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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Infant Screening Demographics Form

0 Shared Subjects

N/A
Clinical Assessments
Demographics
01/06/2017
asdriskdemo01
01/09/2017
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* survey_number_12
src_subject_id String 20 Required Subject ID how it's defined in lab/project survey_id_12
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY dem_date_12
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query respondent String 20 Recommended Respondent Mother;Father;Parent;Guardian;Teacher;Child;Self;Caregiver;Partner;Other dem_respondent_12
respondent_other_specify String 50 Recommended Respondent: Other (specify) dem_resp_other_12
q1_6 String 200 Recommended How did you hear about this study dem_heard_12
Query race String 30 Recommended Race of study subject American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported; Other Non-White; Other dem_race_12
otherrace String 100 Recommended specify other race The following questions are about you or the child's family. dem_race_spec_12
Query ethnicity String 30 Recommended Ethnicity of participant Hispanic or Latino; Not Hispanic or Latino; Unknown dem_hispanic_12
Query mother_race String 55 Recommended Mother's race American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported dem_race_mom_12
p_race_bir String 50 Recommended Mother race, specified for more than one race dem_spec_race_mom_12
Query mother_ethnicity String 30 Recommended Mother ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) Hispanic or Latino;Not Hispanic or Latino;Not Provided dem_hisp_mom_12
Query father_race String 55 Recommended Father's race American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported dem_race_dad_12
p2_race_bir String 50 Recommended Father race, specified for more than one race/biracial dem_spec_race_dad_12
Query father_ethnicity String 30 Recommended Father ethnicity (choices are Hispanic/Latino or Not Hispanic/Latino) Hispanic or Latino;Not Hispanic or Latino;Not Provided dem_hisp_dad_12
Query thous Integer Recommended Total number of persons in household 0=Does not apply (e.g., in institution), 99=unknown dem_household_12
Query adults_household Integer Recommended Number adults in household dem_adults_12
Query children_household Integer Recommended Number children household dem_children_12
Query cg1_relationship String 100 Recommended Caregiver/Parent 1's Relationship to Participant Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother dem_relation_mom_12
cg1_relationship_specify String 100 Recommended Caregiver/Parent 1's Relationship to Participant Other Specify dem_other_rel_mom_12
Query demo_resp_status Integer Recommended respondent's marital status 1::13 1 = Married; 2 = Remarried; 3 = Live with partner (not married); 4 = Separated; 5 = Divorced; 6 = Single (never married); 7 = Widowed; 8=Married or Living Together;9 = Missing/Not Applicable; 10 = Other; 11=Refused to answer; 12= Engaged; 13=Civil union dem_marital_12
Query d21y Integer Recommended Years legally married including common law dem_length_mar_12
Query custody Integer Recommended Who has legal custody of this child? 1::20;-99;77;88 0= Biological mom only (dad may or may not have visitation rights) ; 1= Biological dad only (mom may or may not have visitation rights) ; 2= Both biological parents living together ; 3= Shared custody between biological parents (50/50) ; 4= Step mom ; 5= Step dad ; 6= Former step mom ; 7= Former step dad ; 8= Adoptive mom ; 9= Adoptive dad ; 10=0 Both adoptive parents living together ; 11=1 State ; 12=2 Female relative ; 13=3 Male relative ; 14=4 Foster parent(s) ; 15=5 Other ; 16 = Questionnaire Respondent/CG1; 17 = Other Parent/CG2; 18 = Joint; 19= Mother has sole custody; 20= Father has sole custody;-99= N/A ; 77= Refused ; 88= Missing dem_custodial_12
Query dem_edu_mom_12 Integer Recommended Please indicate the highest level of education of Parent/Caregiver 1: 1::7; 888 1 = 8th grade or less ; 2 = Some high school ; 3 = High school/GED ; 4 = Associate's Degree ; 5 = Bachelor's Degree ; 6 = Master's Degree ; 7 = M.D. = Ph.D. = J.D. or equivalent ; 888 = I do not wish to disclose
Query parent_1_employment Integer Recommended Current employment status for parent 1 1::10 1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose dem_work_mom_12
Query lnghrs Integer Recommended How many hours per week did the client work at that job dem_parttime_mom_12
cg1_occupation String 100 Recommended Caregiver/Parent 1's Occupation dem_jobtitle_mom_12
eo8a_sp_recode String 100 Recommended Job employer dem_employer_mom_12
