CDE Detailed Report

Disease: Friedreich's Ataxia
Sub-Domain: General Health History
CRF: Pediatric Developmental History

Displaying 1 - 12 of 12
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C17499 Special education indicator SpecialEduInd Indicator as to whether the participant/subject has or had special education Indicator as to whether the participant/subject has or had special education Does/did the participant/subject have special education? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17500 Specialized therapy service indicator SpecializedTherapyServiceInd Indicator as to whether the participant/subject receives or received specialized therapies and services Indicator as to whether the participant/subject receives or received specialized therapies and services Does/did the participant/subject receive any specialized therapies and services? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If 'No' or 'Unknown,' skip question 11b

No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18768 Therapy or rehabilitation other text TherpyRehabOTH The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject Other, specify Alphanumeric

Choose all that the participant/ subject receives

No references available Adult;Pediatric Exploratory 1.00 2014-05-27 13:34:46.0 Pediatric Developmental History General Health History Participant History and Family History 4000

Free-Form Entry

C05130 Therapy or rehabilitation type TherpyRehabTyp Type of therapy or rehabilitation services received by the participant/subject. Type of therapy or rehabilitation services received by the participant/subject. If "Yes," indicate the type(s) of specialized therapies and services the participant/subject receives or received Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify Alphanumeric

Choose all that the participant/ subject receives

No references available Adult;Pediatric Exploratory 3.00 2013-07-20 10:21:25.65 Pediatric Developmental History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C18821 School placement other text SchoolPlacementOTH The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance. The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance. Other, specify Alphanumeric No references available Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 Pediatric Developmental History General Health History Participant History and Family History 4000

Free-Form Entry

C11086 School placement type SchoolPlacementTyp The description of the type of education the participant/subject receives with details of being with or without assistance. The description of the type of education the participant/subject receives with details of being with or without assistance. School placement Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify Alphanumeric No references available Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17493 Attention deficit disorder attention deficit hyperactivity disorder indicator AttentionDeficitADHDInd Indicator as to whether the participant/subject has or had attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) Indicator as to whether the participant/subject has or had attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) Does/did the participant/subject have attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17494 Delay language cognitive milestone indicator DelayLangCogMilestoneInd Indicator as to whether the participant/subject has or had delayed acquisition of language or cognitive milestones, as diagnosed by a pediatrician or neurologist Indicator as to whether the participant/subject has or had delayed acquisition of language or cognitive milestones, as diagnosed by a pediatrician or neurologist Does/did the participant/subject have delayed acquisition of language/cognitive milestones, diagnosed by a pediatrician or neurologist? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17495 Delay motor milestone indicator DelayMotorMilestoneInd Indicator as to whether the participant/subject has or had delayed motor milestones, as diagnosed by a pediatrician or neurologist Indicator as to whether the participant/subject has or had delayed motor milestones, as diagnosed by a pediatrician or neurologist Does/did the participant/subject have delayed acquisition of motor milestones, diagnosed by a pediatrician or neurologist? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17496 Delay social function indicator DelaySocialFunctionInd Indicator as to whether the participant/subject has or had delayed social function Indicator as to whether the participant/subject has or had delayed social function Does/did the participant/subject have social delay? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17497 Gait abnormal when began walking indicator GaitAbnrmlWhenBeganWalkInd Indicator as to whether the participant/subject had a gait abnormality at the time they began walking, as noted by parents or a physician Indicator as to whether or not the participant/subject had a gait abnormality at the time they began walking, as noted by parents or a physician Does/did the participant/subject have abnormality of the gait noted by parents or physician at the time the child began walking? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17498 Hand preference before 12 month age indicator HandPrefBefore12MoAgeInd Indicator as to whether the participant/subject had a hand preference before 12 months of age Indicator as to whether the participant/subject had a hand preference before 12 months of age Does/did the participant/subject have a hand preference before 12 months of age? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Exploratory 3.00 2013-07-15 16:08:48.687 Pediatric Developmental History General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV