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Infant Screening Demographics Form

asdriskdemo

01

Download Definition as
Download Submission Template as
Element NameData TypeSizeRequiredDescriptionValue RangeNotesAliases
subjectkeyGUIDRequiredThe NDAR Global Unique Identifier (GUID) for research subjectNDAR*survey_number_12
src_subject_idString20RequiredSubject ID how it's defined in lab/projectsurvey_id_12
interview_dateDateRequiredDate on which the interview/genetic test/sampling/imaging was completed. MM/DD/YYYYRequired fielddem_date_12
interview_ageIntegerRequiredAge in months at the time of the interview/test/sampling/imaging.0 :: 1260Age 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.
genderString20RequiredSex of the subjectM;FM = Male; F = Female
respondentString20RecommendedRespondentMother;Father;Both; Child; Other; Parentdem_respondent_12
respondent_other_specifyString50RecommendedRespondent: Other (specify)dem_resp_other_12
q1_6String200RecommendedHow did you hear about this studydem_heard_12
raceString30RecommendedRace of study subjectAmerican Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reporteddem_race_12
otherraceString50Recommendedspecify other racedem_race_spec_12
ethnicityString30RecommendedEthnicity of participantHispanic or Latino; Not Hispanic or Latino; Unknowndem_hispanic_12
mother_raceString55RecommendedMother's raceAmerican Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reporteddem_race_mom_12
p_race_birString50RecommendedMother race, specified for more than one racedem_spec_race_mom_12
mother_ethnicityString30RecommendedMother ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino)Hispanic or Latino;Not Hispanic or Latino;Not Provideddem_hisp_mom_12
father_raceString55RecommendedFather's raceAmerican Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reporteddem_race_dad_12
p2_race_birString50RecommendedFather race, specified for more than one race/biracialdem_spec_race_dad_12
father_ethnicityString30RecommendedFather ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino)Hispanic or Latino;Not Hispanic or Latino;Not Provideddem_hisp_dad_12
thousIntegerRecommendedTotal number of persons in householddem_household_12
adults_householdIntegerRecommendedNumber adults in householddem_adults_12
children_householdIntegerRecommendedNumber children householddem_children_12
cg1_relationshipString100RecommendedCaregiver/Parent 1's Relationship to ParticipantParent;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 disclosedem_relation_mom_12
cg1_relationship_specifyString100RecommendedCaregiver/Parent 1's Relationship to Participant Other Specifydem_other_rel_mom_12
demo_resp_statusIntegerRecommendedrespondent's marital status1 :: 111 = 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 answerdem_marital_12
d21yIntegerRecommendedYears legally married including common lawdem_length_mar_12
custodyIntegerRecommendedWho has legal custody of this child?1::18;-99;77;880= 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; -99= N/A ; 77= Refused ; 88= Missingdem_custodial_12
dem_edu_mom_12IntegerRecommendedPlease indicate the highest level of education of Parent/Caregiver 1:1::7; 8881 = 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
parent_1_employmentIntegerRecommendedCurrent employment status for parent 11::101=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 disclosedem_work_mom_12
lnghrsIntegerRecommendedHow many hours per week did the client work at that jobdem_parttime_mom_12
cg1_occupationString100RecommendedCaregiver/Parent 1's Occupationdem_jobtitle_mom_12
eo8a_sp_recodeString100RecommendedJob employerdem_employer_mom_12
dem_income_12IntegerRecommendedWhich 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.1::14;777;8881 = 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 ; 777 = Don't know ; 888 = No response
cg2_relationshipString100RecommendedCaregiver/Parent 2's Relationship to ParticipantParent;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 disclosedem_relation_dad_12
cg2_relationship_specifyString100RecommendedCaregiver/Parent 2's Relationship to Participant Other Specifydem_other_rel_dad_12
dem_edu_dad_12IntegerRecommendedPlease indicate the highest level of education of Parent/Caregiver 2:1::7; 8881 = 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
parent_2_employmentIntegerRecommendedCurrent employment status for parent 21::101=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 disclosedem_work_dad_12
spouseindustryString100RecommendedSpouse's occupation: Industry or type of businessdem_industry_dad_12
cg2_occupationString100RecommendedCaregiver/Parent 2's Occupationdem_jobtitle_dad_12
pg_artString50RecommendedWas this pregnancy the result of Assisted Reproductive Technology (ART)?No;Yes;Don't Knowdem_art_12
preg_asstrepString255RecommendedWas any other assisted reproduction used? If so, specifydem_art_spec_12
preg_compString50RecommendedWere there complications during pregnancy?Yes; No;999dem_complications_12
preg_comp_noteString255RecommendedNote regarding complications during pregnancydem_clar_comp_12
dem_abnorm_spec_12String250RecommendedPlease specify how this pregnancy was unusual or abnormal in a way not already mentioned
preg_dxdrugString10RecommendedUsed prescription medications during pregnancy?Yes; No; NKNK = Not knowndem_medications_12
medication1_nameString100RecommendedName first medication that the participant has taken999= Legitimately skipped;dem_med1_name_12
medication2_nameString100RecommendedName second medication that the participant has taken999= Legitimately skipped;dem_med2_name_12
medication3_nameString150RecommendedName third medication that the participant has taken999= Legitimately skipped;dem_med3_name_12
medication4_nameString100RecommendedName fourth medication that the participant has taken999= Legitimately skipped;dem_med4_name_12
medication5_nameString100RecommendedName fifth medication that the participant has takendem_med5_name_12
medication6_nameString100RecommendedName sixth medication that the participant has takendem_med6_name_12
medication7_nameString100RecommendedName seventh medication that the participant has takendem_med7_name_12
medication8_nameString100RecommendedName eighth medication that the participant has takendem_med8_name_12
medication9_nameString100RecommendedName ninth medication that the participant has takendem_med9_name_12
medication10_nameString100RecommendedName tenth medication that the participant has takendem_med10_name_12
omramedotherString150RecommendedOther Medication name (not in list) specifieddem_med_extraneous
prghxothString250RecommendedOther Pregnancy Historydem_pregancy_12
demo_preg_vaginalIntegerRecommendedDid the mother have a vaginal birth or a cesarean birth (C-section)?1;2;971= Vaginal birth ; 2= Cesarean birth (C-section) ; 97= Don't knowdem_csection_12
ldnb_cothersString255RecommendedFor C section - Why was the c-section performed - Othersdem_csec_spec_12
birthIntegerRecommendedPerinatal - Complications at birth?0::30=N/A; 1=no; 2=yes; 3=NKdem_birthcomp_12
cmedhx10IntegerRecommendedHow many days did the baby stay in the hospital after birth?dem_hospstay_12
ldnb_stayicuString50RecommendedDid this baby stay in the neonatal intensive care unitNo;Yes;Don't Knowdem_specialcare_12
demo_child_nicu_daysIntegerRecommendedIf yes, how many days was the child in the NICU?78=Other; 99=N/Adem_specialcare_length_12
medhis_curmedString50RecommendedIs the child currently on any prescription medicationNo;Yes;Not Suredem_child_medications_12
dem_child_med_name_12String50RecommendedWhat is the name of the child's medication?
q53_b6a2String100RecommendedMedication 1 IndicationIndicate use of medicationdem_child_med_purpose_12
medication1_dosageString50RecommendedFirst medication dosagedem_child_med_dose_12
cfmh_chd_visionimpIntegerRecommendedDoes the Child have a vision impairment?1;00 = No; 1 = Yesdem_vision_12
chd_visionimp_spString100RecommendedChild vision impairment, specifydem_vis_spec_12
strconmotordelayString5RecommendedDoes the child have motor delays or slow motor development?Yes; Nodem_motdelay_12
elmotr_cmtString4,000RecommendedMOTOR SKILLS - Commentdem_motdelay_spec_12
child_speechdelayString50RecommendedDoes (did) the Child have a Speech/Language Delay?Yes; No; NK; NSNK= Not known; NS = Not suredem_langdelay_12
ques_langdelaynotesString255RecommendedHad or has a speech or language delay or impairment -Notesdem_langdel_spec_12
q21_15IntegerRecommendedHas this child ever had seizures or convulsions0; 10=No;1=Yesdem_seizure_12
mh_31DateRecommendedDate of onset for SeizuresMM/DD/YYYYdem_seiz_date_12
rev_headfebseizString50RecommendedFebrile SeizuresYes; No; NK; NSNK= Not known; NS = Not suredem_seiz_fever_12
diagnosis_seizures_currentString20RecommendedIs child having seizures currently?Yes; No; Don't Know (DK); Not Applicable (N/A)dem_seiz_now_12
q21_15dIntegerRecommendedDoes this child now take medications to help control seizures0; 10=No;1=Yesdem_seiz_med_12
bio_childage_1IntegerRecommendedBiological child 1 age0::1200In monthsdem_sib1_age_12
bio_childgender_1String50RecommendedBiological child 1 genderMale; Femaledem_sib1_gender_12
bio_childdiagnosis_1String255RecommendedBiological child 1 diagnosisdem_sib1_asd_spec_12
bio_childage_2IntegerRecommendedBiological child 2 age0::1200In monthsdem_sib2_age_12
bio_childgender_2String50RecommendedBiological child 2 genderMale; Femaledem_sib2_gender_12
bio_childdiagnosis_2String255RecommendedBiological child 2 diagnosisdem_sib2_asd_spec_12
bio_childage_3IntegerRecommendedBiological child 3 age0::1200In monthsdem_sib3_age_12
bio_childgender_3String50RecommendedBiological child genderMale; Femaledem_sib3_gender_12
bio_childdiagnosis_3String255RecommendedBiological child diagnosisdem_sib3_asd_spec_12
ieh002dIntegerRecommendedFirst-degree relative with DSM-5 Autism Spectrum Disorder0;1; 2;-90=No; 1=Yes; 2 = I do not wish to disclose; -9=Unknowndem_fam_asd_12
cg2_employerString100RecommendedWho 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_12String50RecommendedWhat is the child's relationship to other adults living with the family?
dem_date_div_12String15RecommendedIf separated/divorced, date of separation/divorce (month, year)MM-YYYY
dem_remarried_12String15RecommendedIf remarried, date of remarriage (month, year) (If not remarried, write N/A)MM-YYYY
dem_industry_mom_12String200RecommendedFor 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 1)
dem_part_time_dad_12FloatRecommendedIf caregiver 2's current main daily activities/responsibilities are part-time, hrs/week
dem_spec_comp_12String500RecommendedList 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
dem_abnormal_12IntegerRecommendedWas this pregnancy unusual or abnormal in any way not already mentioned?0;10 = No; 1 = Yes
dem_med1_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 1: (You may choose more than one answer)
dem_med1_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 1 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med1_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 1 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med1_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 1 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med1_more_12IntegerRecommendedDid you take more than 1 medication during pregnancy?0;10 = No; 1 = Yes
dem_med2_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 2: (You may choose more than one answer)
dem_med2_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 2 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med2_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 2 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med2_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 2 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med2_more_12IntegerRecommendedDid you take more than 2 medications during pregnancy?0;10 = No; 1 = Yes
dem_med3_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 3: (You may choose more than one answer)
dem_med3_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 3 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med3_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 3 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med3_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 3 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med3_more_12IntegerRecommendedDid you take more than 3 medications during pregnancy?0;10 = No; 1 = Yes
dem_med4_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 4: (You may choose more than one answer)
dem_med4_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 4 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med4_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 4 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med4_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 4 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med4_more_12IntegerRecommendedDid you take more than 4 medications during pregnancy?0;10 = No; 1 = Yes
dem_med5_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 5: (You may choose more than one answer)
dem_med5_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 5 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med5_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 5 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med5_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 5 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med5_more_12IntegerRecommendedDid you take more than 5 medications during pregnancy?0;10 = No; 1 = Yes
dem_med6_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 6: (You may choose more than one answer)
dem_med6_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 6 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med6_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 6 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med6_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 6 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med6_more_12IntegerRecommendedDid you take more than 6 medications during pregnancy?0;10 = No; 1 = Yes
dem_med7_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 7: (You may choose more than one answer)
dem_med7_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 7 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med7_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 7 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med7_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 7 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med7_more_12IntegerRecommendedDid you take more than 7 medications during pregnancy?0;10 = No; 1 = Yes
dem_med8_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 8: (You may choose more than one answer)
dem_med8_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 8 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med8_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 8 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med8_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 8 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med8_more_12IntegerRecommendedDid you take more than 8 medications during pregnancy?0;10 = No; 1 = Yes
dem_med9_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 9: (You may choose more than one answer)
dem_med9_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 9 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med9_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 9 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med9_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 9 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med9_more_12IntegerRecommendedDid you take more than 9 medications during pregnancy?0;10 = No; 1 = Yes
dem_med10_trimester_12String100RecommendedPlease specify the period(s) of time that you took medication 10: (You may choose more than one answer)
dem_med10_1sttri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 10 during the FIRST trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med10_2ndtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 10 during the SECOND trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med10_3rddtri_freq_12IntegerRecommendedPlease specify the frequency that you took medication 10 during the THIRD trimester0::40 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
dem_med10_more_12IntegerRecommendedDid you take more than 10 medications during pregnancy?0;10 = No; 1 = Yes
dem_birthcomp_spec_12String500RecommendedPlease explain any difficulties or complications experienced by your child during birth
dem_othercomp_12IntegerRecommendedWere there other complications or illnesses during your child's stay in the hospital after birth (e.g. hyperbilirubinemia, difficulty breathing)?0;10 = No; 1 = Yes
dem_othercomp_spec_12String1,000RecommendedPlease describe Other complications or illnesses during your child's stay in the hospital after birth
dem_illness_12IntegerRecommendedHas your child experienced any serious illness or difficulties in development since birth?0;10 = No; 1 = Yes
dem_illness_spec_12String500RecommendedPlease explain serious illness or difficulties in development since birth
dem_other_devel_12String250RecommendedParental comments about child's health and/or developmental progress?