Query dem_income_12 Integer Recommended Which of these categories best describes your total combined family income for the past 12 months? This should include income (before taxes) from all sources, wages, rent from properties, social security, disability and/or veteran's benefits, unemployment benefits, worker's compensation, help from relatives (including child payments and alimony), and so on. 0::19;777;888 0 = Doesn't know or would rather not say; 1 = Less than $10,000 ; 2 = $10,000 through $19,999 ; 3 = $20,000 through $29,999 ; 4 = $30,000 through $39,999 ; 5 = $40,000 through $49,999 ; 6 = $50,000 through $59,999 ; 7 = $60,000 through $69,999 ; 8 = $70,000 through $79,999 ; 9 = $80,000 through $89,999 ; 10 = $90,000 through $99,999 ; 11 = $100,000 through $119,999 ; 12 = $120,000 through $129,999 ; 13 = $130,000 through $139,999 ; 14 = $140,000 and greater ; 15=$50,000-$74,999; 16=$75,000-$99,999; 17=$100,000-$150,000; 18=over $150,000; 19 = $75,000 or more; 777 = Don't know ; 888 = No response
Query cg2_relationship String 100 Recommended Caregiver/Parent 2's Relationship to Participant Parent;Step-parent;Foster parent;Grandparent;Other family member;Other; Biological Mother; Biological Father; Biological Parent; Adoptive Parent; Adoptive/Foster Parent; I do not wish to disclose; Step-father; Step-mother dem_relation_dad_12
cg2_relationship_specify String 100 Recommended Caregiver/Parent 2's Relationship to Participant Other Specify dem_other_rel_dad_12
Query dem_edu_dad_12 Integer Recommended Please indicate the highest level of education of Parent/Caregiver 2: 1::7; 888 1 = 8th grade or less ; 2 = Some high school ; 3 = High school/GED ; 4 = Associate's Degree ; 5 = Bachelor's Degree ; 6 = Master's Degree ; 7 = M.D. = Ph.D. = J.D. or equivalent ; 888 = I do not wish to disclose
Query parent_2_employment Integer Recommended Current employment status for parent 2 1::10 1=Employed - full time; 2=Retired;3=Employed - part time; 4=Unable to work/Disabled;5=Unemployed; 6=A full time student; 7=Other; 8 = Looking for work; 9 = Keeping house/raising children full-time; 10 = I do not wish to disclose dem_work_dad_12
spouseindustry String 100 Recommended Spouse's occupation: Industry or type of business dem_industry_dad_12
cg2_occupation String 100 Recommended Caregiver/Parent 2's Occupation dem_jobtitle_dad_12
Query pg_art String 50 Recommended Was this pregnancy the result of Assisted Reproductive Technology (ART)? No;Yes;Don't Know dem_art_12
preg_asstrep String 255 Recommended Was any other assisted reproduction used? If so, specify dem_art_spec_12
Query preg_comp String 50 Recommended Were there complications during pregnancy? Yes; No;999 dem_complications_12
preg_comp_note String 300 Recommended Note regarding complications during pregnancy dem_clar_comp_12
dem_abnorm_spec_12 String 250 Recommended Please specify how this pregnancy was unusual or abnormal in a way not already mentioned
Query preg_dxdrug String 10 Recommended Used prescription medications during pregnancy? Yes; No; NK NK = Not known dem_medications_12
Query medication1_name String 500 Recommended Name first medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med1_name_12
Query medication2_name String 500 Recommended Name second medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med2_name_12
medication3_name String 500 Recommended Name third medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med3_name_12
medication4_name String 500 Recommended Name fourth medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med4_name_12
medication5_name String 500 Recommended Name fifth medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med5_name_12
medication6_name String 500 Recommended Name sixth medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med6_name_12
medication7_name String 500 Recommended Name seventh medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med7_name_12
medication8_name String 500 Recommended Name eighth medication that the participant has taken 0 = No medication; 999= Legitimately skipped dem_med8_name_12
medication9_name String 500 Recommended Name ninth medication that the participant has taken dem_med9_name_12
medication10_name String 100 Recommended Name tenth medication that the participant has taken dem_med10_name_12
omramedother String 150 Recommended Other Medication name (not in list) specified dem_med_extraneous
prghxoth String 250 Recommended Other Pregnancy History dem_pregancy_12
Query demo_preg_vaginal Integer Recommended Did the mother have a vaginal birth or a cesarean birth (C-section)? 1;2;97;-999 1= Vaginal birth; 2= Cesarean birth; 97= Do not know; -999= Prefer not to answer dem_csection_12
ldnb_cothers String 255 Recommended For C section - Why was the c-section performed - Others dem_csec_spec_12
Query birth Integer Recommended Perinatal - Complications at birth? 0::3 0=N/A; 1=no; 2=yes; 3=NK dem_birthcomp_12
Query cmedhx10 Integer Recommended How many days did the baby stay in the hospital after birth? dem_hospstay_12
Query ldnb_stayicu String 50 Recommended Did this baby stay in the neonatal intensive care unit No;Yes;Don't Know dem_specialcare_12
Query demo_child_nicu_days Integer Recommended If yes, how many days was the child in the NICU? 78=Other; 99=N/A dem_specialcare_length_12
Query medhis_curmed String 50 Recommended Is the child currently on any prescription medication No;Yes;Not Sure dem_child_medications_12
dem_child_med_name_12 String 50 Recommended What is the name of the child's medication?
