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Protocol - Family History of Speech and Language Impairment

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Description:

The Family History Questionnaire is a 9-item proxy-administered questionnaire completed by a parent for their young child. It asks about the child's personal and family history of speech and language impairment.

Protocol:

Family History Questionnaire

Target child/person items:

1. By age 2, was your child talking in short phrases or sentences?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

2. When your child was 2 years old, were you concerned that he/she was having difficulty learning to talk?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

3. At this time, do people frequently have trouble understanding your child?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

4. Has anyone in your child's family had speech or language therapy?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

If Yes, Relationship to child? ___________________________________

What for? ____________________________________

Family items

Family: Parents and biologically related siblings

5. Has anyone in your child's family had difficulty learning to read or had problems with school work? (e.g., repeated a grade)

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

If Yes, what are the details? _________________________________________

6. Has anyone in your child's family been diagnosed as mentally retarded?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

7. Does anyone in your child's family have a hearing difficulty?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

8. Has anyone in your child's family been slow in learning to talk?

[ ] 0 No

[ ] 1 Yes

[ ] 99 Don't Know

9. Has anyone in your child's family had any other type of communication disorder such as:

9.1. Stuttering?

[ ] 0 No

[ ] 1 Yes

9.2. Is less talkative?

[ ] 0 No

[ ] 1 Yes

9.3. Has a hard time carrying on a conversation?

[ ] 0 No

[ ] 1 Yes

9.4. Doesn't like to read?

[ ] 0 No

[ ] 1 Yes

9.5. Doesn't read well?

[ ] 0 No

[ ] 1 Yes

9.6. Has difficulty thinking of words (s)he wants to say when talking?

[ ] 0 No

[ ] 1 Yes

9.7. Has a poorer vocabulary than other family members?

[ ] 0 No

[ ] 1 Yes

9.8. Is a poor speller?

[ ] 0 No

[ ] 1 Yes

9.9. Has awkward sentence structures when writing or talking?

[ ] 0 No

[ ] 1 Yes

9.10. Mispronounces long words?

[ ] 0 No

[ ] 1 Yes

9.11. Is hard to follow when (s)he tells you something, such as a personal experience?

[ ] 0 No

[ ] 1 Yes

9.12. Has difficulty explaining things?

[ ] 0 No

[ ] 1 Yes

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required
None
Equipment Needs
The respondent will need a copy of the questionnaire.
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Proxy-administered questionnaire

Life Stage:

Child, Adolescent, Adult

Participants:

The parents of children and adolescents, ages 3-21 years old

Specific Instructions:
Rosa's Law, enacted in October 2010, changes references in federal laws and acts from "mental retardation" to "intellectual disability," and references to a "mentally retarded individual" to "an individual with an intellectual disability." The PhenX Working Group notes that this protocol was developed and tested using previously accepted terminology. Replacing this terminology with the newly enacted standard is at the researcher's discretion.
Selection Rationale

The Family History Questionnaire was selected because it is a simple, reliable protocol that can be quickly and easily administered to capture a child's personal and family history of speech and language impairment.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Family Medical History Speech And Language Impairment Assessment Description Text 3139293 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Fam hx speech lang impair proto 62984-0 LOINC
Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source
Mabel L. Rice, author. Family History Questionnaire. Language Acquisition Studies Lab. University of Kansas, Lawrence, KS.
General References

Rice, M. L., Haney, K. R., & Wexler, K. (1998). Family histories of children with SLI who show extended optional infinitives. Journal of Speech, Language, and Hearing Research, 41, 419–432.

Protocol ID:

200401

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX200401_Difficulty_Learning_To_Read PX200401050000 Has anyone in your child's family had difficulty learning to read or had problems with school work? (e.g. repeated a grade) 4 N/A
PX200401_Difficulty_Learning_To_Read_Details PX200401050100 Has anyone in your child's family had difficulty learning to read or had problems with school work? (e.g. repeated a grade) If Yes, what are the details? 4 N/A
PX200401_Difficulty_Learning_To_Talk PX200401020000 When your child was two years old, were you concerned that he/she was having difficulty learning to talk? 4 N/A
PX200401_Family_History_Awkward_Sentence_Structure PX200401090900 Has anyone in your child's family had any other type of communication disorder such as: Has awkward sentence structures when writing or talking 4 N/A
PX200401_Family_History_Difficulty_Explaining_Things PX200401091200 Has anyone in your child's family had any other type of communication disorder such as: Has difficulty explaining things 4 N/A
PX200401_Family_History_DoesNot_Like_Read PX200401090400 Has anyone in your child's family had any other type of communication disorder such as: Doesn't like to read 4 N/A
PX200401_Family_History_DoesNot_Read_Well PX200401090500 Has anyone in your child's family had any other type of communication disorder such as: Doesn't read well 4 N/A
PX200401_Family_History_Hard_To_Follow PX200401091100 Has anyone in your child's family had any other type of communication disorder such as: Is hard to follow when (s)he tells you something, such as a personal experience 4 N/A
PX200401_Family_History_Hearing_Difficulty PX200401070000 Does anyone in your child's family have a hearing difficulty? 4 N/A
PX200401_Family_History_Less_Talkative PX200401090200 Has anyone in your child's family had any other type of communication disorder such as: Is less talkative 4 N/A
PX200401_Family_History_Mispronounce_Long_Words PX200401091000 Has anyone in your child's family had any other type of communication disorder such as: Mispronounces long words 4 N/A
PX200401_Family_History_Poorer_Vocabulary PX200401090700 Has anyone in your child's family had any other type of communication disorder such as: Has a poorer vocabulary than other family members 4 N/A
PX200401_Family_History_Poor_Speller PX200401090800 Has anyone in your child's family had any other type of communication disorder such as: Is a poor speller 4 N/A
PX200401_Family_History_Retardation PX200401060000 Has anyone in your child's family been diagnosed as mentally retarded? 4 N/A
PX200401_Family_History_Slow_To_Talk PX200401080000 Has anyone in your child's family been slow in learning to talk? 4 N/A
PX200401_Family_History_SpeechLanguageTherapy_Purpose PX200401040200 Has anyone in your child's family had speech or language therapy? If Yes, What for? 4 N/A
PX200401_Family_History_SpeechLanguageTherapy_Relationship PX200401040100 Has anyone in your child's family had speech or language therapy? If Yes, Relationship to child? 4 N/A
PX200401_Family_History_Speech_Language_Therapy PX200401040000 Has anyone in your child's family had speech or language therapy? 4 N/A
PX200401_Family_History_Stuttering PX200401090100 Has anyone in your child's family had any other type of communication disorder such as: Stuttering 4 N/A
PX200401_Family_History_Thinking_Of_Words PX200401090600 Has anyone in your child's family had any other type of communication disorder such as: Has difficulty thinking of words (s)he wants to say when talking 4 N/A
PX200401_Family_History_Trouble_CarryOn_Conversation PX200401090300 Has anyone in your child's family had any other type of communication disorder such as: Has a hard time carrying on a conversation 4 N/A
PX200401_Talking_Short_Sentences PX200401010000 By age 2, was your child talking in short phrases or sentences? 4 N/A
PX200401_Trouble_Understanding_Child PX200401030000 At this time, do people frequently have trouble understanding your child? 4 N/A
Research Domain Information
Measure Name:

Family History of Speech and Language Impairment

Release Date:

October 8, 2010

Definition

This measure is a questionnaire to identify family history of speech and language impairment.

Purpose

This measure can be used to assess familial risk factors related to speech and language impairment.

Keywords

Family history, Speech, Language, Speech and Hearing