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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Background History Form

156 Shared Subjects

Background History Form.
Clinical Assessments
Demographics
11/21/2012
back_hist01
11/21/2012
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
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
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 hispanic Integer Recommended Is subject of Hispanic, Latino, or Spanish origin? 0; 1; 999 0 = No; 1 = Yes; 999= missing
Query race String 30 Required 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
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
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
Query cg_relation_status String 50 Recommended Caregiver's relationship status married; widowed;separated;widowed, remarried;divorced, neither remarried;unmarried;divorced, both remarried;other;divorced, one remarried; living as though married; divorced
cg_relation_status_specify String 50 Recommended Caregiver's relationship status other, specify
Query liveswith String 100 Recommended child lives with
Both biological mother and father;Biological mother only;Biological father only;Biological mother and stepfather;Biological father and stepmother;Adoptive parents;Foster parents;Relatives;Other
liveswithother String 50 Recommended Child lives with other, specify
Query household_physical_custody String 50 Recommended Physical Custody situation if mother and father are divorced or separated Joint;Mother has sole custody;Father has sole custody
Query num_in_house_kids Integer Recommended Number of Individuals in Household Children
Query child1_age String 100 Recommended Other Child in Household 1 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child1_gender String 10 Recommended Other Child in Household 1 Gender Male;Female;Other
Query child1_education String 100 Recommended Other Child in Household 1 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child1_handedness String 100 Recommended Other Child in Household 1 Handedness Left-handed;Right-handed
Query child1_proband_relationship String 100 Recommended Other Child in Household 1 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
Query child2_age String 100 Recommended Other Child in Household 2 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child2_gender String 10 Recommended Other Child in Household 2 Gender Male;Female;Other
Query child2_education String 100 Recommended Other Child in Household 2 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child2_handedness String 100 Recommended Other Child in Household 2 Handedness Left-handed;Right-handed
Query child2_proband_relationship String 100 Recommended Other Child in Household 2 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
Query child3_age String 100 Recommended Other Child in Household 3 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child3_gender String 10 Recommended Other Child in Household 3 Gender Male;Female;Other
Query child3_education String 100 Recommended Other Child in Household 3 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child3_handedness String 100 Recommended Other Child in Household 3 Handedness Left-handed;Right-handed
Query child3_proband_relationship String 100 Recommended Other Child in Household 3 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
Query child4_age String 100 Recommended Other Child in Household 4 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child4_gender String 10 Recommended Other Child in Household 4 Gender Male;Female;Other
Query child4_education String 100 Recommended Other Child in Household 4 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child4_handedness String 100 Recommended Other Child in Household 4 Handedness Left-handed;Right-handed
Query child4_proband_relationship String 100 Recommended Other Child in Household 4 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
Query child5_age String 100 Recommended Other Child in Household 5 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child5_gender String 10 Recommended Other Child in Household 5 Gender Male;Female;Other
Query child5_education String 100 Recommended Other Child in Household 5 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child5_handedness String 100 Recommended Other Child in Household 5 Handedness Left-handed;Right-handed
Query child5_proband_relationship String 100 Recommended Other Child in Household 5 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
child6_age String 100 Recommended Other Child in Household 6 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child6_gender String 10 Recommended Other Child in Household 6 Gender Male;Female;Other
Query child6_education String 100 Recommended Other Child in Household 6 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child6_handedness String 100 Recommended Other Child in Household 6 Handedness Left-handed;Right-handed
Query child6_proband_relationship String 100 Recommended Other Child in Household 6 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
child7_age String 100 Recommended Other Child in Household 7 Age 0-4 years; 5-8 years; 9-12 years; 13-17 years; 18+ years
Query child7_gender String 10 Recommended Other Child in Household 7 Gender Male;Female
Query child7_education String 100 Recommended Other Child in Household 7 School Level Pre-school;Elementary;Jr high/middle;High school;Post-HS
