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Protocol - Family History of Speech and Language Impairment

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Protocol Name from Source:

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

Availability:

Publicly available

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

Personnel and Training Required

None

Equipment Needs

The respondent will need a copy of the questionnaire.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Child, Adolescent, Adult

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.
Research Domain Information

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.

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 Text3139293CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Fam hx speech lang impair proto62984-0LOINC

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_Talking_Short_SentencesPX200401010000By age 2, was your child talking in short phrases or sentences?4N/A
PX200401_Difficulty_Learning_To_TalkPX200401020000When your child was two years old, were you concerned that he/she was having difficulty learning to talk?4N/A
PX200401_Trouble_Understanding_ChildPX200401030000At this time, do people frequently have trouble understanding your child?4N/A
PX200401_Family_History_Speech_Language_TherapyPX200401040000Has anyone in your child's family had speech or language therapy?4N/A
PX200401_Family_History_SpeechLanguageTherapy_RelationshipPX200401040100Has anyone in your child's family had speech or language therapy? If Yes, Relationship to child?4N/A
PX200401_Family_History_SpeechLanguageTherapy_PurposePX200401040200Has anyone in your child's family had speech or language therapy? If Yes, What for?4N/A
PX200401_Difficulty_Learning_To_ReadPX200401050000Has anyone in your child's family had difficulty learning to read or had problems with school work? (e.g. repeated a grade)4N/A
PX200401_Difficulty_Learning_To_Read_DetailsPX200401050100Has 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?4N/A
PX200401_Family_History_RetardationPX200401060000Has anyone in your child's family been diagnosed as mentally retarded?4N/A
PX200401_Family_History_Hearing_DifficultyPX200401070000Does anyone in your child's family have a hearing difficulty?4N/A
PX200401_Family_History_Slow_To_TalkPX200401080000Has anyone in your child's family been slow in learning to talk?4N/A
PX200401_Family_History_StutteringPX200401090100Has anyone in your child's family had any other type of communication disorder such as: Stuttering4N/A
PX200401_Family_History_Less_TalkativePX200401090200Has anyone in your child's family had any other type of communication disorder such as: Is less talkative4N/A
PX200401_Family_History_Trouble_CarryOn_ConversationPX200401090300Has anyone in your child's family had any other type of communication disorder such as: Has a hard time carrying on a conversation4N/A
PX200401_Family_History_DoesNot_Like_ReadPX200401090400Has anyone in your child's family had any other type of communication disorder such as: Doesn't like to read4N/A
PX200401_Family_History_DoesNot_Read_WellPX200401090500Has anyone in your child's family had any other type of communication disorder such as: Doesn't read well4N/A
PX200401_Family_History_Thinking_Of_WordsPX200401090600Has 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 talking4N/A
PX200401_Family_History_Poorer_VocabularyPX200401090700Has anyone in your child's family had any other type of communication disorder such as: Has a poorer vocabulary than other family members4N/A
PX200401_Family_History_Poor_SpellerPX200401090800Has anyone in your child's family had any other type of communication disorder such as: Is a poor speller4N/A
PX200401_Family_History_Awkward_Sentence_StructurePX200401090900Has anyone in your child's family had any other type of communication disorder such as: Has awkward sentence structures when writing or talking4N/A
PX200401_Family_History_Mispronounce_Long_WordsPX200401091000Has anyone in your child's family had any other type of communication disorder such as: Mispronounces long words4N/A
PX200401_Family_History_Hard_To_FollowPX200401091100Has 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 experience4N/A
PX200401_Family_History_Difficulty_Explaining_ThingsPX200401091200Has anyone in your child's family had any other type of communication disorder such as: Has difficulty explaining things4N/A