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NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Peds - Screening and Exclusion Form (0:0 to 4:5 y:m)

554 Shared Subjects

Screening and Exclusion Form (0:0 to 4:5 y:m) as defined by the NIH Pediatric MRI Project
Clinical Assessments
Questionnaire
03/08/2010
peds_exclusion_form01
12/16/2022
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
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 Subject_ID
Query timepoint_label String 50 Recommended Timepoint/visit label
Query age_in_days_dot_to_edc Integer Recommended Age in days obtained by subtracting the Expected Date of Confinement (EDC/Due Date) from the date of test Exclusion_Age_in_Days_DOT_to_EDC
Query admin_status String 20 Recommended Instrument administration status Complete;Partial;Not Administered;Not Applicable Exclusion_Administration_Status
Query ex_ia_demo_parents_uncom_engl String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IA Both biological mother and father of the Child of Interest (COI) are uncomfortable reading English documents (One parent uncomfortable with reading English is not exclusionary)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IA_Demographic_COI_Parents_Uncomfortable_English
Query ex_ib_demo_adopted_or_osd String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IB Child of Interest (COI) adopted or product of ovum/sperm donation (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IB_Demographic_COI_Adopted_or_Ovum_Sperm_Donation
Query ex_ic_demo_bio_parent_unkwn_hx String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IC Biological father or mother of Child of Interest (COI) has unknown history (ex. Medical) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IC_Demographic_COI_Biol_Parent_with_Unknown_History
Query ex_iia1_preg_mom_age_coi_birth Integer Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIA1 Maternal age at Child of Interest (COI) birth Exclusion_IIA1_Pregnancy_Maternal_Age_at_COIs_Birth_in_Years
Query ex_iia2_preg_mom_age_ran_birth String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIA2 Maternal age at Child of Interest (COI) birth <16 years or >44 years (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIA2_Pregnancy_Maternal_Age_Range_at_COI_Birth
Query ex_iib1_preg_mom_smoking String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIB1 Maternal Smoking >10 cigarettes/week during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIB1_Pregnancy_COI_Maternal_Smoking
Query ex_iib2_preg_mom_alc_intake String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIB2 Maternal Alcohol intake >2 drinks/week during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIB2_Pregnancy_COI_Maternal_Alcohol_Intake
Query ex_iib3a_preg_mom_ex_meds_used String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIB3a Maternal exclusionary medications used during pregnancy with Child of Interest (COI) from Appendix A (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIB3a_Pregnancy_COI_Maternal_Exclusionary_Meds_Used
Query ex_iib4_preg_mom_drugs_abuse String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIB4 Maternal drugs of abuse used during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIB4_Pregnancy_COI_Maternal_Drugs_of_Abuse
Query ex_iic1_preg_mom_plac_abrupt String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC1 Maternal placental abruption during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC1_Pregnancy_COI_Maternal_Placental_Abruption
Query ex_iic2_preg_mom_preeclampsia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC2 Maternal preeclampsia with treatment during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC2_Pregnancy_COI_Maternal_Preeclampsia_Treatment
Query ex_iic3_preg_mom_strct_bedrest String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC3 Maternal strict bed rest >6 weeks duration during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC3_Pregnancy_COI_Maternal_Strict_Bedrest
Query ex_iic4_preg_mom_hospital_ad String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC4 Maternal pre-delivery hospital admissions related to pregnancy, during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC4_Pregnancy_COI_Maternal_Hospital_Admissions
Query ex_iic5_preg_mom_a_hemorrhage String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC5 Maternal antepartum hemorrhage during pregnacy with Child of Interest (COI) (spotting is not exclusionary) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC5_Pregnancy_COI_Maternal_Antepartum_Hemorrhage
Query ex_iic6_preg_mom_premature_rup String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC6 Maternal premature rupture of membranes >24 hours prior to delivery of Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC6_Pregnancy_COI_Maternal_Premature_Rupture
Query ex_iic7_preg_mom_general_anes String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC7 Maternal general anesthesia during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC7_Pregnancy_COI_Maternal_General_Anesthesia
Query ex_iic8_preg_mom_medical_cond String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC8 Maternal medical conditions during pregnancy with Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC8_Pregnancy_COI_Maternal_Medical_Conditions
Query ex_iic9_preg_mom_infection_del String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIC9 Maternal infections around time of delivery of Child of Interest (COI) (e.g., HIV, sepsis, toxoplasmosis, rubella, CMV, herpes, syphilis [ToRCHeS], hepatitis, positive culture (fever)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIC9_Pregnancy_COI_Maternal_Infection_Around_Delivery
Query ex_iiia_del_c_section_distress String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIIA C-section performed secondary to Child of Interest (COI) or maternal medical distress (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIIA_Delivery_C_Section_Maternal_COI_Distress
Query ex_iiib_del_multiple_births String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIIB Multiple Births (e.g., Child of Interest (COI) a twin, triplet, etc.) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIIB_Delivery_COI_Multiple_Births
Query ex_iiic_del_high_forceps String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIIC High Forceps used during delivery of the Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIIC_Delivery_COI_High_Forceps