Query child7_handedness String 100 Recommended Other Child in Household 7 Handedness Left-handed;Right-handed
Query child7_proband_relationship String 100 Recommended Other Child in Household 7 Relationship to Participant Sibling;Half-sibling;Other relative;Not related
Query chi_living Integer Recommended child living arrangement 1::3 1 = At home; 2 = In an institution; 3 = Other
chi_living_other String 255 Recommended child living arrangement_other Other living arrangement
Query cg1_education String 100 Recommended Caregiver/Prent 1's Highest Level of Education Some primary school;Some high school;High school diploma;GED;Some college or technical school;Associate degree;Baccalaureate degree;Graduate or professional degree; did not graduate from high school; college graduate; Middle School
Query cg2_education String 100 Recommended Caregiver/Parent 2's Highest Level of Education Some primary school;Some high school;High school diploma;GED;Some college or technical school;Associate degree;Baccalaureate degree;Graduate or professional degree; did not graduate from high school; college graduate; Middle School
cg1_occupation String 100 Recommended Caregiver/Parent 1's Occupation
cg2_occupation String 100 Recommended Caregiver/Parent 2's Occupation
Query cg_totalincome Integer Recommended total combined family income 1::7 1 = Less than $20,000; 2 = $20,000 to $35,000; 3 = $35,000 to $60,000; 4 = $60,000 to $100,000; 5 = $100,000 - $130,000; 6 = $130,000-$160,000; 7 = Over $160,000
Query milestone_age_mo_smile Integer Recommended Age in which the participant accomplished the following milestone in months: smiled
Query milestone_age_mo_satup Integer Recommended Age in which the participant accomplished the following milestone in months: sat up without support
Query milestone_age_mo_crawl Integer Recommended Age in which the participant accomplished the following milestone in months: crawled
Query milestone_age_mo_solidfood Float Recommended Age in which the participant accomplished the following milestone in months: started solid foods
Query milestone_age_mo_words Integer Recommended Age in which the participant accomplished the following milestone in months: used words
Query milestone_age_mo_stopbottle Integer Recommended Age in which the participant accomplished the following milestone in months: gave up bottle
Query milestone_age_mo_toilettrain Integer Recommended Age in which the participant accomplished the following milestone in months: was toilet trained
Query milestone_age_mo_walkalone Integer Recommended Age in which the participant accomplished the following milestone in months: walked alone
Query milestone_age_mo_fedselfspoon Integer Recommended Age in which the participant accomplished the following milestone in months: fed self with a spoon
Query toilet_train_day Integer Recommended 8. Acquisition of bladder control: daytime 0 :: 600; 993;994;995;996;997;998;999 993 = Successfully toilet trained for a period of 12 months but has relapsed and now regularly wets; 994 = Never achieved continence; 995 = Still not reached; 996 = N/K but apparently normal; 997 = N/K but apparently delayed; 998 = N/A; 999 = N/K or not asked
Query toilet_train_night Integer Recommended 9. Acquisition of bladder control: nighttime 0 :: 120;993;994;995;996;997;998;999 993 = Successfully toilet trained for a period of 12 months but has relapsed and now regularly wets; 994 = Never achieved continence; 995 = Still not reached; 996 = N/K but apparently normal; 997 = N/K but apparently delayed; 998 = N/A; 999 = N/K or not asked
Query milestone_age_mo_word_sent Integer Recommended Age in which the participant accomplished the following milestone in months: combined words in short sentences
cllinical_diagnosis String 100 Recommended clinical diagnosis Autism; PDD-NOS; Asperger's; ADHD; Language Disorder; Other; None
Query diag_ageatdiag Integer Recommended Age at diagnosis(in months)
0 :: 1200
Query lang_use Integer Recommended Please estimate your child's use of language 0::3 0 = Does not yet use single words; 1 = Uses 1 to 5 words daily; 2 = 2-3 word combinations daily; 3 = Full sentences daily
Query child_education Integer Recommended Current educational or other placement 0::7 0 = At home; 1 = Day care; 2 = Nursery/preschool; 3 = Kindergarten; 4 = School; 5 = Day program; 6 = Independent job; 7 = Supported job
Query chi_school Integer Recommended Highest grade of school child has completed / What is the highest level of education your child has completed? 1::22 1 = Preschool; 2 = Kindergarten; 3 = 1st grade; 4 = 2nd grade; 5 = 3rd grade; 6 = 4th grade; 7 = 5th grade; 8 = 6th grade; 9 = 7th grade; 10 = 8th grade; 11 = 9th grade; 12 = 10th grade; 13 = 11th grade; 14 = 12th grade; 15 = High school graduate / Other; 16 = GED; 17 = Some college credite but less than 1 year; 18 = One or more years of college at a 2-year program, no degree; 19 = Two years of college at a 4-year program, no degree; 20 = Three years or more of college at a 4-year, no degree; 21 = Associates degree; 22 = Bachelors degree
job_detail String 255 Recommended Please indicate type of program/job and amount of hours per week.
class_detail String 255 Recommended Any special type of classes or extra support provided? Specify
medication1_name String 500 Recommended Name first medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication1_current String 10 Required First medication currently taking?
Yes;No;999
999=NA/missing
Query medication1_past String 10 Recommended First medication took in the past?
