|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
survey_number_12 |
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
survey_id_12 |
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
dem_date_12 |
|
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.
|
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
Query
|
respondent |
String |
20
|
Recommended |
Respondent |
Mother;Father;Parent;Guardian;Teacher;Child;Self;Caregiver;Partner;Other
|
|
dem_respondent_12 |
|
respondent_other_specify |
String |
50
|
Recommended |
Respondent: Other (specify) |
|
|
dem_resp_other_12 |
|
q1_6 |
String |
200
|
Recommended |
How did you hear about this study |
|
|
dem_heard_12 |
Query
|
race |
String |
30
|
Recommended |
Race of study subject |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported; Other Non-White; Other
|
|
dem_race_12 |
|
otherrace |
String |
100
|
Recommended |
specify other race |
|
The following questions are about you or the child's family.
|
dem_race_spec_12 |
Query
|
ethnicity |
String |
30
|
Recommended |
Ethnicity of participant |
Hispanic or Latino; Not Hispanic or Latino; Unknown
|
|
dem_hispanic_12 |
Query
|
mother_race |
String |
55
|
Recommended |
Mother's race |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
|
|
dem_race_mom_12 |
|
p_race_bir |
String |
50
|
Recommended |
Mother race, specified for more than one race |
|
|
dem_spec_race_mom_12 |
Query
|
mother_ethnicity |
String |
30
|
Recommended |
Mother ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) |
Hispanic or Latino;Not Hispanic or Latino;Not Provided
|
|
dem_hisp_mom_12 |
Query
|
father_race |
String |
55
|
Recommended |
Father's race |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
|
|
dem_race_dad_12 |
|
p2_race_bir |
String |
50
|
Recommended |
Father race, specified for more than one race/biracial |
|
|
dem_spec_race_dad_12 |
Query
|
father_ethnicity |
String |
30
|
Recommended |
Father ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) |
Hispanic or Latino;Not Hispanic or Latino;Not Provided
|
|
dem_hisp_dad_12 |
Query
|
thous |
Integer |
|
Recommended |
Total number of persons in household |
|
0=Does not apply (e.g., in institution), 99=unknown
|
dem_household_12 |
Query
|
adults_household |
Integer |
|
Recommended |
Number adults in household |
|
|
dem_adults_12 |
Query
|
children_household |
Integer |
|
Recommended |
Number children household |
|
|
dem_children_12 |
Query
|
cg1_relationship |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship to Participant |
|
Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother
|
dem_relation_mom_12 |
|
cg1_relationship_specify |
String |
100
|
Recommended |
Caregiver/Parent 1's Relationship to Participant Other Specify |
|
|
dem_other_rel_mom_12 |
Query
|
demo_resp_status |
Integer |
|
Recommended |
respondent's marital status |
1::13
|
1 = Married; 2 = Remarried; 3 = Live with partner (not married); 4 = Separated; 5 = Divorced; 6 = Single (never married); 7 = Widowed; 8=Married or Living Together;9 = Missing/Not Applicable; 10 = Other; 11=Refused to answer; 12= Engaged; 13=Civil union
|
dem_marital_12 |
Query
|
d21y |
Integer |
|
Recommended |
Years legally married including common law |
|
|
dem_length_mar_12 |
Query
|
custody |
Integer |
|
Recommended |
Who has legal custody of this child? |
1::20;-99;77;88
|
0= Biological mom only (dad may or may not have visitation rights) ; 1= Biological dad only (mom may or may not have visitation rights) ; 2= Both biological parents living together ; 3= Shared custody between biological parents (50/50) ; 4= Step mom ; 5= Step dad ; 6= Former step mom ; 7= Former step dad ; 8= Adoptive mom ; 9= Adoptive dad ; 10=0 Both adoptive parents living together ; 11=1 State ; 12=2 Female relative ; 13=3 Male relative ; 14=4 Foster parent(s) ; 15=5 Other ; 16 = Questionnaire Respondent/CG1; 17 = Other Parent/CG2; 18 = Joint; 19= Mother has sole custody; 20= Father has sole custody;-99= N/A ; 77= Refused ; 88= Missing
|
dem_custodial_12 |
Query
|
dem_edu_mom_12 |
Integer |
|
Recommended |
Please indicate the highest level of education of Parent/Caregiver 1: |
1::7; 888
|
1 = 8th grade or less ; 2 = Some high school ; 3 = High school/GED ; 4 = Associate's Degree ; 5 = Bachelor's Degree ; 6 = Master's Degree ; 7 = M.D. = Ph.D. = J.D. or equivalent ; 888 = I do not wish to disclose
|
|
Query
|
parent_1_employment |
Integer |
|
Recommended |
Current employment status for parent 1 |
1::10
|
1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose
|
dem_work_mom_12 |
Query
|
lnghrs |
Integer |
|
Recommended |
How many hours per week did the client work at that job |
|
|
dem_parttime_mom_12 |
|
cg1_occupation |
String |
100
|
Recommended |
Caregiver/Parent 1's Occupation |
|
|
dem_jobtitle_mom_12 |
|
eo8a_sp_recode |
String |
100
|
Recommended |
Job employer |
|
|
dem_employer_mom_12 |
Query
|
dem_income_12 |
Integer |
|
Recommended |
Which of these categories best describes your total combined family income for the past 12 months? This should include income (before taxes) from all sources, wages, rent from properties, social security, disability and/or veteran's benefits, unemployment benefits, worker's compensation, help from relatives (including child payments and alimony), and so on. |
0::19;777;888
|
0 = Doesn't know or would rather not say; 1 = Less than $10,000 ; 2 = $10,000 through $19,999 ; 3 = $20,000 through $29,999 ; 4 = $30,000 through $39,999 ; 5 = $40,000 through $49,999 ; 6 = $50,000 through $59,999 ; 7 = $60,000 through $69,999 ; 8 = $70,000 through $79,999 ; 9 = $80,000 through $89,999 ; 10 = $90,000 through $99,999 ; 11 = $100,000 through $119,999 ; 12 = $120,000 through $129,999 ; 13 = $130,000 through $139,999 ; 14 = $140,000 and greater ; 15=$50,000-$74,999; 16=$75,000-$99,999; 17=$100,000-$150,000; 18=over $150,000; 19 = $75,000 or more; 777 = Don't know ; 888 = No response
|
|
Query
|
cg2_relationship |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship to Participant |
|
Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother
|
dem_relation_dad_12 |
|
cg2_relationship_specify |
String |
100
|
Recommended |
Caregiver/Parent 2's Relationship to Participant Other Specify |
|
|
dem_other_rel_dad_12 |
Query
|
dem_edu_dad_12 |
Integer |
|
Recommended |
Please indicate the highest level of education of Parent/Caregiver 2: |
1::7; 888
|
1 = 8th grade or less ; 2 = Some high school ; 3 = High school/GED ; 4 = Associate's Degree ; 5 = Bachelor's Degree ; 6 = Master's Degree ; 7 = M.D. = Ph.D. = J.D. or equivalent ; 888 = I do not wish to disclose
|
|
Query
|
parent_2_employment |
Integer |
|
Recommended |
Current employment status for parent 2 |
1::10
|
1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose
|
dem_work_dad_12 |
|
spouseindustry |
String |
100
|
Recommended |
Spouse's occupation: Industry or type of business |
|
|
dem_industry_dad_12 |
|
cg2_occupation |
String |
100
|
Recommended |
Caregiver/Parent 2's Occupation |
|
|
dem_jobtitle_dad_12 |
Query
|
pg_art |
String |
50
|
Recommended |
Was this pregnancy the result of Assisted Reproductive Technology (ART)? |
No;Yes;Don't Know
|
|
dem_art_12 |
|
preg_asstrep |
String |
255
|
Recommended |
Was any other assisted reproduction used? If so, specify |
|
|
dem_art_spec_12 |
Query
|
preg_comp |
String |
50
|
Recommended |
Were there complications during pregnancy? |
Yes; No;999
|
|
dem_complications_12 |
|
preg_comp_note |
String |
300
|
Recommended |
Note regarding complications during pregnancy |
|
|
dem_clar_comp_12 |
|
dem_abnorm_spec_12 |
String |
250
|
Recommended |
Please specify how this pregnancy was unusual or abnormal in a way not already mentioned |
|
|
|
Query
|
preg_dxdrug |
String |
10
|
Recommended |
Used prescription medications during pregnancy? |
Yes; No; NK
|
NK = Not known
|
dem_medications_12 |
Query
|
medication1_name |
String |
500
|
Recommended |
Name first medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med1_name_12 |
Query
|
medication2_name |
String |
500
|
Recommended |
Name second medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med2_name_12 |
|
medication3_name |
String |
500
|
Recommended |
Name third medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med3_name_12 |
|
medication4_name |
String |
500
|
Recommended |
Name fourth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med4_name_12 |
|
medication5_name |
String |
500
|
Recommended |
Name fifth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med5_name_12 |
|
medication6_name |
String |
500
|
Recommended |
Name sixth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med6_name_12 |
|
medication7_name |
String |
500
|
Recommended |
Name seventh medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med7_name_12 |
|
medication8_name |
String |
500
|
Recommended |
Name eighth medication that the participant has taken |
|
0 = No medication; 999= Legitimately skipped
|
dem_med8_name_12 |
|
medication9_name |
String |
500
|
Recommended |
Name ninth medication that the participant has taken |
|
|
dem_med9_name_12 |
|
medication10_name |
String |
100
|
Recommended |
Name tenth medication that the participant has taken |
|
|
dem_med10_name_12 |
|
omramedother |
String |
150
|
Recommended |
Other Medication name (not in list) specified |
|
|
dem_med_extraneous |
|
prghxoth |
String |
250
|
Recommended |
Other Pregnancy History |
|
|
dem_pregancy_12 |
Query
|
demo_preg_vaginal |
Integer |
|
Recommended |
Did the mother have a vaginal birth or a cesarean birth (C-section)? |
1;2;97;-999
|
1= Vaginal birth; 2= Cesarean birth; 97= Do not know; -999= Prefer not to answer
|
dem_csection_12 |
|
ldnb_cothers |
String |
255
|
Recommended |
For C section - Why was the c-section performed - Others |
|
|
dem_csec_spec_12 |
Query
|
birth |
Integer |
|
Recommended |
Perinatal - Complications at birth? |
0::3
|
0=N/A; 1=no; 2=yes; 3=NK
|
dem_birthcomp_12 |
Query
|
cmedhx10 |
Integer |
|
Recommended |
How many days did the baby stay in the hospital after birth? |
|
|
dem_hospstay_12 |
Query
|
ldnb_stayicu |
String |
50
|
Recommended |
Did this baby stay in the neonatal intensive care unit |
No;Yes;Don't Know
|
|
dem_specialcare_12 |
Query
|
demo_child_nicu_days |
Integer |
|
Recommended |
If yes, how many days was the child in the NICU? |
|
78=Other; 99=N/A
|
dem_specialcare_length_12 |
Query
|
medhis_curmed |
String |
50
|
Recommended |
Is the child currently on any prescription medication |
No;Yes;Not Sure
|
|
dem_child_medications_12 |
|
dem_child_med_name_12 |
String |
50
|
Recommended |
What is the name of the child's medication? |
|
|
|
|
q53_b6a2 |
String |
100
|
Recommended |
Medication 1 Indication |
|
Indicate use of medication
|
dem_child_med_purpose_12 |
|
medication1_dosage |
String |
150
|
Recommended |
First medication dosage |
|
0 = No medication; 999 = Missing
|
dem_child_med_dose_12 |
Query
|
cfmh_chd_visionimp |
Integer |
|
Recommended |
Does the Child have a vision impairment? |
1;0
|
0 = No; 1 = Yes
|
dem_vision_12 |
|
chd_visionimp_sp |
String |
100
|
Recommended |
Child vision impairment, specify |
|
|
dem_vis_spec_12 |
Query
|
strconmotordelay |
String |
5
|
Recommended |
Does the child have motor delays or slow motor development? |
Yes; No
|
|
dem_motdelay_12 |
|
elmotr_cmt |
String |
4,000
|
Recommended |
MOTOR SKILLS - Comment |
|
|
dem_motdelay_spec_12 |
Query
|
child_speechdelay |
String |
50
|
Recommended |
Does (did) the Child have a Speech/Language Delay? |
Yes; No; NK; NS
|
NK= Not known; NS = Not sure
|
dem_langdelay_12 |
|
ques_langdelaynotes |
String |
255
|
Recommended |
Had or has a speech or language delay or impairment -Notes |
|
|
dem_langdel_spec_12 |
Query
|
q21_15 |
Integer |
|
Recommended |
Has this child ever had seizures or convulsions |
0; 1
|
0=No;1=Yes
|
dem_seizure_12 |
|
mh_31 |
Date |
|
Recommended |
Date of onset for Seizures |
|
MM/DD/YYYY
|
dem_seiz_date_12 |
Query
|
rev_headfebseiz |
String |
50
|
Recommended |
Febrile Seizures |
Yes; No; NK; NS
|
NK= Not known; NS = Not sure
|
dem_seiz_fever_12 |
Query
|
diagnosis_seizures_current |
String |
20
|
Recommended |
Is child having seizures currently? |
Yes; No; Don't Know (DK); Not Applicable (N/A)
|
|
dem_seiz_now_12 |
Query
|
q21_15d |
Integer |
|
Recommended |
Does this child now take medications to help control seizures |
0; 1
|
0=No;1=Yes
|
dem_seiz_med_12 |
Query
|
bio_childage_1 |
Integer |
|
Recommended |
Biological child 1 age |
0::1200
|
In months
|
dem_sib1_age_12 |
Query
|
bio_childgender_1 |
String |
50
|
Recommended |
Biological child 1 gender |
Male; Female
|
|
dem_sib1_gender_12 |
Query
|
bio_childdiagnosis_1 |
String |
255
|
Recommended |
Biological child 1 diagnosis |
|
|
dem_sib1_asd_spec_12 |
Query
|
bio_childage_2 |
Integer |
|
Recommended |
Biological child 2 age |
0::1200
|
In months
|
dem_sib2_age_12 |
Query
|
bio_childgender_2 |
String |
50
|
Recommended |
Biological child 2 gender |
Male; Female
|
|
dem_sib2_gender_12 |
|
bio_childdiagnosis_2 |
String |
255
|
Recommended |
Biological child 2 diagnosis |
|
|
dem_sib2_asd_spec_12 |
Query
|
bio_childage_3 |
Integer |
|
Recommended |
Biological child 3 age |
0::1200
|
In months
|
dem_sib3_age_12 |
Query
|
bio_childgender_3 |
String |
50
|
Recommended |
Biological child gender |
Male; Female
|
|
dem_sib3_gender_12 |
|
bio_childdiagnosis_3 |
String |
255
|
Recommended |
Biological child diagnosis |
|
|
dem_sib3_asd_spec_12 |
Query
|
ieh002d |
Integer |
|
Recommended |
First-degree relative with DSM-5 Autism Spectrum Disorder |
0;1; 2;-9
|
0=No; 1=Yes; 2 = I do not wish to disclose; -9=Unknown
|
dem_fam_asd_12 |
|
cg2_employer |
String |
100
|
Recommended |
Who is Parent 2's employer? (For example: Mass General Hospital, Cambridge Bank, Trader Joe's, Arlington Public Schools) |
|
|
dem_employer_dad_12 |
|
dem_adult_relation_12 |
String |
50
|
Recommended |
What is the child's relationship to other adults living with the family? |
|
|
|
|
dem_date_div_12 |
String |
15
|
Recommended |
If separated/divorced, date of separation/divorce (month, year) |
|
MM-YYYY
|
|
|
dem_remarried_12 |
String |
15
|
Recommended |
If remarried, date of remarriage (month, year)
(If not remarried, write N/A) |
|
MM-YYYY
|
|
|
dem_industry_mom_12 |
String |
200
|
Recommended |
For your current or most recent job, in what kind of industry did/do you work? (For example: hospital, auto engine manufacturing, newspaper publishing, mail order house) (Parent/Caregiver 1) |
|
|
|
Query
|
dem_part_time_dad_12 |
Float |
|
Recommended |
If caregiver 2's current main daily activities/responsibilities are part-time, hrs/week |
|
|
|
|
dem_spec_comp_12 |
String |
500
|
Recommended |
List all applicable prenatal complications: |
|
Examples: Pre-eclampsia ; Gestational Diabetes ; Placental Abruption ; Abnormal Contractions ; Bleeding from the vagina ; Swelling (Edema) ; High Blood Pressure ; Toxemia ; Rubella ; Weight loss (if s please specify how much below) ; Anemia ; Serious Injury (please specify below) ; Other Illness (please specify below) ; Confined to Bed ; Surgery (please specify below) ; Infections (please specify below) ; X-rays
|
|
Query
|
dem_abnormal_12 |
Integer |
|
Recommended |
Was this pregnancy unusual or abnormal in any way not already mentioned? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med1_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 1:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med1_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 1 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med1_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 1 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med1_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 1 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med1_more_12 |
Integer |
|
Recommended |
Did you take more than 1 medication during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med2_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 2:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med2_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 2 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med2_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 2 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med2_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 2 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med2_more_12 |
Integer |
|
Recommended |
Did you take more than 2 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med3_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 3:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med3_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 3 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med3_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 3 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med3_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 3 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med3_more_12 |
Integer |
|
Recommended |
Did you take more than 3 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med4_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 4:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med4_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 4 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med4_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 4 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med4_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 4 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med4_more_12 |
Integer |
|
Recommended |
Did you take more than 4 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med5_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 5:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med5_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 5 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med5_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 5 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med5_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 5 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med5_more_12 |