Query ex_iiid_del_vacuum_extraction String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIID Vacuum Extraction used during delivery of the Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIID_Delivery_COI_Vacuum_Extraction
Query ex_iiie_del_breech_malpresent String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IIIE Breech or malpresentation during delivery of the Child of Interest (COI) (not exclusionary with planned c-section) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IIIE_Delivery_COI_Breech_Malpresentation
Query ex_iva5a_bn_born_early_or_late String 10 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVA5a Was the Child of Interest (COI) born early or late? (Early, Late, NA=Not Available) Early;Late;NA NA = Not available Exclusion_IVA5a_Birth_Neonatal_COI_Born_Early_or_Late
Query ex_iva6_bn_37wks4day_42wks3day String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVA6 Child of Interest (COI) born born at <37 weeks 4 days or >42 weeks 3 days (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVA6_Birth_Neonatal_COI_37weeks4days_42weeks3days
Query ex_ivb1a_bn_birth_body_wt_gram Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB1a Child of Interest (COI) birth body weight in grams Exclusion_IVB1a_Birth_Neonatal_COI_Birth_Body_Weight_Grams
Query ex_ivb1b_bn_birth_body_wt_perc Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB1b Child of Interest (COI) birth body weight percentile Exclusion_IVB1b_Birth_Neonatal_COI_Birth_Body_Weight_Perc
Query ex_ivb1c_bn_body_wt_less_5_pct String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB1c Was the Child of Interest (COI) birth body weight less than the 5th percentile? (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVB1c_Birth_Neonatal_COI_Body_Wgt_Less_Than_5th_Perc
Query ex_ivb2a_bn_birth_body_lgth_cm Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB2a Child of Interest (COI) birth body length in centimeters Exclusion_IVB2a_Birth_Neonatal_COI_Birth_Body_Length_cm
Query ex_ivb2b_bn_birth_bdy_lgth_pct Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB2b Child of Interest (COI) birth body length percentile Exclusion_IVB2b_Birth_Neonatal_COI_Birth_Body_Length_Perc
Query ex_ivb2c_bn_bdy_lgth_less_5pct String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB2c Was the Child of Interest (COI) birth body length less than the 5th percentile? (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVB2c_Birth_Neonatal_COI_Body_Lgth_Less_Than_5th_Perc
Query ex_ivb3a_bn_birth_ofc_cm Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB3a Child of Interest (COI) birth Head Circumference (OFC) in centimeters Exclusion_IVB3a_Birth_Neonatal_COI_Birth_OFC_cm
Query ex_ivb3b_bn_birth_ofc_perc Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB3b Child of Interest (COI) birth Head Circumference (OFC) percentile Exclusion_IVB3b_Birth_Neonatal_COI_Birth_OFC_Perc
Query ex_ivb3c_bn_brth_ofc_less_5pct String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB3c Was the Child of Interest (COI) Head Circumference OFC less than the 5th percentile at Birth? (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVB3c_Birth_Neonatal_COI_Birth_OFC_Less_Than_5th_Perc
Query ex_ivb4a_bn_weight_length_pct Float Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB4a Child of Interest (COI) birth body weight-for-length or stature percentile Exclusion_IVB4a_Birth_Neonatal_COI_Weight_for_Length_Perc
Query ex_ivb4b_bn_wt_lgth_less_5_pct String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB4b Was the Child of Interest (COI) weight-for-length or stature at birth less than the 5th percentile? (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVB4b_Birth_Neonatal_COI_Wgt_for_Lgth_Less_5th_Perc
Query ex_ivb5a_bn_apgar_at_1_minute Integer Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB5a Child of Interest (COI) Apgar score at 1 minute (0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10) Exclusion_IVB5a_Birth_Neonatal_COI_Apgar_at_1_Minute
Query ex_ivb5b_bn_apgar_at_5_minutes Integer Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB5b Child of Interest (COI) Apgar score at 5 minutes (0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10) Exclusion_IVB5b_Birth_Neonatal_COI_Apgar_at_5_Minutes
Query ex_ivb5c_bn_apgar_less_8at5min String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVB5c Was the Child of Interest (COI) Apgar score less than 8 at 5 minutes? (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVB5c_Birth_Neonatal_COI_Apgar_Less_Than_8_at_5_Min
Query ex_ivc1_bn_seizures String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC1 Child of Interest (COI) seizures (all, including febrile seizures) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC1_Birth_Neonatal_COI_Seizures
Query ex_ivc2_bn_hyperbilirubinemia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC2 Child of Interest (COI) hyperbilirubinemia requiring transfusion, phototherapy, or bili-blanket >48 hours, or, hospital re-admission with treatment (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC2_Birth_Neonatal_COI_Hyperbilirubinemia
Query ex_ivc3_bn_structural_abnormal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC3 Child of Interest (COI) structural abnormalities of body (limbs, head or face) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC3_Birth_Neonatal_COI_Structural_Abnormalities
Query ex_ivc4_bn_medical_conditions String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC4 Child of Interest (COI) medical conditions (e.g., PKU, hypothyroidism, hyperthyroidism, anemia) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC4_Birth_Neonatal_COI_Medical_Conditions
Query ex_ivc5_bn_resp_distress String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC5 Child of Interest (COI) respiratory distress (e.g., chest compression, intubation, ventilator, supplemental oxygen, meconium, pneumonia) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC5_Birth_Neonatal_COI_Respiratory_Distress
Query ex_ivc6a_bn_admitted_neonatal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC6a Child of Interest (COI) admitted to specialized neonatal care unit (ex. NICU) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC6a_Birth_Neonatal_COI_Admitted_to_Neonatal_Care
Query ex_ivc7_bn_heart_disease_surg String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC7 Child of Interest (COI) heart disease or heart surgery (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC7_Birth_Neonatal_COI_Heart_Disease_Surgery
