CDE Detailed Report

Disease: Friedreich's Ataxia
Sub-Domain: Quality of Life/Patient Reported Outcomes
CRF: Pediatric Quality of Life Inventory (PEDSQL)

Displaying 1 - 27 of 27
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
C21948 Pediatric Quality of Life Inventory (PedsQL) - Problem heavy lift difficulty scale PedsQLLiftScl Scale of problems with lifting something heavy, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with lifting something heavy, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: LIFTING: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Lifting something heavy; For all the other Age Ranges: In the past one month, how much of a problem has your child had with: Lifting something heavy? Standard Version: Self: In the past one month, how much of a problem has this been for you : It is hard for me to lift something heavy? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Lifting something heavy; For all the other Age Ranges: In the past 7 days, how much of a problem has your child had with: Lifting something heavy? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to lift something heavy. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen. Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:48:29.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21961 Pediatric Quality of Life Inventory (PedsQL) - Problem peer teasing difficulty scale PedsQLTeasedScl Scale of problems with getting teased by other teen/kids, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with getting teased by other teen/kids, as part of the Pediatric Quality of Life Inventory (PedsQL). SOCIAL FUNCTIONING:BEING TEASED: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Getting teased by other teens? For all the other Age Ranges: In the past month ,how much of a problem has your child had with: Getting teased by other children? Standard Version: Self: In the past one month, how much of a problem has this been for you: Other kids tease me. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Getting teased by other teens? For all the other Age Ranges: In the past 7 days ,how much of a problem has your child had with: Getting teased by other kids? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: Other kids tease me. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 16:02:23.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21934 Pediatric Quality of Life Inventory (PedsQL) - Problem angry scale PedsQLAngryScl Scale of problems with feeling mad, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with feeling mad, as part of the Pediatric Quality of Life Inventory (PedsQL). EMOTIONAL FUNCTIONING: FEELING ANGRY: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Feeling angry; For all the other Age Ranges: In the past month, how much of a problem has your child had with: Feeling angry? Standard Version: Self: In the past one month, how much of a problem has this been for you: I feel angry; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Feeling angry; For all the other Age Ranges: In the past 7 days, how often did the child have with feeling angry? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I feel angry. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:33:56.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21949 Pediatric Quality of Life Inventory (PedsQL) - Problem doctor hospital appointment school absent difficulty scale PedsQLMisSchDocScl Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: MISSING SCHOOL/DOCTOR/HOSPITAL VISIT: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Missing school to go the doctor or hospital; For all other Age Ranges: In the past month, how much of a problem has your teen had with: Missing school to go to the doctor or hospital. Standard Version: Self: In the past one month, how much of a problem has your child had with: : I miss school to go the doctor or hospital. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Missing school to go the doctor or hospital; For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Missing school to go to the doctor or hospital? Acute Version: Self: In the past 7 days, how much of a problem has your child had with: I miss school to go the doctor or hospital. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:49:47.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21962 Pediatric Quality of Life Inventory(PedsQL) - Total score PedsQLTtlScore Total Score as a part of Pediatric Quality of Life Inventory (PedsQL). Total Score as a part of Pediatric Quality of Life Inventory (PedsQL). Total Score= Sum of al the items over the number of items answered on all the Scales Numeric Values

Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf. Step 1: Transform Score: Items are reversed scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25,4=0. Step 2: Calculate Scores: Score by Dimensions: If more than 50% of the items in the scale are missing, the Scale Scores should not be computed. Mean Score = Sum of the items over the numbers of items answered.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf " Pediatric Supplemental 1.00 2016-06-06 16:03:25.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

0 100
C21935 Pediatric Quality of Life Inventory (PedsQL) - Problem school class attention difficulty scale PedsQLAttClssScl Scale of problems paying attention in class, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems paying attention in class, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: PAYING ATTENTION IN CLASS: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Paying attention in class? For all other Age Ranges: In the past month, how much of a problem has your child had with: Paying attention in class? Standard Version: Self: In the past one month, how much of a problem has this been for you: It is hard to pay attention in class? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Paying attention in class. For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Paying attention in class? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: It is hard to pay attention in class. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:36:11.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21950 Pediatric Quality of Life Inventory (PedsQL) - Problem school absent unwell difficulty scale PedsQLMisSchSickScl Scale of problems with missing school because of not feeling well, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with missing school because of not feeling well, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: MISSING SCHOOL/NOT FEELING WELL: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Missing school because of not feeling well; For all other Age Ranges: In the past month, how much of a problem has your child had with: Missing school because of not feeling well. Standard Version: Self: In the past one month, how much of a problem has your child had with: I miss school because of not feeling well?; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Missing school because of not feeling well; For all other Age Ranges: In the past 7 days, how much of a problem has your teen had with: Missing school because of not feeling well? Acute Version: Self: In the past 7 days, how much of a problem has your child had with: I miss school because of not feeling well. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:51:07.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21964 Pediatric Quality of Life Inventory (PedsQL) - Problem walk greater than one block difficulty scale PedsQLWalkScl Scale of problems with walking more than one block, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with walking more than one block, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: WALKING: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Walking more than one block?; For all the other Age Ranges: In the past one month, how much of a problem has your child had with: Walking more than one block? Standard Version: Self: In the past one month, how much of a problem has this been for you : It is hard for me to walk more than one block; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Walking more than one block?; FOR ALL OTHER AGE RANGES: In the past 7 days, how much of a problem has your child had with: Walking more than one block? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to walk more than one block. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 16:06:14.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21936 Pediatric Quality of Life Inventory (PedsQL) - Problem bath shower alone scale PedsQLBathScl Scale of problems with taking a bath or shower by themselves, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with taking a bath or shower by themselves, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: BATH/SHOWER: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Taking a bath or shower by him or herself; For all the other Age Ranges :In the past month, how much of a problem has your child had with: Taking a bath or shower by him or herself; ? Standard Version: Self: In the past one month, how much of a problem has this been for you: It is hard for me to take a bath or shower by myself? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Taking a bath or shower by him or herself; ; For all the other Age Ranges :In the past 7 days, how much of a problem has your teen had with: Taking a bath or shower by him or herself; Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to take a bath or shower by myself. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:37:41.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21951 Pediatric Quality of Life Inventory (PedsQL) - Problem unable social activity skill peer difficulty scale PedsQLNotDoThingScl Scale of problems with not being able to do things that other teens/kids their age can do, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with not being able to do things that other teens/kids their age can do, as part of the Pediatric Quality of Life Inventory (PedsQL). SOCIAL FUNCTIONING: DOING THINGS: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Not being able to do things that other teens his or her age can do; For all other Age Ranges: In the past month, how much of a problem has your child had with: Not being able to do things that other children his or her age can do? Standard Version: Self: In the past one month, how much of a problem has this been for you: I cannot do things that other kids my age can do. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Not being able to do things that other teens his or her age can do; For all other Age Ranges: In the past 7 days, how much of a problem has your teen had with: Not being able to do things that other teens his or her age can do. Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I cannot do things that other kids my age can do. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:52:31.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21965 Pediatric Quality of Life Inventory (PedsQL) - Problem worry self difficulty scale PedsQLWorryScl Scale of problems worrying about what will happen to you, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems worrying about what will happen to you, as part of the Pediatric Quality of Life Inventory (PedsQL). EMOTIONAL FUNCTIONING: WORRYING: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Worrying about what will happen to him or her? For all other Age Ranges: In the past month, how much of a problem has your child had with: Worrying about what will happen to him or her. Standard Version: Self: In the past one month, how much of a problem has this been for you: I worry about what will happen to me? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Worrying about what will happen to him or her. For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Worrying about what will happen to him or her. Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I worry about what will happen to me? 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 16:07:17.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21938 Pediatric Quality of Life Inventory (PedsQL) - Problem house chore difficulty scale PedsQLChoresScl Scale of problems with doing chores around the house, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with doing chores around the house, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: PERFORMING CHORES: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Doing chores around the house; For all the other Age Ranges: In the past month, how much of a problem has your child had with: Doing chores around the house? Standard Version: Self: In the past one month, how much of a problem has this been for you : It is hard for me to do chores around the house? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Doing chores around the house; For all the other Age Ranges: In the past 7 days, how much of a problem has your child had with: Doing chores around the house? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to do chores around the house. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:38:58.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21953 Pediatric Quality of Life Inventory(PedsQL) - Physical health summary score PedsQLPhyHeaSumScore Summary Score of the Physical Functioning Scale Score as a part of Pediatric Quality of Life Inventory (PedsQL). Summary Score of the Physical Functioning Scale Score as a part of Pediatric Quality of Life Inventory (PedsQL). Physical Health Summary Score= Sum of the physical functioning subscale as a part of Pediatric Quality of Life (PedsQL) Numeric Values

Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf. Step 1: Transform Score: Items are reversed scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25,4=0. Step 2: Calculate Scores: Score by Dimensions: If more than 50% of the items in the scale are missing, the Scale Scores should not be computed. Mean Score = Sum of the items over the numbers of items answered.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf " Pediatric Supplemental 1.00 2016-06-06 15:53:45.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

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C21939 Pediatric Quality of Life Inventory (PedsQL) - Problem low energy difficulty scale PedsQLEnergyScl Scale of problems with low energy, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with low energy, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: LOW ENERGY: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Low energy level; For all the other Age Ranges: In the past month, how much of a problem has your teen had with: Low energy level? Standard Version: Self: In the past one month, how much of a problem has your child had with: I have low energy level. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Low energy level; For all the other Age Ranges: In the past 7 days, how often did the child/you have low energy? Acute Version: Self: In the past 7 days, how much of a problem has your teen had with: I have low energy level? 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:40:04.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21954 Pediatric Quality of Life Inventory(PedsQL) - Psychosocial health summary score PedsQLPsyHeaSumScore Psychosocial Health Summary Score as a part of Pediatric Quality of Life Inventory (PedsQL). Psychosocial Health Summary Score as a part of Pediatric Quality of Life Inventory (PedsQL). Psychosocial Health Summary Score= Sum of the items over the number of items answered in the Emotional, Social, and School Functioning Scales Numeric Values

Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf. Step 1: Transform Score: Items are reversed scored and linearly transformed to a 0-100 scale as follows: 0=100, 1=75, 2=50, 3=25,4=0. Step 2: Calculate Scores: Score by Dimensions: If more than 50% of the items in the scale are missing, the Scale Scores should not be computed. Mean Score = Sum of the items over the numbers of items answered.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. Scoring instructions for all PedsQL Instruments: http://www.pedsql.org/PedsQL-Scoring.pdf " Pediatric Supplemental 1.00 2016-06-06 15:55:48.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