q53_b6a2 String 100 Recommended Medication 1 Indication Indicate use of medication dem_child_med_purpose_12
medication1_dosage String 150 Recommended First medication dosage 0 = No medication; 999 = Missing dem_child_med_dose_12
Query cfmh_chd_visionimp Integer Recommended Does the Child have a vision impairment? 1;0 0 = No; 1 = Yes dem_vision_12
chd_visionimp_sp String 100 Recommended Child vision impairment, specify dem_vis_spec_12
Query strconmotordelay String 5 Recommended Does the child have motor delays or slow motor development? Yes; No dem_motdelay_12
elmotr_cmt String 4,000 Recommended MOTOR SKILLS - Comment dem_motdelay_spec_12
Query child_speechdelay String 50 Recommended Does (did) the Child have a Speech/Language Delay? Yes; No; NK; NS NK= Not known; NS = Not sure dem_langdelay_12
ques_langdelaynotes String 255 Recommended Had or has a speech or language delay or impairment -Notes dem_langdel_spec_12
Query q21_15 Integer Recommended Has this child ever had seizures or convulsions 0; 1 0=No;1=Yes dem_seizure_12
mh_31 Date Recommended Date of onset for Seizures MM/DD/YYYY dem_seiz_date_12
Query rev_headfebseiz String 50 Recommended Febrile Seizures Yes; No; NK; NS NK= Not known; NS = Not sure dem_seiz_fever_12
Query diagnosis_seizures_current String 20 Recommended Is child having seizures currently? Yes; No; Don't Know (DK); Not Applicable (N/A) dem_seiz_now_12
Query q21_15d Integer Recommended Does this child now take medications to help control seizures 0; 1 0=No;1=Yes dem_seiz_med_12
Query bio_childage_1 Integer Recommended Biological child 1 age 0::1200 In months dem_sib1_age_12
Query bio_childgender_1 String 50 Recommended Biological child 1 gender Male; Female dem_sib1_gender_12
Query bio_childdiagnosis_1 String 255 Recommended Biological child 1 diagnosis dem_sib1_asd_spec_12
Query bio_childage_2 Integer Recommended Biological child 2 age 0::1200 In months dem_sib2_age_12
Query bio_childgender_2 String 50 Recommended Biological child 2 gender Male; Female dem_sib2_gender_12
bio_childdiagnosis_2 String 255 Recommended Biological child 2 diagnosis dem_sib2_asd_spec_12
Query bio_childage_3 Integer Recommended Biological child 3 age 0::1200 In months dem_sib3_age_12
Query bio_childgender_3 String 50 Recommended Biological child gender Male; Female dem_sib3_gender_12
bio_childdiagnosis_3 String 255 Recommended Biological child diagnosis dem_sib3_asd_spec_12
Query ieh002d Integer Recommended First-degree relative with DSM-5 Autism Spectrum Disorder 0;1; 2;-9 0=No; 1=Yes; 2 = I do not wish to disclose; -9=Unknown dem_fam_asd_12
cg2_employer String 100 Recommended Who is Parent 2's employer? (For example: Mass General Hospital, Cambridge Bank, Trader Joe's, Arlington Public Schools) dem_employer_dad_12
dem_adult_relation_12 String 50 Recommended What is the child's relationship to other adults living with the family?
dem_date_div_12 String 15 Recommended If separated/divorced, date of separation/divorce (month, year) MM-YYYY
dem_remarried_12 String 15 Recommended If remarried, date of remarriage (month, year) (If not remarried, write N/A) MM-YYYY
dem_industry_mom_12 String 200 Recommended For your current or most recent job, in what kind of industry did/do you work? (For example: hospital, auto engine manufacturing, newspaper publishing, mail order house) (Parent/Caregiver 1)
Query dem_part_time_dad_12 Float Recommended If caregiver 2's current main daily activities/responsibilities are part-time, hrs/week
dem_spec_comp_12 String 500 Recommended List all applicable prenatal complications: Examples: Pre-eclampsia ; Gestational Diabetes ; Placental Abruption ; Abnormal Contractions ; Bleeding from the vagina ; Swelling (Edema) ; High Blood Pressure ; Toxemia ; Rubella ; Weight loss (if s please specify how much below) ; Anemia ; Serious Injury (please specify below) ; Other Illness (please specify below) ; Confined to Bed ; Surgery (please specify below) ; Infections (please specify below) ; X-rays
Query dem_abnormal_12 Integer Recommended Was this pregnancy unusual or abnormal in any way not already mentioned? 0;1 0 = No; 1 = Yes
dem_med1_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 1: (You may choose more than one answer)
Query dem_med1_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 1 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med1_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 1 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med1_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 1 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med1_more_12 Integer Recommended Did you take more than 1 medication during pregnancy? 0;1 0 = No; 1 = Yes
dem_med2_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 2: (You may choose more than one answer)
Query dem_med2_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 2 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med2_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 2 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med2_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 2 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med2_more_12 Integer Recommended Did you take more than 2 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med3_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 3: (You may choose more than one answer)
Query dem_med3_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 3 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med3_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 3 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med3_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 3 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med3_more_12 Integer Recommended Did you take more than 3 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med4_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 4: (You may choose more than one answer)
Query dem_med4_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 4 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med4_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 4 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med4_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 4 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med4_more_12 Integer Recommended Did you take more than 4 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med5_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 5: (You may choose more than one answer)
Query dem_med5_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 5 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med5_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 5 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med5_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 5 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med5_more_12 Integer Recommended Did you take more than 5 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med6_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 6: (You may choose more than one answer)
Query dem_med6_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 6 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med6_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 6 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med6_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 6 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med6_more_12 Integer Recommended Did you take more than 6 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med7_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 7: (You may choose more than one answer)
Query dem_med7_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 7 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med7_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 7 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med7_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 7 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med7_more_12 Integer Recommended Did you take more than 7 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med8_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 8: (You may choose more than one answer)
Query dem_med8_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 8 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med8_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 8 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med8_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 8 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med8_more_12 Integer Recommended Did you take more than 8 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med9_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 9: (You may choose more than one answer)
Query dem_med9_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 9 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med9_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 9 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med9_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 9 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med9_more_12 Integer Recommended Did you take more than 9 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_med10_trimester_12 String 100 Recommended Please specify the period(s) of time that you took medication 10: (You may choose more than one answer)
Query dem_med10_1sttri_freq_12 Integer Recommended Please specify the frequency that you took medication 10 during the FIRST trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med10_2ndtri_freq_12 Integer Recommended Please specify the frequency that you took medication 10 during the SECOND trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med10_3rddtri_freq_12 Integer Recommended Please specify the frequency that you took medication 10 during the THIRD trimester 0::4 0 = Once; 1 = Fewer than three times a month; 2 = Once a week; 3 = More than once a week; 4 = Daily
Query dem_med10_more_12 Integer Recommended Did you take more than 10 medications during pregnancy? 0;1 0 = No; 1 = Yes
dem_birthcomp_spec_12 String 500 Recommended Please explain any difficulties or complications experienced by your child during birth
Query dem_othercomp_12 Integer Recommended Were there other complications or illnesses during your child's stay in the hospital after birth (e.g. hyperbilirubinemia, difficulty breathing)? 0;1 0 = No; 1 = Yes
dem_othercomp_spec_12 String 1,000 Recommended Please describe Other complications or illnesses during your child's stay in the hospital after birth
Query dem_illness_12 Integer Recommended Has your child experienced any serious illness or difficulties in development since birth? 0;1 0 = No; 1 = Yes
dem_illness_spec_12 String 500 Recommended Please explain serious illness or difficulties in development since birth
dem_other_devel_12 String 250 Recommended Parental comments about child's health and/or developmental progress?
Query dem_sib1 Integer Recommended Number of FULL older siblings?
Query dem_sib1_home_12 Integer Recommended Is the older sibling (1) living at parental home? 0;1 0 = No; 1 = Yes
Query dem_sib1_asd_12 Integer Recommended Does the older sibling (1) have a diagnosis of ASD? 0;1 0 = No; 1 = Yes
dem_sib1_asd_who_12 String 50 Recommended Who originally diagnosed your child (older sibling 1) with ASD?
dem_sib1_asd_where_12 String 50 Recommended Where was your child (older sibling 1) diagnosed with ASD?
dem_sib1_asd_date_12 String 15 Recommended What was the date of the ASD evaluation of older sibling (1)?
Query dem_sib1_asd_age_12 Integer Recommended How old was older sibling (1) when he/she was diagnosed with an ASD? 0::1200 Age in months
Query dem_sib1_asd_bhv_12 String 200 Recommended What were the behaviors that supported older sibling (1)'s ASD diagnosis?
Query dem_sib1_disorder_12 Integer Recommended Has older sibling (1) ever been diagnosed with a neurological or genetic disorder? 0;1 0 = No; 1 = Yes
dem_sib1_disorder_spec_12 String 50 Recommended Please specify the neurological or genetic diagnosis of older sibling (1)
dem_sib1_dis_who_12 String 50 Recommended Who originally diagnosed your child (older sibling 1) with the neurological or genetic disorder?
dem_sib1_dis_where_12 String 50 Recommended Where was your child (older sibling1) diagnosed with the neurological or genetic disorder?
dem_sib1_dis_date_12 String 15 Recommended What was the date of the evaluation for older sibling (1)'s neurological or genetic disorder?
Query dem_sib1_dis_age_12 Integer Recommended How old was your child (older sibling 1) when he/she was diagnosed with the neurological/genetic disorder? 0::1200 Age in months
dem_sib1_dis_bhv_12 String 200 Recommended What were the behaviors that supported the diagnosis of older sibling (1) with the neurological/genetic disorder?
Query dem_sib1_asd_services_12 Integer Recommended Is your child (older sibling 1) currently receiving services for this ASD diagnosis? 0;1 0 = No; 1 = Yes
dem_sib1_asd_services_spec_12 String 150 Recommended If yes, please specify the types of services this older sibling (1) receives for ASD
Query dem_sib1_condition_12 Integer Recommended Has the older sibling (1) ever been diagnosed with a medical condition not previously specified? 0;1 0 = No; 1 = Yes
dem_sib1_cond_spec_12 String 50 Recommended Please specify the medical condition not previously mentioned for older sibling (1).
Query dem_sib1_motdelay_12 Integer Recommended To the best of your knowledge, does your child (older sibling 1) experience any delays in motor development? 0;1 0 = No; 1 = Yes
dem_sib1_motdelay_spec_12 String 200 Recommended If yes, please explain older sibling (1)'s delays in motor development?
Query dem_sib1_vocdelay_12 Integer Recommended To the best of your knowledge, does older sibling (1) experience any delays in vocalization or language development? 0;1 0 = No; 1 = Yes
dem_sib1_vocdelay_spec_12 String 200 Recommended If yes, please explain older sibling (1)'s delays in vocalization or language development
dem_sib1_other_12 String 500 Recommended Do you have any other concerns about the older sibling (1)'s health and/or developmental progress?
Query dem_sib2_home_12 Integer Recommended Is the older sibling (2) living at parental home? 0;1 0 = No; 1 = Yes
Query dem_sib2_asd_12 Integer Recommended Does the older sibling (2) have a diagnosis of ASD? 0;1 0 = No; 1 = Yes
dem_sib2_asd_who_12 String 50 Recommended Who originally diagnosed your child (older sibling 2) with ASD?
dem_sib2_asd_where_12 String 50 Recommended Where was your child (older sibling 2) diagnosed with ASD?
dem_sib2_asd_date_12 String 15 Recommended What was the date of the ASD evaluation of older sibling (2)?
Query dem_sib2_asd_age_12 Integer Recommended How old was older sibling (2) when he/she was diagnosed with an ASD? 0::1200 Age in months
dem_sib2_asd_bhv_12 String 200 Recommended What were the behaviors that supported older sibling (2)'s ASD diagnosis?
Query dem_sib2_asd_services_12 Integer Recommended Has older sibling (2) ever been diagnosed with a neurological or genetic disorder? 0;1 0 = No; 1 = Yes
dem_sib2_dis_services_spec_12 String 50 Recommended Please specify the neurological or genetic diagnosis of older sibling (2)
dem_sib2_disorder_12 String 50 Recommended Who originally diagnosed your child (older sibling 2) with the neurological or genetic disorder?
dem_sib2_disorder_spec_12 String 50 Recommended Where was your child (older sibling2) diagnosed with the neurological or genetic disorder?
dem_sib2_dis_who_12 String 15 Recommended What was the date of the evaluation for older sibling (2)'s neurological or genetic disorder?
Query dem_sib2_dis_where_12 Integer Recommended How old was your child (older sibling 2) when he/she was diagnosed with the neurological/genetic disorder? 0::1200 Age in months
dem_sib2_dis_date_12 String 200 Recommended What were the behaviors that supported the diagnosis of older sibling (2) with the neurological/genetic disorder?
Query dem_sib2_dis_age_12 Integer Recommended Is your child (older sibling 2) currently receiving services for this ASD diagnosis? 0;1 0 = No; 1 = Yes
dem_sib2_dis_bhv_12 String 150 Recommended If yes, please specify the types of services this older sibling (2) receives for ASD
Query dem_sib2_condition_12 Integer Recommended Has the older sibling (2) ever been diagnosed with a medical condition not previously specified? 0;1 0 = No; 1 = Yes
dem_sib2_cond_spec_12 String 50 Recommended Please specify the medical condition not previously mentioned for older sibling (2).
Query dem_sib2_motdelay_12 Integer Recommended To the best of your knowledge, does your child (older sibling 2) experience any delays in motor development? 0;1 0 = No; 1 = Yes
dem_sib2_motdelay_spec_12 String 200 Recommended If yes, please explain older sibling (2)'s delays in motor development?
Query dem_sib2_vocdelay_12 Integer Recommended To the best of your knowledge, does older sibling (2) experience any delays in vocalization or language development? 0;1 0 = No; 1 = Yes
dem_sib2_vocdelay_spec_12 String 200 Recommended If yes, please explain older sibling (2)'s delays in vocalization or language development
dem_sib2_other_12 String 500 Recommended Do you have any other concerns about the older sibling (2)'s health and/or developmental progress?
Query dem_sib3_home_12 Integer Recommended Is the older sibling (3) living at parental home? 0;1 0 = No; 1 = Yes
Query dem_sib3_asd_12 Integer Recommended Does the older sibling (3) have a diagnosis of ASD? 0;1 0 = No; 1 = Yes
dem_sib3_asd_who_12 String 50 Recommended Who originally diagnosed your child (older sibling 3) with ASD?
dem_sib3_asd_where_12 String 50 Recommended Where was your child (older sibling 3) diagnosed with ASD?
dem_sib3_asd_date_12 String 15 Recommended What was the date of the ASD evaluation of older sibling (3)?
Query dem_sib3_asd_age_12 Integer Recommended How old was older sibling (3) when he/she was diagnosed with an ASD? 0::1200 Age in months
dem_sib3_asd_bhv_12 String 200 Recommended What were the behaviors that supported older sibling (3)'s ASD diagnosis?
Query dem_sib3_asd_services_12 Integer Recommended Has older sibling (3) ever been diagnosed with a neurological or genetic disorder? 0;1 0 = No; 1 = Yes
dem_sib3_asd_services_spec_12 String 50 Recommended Please specify the neurological or genetic diagnosis of older sibling (3)
dem_sib3_disorder_12 String 50 Recommended Who originally diagnosed your child (older sibling 3) with the neurological or genetic disorder?
dem_sib3_dis_who_12 String 50 Recommended Where was your child (older sibling3) diagnosed with the neurological or genetic disorder?
dem_sib3_disorder_spec_12 String 15 Recommended What was the date of the evaluation for older sibling (3)'s neurological or genetic disorder?
