seen your child do? put rings on ring stacker in order Yes; No
object_use_q40g String 50 Recommended Which of these actions have you seen your child do? hold crayon or marker and scribble on paper Yes; No
object_use_q40h String 50 Recommended Which of these actions have you seen your child do? draw shapes or patterns on paper Yes; No
object_use_q40i String 50 Recommended Which of these actions have you seen your child do? squeeze and bang playdough Yes; No
object_use_q40k String 50 Recommended Which of these actions have you seen your child do? make shapes with playdough, such as hot dogs or pancakes Yes; No
object_use_q41a String 50 Recommended Which of these actions have you seen your child do with books? turn pages Yes; No
object_use_q41b String 50 Recommended Which of these actions have you seen your child do with books? look at pictures Yes; No
object_use_q41c String 50 Recommended Which of these actions have you seen your child do with books? look at pictures and then look at you Yes; No
object_use_q41d String 50 Recommended Which of these actions have you seen your child do with books? point to pictures without being asked Yes; No
object_use_q41e String 50 Recommended Which of these actions have you seen your child do with books? point to pictures when asked Yes; No
object_use_q41g String 50 Recommended Which of these actions have you seen your child do with books? label pictures Yes; No
additional_q42 String 255 Recommended How has your child's communication changed over the past few months?
additional_q43 String 255 Recommended List a few strengths or assets you observe in your child.
additional_q44 String 255 Recommended List any concerns you have about your child's development.
additional_q45 String 255 Recommended Is there anything else about your child that you think is important to share with us?
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