NAME
Item
NAME
text
C1299487 (UMLS CUI [1])
TODAY'S DATE
Item
TODAY'S DATE
date
C0011008 (UMLS CUI [1])
CHILD'S BIRTH DATE
Item
CHILD'S BIRTH DATE
date
C0421451 (UMLS CUI [1])
CHILD'S AGE
Item
CHILD'S AGE
integer
C0001779 (UMLS CUI [1])
Item
CHILD'S SEX
integer
C0079399 (UMLS CUI [1])
Item
CHILD'S ETHNIC GROUP/RACE
integer
C0034510 (UMLS CUI [1])
C0015031 (UMLS CUI [2])
Code List
CHILD'S ETHNIC GROUP/RACE
CL Item
AFRICAN-AMERICAN (1)
CL Item
NATIVE AMERICAN (3)
CL Item
OTHER (SPECIFY) (6)
CHILD'S ETHNIC GROUP/RACE: OTHER (SPECIFY)
Item
CHILD'S ETHNIC GROUP/RACE: OTHER (SPECIFY)
text
C0034510 (UMLS CUI [1,1])
C3845569 (UMLS CUI [1,2])
C0015031 (UMLS CUI [2,1])
C3845569 (UMLS CUI [2,2])
Item
YOUR RELATIONSHIP
integer
C0021797 (UMLS CUI [1,1])
C0008059 (UMLS CUI [1,2])
Code List
YOUR RELATIONSHIP
CL Item
OTHER (SPECIFY) (3)
YOUR RELATIONSHIP: OTHER (SPECIFY)
Item
YOUR RELATIONSHIP: OTHER (SPECIFY)
text
C0021797 (UMLS CUI [1,1])
C0008059 (UMLS CUI [1,2])
C3845569 (UMLS CUI [1,3])
PRIMARY CAREGIVER’S RELATIONSHIP (if different than parents)
Item
PRIMARY CAREGIVER’S RELATIONSHIP (if different than parents)
text
C1830484 (UMLS CUI [1,1])
C0021797 (UMLS CUI [1,2])
HEAD OF THE HOUSEHOLD’S RELATIONSHIP (if different than the primary caregiver)
Item
HEAD OF THE HOUSEHOLD’S RELATIONSHIP (if different than the primary caregiver)
text
C0018677 (UMLS CUI [1,1])
C0021797 (UMLS CUI [1,2])
MOTHER'S TYPE OF WORK
Item
MOTHER'S TYPE OF WORK
text
C0026591 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
FATHER'S TYPE OF WORK
Item
FATHER'S TYPE OF WORK
text
C0015671 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
PRIMARY CAREGIVER’S TYPE OF WORK
Item
PRIMARY CAREGIVER’S TYPE OF WORK
text
C0043227 (UMLS CUI [1,1])
C1830484 (UMLS CUI [1,2])
HEAD OF THE HOUSEHOLD’S TYPE OF WORK
Item
HEAD OF THE HOUSEHOLD’S TYPE OF WORK
text
C0018677 (UMLS CUI [1,1])
C0043227 (UMLS CUI [1,2])
HIGHEST GRADE COMPLETED: MOTHER
Item
HIGHEST GRADE COMPLETED: MOTHER
text
C0013658 (UMLS CUI [1,1])
C0026591 (UMLS CUI [1,2])
HIGHEST GRADE COMPLETED: FATHER
Item
HIGHEST GRADE COMPLETED: FATHER
text
C0013658 (UMLS CUI [1,1])
C0015671 (UMLS CUI [1,2])
HIGHEST GRADE COMPLETED: PRIMARY CAREGIVER
Item
HIGHEST GRADE COMPLETED: PRIMARY CAREGIVER
text
C0013658 (UMLS CUI [1,1])
C1830484 (UMLS CUI [1,2])
HIGHEST GRADE COMPLETED: HEAD OF THE HOUSEHOLD
Item
HIGHEST GRADE COMPLETED: HEAD OF THE HOUSEHOLD
text
C0013658 (UMLS CUI [1,1])
C0018677 (UMLS CUI [1,2])