dem_sib1IntegerRecommendedNumber of FULL older siblings?
dem_sib1_home_12IntegerRecommendedIs the older sibling (1) living at parental home?0;10 = No; 1 = Yes
dem_sib1_asd_12IntegerRecommendedDoes the older sibling (1) have a diagnosis of ASD?0;10 = No; 1 = Yes
dem_sib1_asd_who_12String50RecommendedWho originally diagnosed your child (older sibling 1) with ASD?
dem_sib1_asd_where_12String50RecommendedWhere was your child (older sibling 1) diagnosed with ASD?
dem_sib1_asd_date_12String15RecommendedWhat was the date of the ASD evaluation of older sibling (1)?
dem_sib1_asd_age_12IntegerRecommendedHow old was older sibling (1) when he/she was diagnosed with an ASD?0::1200Age in months
dem_sib1_asd_bhv_12String200RecommendedWhat were the behaviors that supported older sibling (1)'s ASD diagnosis?
dem_sib1_disorder_12IntegerRecommendedHas older sibling (1) ever been diagnosed with a neurological or genetic disorder?0;10 = No; 1 = Yes
dem_sib1_disorder_spec_12String50RecommendedPlease specify the neurological or genetic diagnosis of older sibling (1)
dem_sib1_dis_who_12String50RecommendedWho originally diagnosed your child (older sibling 1) with the neurological or genetic disorder?
dem_sib1_dis_where_12String50RecommendedWhere was your child (older sibling1) diagnosed with the neurological or genetic disorder?
dem_sib1_dis_date_12String15RecommendedWhat was the date of the evaluation for older sibling (1)'s neurological or genetic disorder?
dem_sib1_dis_age_12IntegerRecommendedHow old was your child (older sibling 1) when he/she was diagnosed with the neurological/genetic disorder?0::1200Age in months
dem_sib1_dis_bhv_12String200RecommendedWhat were the behaviors that supported the diagnosis of older sibling (1) with the neurological/genetic disorder?
dem_sib1_asd_services_12IntegerRecommendedIs your child (older sibling 1) currently receiving services for this ASD diagnosis?0;10 = No; 1 = Yes
dem_sib1_asd_services_spec_12String150RecommendedIf yes, please specify the types of services this older sibling (1) receives for ASD
dem_sib1_condition_12IntegerRecommendedHas the older sibling (1) ever been diagnosed with a medical condition not previously specified?0;10 = No; 1 = Yes
dem_sib1_cond_spec_12String50RecommendedPlease specify the medical condition not previously mentioned for older sibling (1).
dem_sib1_motdelay_12IntegerRecommendedTo the best of your knowledge, does your child (older sibling 1) experience any delays in motor development?0;10 = No; 1 = Yes
dem_sib1_motdelay_spec_12String200RecommendedIf yes, please explain older sibling (1)'s delays in motor development?
dem_sib1_vocdelay_12IntegerRecommendedTo the best of your knowledge, does older sibling (1) experience any delays in vocalization or language development?0;10 = No; 1 = Yes
dem_sib1_vocdelay_spec_12String200RecommendedIf yes, please explain older sibling (1)'s delays in vocalization or language development
dem_sib1_other_12String500RecommendedDo you have any other concerns about the older sibling (1)'s health and/or developmental progress?
dem_sib2_home_12IntegerRecommendedIs the older sibling (2) living at parental home?0;10 = No; 1 = Yes
dem_sib2_asd_12IntegerRecommendedDoes the older sibling (2) have a diagnosis of ASD?0;10 = No; 1 = Yes
dem_sib2_asd_who_12String50RecommendedWho originally diagnosed your child (older sibling 2) with ASD?
dem_sib2_asd_where_12String50RecommendedWhere was your child (older sibling 2) diagnosed with ASD?
dem_sib2_asd_date_12String15RecommendedWhat was the date of the ASD evaluation of older sibling (2)?
dem_sib2_asd_age_12IntegerRecommendedHow old was older sibling (2) when he/she was diagnosed with an ASD?0::1200Age in months
dem_sib2_asd_bhv_12String200RecommendedWhat were the behaviors that supported older sibling (2)'s ASD diagnosis?
dem_sib2_asd_services_12IntegerRecommendedHas older sibling (2) ever been diagnosed with a neurological or genetic disorder?0;10 = No; 1 = Yes
dem_sib2_dis_services_spec_12String50RecommendedPlease specify the neurological or genetic diagnosis of older sibling (2)
dem_sib2_disorder_12String50RecommendedWho originally diagnosed your child (older sibling 2) with the neurological or genetic disorder?
dem_sib2_disorder_spec_12String50RecommendedWhere was your child (older sibling2) diagnosed with the neurological or genetic disorder?
dem_sib2_dis_who_12String15RecommendedWhat was the date of the evaluation for older sibling (2)'s neurological or genetic disorder?
dem_sib2_dis_where_12IntegerRecommendedHow old was your child (older sibling 2) when he/she was diagnosed with the neurological/genetic disorder?0::1200Age in months
dem_sib2_dis_date_12String200RecommendedWhat were the behaviors that supported the diagnosis of older sibling (2) with the neurological/genetic disorder?
dem_sib2_dis_age_12IntegerRecommendedIs your child (older sibling 2) currently receiving services for this ASD diagnosis?0;10 = No; 1 = Yes
dem_sib2_dis_bhv_12String150RecommendedIf yes, please specify the types of services this older sibling (2) receives for ASD
dem_sib2_condition_12IntegerRecommendedHas the older sibling (2) ever been diagnosed with a medical condition not previously specified?0;10 = No; 1 = Yes
dem_sib2_cond_spec_12String50RecommendedPlease specify the medical condition not previously mentioned for older sibling (2).
dem_sib2_motdelay_12IntegerRecommendedTo the best of your knowledge, does your child (older sibling 2) experience any delays in motor development?0;10 = No; 1 = Yes
dem_sib2_motdelay_spec_12String200RecommendedIf yes, please explain older sibling (2)'s delays in motor development?
dem_sib2_vocdelay_12IntegerRecommendedTo the best of your knowledge, does older sibling (2) experience any delays in vocalization or language development?0;10 = No; 1 = Yes
dem_sib2_vocdelay_spec_12String200RecommendedIf yes, please explain older sibling (2)'s delays in vocalization or language development
dem_sib2_other_12String500RecommendedDo you have any other concerns about the older sibling (2)'s health and/or developmental progress?
dem_sib3_home_12IntegerRecommendedIs the older sibling (3) living at parental home?0;10 = No; 1 = Yes
dem_sib3_asd_12IntegerRecommendedDoes the older sibling (3) have a diagnosis of ASD?0;10 = No; 1 = Yes
dem_sib3_asd_who_12String50RecommendedWho originally diagnosed your child (older sibling 3) with ASD?
dem_sib3_asd_where_12String50RecommendedWhere was your child (older sibling 3) diagnosed with ASD?
dem_sib3_asd_date_12String15RecommendedWhat was the date of the ASD evaluation of older sibling (3)?
dem_sib3_asd_age_12IntegerRecommendedHow old was older sibling (3) when he/she was diagnosed with an ASD?0::1200Age in months
dem_sib3_asd_bhv_12String200RecommendedWhat were the behaviors that supported older sibling (3)'s ASD diagnosis?
dem_sib3_asd_services_12IntegerRecommendedHas older sibling (3) ever been diagnosed with a neurological or genetic disorder?0;10 = No; 1 = Yes
dem_sib3_asd_services_spec_12String50RecommendedPlease specify the neurological or genetic diagnosis of older sibling (3)
dem_sib3_disorder_12String50RecommendedWho originally diagnosed your child (older sibling 3) with the neurological or genetic disorder?
dem_sib3_dis_who_12String50RecommendedWhere was your child (older sibling3) diagnosed with the neurological or genetic disorder?