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C21940 Pediatric Quality of Life Inventory (PedsQL) - Problem memory difficulty scale PedsQLForgetScl Scale of problems forgetting things, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems forgetting things, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: FORGETTING THINGS: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Forgetting things; For all other Age Ranges: In the past month, how much of a problem has your child had with: Forgetting things. Standard Version: Self: In the past one month, how much of a problem has this been for you: I forget things; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Forgetting things. For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Forgetting things.? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I forget things. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:41:20.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21955 Pediatric Quality of Life Inventory (PedsQL) - Problem run difficulty scale PedsQLRunScl Scale of problems with running, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with running, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: RUNNING: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Running. For all other Age Ranges: In the past one month, how much of a problem has your child had with: Running? Standard Version: Self: In the past one month, how often did you have problems : It is hard for me to run. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Running? For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Running? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to run. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:56:44.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21942 Pediatric Quality of Life Inventory (PedsQL) - Problem gain friend difficulty scale PedsQLFriendsScl Scale of problems with other kids not wanting to be their friend, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with other kids not wanting to be their friend, as part of the Pediatric Quality of Life Inventory (PedsQL). SOCIAL FUNCTIONING:OTHER TEENS/KIDS: Standard Version: Parent: TEEN: In the past one month , how much of a problem has your teen had with: Other teens not wanting to be his or her friend; For all other Age Ranges: In the past month, how much of a problem has your child had with: Other kids not wanting to be his or her friend? Standard Version: Self: In the past one month , how much of a problem has this been for you: Other kids do not want to be my friend? Acute Version: Parent: TEEN: In the past 7 days , how much of a problem has your teen had with: Other teens not wanting to be his or her friend; For all other Age Ranges: In the past 7 days, how much of a problem has your child had with: Other kids not wanting to be his or her friend? Acute Version: Self: In the past 7 days , how much of a problem has this been for you: Other kids do not want to be my friend 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:43:13.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21956 Pediatric Quality of Life Inventory (PedsQL) - Problem sad difficulty scale PedsQLSadScl Scale of problems with feeling sad or blue, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with feeling sad or blue, as part of the Pediatric Quality of Life Inventory (PedsQL). EMOTIONAL FUNCTIONING: FEELING SAD/BLUE: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Feeling sad or blue; For all the other Age ranges: In the past month, how much of a problem has your teen had with: Feeling sad or blue? Standard Version: Self: In the past one month, how much of a problem has this been for you: I feel sad or blue. Acute Version: Parent: TEEN: In the past 7 days, how often did the teen have with feeling sad or blue; For all the other Age ranges: In the past 7 days, how often did the child have the feeling of being sad or blue? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I feel sad or blue. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:57:45.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21943 Pediatric Quality of Life Inventory (PedsQL) - Problem harmony peer difficulty scale PedsQLGetAlongScl Scale of problems with getting along with other kids, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with getting along with other kids, as part of the Pediatric Quality of Life Inventory (PedsQL). SOCIAL FUNCTIONING: GETTING ALONG: Standard Version: Parent:TEEN: In the past one month, how much of a problem has your teen had with: Getting along with other teens; For all the other Age Ranges: In the past month,how much of a problem has your child had with: Getting along with other children? Standard Version: Self: In the past one month, how much of a problem has this been for you: I have trouble getting along with other kids? Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Getting along with other teens; For all the other Age Ranges: In the past 7 days,how much of a problem has your child had with: Getting along with other children? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I have trouble getting along with other kids 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:45:00.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21957 Pediatric Quality of Life Inventory (PedsQL) - Problem peer school activity difficulty scale PedsQLSamSchActScl Scale of frequency of difficulties doing the same school activities as peers, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of frequency of difficulties doing the same school activities as peers, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: SAME SCHOOL ACTIVITIES: Standard Version: Parent: Toddler: In the past one month, how much of a problem has your child had with doing the same school activities as peers? Acute Version: Parent: Toddler: In the past 7 days, how much of a problem has your child had with: Doing the same school activities as peers. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen child . Please tell us how much of a problem each one has been for your child during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help. Please complete this section if your child attends school or daycare