Item
1. When you talk to your child, does s/he look at you?
integer
C0008059 (UMLS CUI [1,1])
C0009452 (UMLS CUI [1,2])
Code List
1. When you talk to your child, does s/he look at you?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
2. Does your child try to get your attention to show you things?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
Code List
2. Does your child try to get your attention to show you things?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
3. Does your child interact with you back and forth over a few turns using speech or sounds?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0009452 (UMLS CUI [1,3])
Code List
3. Does your child interact with you back and forth over a few turns using speech or sounds?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
4. Does your child greet you when you return home by making sounds or talking to you?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0566229 (UMLS CUI [1,3])
Code List
4. Does your child greet you when you return home by making sounds or talking to you?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
5. Does your child greet you when you return home by hugging you?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0566229 (UMLS CUI [1,3])
Code List
5. Does your child greet you when you return home by hugging you?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
6. Does your child respond playfully by playing “dressing up” games?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0032214 (UMLS CUI [1,3])
Code List
6. Does your child respond playfully by playing “dressing up” games?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
7. Does your child respond playfully by playing pretend games with dolls, cars, action figures, dollhouse?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0032214 (UMLS CUI [1,3])
Code List
7. Does your child respond playfully by playing pretend games with dolls, cars, action figures, dollhouse?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
8. During meals does your child interact with you by making sounds or talking?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C1998602 (UMLS CUI [1,3])
Code List
8. During meals does your child interact with you by making sounds or talking?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
9. During meals does your child show what food s/he likes by speech or making sounds?
integer
C0008059 (UMLS CUI [1,1])
C1998602 (UMLS CUI [1,2])
C0009452 (UMLS CUI [1,3])
Code List
9. During meals does your child show what food s/he likes by speech or making sounds?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
10. Does your child copy you by washing dishes, pretending to cook or mow the lawn, etc.?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C2584305 (UMLS CUI [1,3])
Code List
10. Does your child copy you by washing dishes, pretending to cook or mow the lawn, etc.?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
11. Does your child show you things that s/he has done and wants you to praise?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0679455 (UMLS CUI [1,3])
Code List
11. Does your child show you things that s/he has done and wants you to praise?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
12. Does your child smile when you praise him/her?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0557963 (UMLS CUI [1,3])
Code List
12. Does your child smile when you praise him/her?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
13. Can your child tell from the look on your face or the tone of your voice that you are angry?
integer
C0008059 (UMLS CUI [1,1])
C0002957 (UMLS CUI [1,2])
Code List
13. Can your child tell from the look on your face or the tone of your voice that you are angry?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
14. Does your child show interest in other children by watching them?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C2371283 (UMLS CUI [1,3])
Code List
14. Does your child show interest in other children by watching them?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
15. Does your child show interest in other children by staying close to them?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0444337 (UMLS CUI [1,3])
Code List
15. Does your child show interest in other children by staying close to them?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
16. Does your child show interest in other children by joining in the play if they invite him/her?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0032214 (UMLS CUI [1,3])
Code List
16. Does your child show interest in other children by joining in the play if they invite him/her?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
17. Does your child show interest in other children by showing concern if another child is upset?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C2699424 (UMLS CUI [1,3])
Code List
17. Does your child show interest in other children by showing concern if another child is upset?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
18. Is your child able to start a social exchange with other children?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
Code List
18. Is your child able to start a social exchange with other children?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
19. Is your child able to take turns in play?
integer
C0008059 (UMLS CUI [1,1])
C0032214 (UMLS CUI [1,2])
Code List
19. Is your child able to take turns in play?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
20. Does your child have playmates who s/he prefer to play with?
integer
C0008059 (UMLS CUI [1,1])
C0032214 (UMLS CUI [1,2])
C0079382 (UMLS CUI [1,3])
Code List
20. Does your child have playmates who s/he prefer to play with?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Item
21. Does your child share toys and favorite objects with siblings or other children his/her age?
integer
C0008059 (UMLS CUI [1,1])
C0037420 (UMLS CUI [1,2])
C0237876 (UMLS CUI [1,3])
Code List
21. Does your child share toys and favorite objects with siblings or other children his/her age?
CL Item
Some of the time (1)
CL Item
Most of the time (2)
CL Item
Almost all of the time (3)
Comments
Item
Please write any comments or questions this you may have regarding the questionnaire. Thank you.
text
C0947611 (UMLS CUI [1])