Query dem_sib3_dis_where_12 Integer Recommended How old was your child (older sibling 3) when he/she was diagnosed with the neurological/genetic disorder? 0::1200 Age in months
dem_sib3_dis_date_12 String 200 Recommended What were the behaviors that supported the diagnosis of older sibling (3) with the neurological/genetic disorder?
Query dem_sib3_dis_age_12 Integer Recommended Is your child (older sibling 3) currently receiving services for this ASD diagnosis? 0;1 0 = No; 1 = Yes
dem_sib3_dis_bhv_12 String 150 Recommended If yes, please specify the types of services this older sibling (3) receives for ASD
Query dem_sib3_condition_12 Integer Recommended Has the older sibling (3) ever been diagnosed with a medical condition not previously specified? 0;1 0 = No; 1 = Yes
dem_sib3_cond_spec_12 String 50 Recommended Please specify the medical condition not previously mentioned for older sibling (3).
Query dem_sib3_motdelay_12 Integer Recommended To the best of your knowledge, does your child (older sibling 3) experience any delays in motor development? 0;1 0 = No; 1 = Yes
dem_sib3_motdelay_spec_12 String 200 Recommended If yes, please explain older sibling (3)'s delays in motor development?
Query dem_sib3_vocdelay_12 Integer Recommended To the best of your knowledge, does older sibling (3) experience any delays in vocalization or language development? 0;1 0 = No; 1 = Yes
dem_sib3_vocdelay_spec_12 String 200 Recommended If yes, please explain older sibling (3)'s delays in vocalization or language development
dem_sib3_other_12 String 500 Recommended Do you have any other concerns about the older sibling (3)'s health and/or developmental progress?
dem_moresibs_12 String 1,000 Recommended Please list other older siblings along with any ASD diagnosis and other developmental concerns
Query dem_fam_rel_12 Integer Recommended Relation of relative with ASD to subject with ASD 1::3 1 = Mother ; 2 = Father ; 3 = Other
Query dem_rel_asd_age_12 Integer Recommended Family Member Diagnosed with ASD: Current Age 0::1200
dem_fam_asd_spec_12 String 50 Recommended Specify Diagnosis of Family Member Diagnosed with ASD
dem_rel_asd_diag_12 String 50 Recommended Who originally diagnosed family member with ASD?
dem_rel_asd_where_12 String 50 Recommended Where was the family member with ASD diagnosed?
dem_rel_asd_date_12 String 15 Recommended What was the date of the evaluation at which Family Member was diagnosed with ASD? year
Query dem_rel_asd_aged_12 Integer Recommended How old was the Family Member with ASD when he/she was diagnosed? 0::1200
dem_rel_asd_bhv_12 String 200 Recommended What were the behaviors that supported the Family Member's ASD diagnosis?
Query dem_fam_disorder_12 Integer Recommended Have any of the child's/subject's immediate biological family members been diagnosed with a neurobiological or genetic disorder (i.e. Epilepsy, Tourette Syndrome, Cerebral Palsy, Multiple Sclerosis, Down Syndrome, Fragile X, Tuberous Sclerosis Complex, etc.)? 0;1 0 = No; 1 = Yes
dem_fam_dis_spec_12 String 100 Recommended Please specify relationship and diagnosis of Family Member diagnosed with a neurobiological or genetic disorder
Query dem_fam_mental_12 Integer Recommended Have any of the child's/subject's immediate biological family members been diagnosed with a mental health disorder (i.e. Anxiety, Depression, ADHD/ADD, Bipolar Disorder, Schizophrenia, etc.)? 0;1 0 = No; 1 = Yes
dem_fam_mental_spec_12 String 100 Recommended Please specify the subject's affected family member and the mental health diagnosis
Query dem_fam_langdelay_12 Integer Recommended Do any of the child's/subject's immediate biological family members have a current diagnosis or history of language impairment or delay? 0;1 0 = No; 1 = Yes
dem_fam_langdelay_spec_12 String 100 Recommended Please specify the subject's Family Member with language impairment/delay and the diagnosis
Query dem_fam_learn_12 Integer Recommended Do any of the child's immediate biological family members have a current diagnosis or history of intellectual or learning disabilities (i.e. dyslexia, SLD, developmental delay, etc.)? 0;1 0 = No; 1 = Yes
dem_fam_learn_spec_12 String 100 Recommended Please specify the subject's affected family member and the diagnosis of intellectual disability (mental retardation) or learning disabilities
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.

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