Integer |
|
Recommended |
Did you take more than 5 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med6_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 6:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med6_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 6 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med6_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 6 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med6_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 6 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med6_more_12 |
Integer |
|
Recommended |
Did you take more than 6 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med7_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 7:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med7_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 7 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med7_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 7 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med7_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 7 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med7_more_12 |
Integer |
|
Recommended |
Did you take more than 7 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med8_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 8:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med8_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 8 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med8_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 8 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med8_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 8 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med8_more_12 |
Integer |
|
Recommended |
Did you take more than 8 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med9_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 9:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med9_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 9 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med9_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 9 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med9_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 9 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med9_more_12 |
Integer |
|
Recommended |
Did you take more than 9 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_med10_trimester_12 |
String |
100
|
Recommended |
Please specify the period(s) of time that you took medication 10:
(You may choose more than one answer) |
|
|
|
Query
|
dem_med10_1sttri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 10 during the FIRST trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med10_2ndtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 10 during the SECOND trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med10_3rddtri_freq_12 |
Integer |
|
Recommended |
Please specify the frequency that you took medication 10 during the THIRD trimester |
0::4
|
0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
|
|
Query
|
dem_med10_more_12 |
Integer |
|
Recommended |
Did you take more than 10 medications during pregnancy? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_birthcomp_spec_12 |
String |
500
|
Recommended |
Please explain any difficulties or complications experienced by your child during birth |
|
|
|
Query
|
dem_othercomp_12 |
Integer |
|
Recommended |
Were there other complications or illnesses during your child's stay in the hospital after birth (e.g. hyperbilirubinemia, difficulty breathing)? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_othercomp_spec_12 |
String |
1,000
|
Recommended |
Please describe Other complications or illnesses during your child's stay in the hospital after birth |
|
|
|
Query
|
dem_illness_12 |
Integer |
|
Recommended |
Has your child experienced any serious illness or difficulties in development since birth? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_illness_spec_12 |
String |
500
|
Recommended |
Please explain serious illness or difficulties in development since birth |
|
|
|
|
dem_other_devel_12 |
String |
250
|
Recommended |
Parental comments about child's health and/or developmental progress? |
|
|
|
Query
|
dem_sib1 |
Integer |
|
Recommended |
Number of FULL older siblings? |
|
|
|
Query
|
dem_sib1_home_12 |
Integer |
|
Recommended |
Is the older sibling (1) living at parental home? |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