Query ex_ivc8_bn_chromosomal_anomal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC8 Child of Interest (COI) chromosomal/congenital anomalies (Downs, Turners, Klinefelters, Cleft lip) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC8_Birth_Neonatal_COI_Chromosomal_Anomalies
Query ex_ivc9_bn_infections String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC9 Child of Interest (COI) infections (e.g., HIV, sepsis, toxoplasmosis, rubella, CMV, herpes, syphilis [ToRCHeS], hepatitis, meningitis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC9_Birth_Neonatal_COI_Infections
Query ex_ivc10_bn_abn_brain_scan_eeg String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC10 Child of Interest (COI) abnormal brain scan or EEG (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC10_Birth_Neonatal_COI_Abnormal_Brain_Scan_EEG
Query ex_ivc11_bn_vision_hear_impair String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC11 Child of Interest (COI) vision or hearing impairment (e.g., abnormal BAER or Autoacoustic, Retinopathy, Ophthalmia) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC11_Birth_Neonatal_COI_Vision_Hearing_Impairment
Query ex_ivc12_bn_tumors_diap_hernia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question IVC12 Child of Interest (COI) tumors or diaphragmatic hernia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_IVC12_Birth_Neonatal_COI_Tumors_Diaphragmatic_Hernia
Query ex_va1_dev_non_fluent_english String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VA1 Child of Interest (COI) non-fluent in English, if age appropriate (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VA1_Development_COI_Non_Fluent_in_English
Query ex_va2a_dev_mom_drug_breastfed String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VA2a If Child of Interest (COI) breastfed: Exclusionary maternal medications and drugs of abuse from Appendix A (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VA2a_Development_COI_Maternal_Drugs_Breastfeeding
Query ex_vc1_dev_chronic_med_cond String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC1 Child of Interest (COI) chronic medical conditions (e.g., diabetes, kidney, or liver problems) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC1_Development_COI_Chronic_Medical_Conditions
Query ex_vc2_dev_metal_implants String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC2 Child of Interest (COI) metal implants (e.g., pacemaker, electronic medical implants, teeth braces, pins) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC2_Development_COI_Metal_Implants
Query ex_vc3_dev_metal_frag_eye_face String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC3 Child of Interest (COI) metal fragments in the eye or face (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC3_Development_COI_Metal_Fragments_Eye_Face
Query ex_vc4_dev_nr_piercings String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC4 Child of Interest (COI) non-removable body piercings (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC4_Development_COI_Non_Removable_Piercings
Query ex_vc5_dev_system_rheum_ill String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC5 Child of Interest (COI) systematic rheumatologic illness or disorder (e.g., arthritis) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC5_Development_COI_Systematic_Rheumatologic_Illness
Query ex_vc6_dev_malignancy_cancer String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC6 Child of Interest (COI) malignancy or cancer (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC6_Development_COI_Malignancy_Cancer
Query ex_vc7_dev_sign_heart_disease String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC7 Child of Interest (COI) significant heart disease (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC7_Development_COI_Significant_Heart_Disease
Query ex_vc8_dev_major_surgery String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC8 Child of Interest (COI) major surgery (e.g., neuro, heart) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC8_Development_COI_Major_Surgery
Query ex_vc9_dev_chemo_rad_therapy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC9 Child of Interest (COI) chemotherapy or radiation therapy (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC9_Development_COI_Chemo_Radiation_Therapy
Query ex_vc10_dev_nr_dental_work String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC10 Child of Interest (COI) non-removable metal dental work (e.g., braces, retainer [tooth fillings are not exclusionary]) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC10_Development_COI_Non_Removable_Dental_Work
Query ex_vc11_dev_congenital_abnorm String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC11 Child of Interest (COI) congenital abnormalities of face, head, or limbs (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC11_Development_COI_Congenital_Abnormalities
Query ex_vc12a_dev_exclusionary_meds String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VC12a Child of Interest (COI) exclusionary medications used during past year from Appendix A (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VC12a_Development_COI_Exclusionary_Medications
Query ex_vd1_dev_seizures String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD1 Child of Interest (COI) seizures (all, including febrile seizures) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD1_Development_COI_Seizures
Query ex_vd2_dev_muscular_dystrophy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD2 Child of Interest (COI) Muscular Dystrophy (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD2_Development_COI_Muscular_Dystrophy
Query ex_vd3_dev_myotonic_dystrophy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD3 Child of Interest (COI) Myotonic Dystrophy (e.g., muscle disease) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD3_Development_COI_Myotonic_Dystrophy
Query ex_vd4_dev_cns_infection String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD4 Child of Interest (COI) CNS Infection (e.g., meningitis, encephalitis) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD4_Development_COI_CNS_Infection
Query ex_vd5_dev_closed_head_injury String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD5 Child of Interest (COI) closed head injury (e.g., >5 minutes loss of consciousness, overnight hospital stay) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD5_Development_COI_Closed_Head_Injury
Query ex_vd6_dev_hearing_impairment String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD6 Child of Interest (COI) hearing impairment requiring treatment/intervention (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD6_Development_COI_Hearing_Impairment
Query ex_vd7_dev_visual_impairment String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD7 Child of Interest (COI) visual impairment (e.g., strabismus, visual disability [conventional glasses correction to 20/40 or better is not exclusionary]) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD7_Development_COI_Visual_Impairment
Query ex_vd8_dev_tuberous_sclerosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD8 Child of Interest (COI) Tuberous Sclerosis (e.g., brain lesion causing seizures, skin lesions) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD8_Development_COI_Tuberous_Sclerosis
Query ex_vd9_dev_neurofibromatosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD9 Child of Interest (COI) Neurofibromatosis (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD9_Development_COI_Neurofibromatosis
Query ex_vd10_dev_cns_radiotherapy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD10 Child of Interest (COI) CNS Radiotherapy (e.g., radiation treatment for cancer) (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD10_Development_COI_CNS_Radiotherapy
Query ex_vd11a_dev_other_neuro_cond String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VD11a Child of Interest (COI) Other diagnosed/treated neurological conditions (Y=Yes, N=No)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VD11a_Development_COI_Other_Neurological_Conditions
Query ex_ve1_dev_lang_learning_dis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VE1 Child of Interest (COI) Significant language or learning disorder program or treatment (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VE1_Development_COI_Language_Learning_Disorder
Query ex_ve2_dev_special_educ_pl String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VE2 Child of Interest (COI) Special types of educational placement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VE2_Development_COI_Special_Educational_Placement
Query ex_ve3_dev_occupational_therap String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VE3 Child of Interest (COI) Occupational therapy related to medical or neurological exclusion (current or past) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VE3_Development_COI_Occupational_Therapy
Query ex_ve4_dev_physical_therapy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VE4 Child of Interest (COI) Physical therapy related to medical or neurological exclusion (current or past) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VE4_Development_COI_Physical_Therapy
Query ex_ve5_dev_lead String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VE5 Child of Interest (COI) Tested for lead and clinic treatment or intervention (e.g., hospitalization, medications, chelation, change in diet or environment) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VE5_Development_COI_Lead
Query ex_vf1_dev_mood String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF1 Child of Interest (COI) diagnosed with a Mood Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF1_Development_COI_Mood
Query ex_vf2_dev_separation_anxiety String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF2 Child of Interest (COI) diagnosed with Separation Anxiety (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF2_Development_COI_Separation_Anxiety
Query ex_vf3_dev_conduct_disorder String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF3 Child of Interest (COI) diagnosed with Conduct Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF3_Development_COI_Conduct_Disorder
Query ex_vf4_dev_adhd String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF4 Child of Interest (COI) diagnosed with Attention Deficit-Hyperactivity Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF4_Development_COI_ADHD
Query ex_vf5_dev_ocd String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF5 Child of Interest (COI) diagnosed with Obsessive Compulsive Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF5_Development_COI_OCD
Query ex_vf6_dev_pdd String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF6 Child of Interest (COI) diagnosed with Pervasive Developmental Disorder (PDD) (e.g. Autism, Asperger Syndrome, etc.) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF6_Development_COI_PDD
Query ex_vf7_dev_tic_disorder String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF7 Child of Interest (COI) diagnosed with Tic Disorder (e.g., motor and vocal) (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF7_Development_COI_Tic_Disorder
Query ex_vf8_dev_child_disintegr_dis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF8 Child of Interest (COI) diagnosed with Childhood Disintegration Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF8_Development_COI_Childhood_Disintegration_Disorder
Query ex_vf9_dev_retts_disorder String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF9 Child of Interest (COI) diagnosed with Retts Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF9_Development_COI_Retts_Disorder
Query ex_vf10_dev_reactive_attch_dis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF10 Child of Interest (COI) diagnosed with Reactive Attachment Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF10_Development_COI_Reactive_Attachment_Disorder
Query ex_vf11_dev_feed_dis_infancy String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF11 Child of Interest (COI) diagnosed with Feeding Disorder of Infancy (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF11_Development_COI_Feeding_Disorder_of_Infancy
Query ex_vf12_dev_pica String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF12 Child of Interest (COI) diagnosed with Pica (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF12_Development_COI_Pica
Query ex_vf13_dev_rumination_dis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF13 Child of Interest (COI) diagnosed with Rumination Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF13_Development_COI_Rumination_Disorder
Query ex_vf14_dev_selective_mutism String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF14 Child of Interest (COI) diagnosed with Selective Mutism (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF14_Development_COI_Selective_Mutism