Yes;No
Query medication1_frequency String 120 Recommended First medication frequency
medication1_dosage String 150 Recommended First medication dosage 0 = No medication; 999 = Missing
Query medication1_time Integer Recommended How long has first medication been taken? months
medication2_name String 500 Recommended Name second medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication2_current String 10 Recommended second medication currently taking?
Yes;No
Query medication2_past String 10 Recommended second medication took in the past?
Yes;No
Query medication2_frequency String 50 Recommended Second medication frequency
Query medication2_dosage String 100 Recommended Second medication dosage 0 = No medication; 999 = Missing
Query medication2_time Integer Recommended How long has second medication been taken? months
Query medication3_name String 500 Recommended Name third medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication3_current String 10 Recommended third medication currently taking?
Yes;No
Query medication3_past String 10 Recommended third medication took in the past?
Yes;No
Query medication3_frequency String 70 Recommended Third medication frequency
Query medication3_dosage String 100 Recommended Third medication dosage 0 = No medication; 999 = Missing
Query medication3_time Integer Recommended How long has third medication been taken? months
Query medication4_name String 500 Recommended Name fourth medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication4_current String 10 Recommended fourth medication currently taking?
Yes;No
Query medication4_past String 10 Recommended fourth medication took in the past?
Yes;No
Query medication4_frequency String 50 Recommended Fourth medication frequency
Query medication4_dosage String 100 Recommended Fourth medication dosage 0 = No medication; 999 = Missing
Query medication4_time Integer Recommended How long has fourth medication been taken? months
Query medication5_name String 500 Recommended Name fifth medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication5_current String 10 Recommended fifth medication currently taking?
Yes;No
Query medication5_past String 10 Recommended fifth medication took in the past?
Yes;No
Query medication5_frequency String 50 Recommended Fifth medication frequency
Query medication5_dosage String 100 Recommended Fifth medication dosage 0 = No medication; 999 = Missing
Query medication5_time Integer Recommended How long has fifth medication been taken? months
Query medication6_name String 500 Recommended Name sixth medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication6_current String 10 Recommended sixth medication currently taking?
Yes;No
Query medication6_past String 10 Recommended sixth medication took in the past?
Yes;No
Query medication6_frequency String 50 Recommended Sixth medication frequency
Query medication6_dosage String 100 Recommended Sixth medication dosage 0 = No medication; 999 = Missing
Query medication6_time Integer Recommended How long has sixth medication been taken? months
Query medication7_name String 500 Recommended Name seventh medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication7_current String 10 Recommended seventh medication currently taking?
Yes;No
Query medication7_past String 10 Recommended seventh medication took in the past?
Yes;No
Query medication7_frequency String 50 Recommended Seventh medication frequency
medication7_dosage String 100 Recommended Seventh medication dosage 0 = No medication; 999 = Missing
Query medication7_time Integer Recommended How long has seventh medication been taken? months
Query medication8_name String 500 Recommended Name eighth medication that the participant has taken 0 = No medication; 999= Legitimately skipped
Query medication8_current String 10 Recommended eighth medication currently taking?
Yes;No
Query medication8_past String 10 Recommended eighth medication took in the past?
Yes;No
medication8_frequency String 50 Recommended Eighth medication frequency
medication8_dosage String 100 Recommended Eighth medication dosage 0 = No medication; 999 = Missing
Query medication8_time Integer Recommended How long has eighth medication been taken? months
Query medication9_name String 500 Recommended Name ninth medication that the participant has taken
Query medication9_current String 10 Recommended ninth medication currently taking?
Yes;No
Query medication9_past String 10 Recommended ninth medication took in the past?
Yes;No
medication9_frequency String 50 Recommended Ninth medication frequency
medication9_dosage String 100 Recommended Ninth medication dosage
Query medication9_time Integer Recommended How long has ninth medication been taken? months
Query medication10_name String 100 Recommended Name tenth medication that the participant has taken
Query medication10_current String 10 Recommended tenth medication currently taking?
Yes;No
Query medication10_past String 10 Recommended tenth medication took in the past?
Yes;No
medication10_frequency String 50 Recommended Tenth medication frequency
medication10_dosage String 50 Recommended Tenth medication dosage
Query medication10_time Integer Recommended How long has tenth medication been taken? months
Query cg1_race String 100 Recommended Race of the Caregiver/Parent 1 American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
Query cg2_race String 100 Recommended Race of the Caregiver/Parent 2 American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported
Query cg1_ethnicity String 30 Recommended Caregiver/Parent 1's ethnicity Hispanic or Latino; Not Hispanic or Latino
Query cg2_ethnicity String 30 Recommended Caregiver/Parent 2's ethnicity Hispanic or Latino; Not Hispanic or Latino
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

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