dem_sib1_asd_12 |
Integer |
|
Recommended |
Does the older sibling (1) have a diagnosis of ASD? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_asd_who_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 1) with ASD? |
|
|
|
|
dem_sib1_asd_where_12 |
String |
50
|
Recommended |
Where was your child (older sibling 1) diagnosed with ASD? |
|
|
|
|
dem_sib1_asd_date_12 |
String |
15
|
Recommended |
What was the date of the ASD evaluation of older sibling (1)? |
|
|
|
Query
|
dem_sib1_asd_age_12 |
Integer |
|
Recommended |
How old was older sibling (1) when he/she was diagnosed with an ASD? |
0::1200
|
Age in months
|
|
Query
|
dem_sib1_asd_bhv_12 |
String |
200
|
Recommended |
What were the behaviors that supported older sibling (1)'s ASD diagnosis? |
|
|
|
Query
|
dem_sib1_disorder_12 |
Integer |
|
Recommended |
Has older sibling (1) ever been diagnosed with a neurological or genetic disorder? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_disorder_spec_12 |
String |
50
|
Recommended |
Please specify the neurological or genetic diagnosis of older sibling (1) |
|
|
|
|
dem_sib1_dis_who_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 1) with the neurological or genetic disorder? |
|
|
|
|
dem_sib1_dis_where_12 |
String |
50
|
Recommended |
Where was your child (older sibling1) diagnosed with the neurological or genetic disorder? |
|
|
|
|
dem_sib1_dis_date_12 |
String |
15
|
Recommended |
What was the date of the evaluation for older sibling (1)'s neurological or genetic disorder? |
|
|
|
Query
|
dem_sib1_dis_age_12 |
Integer |
|
Recommended |
How old was your child (older sibling 1) when he/she was diagnosed with the neurological/genetic disorder? |
0::1200
|
Age in months
|
|
|
dem_sib1_dis_bhv_12 |
String |
200
|
Recommended |
What were the behaviors that supported the diagnosis of older sibling (1) with the neurological/genetic disorder? |
|
|
|
Query
|
dem_sib1_asd_services_12 |
Integer |
|
Recommended |
Is your child (older sibling 1) currently receiving services for this ASD diagnosis? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_asd_services_spec_12 |
String |
150
|
Recommended |
If yes, please specify the types of services this older sibling (1) receives for ASD |
|
|
|
Query
|
dem_sib1_condition_12 |
Integer |
|
Recommended |
Has the older sibling (1) ever been diagnosed with a medical condition not previously specified? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_cond_spec_12 |
String |
50
|
Recommended |
Please specify the medical condition not previously mentioned for older sibling (1). |
|
|
|
Query
|
dem_sib1_motdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does your child (older sibling 1) experience any delays in motor development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_motdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (1)'s delays in motor development? |
|
|
|
Query
|
dem_sib1_vocdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does older sibling (1) experience any delays in vocalization or language development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib1_vocdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (1)'s delays in vocalization or language development |
|
|
|
|
dem_sib1_other_12 |
String |
500
|
Recommended |
Do you have any other concerns about the older sibling (1)'s health and/or developmental progress? |
|
|
|
Query
|
dem_sib2_home_12 |
Integer |
|
Recommended |
Is the older sibling (2) living at parental home? |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
dem_sib2_asd_12 |
Integer |
|
Recommended |
Does the older sibling (2) have a diagnosis of ASD? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_asd_who_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 2) with ASD? |
|
|
|
|
dem_sib2_asd_where_12 |
String |
50
|
Recommended |
Where was your child (older sibling 2) diagnosed with ASD? |
|
|
|
|
dem_sib2_asd_date_12 |
String |
15
|
Recommended |
What was the date of the ASD evaluation of older sibling (2)? |
|
|
|
Query
|
dem_sib2_asd_age_12 |
Integer |
|
Recommended |
How old was older sibling (2) when he/she was diagnosed with an ASD? |
0::1200
|
Age in months
|
|
|
dem_sib2_asd_bhv_12 |
String |
200
|
Recommended |
What were the behaviors that supported older sibling (2)'s ASD diagnosis? |
|
|
|
Query
|
dem_sib2_asd_services_12 |
Integer |
|
Recommended |
Has older sibling (2) ever been diagnosed with a neurological or genetic disorder? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_dis_services_spec_12 |