dem_sib3_disorder_spec_12String15RecommendedWhat was the date of the evaluation for older sibling (3)'s neurological or genetic disorder?
dem_sib3_dis_where_12IntegerRecommendedHow old was your child (older sibling 3) when he/she was diagnosed with the neurological/genetic disorder?0::1200Age in months
dem_sib3_dis_date_12String200RecommendedWhat were the behaviors that supported the diagnosis of older sibling (3) with the neurological/genetic disorder?
dem_sib3_dis_age_12IntegerRecommendedIs your child (older sibling 3) currently receiving services for this ASD diagnosis?0;10 = No; 1 = Yes
dem_sib3_dis_bhv_12String150RecommendedIf yes, please specify the types of services this older sibling (3) receives for ASD
dem_sib3_condition_12IntegerRecommendedHas the older sibling (3) ever been diagnosed with a medical condition not previously specified?0;10 = No; 1 = Yes
dem_sib3_cond_spec_12String50RecommendedPlease specify the medical condition not previously mentioned for older sibling (3).
dem_sib3_motdelay_12IntegerRecommendedTo the best of your knowledge, does your child (older sibling 3) experience any delays in motor development?0;10 = No; 1 = Yes
dem_sib3_motdelay_spec_12String200RecommendedIf yes, please explain older sibling (3)'s delays in motor development?
dem_sib3_vocdelay_12IntegerRecommendedTo the best of your knowledge, does older sibling (3) experience any delays in vocalization or language development?0;10 = No; 1 = Yes
dem_sib3_vocdelay_spec_12String200RecommendedIf yes, please explain older sibling (3)'s delays in vocalization or language development
dem_sib3_other_12String500RecommendedDo you have any other concerns about the older sibling (3)'s health and/or developmental progress?
dem_moresibs_12String1,000RecommendedPlease list other older siblings along with any ASD diagnosis and other developmental concerns
dem_fam_rel_12IntegerRecommendedRelation of relative with ASD to subject with ASD1::31 = Mother ; 2 = Father ; 3 = Other
dem_rel_asd_age_12IntegerRecommendedFamily Member Diagnosed with ASD: Current Age0::1200
dem_fam_asd_spec_12String50RecommendedSpecify Diagnosis of Family Member Diagnosed with ASD
dem_rel_asd_diag_12String50RecommendedWho originally diagnosed family member with ASD?
dem_rel_asd_where_12String50RecommendedWhere was the family member with ASD diagnosed?
dem_rel_asd_date_12String15RecommendedWhat was the date of the evaluation at which Family Member was diagnosed with ASD?year
dem_rel_asd_aged_12IntegerRecommendedHow old was the Family Member with ASD when he/she was diagnosed?0::1200
dem_rel_asd_bhv_12String200RecommendedWhat were the behaviors that supported the Family Member's ASD diagnosis?
dem_fam_disorder_12IntegerRecommendedHave 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;10 = No; 1 = Yes
dem_fam_dis_spec_12String100RecommendedPlease specify relationship and diagnosis of Family Member diagnosed with a neurobiological or genetic disorder
dem_fam_mental_12IntegerRecommendedHave 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;10 = No; 1 = Yes
dem_fam_mental_spec_12String100RecommendedPlease specify the subject's affected family member and the mental health diagnosis
dem_fam_langdelay_12IntegerRecommendedDo any of the child's/subject's immediate biological family members have a current diagnosis or history of language impairment or delay?0;10 = No; 1 = Yes
dem_fam_langdelay_spec_12String100RecommendedPlease specify the subject's Family Member with language impairment/delay and the diagnosis
dem_fam_learn_12IntegerRecommendedDo 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;10 = No; 1 = Yes
dem_fam_learn_spec_12String100RecommendedPlease specify the subject's affected family member and the diagnosis of intellectual disability (mental retardation) or learning disabilities
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
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

Please email the The NDA Help Desk with any questions.

Distribution for DataStructure: asdriskdemo01 and Element:
Chart Help

Filters enable researchers to view the data shared in NDA before applying for access or for selecting specific data for download or NDA Study assignment. For those with access to NDA shared data, you may select specific values to be included by selecting an individual bar chart item or by selecting a range of values (e.g. interview_age) using the "Add Range" button. Note that not all elements have appropriately distinct values like comments and subjectkey and are not available for filtering. Additionally, item level detail is not always provided by the research community as indicated by the number of null values given.

Filters for multiple data elements within a structure are supported. Selections across multiple data structures will be supported in a future version of NDA.