Query ex_vf15_dev_tourettes_syndrome String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF15 Child of Interest (COI) diagnosed with Tourettes Syndrome (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF15_Development_COI_Tourettes_Syndrome
Query ex_vf16_dev_stereo_move_dis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VF16 Child of Interest (COI) diagnosed with Stereotypic Movement Disorder (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VF16_Development_COI_Stereotypic_Movement_Disorder
Query ex_viiia_n_admin_status String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA Neurological Exam 0:0 to 0:1 Was this exam administered to the Child of Interest (COI)?
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA_NEURO_COI_0y0m_to_0y1m_Administration_Status
Query ex_viiia1_n_dysmorphisms String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA1 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Facial Dysmorphisms (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA1_NEURO_COI_0y0m_to_0y1m_Dysmorphisms
Query ex_viiia1a_n_dysmorph_palatal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA1a Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired palatal cleft
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiia1b_n_dysmorph_labial String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA1b Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired labial cleft
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiia1c_n_dysmorph_sturge String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA1c Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of Sturge Weber disease
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiia1d_n_dysmorph_tuberous String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA1d Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of tuberous sclerosis
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiia2_n_hypertonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA2 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypertonia (Y=Yes, N=No, NA=NotAvailable)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA2_NEURO_COI_0y0m_to_0y1m_Hypertonia
Query ex_viiia3_n_hypotonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA3 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypotonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA3_NEURO_COI_0y0m_to_0y1m_Hypotonia
Query ex_viiia4_n_strength String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA4 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Strength <4/5 (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA4_NEURO_COI_0y0m_to_0y1m_Strength
Query ex_viiia5_n_clonus_ankle String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA5 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with >10 beats of Clonus at ankles (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA5_NEURO_COI_0y0m_to_0y1m_Clonus_Ankle
Query ex_viiia6_n_clonus_other String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA6 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Clonus at site other than ankle (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA6_NEURO_COI_0y0m_to_0y1m_Clonus_Other
Query ex_viiia7_n_dystonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA7 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Dystonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA7_NEURO_COI_0y0m_to_0y1m_Dystonia
Query ex_viiia8_n_choreoathetosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA8 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Choreoathetosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA8_NEURO_COI_0y0m_to_0y1m_Choreoathetosis
Query ex_viiia9_n_tremor String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA9 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Tremor (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA9_NEURO_COI_0y0m_to_0y1m_Tremor
Query ex_viiia10_n_tics String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA10 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Tics (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA10_NEURO_COI_0y0m_to_0y1m_Tics
Query ex_viiia11_n_exo_esotropia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA11 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with any clearly noticeable Exo- or Esotropia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA11_NEURO_COI_0y0m_to_0y1m_Exo_Esotropia
Query ex_viiia12_n_nystagmus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA12 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with jerk, pendular, rotatory, or monocular Nystagmus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA12_NEURO_COI_0y0m_to_0y1m_Nystagmus
Query ex_viiia13_n_asym_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA13 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Asymmetry of Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA13_NEURO_COI_0y0m_to_0y1m_Asymmetry_Facial_Move
Query ex_viiia14_n_abn_visual_fields String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA14 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Abnormal Visual Fields (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA14_NEURO_COI_0y0m_to_0y1m_Abnormal_Visual_Fields
Query ex_viiia15_n_ocular_motility String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA15 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Ocular Motility Disturbance (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA15_NEURO_COI_0y0m_to_0y1m_Ocular_Motility
Query ex_viiia16_n_strabismus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA16 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Strabismus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA16_NEURO_COI_0y0m_to_0y1m_Strabismus
Query ex_viiia17_n_abn_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIA17 Neurological Exam 0:0 to 0:1 Child of Interest (COI) diagnosed with Markedly Abnormal Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIA17_NEURO_COI_0y0m_to_0y1m_Abnormal_Facial_Move
Query ex_viiib_n_admin_status String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB Neurological Exam 0:2 to 0:11 Was this exam administered to the Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)?
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB_NEURO_COI_0y2m_to_0y11m_Administration_Status
Query ex_viiib1_n_dysmorphisms String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB1 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB1_NEURO_COI_0y2m_to_0y11m_Dysmorphisms
Query ex_viiib1a_n_dysmorph_palatal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB1a Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired palatal cleft
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiib1b_n_dysmorph_labial String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB1b Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired labial cleft
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiib1c_n_dysmorph_sturge String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB1c Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of Sturge Weber disease
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiib1d_n_dysmorph_tuberous String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB1d Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of tuberous sclerosis
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiib2_n_hypertonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB2 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypertonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB2_NEURO_COI_0y2m_to_0y11m_Hypertonia
Query ex_viiib20_n_cannot_sit_indep String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB20 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with inability to sit independently by 8 months (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB20_NEURO_COI_0y2m_to_0y11m_Cannot_Sit_Indep
Query ex_viiib21_n_cannot_roll String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB21 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with inability to roll from front to back or back to front by 6 months (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB21_NEURO_COI_0y2m_to_0y11m_Cannot_Roll
Query ex_viiib22_n_tonic_neck_reflex String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB22 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with present tonic neck reflex after 7 months (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB22_NEURO_COI_0y2m_to_0y11m_Tonic_Neck_Reflex
Query ex_viiib3_n_hypotonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB3 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypotonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB3_NEURO_COI_0y2m_to_0y11m_Hypotonia
Query ex_viiib4_n_strength String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB4 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Strength <4/5 (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB4_NEURO_COI_0y2m_to_0y11m_Strength
Query ex_viiib5_n_clonus_ankle String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB5 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with >5 beats of Clonus at ankles for children 2-4 months of age; any ankle Clonus in children >4 months of age
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB5_NEURO_COI_0y2m_to_0y11m_Clonus_Ankle
Query ex_viiib6_n_clonus_other String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB6 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Clonus at site other than ankle (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB6_NEURO_COI_0y2m_to_0y11m_Clonus_Other
Query ex_viiib7_n_dystonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB7 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Dystonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB7_NEURO_COI_0y2m_to_0y11m_Dystonia
Query ex_viiib8_n_choreoathetosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB8 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Choreoathetosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB8_NEURO_COI_0y2m_to_0y11m_Choreoathetosis
Query ex_viiib9_n_tremor String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB9 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Tremor (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB9_NEURO_COI_0y2m_to_0y11m_Tremor
Query ex_viiib10_n_tics String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB10 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Tics (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB10_NEURO_COI_0y2m_to_0y11m_Tics
Query ex_viiib11_n_dysmetria String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB11 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Dysmetria (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB11_NEURO_COI_0y2m_to_0y11m_Dysmetria
Query ex_viiib12_n_ataxia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB12 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Ataxia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB12_NEURO_COI_0y2m_to_0y11m_Ataxia
Query ex_viiib13_n_exo_esotropia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB13 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with any clearly noticeable Exo- or Esotropia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB13_NEURO_COI_0y2m_to_0y11m_Exo_Esotropia
Query ex_viiib14_n_nystagmus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB14 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with jerk, pendular, rotatory, or monocular Nystagmus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB14_NEURO_COI_0y2m_to_0y11m_Nystagmus
Query ex_viiib15_n_asym_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB15 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Asymmetry of Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB15_NEURO_COI_0y2m_to_0y11m_Asymmetry_Facial_Move
Query ex_viiib16_n_abn_visual_field String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB16 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Abnormal Visual Fields (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB16_NEURO_COI_0y2m_to_0y11m_Abnormal_Visual_Field
Query ex_viiib17_n_ocular_motility String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB17 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Ocular Motility Disturbance (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB17_NEURO_COI_0y2m_to_0y11m_Ocular_Motility
Query ex_viiib18_n_strabismus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB18 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Strabismus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB18_NEURO_COI_0y2m_to_0y11m_Strabismus
Query ex_viiib19_n_abnfacial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIB19 Neurological Exam 0:2 to 0:11 Child of Interest (COI) diagnosed with Markedly Abnormal Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIB19_NEURO_COI_0y2m_to_0y11m_Abnormal_Facial_Move
Query ex_viiic_n_admin_status String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC Neurological Exam 1:0 to 2:11 Was this exam administered to the Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)?
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC_NEURO_COI_1y0m_to_2y11m_Administration_Status
Query ex_viiic1_n_dysmorphisms String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC1 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC1_NEURO_COI_1y0m_to_2y11m_Dysmorphisms
Query ex_viiic1a_n_dysmorph_palatal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC1a Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired palatal cleft (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiic1b_n_dysmorph_labial String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC1b Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired labial cleft (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiic1c_n_dysmorph_sturge String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC1c Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of Sturge Weber disease (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiic1d_n_dysmorph_tuberous String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC1d Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of tuberous sclerosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiic2_n_hypertonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC2 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypertonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC2_NEURO_COI_1y0m_to_2y11m_Hypertonia
Query ex_viiic3_n_hypotonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC3 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypotonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC3_NEURO_COI_1y0m_to_2y11m_Hypotonia
Query ex_viiic4_n_strength String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC4 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Strength <4/5 (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC4_NEURO_COI_1y0m_to_2y11m_Strength
Query ex_viiic5_n_clonus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC5 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Clonus at any site (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC5_NEURO_COI_1y0m_to_2y11m_Clonus
Query ex_viiic6_n_dystonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC6 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Dystonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC6_NEURO_COI_1y0m_to_2y11m_Dystonia
Query ex_viiic7_n_choreoathetosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC7 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Choreoathetosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC7_NEURO_COI_1y0m_to_2y11m_Choreoathetosis
Query ex_viiic8_n_tremor String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC8 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Tremor (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC8_NEURO_COI_1y0m_to_2y11m_Tremor
Query ex_viiic9_n_tics String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC9 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Tics (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC9_NEURO_COI_1y0m_to_2y11m_Tics
Query ex_viiic10_n_dysmetria String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC10 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Dysmetria (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC10_NEURO_COI_1y0m_to_2y11m_Dysmetria
Query ex_viiic11_n_ataxia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC11 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Ataxia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC11_NEURO_COI_1y0m_to_2y11m_Ataxia
Query ex_viiic12_n_exo_esotropia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC12 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with any clearly noticeable Exo- or Esotropia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC12_NEURO_COI_1y0m_to_2y11m_Exo_Esotropia
Query ex_viiic13_n_nystagmus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC13 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with jerk, pendular, rotatory, or monocular Nystagmus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC13_NEURO_COI_1y0m_to_2y11m_Nystagmus
Query ex_viiic14_n_asym_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC14 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Asymmetry of Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC14_NEURO_COI_1y0m_to_2y11m_Asymmetry_Facial_Move
Query ex_viiic15_n_abn_visual_field String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC15 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Abnormal Visual Fields (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC15_NEURO_COI_1y0m_to_2y11m_Abnormal_Visual_Field
Query ex_viiic16_n_ocular_motility String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC16 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Ocular Motility Disturbance (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC16_NEURO_COI_1y0m_to_2y11m_Ocular_Motility
Query ex_viiic17_n_strabismus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC17 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Strabismus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC17_NEURO_COI_1y0m_to_2y11m_Strabismus
Query ex_viiic18_n_abn_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC18 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with Markedly Abnormal Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC18_NEURO_COI_1y0m_to_2y11m_Abnormal_Facial_Move
Query ex_viiic19_n_babbling String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC19 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with inability to babble by 12 months (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC19_NEURO_COI_1y0m_to_2y11m_Babbling
Query ex_viiic20_n_expressive_lang String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIIC20 Neurological Exam 1:0 to 2:11 Child of Interest (COI) diagnosed with no Expressive Language (word expression) by 24 months (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIIC20_NEURO_COI_1y0m_to_2y11m_Expressive_Language
Query ex_viiid_n_admin_status String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID Neurological Exam 3:0 to 4:5 Was this exam administered to the Child of Interest (COI) (Y=Yes, N=No, NA=Not Available)?
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID_NEURO_COI_3y0m_to_4y5m_Administration_Status
Query ex_viiid1_n_dysmorphisms String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID1 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Facial Dysmorphisms (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID1_NEURO_COI_3y0m_to_4y5m_Dysmorphisms
Query ex_viiid1a_n_dysmorph_palatal String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID1a Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired palatal cleft (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiid1b_n_dysmorph_labial String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID1b Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Facial Dysmorphisms - repaired or unrepaired labial cleft (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiid1c_n_dysmorph_sturge String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID1c Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of Sturge Weber disease (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiid1d_n_dysmorph_tuberous String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID1d Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Facial Dysmorphisms - facial stigmata of tuberous sclerosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available
Query ex_viiid2_n_hypertonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID2 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypertonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID2_NEURO_COI_3y0m_to_4y5m_Hypertonia
Query ex_viiid3_n_hypotonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID3 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with mild, moderate, or severe Hypotonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID3_NEURO_COI_3y0m_to_4y5m_Hypotonia
Query ex_viiid4_n_strength String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID4 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Strength <4/5 (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID4_NEURO_COI_3y0m_to_4y5m_Strength
Query ex_viiid5_n_clonus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID5 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Clonus at any site (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID5_NEURO_COI_3y0m_to_4y5m_Clonus
Query ex_viiid6_n_dystonia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID6 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Dystonia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID6_NEURO_COI_3y0m_to_4y5m_Dystonia
Query ex_viiid7_n_choreoathetosis String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID7 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Choreoathetosis (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID7_NEURO_COI_3y0m_to_4y5m_Choreoathetosis
Query ex_viiid8_n_tremor String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID8 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Tremor (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID8_NEURO_COI_3y0m_to_4y5m_Tremor
Query ex_viiid9_n_tics String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID9 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Tics (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID9_NEURO_COI_3y0m_to_4y5m_Tics
Query ex_viiid10_n_dysmetria String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID10 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Dysmetria (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID10_NEURO_COI_3y0m_to_4y5m_Dysmetria
Query ex_viiid11_n_ataxia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID11 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Ataxia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID11_NEURO_COI_3y0m_to_4y5m_Ataxia
Query ex_viiid12_n_exo_esotropia String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID12 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with any clearly noticeable Exo- or Esotropia (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID12_NEURO_COI_3y0m_to_4y5m_Exo_Esotropia
Query ex_viiid13_n_nystagmus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID13 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with jerk, pendular, rotatory, or monocular Nystagmus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID13_NEURO_COI_3y0m_to_4y5m_Nystagmus
Query ex_viiid14_n_asym_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID14 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Asymmetry of Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID14_NEURO_COI_3y0m_to_4y5m_Asymmetry_Facial_Move
Query ex_viiid15_n_abn_visual_fields String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID15 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Abnormal Visual Fields (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID15_NEURO_COI_3y0m_to_4y5m_Abnormal_Visual_Fields
Query ex_viiid16_n_ocular_motility String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID16 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Ocular Motility Disturbance (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID16_NEURO_COI_3y0m_to_4y5m_Ocular_Motility
Query ex_viiid17_n_strabismus String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID17 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Strabismus (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID17_NEURO_COI_3y0m_to_4y5m_Strabismus
Query ex_viiid18_n_abn_facial_move String 2 Recommended Screening and Exclusion Form (0:0 to 4:5 y:m) Question VIIID18 Neurological Exam 3:0 to 4:5 Child of Interest (COI) diagnosed with Markedly Abnormal Facial Movement (Y=Yes, N=No, NA=Not Available)
Y;N;NA
Y = Yes; N = No; NA = Not available Exclusion_VIIID18_NEURO_COI_3y0m_to_4y5m_Abnormal_Facial_Move
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
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