String |
50
|
Recommended |
Please specify the neurological or genetic diagnosis of older sibling (2) |
|
|
|
|
dem_sib2_disorder_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 2) with the neurological or genetic disorder? |
|
|
|
|
dem_sib2_disorder_spec_12 |
String |
50
|
Recommended |
Where was your child (older sibling2) diagnosed with the neurological or genetic disorder? |
|
|
|
|
dem_sib2_dis_who_12 |
String |
15
|
Recommended |
What was the date of the evaluation for older sibling (2)'s neurological or genetic disorder? |
|
|
|
Query
|
dem_sib2_dis_where_12 |
Integer |
|
Recommended |
How old was your child (older sibling 2) when he/she was diagnosed with the neurological/genetic disorder? |
0::1200
|
Age in months
|
|
|
dem_sib2_dis_date_12 |
String |
200
|
Recommended |
What were the behaviors that supported the diagnosis of older sibling (2) with the neurological/genetic disorder? |
|
|
|
Query
|
dem_sib2_dis_age_12 |
Integer |
|
Recommended |
Is your child (older sibling 2) currently receiving services for this ASD diagnosis? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_dis_bhv_12 |
String |
150
|
Recommended |
If yes, please specify the types of services this older sibling (2) receives for ASD |
|
|
|
Query
|
dem_sib2_condition_12 |
Integer |
|
Recommended |
Has the older sibling (2) ever been diagnosed with a medical condition not previously specified? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_cond_spec_12 |
String |
50
|
Recommended |
Please specify the medical condition not previously mentioned for older sibling (2). |
|
|
|
Query
|
dem_sib2_motdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does your child (older sibling 2) experience any delays in motor development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_motdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (2)'s delays in motor development? |
|
|
|
Query
|
dem_sib2_vocdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does older sibling (2) experience any delays in vocalization or language development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib2_vocdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (2)'s delays in vocalization or language development |
|
|
|
|
dem_sib2_other_12 |
String |
500
|
Recommended |
Do you have any other concerns about the older sibling (2)'s health and/or developmental progress? |
|
|
|
Query
|
dem_sib3_home_12 |
Integer |
|
Recommended |
Is the older sibling (3) living at parental home? |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
dem_sib3_asd_12 |
Integer |
|
Recommended |
Does the older sibling (3) have a diagnosis of ASD? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_asd_who_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 3) with ASD? |
|
|
|
|
dem_sib3_asd_where_12 |
String |
50
|
Recommended |
Where was your child (older sibling 3) diagnosed with ASD? |
|
|
|
|
dem_sib3_asd_date_12 |
String |
15
|
Recommended |
What was the date of the ASD evaluation of older sibling (3)? |
|
|
|
Query
|
dem_sib3_asd_age_12 |
Integer |
|
Recommended |
How old was older sibling (3) when he/she was diagnosed with an ASD? |
0::1200
|
Age in months
|
|
|
dem_sib3_asd_bhv_12 |
String |
200
|
Recommended |
What were the behaviors that supported older sibling (3)'s ASD diagnosis? |
|
|
|
Query
|
dem_sib3_asd_services_12 |
Integer |
|
Recommended |
Has older sibling (3) ever been diagnosed with a neurological or genetic disorder? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_asd_services_spec_12 |
String |
50
|
Recommended |
Please specify the neurological or genetic diagnosis of older sibling (3) |
|
|
|
|
dem_sib3_disorder_12 |
String |
50
|
Recommended |
Who originally diagnosed your child (older sibling 3) with the neurological or genetic disorder? |
|
|
|
|
dem_sib3_dis_who_12 |
String |
50
|
Recommended |
Where was your child (older sibling3) diagnosed with the neurological or genetic disorder? |
|
|
|
|
dem_sib3_disorder_spec_12 |
String |
15
|
Recommended |
What was the date of the evaluation for older sibling (3)'s neurological or genetic disorder? |
|
|
|
Query
|
dem_sib3_dis_where_12 |
Integer |
|
Recommended |
How old was your child (older sibling 3) when he/she was diagnosed with the neurological/genetic disorder? |
0::1200
|
Age in months
|
|
|
dem_sib3_dis_date_12 |
String |
200
|
Recommended |
What were the behaviors that supported the diagnosis of older sibling (3) with the neurological/genetic disorder? |
|
|
|
Query
|
dem_sib3_dis_age_12 |
Integer |
|
Recommended |
Is your child (older sibling 3) currently receiving services for this ASD diagnosis? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_dis_bhv_12 |
String |
150
|
Recommended |
If yes, please specify the types of services this older sibling (3) receives for ASD |
|
|
|
Query
|
dem_sib3_condition_12 |
Integer |
|
Recommended |
Has the older sibling (3) ever been diagnosed with a medical condition not previously specified? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_cond_spec_12 |
String |
50
|
Recommended |
Please specify the medical condition not previously mentioned for older sibling (3). |
|
|
|
Query
|
dem_sib3_motdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does your child (older sibling 3) experience any delays in motor development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_motdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (3)'s delays in motor development? |
|
|
|
Query
|
dem_sib3_vocdelay_12 |
Integer |
|
Recommended |
To the best of your knowledge, does older sibling (3) experience any delays in vocalization or language development? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_sib3_vocdelay_spec_12 |
String |
200
|
Recommended |
If yes, please explain older sibling (3)'s delays in vocalization or language development |
|
|
|
|
dem_sib3_other_12 |
String |
500
|
Recommended |
Do you have any other concerns about the older sibling (3)'s health and/or developmental progress? |
|
|
|
|
dem_moresibs_12 |
String |
1,000
|
Recommended |
Please list other older siblings along with any ASD diagnosis and other developmental concerns |
|
|
|
Query
|
dem_fam_rel_12 |
Integer |
|
Recommended |
Relation of relative with ASD to subject with ASD |
1::3
|
1 = Mother ; 2 = Father ; 3 = Other
|
|
Query
|
dem_rel_asd_age_12 |
Integer |
|
Recommended |
Family Member Diagnosed with ASD: Current Age |
0::1200
|
|
|
|
dem_fam_asd_spec_12 |
String |
50
|
Recommended |
Specify Diagnosis of Family Member Diagnosed with ASD |
|
|
|
|
dem_rel_asd_diag_12 |
String |
50
|
Recommended |
Who originally diagnosed family member with ASD? |
|
|
|
|
dem_rel_asd_where_12 |
String |
50
|
Recommended |
Where was the family member with ASD diagnosed? |
|
|
|
|
dem_rel_asd_date_12 |
String |
15
|
Recommended |
What was the date of the evaluation at which Family Member was diagnosed with ASD? |
|
year
|
|
Query
|
dem_rel_asd_aged_12 |
Integer |
|
Recommended |
How old was the Family Member with ASD when he/she was diagnosed? |
0::1200
|
|
|
|
dem_rel_asd_bhv_12 |
String |
200
|
Recommended |
What were the behaviors that supported the Family Member's ASD diagnosis? |
|
|
|
Query
|
dem_fam_disorder_12 |
Integer |
|
Recommended |
Have any of the child's/subject's immediate biological family members been diagnosed with a neurobiological or genetic disorder (i.e. Epilepsy, Tourette Syndrome, Cerebral Palsy, Multiple Sclerosis, Down Syndrome, Fragile X, Tuberous Sclerosis Complex, etc.)? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_fam_dis_spec_12 |
String |
100
|
Recommended |
Please specify relationship and diagnosis of Family Member diagnosed with a neurobiological or genetic disorder |
|
|
|
Query
|
dem_fam_mental_12 |
Integer |
|
Recommended |
Have any of the child's/subject's immediate biological family members been diagnosed with a mental health disorder (i.e. Anxiety, Depression, ADHD/ADD, Bipolar Disorder, Schizophrenia, etc.)? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_fam_mental_spec_12 |
String |
100
|
Recommended |
Please specify the subject's affected family member and the mental health diagnosis |
|
|
|
Query
|
dem_fam_langdelay_12 |
Integer |
|
Recommended |
Do any of the child's/subject's immediate biological family members have a current diagnosis or history of language impairment or delay? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_fam_langdelay_spec_12 |
String |
100
|
Recommended |
Please specify the subject's Family Member with language impairment/delay and the diagnosis |
|
|
|
Query
|
dem_fam_learn_12 |
Integer |
|
Recommended |
Do any of the child's immediate biological family members have a current diagnosis or history of intellectual or learning disabilities (i.e. dyslexia, SLD, developmental delay, etc.)? |
0;1
|
0 = No; 1 = Yes
|
|
|
dem_fam_learn_spec_12 |
String |
100
|
Recommended |
Please specify the subject's affected family member and the diagnosis of intellectual disability (mental retardation) or learning disabilities |
|
|
|