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:58:49.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21945 Pediatric Quality of Life Inventory (PedsQL) - Problem schoolwork difficulty scale PedsQLKeepUpSchoolScl Scale of problems keeping up with schoolwork, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems keeping up with schoolwork, as part of the Pediatric Quality of Life Inventory (PedsQL). SCHOOL FUNCTIONING: KEEPING UP SCHOOLWORK: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Keeping up with schoolwork; For all other Age Ranges: In the past month, how much of a problem has your teen had with: Keeping up with schoolwork. Standard Version: Self: In the past one month, how much of a problem has this been for you: I have trouble keeping up with my schoolwork.; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Keeping up with schoolwork. For all other Age Ranges: In the past 7 days, how much of a problem has your teen had with: Keeping up with schoolwork. Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I have trouble keeping up with my schoolwork. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:46:11.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21959 Pediatric Quality of Life Inventory (PedsQL) - Problem sleep trouble scale PedsQLSleepScl Scale of problems with trouble sleeping, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with trouble sleeping, as part of the Pediatric Quality of Life Inventory (PedsQL). EMOTIONAL FUNCTIONING: TROUBLE SLEEPING: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Trouble sleeping. For all other Age Ranges: In the past month, how much of a problem has your teen had with: Trouble sleeping? Standard Version: Self: In the past one month, how much of a problem has this been for you: I have trouble sleeping. Acute Version: Parent: TEEN: In the past 7 days, how often did the teen have problems with trouble sleeping? For all other Age Ranges: In the past 7 days, how often did the child have trouble sleeping? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I have trouble sleeping. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 16:00:16.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21930 Pediatric Quality of Life Inventory (PedsQL) - Problem hurt ache scale PedsQLAchesScl Scale of problems with having hurts or aches, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with having hurts or aches, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: HURTS/ACHES: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Having hurts or aches; For all the other Age Ranges: In the past month, how much of a problem has your child had with: Having hurts or aches? Standard Version: Self: In the past one month, how much of a problem has this been for you : I hurt or ache. Acute Version: Parent: TEEN: In the past 7 days, how often did the teen have with having hurts or aches; For all the other Age Ranges: In the past 7 days, how often did the child/you have hurts or aches? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : I hurt or ache. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:26:52.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21946 Pediatric Quality of Life Inventory (PedsQL) - Problem play energy peer difficulty scale PedsQLKeepUpScl Scale of problems with keeping up when playing with other children, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with keeping up when playing with other children, as part of the Pediatric Quality of Life Inventory (PedsQL). SOCIAL FUNCTIONING: KEEPING UP WITH OTHERS: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Keeping up with other teens; For all other Age Ranges: In the past month, how much of a problem has your child had with: Keeping up when playing with other children? Standard Version: Self: In the past one month, how much of a problem has this been for you: It is hard to keep up with my peers/when I play with other kids. Acute Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Keeping up with other teens; For all other Age Ranges: In the past month, how much of a problem has your teen had with: Keeping up with other teens? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: It is hard to keep up with my peers/when I play with other kids. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:47:16.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21960 Pediatric Quality of Life Inventory (PedsQL) - Problem sport activity exercise participation difficulty scale PedsQLSportsScl Scale of problems with participating in sports activity or exercise, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with participating in sports activity or exercise, as part of the Pediatric Quality of Life Inventory (PedsQL). PHYSICAL FUNCTIONING: PLAYING SPORTS: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Participating in sports activity or exercise; For all the other Age Ranges: In the past one month, how much of a problem has your child had with: Participating in sports activity or exercise? Standard Version: Self: In the past one month, how much of a problem has this been for you : It is hard for me to do sports activity or exercise. Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Participating in sports activity or exercise; For all the other Age Ranges: In the past 7 days, how much of a problem has your child had with: Participating in sports activity or exercise? Acute Version: Self: In the past 7 days, how much of a problem has this been for you : It is hard for me to do sports activity or exercise. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 16:01:26.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C21933 Pediatric Quality of Life Inventory (PedsQL) - Problem fear scale PedsQLAfraidScl Scale of problems with feeling afraid or scared, as part of the Pediatric Quality of Life Inventory (PedsQL). Scale of problems with feeling afraid or scared, as part of the Pediatric Quality of Life Inventory (PedsQL). EMOTIONAL FUNCTIONING: FEELING SCARED/AFRAID: Standard Version: Parent: TEEN: In the past one month, how much of a problem has your teen had with: Feeling afraid or scared; For all the other Age Ranges: In the past month, how much of a problem has your child had with: Feeling afraid or scared? Standard Version: Self: In the past one month, how much of a problem has this been for you: I feel afraid or scared; Acute Version: Parent: TEEN: In the past 7 days, how much of a problem has your teen had with: Feeling afraid or scared; For all the other Age Ranges: In the past 7 days, how much of a problem has your child had with: Feeling afraid or scared;? Acute Version: Self: In the past 7 days, how much of a problem has this been for you: I feel afraid or scared. 0;1;2;3;4 Never;Almost never;Sometimes;Often;Almost Always Numeric Values

On the following page is a list of things that might be a problem for you/your child/your teen . Please tell us how much of a problem each one has been for your during the past ONE month by circling: 0 if it is never a problem, 1 if it is almost never a problem, 2 if it is sometimes a problem, 3 if it is often a problem, 4 if it is always a problem. There are no right or wrong answers. If you do not understand a question, please ask for help.

"Copyright 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni. Retrieved from the PROQOLID website: http://www.proqolid.org/content/download/11861/176794/version/1/file/RC_PedsQL-4.0-Core-All_AU4.0_eng-USori.pdf, Generic Score Scales pg.20-23; http://www.proqolid.org/content/download/11824/176685/version/1/file/RC_PedsQL-3.0-Cog+Functioning-All_AU3.0_eng-USori.pdf, Cognitive Functioning Scale pg.20-23. " Pediatric Supplemental 1.00 2016-06-06 15:30:25.0 Pediatric Quality of Life Inventory (PEDSQL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

CSV