R1:

• Read through the consent form with mom using the Consent Form Script.

• Ensure you are telling mom that the team needs 30 mins before collecting epi and asking her if now is a good time to start those 30 mins?

• After consenting, read through the assent form with the child using the Consent/Assent Form Script.

• After consenting, go through the sticker chart with the child (use the Consent/Assent Form Script). Have the child choose which sticker sheet they want.

R2:

• Ask child to draw their favorite animal while R1 runs through consent form with mom.

• Follow child’s lead during drawing/play, minimize giving directions and asking lots of questions during play time

• As mom is filling out the consent form, set up the tripod and the camcorder so that it is facing the play area (use your stickers as your guide). Be sure to have the white board (pre-filled with visit details) close by as well.

R1:

• Play with child while mom watches the epi video and R2 asks her questions.

• Show the mom and child the example swab and let them feel how soft the cotton is: “now we’re going to collect mom’s spit! Isn’t that funny! Mom here feel the swab, doesn’t it feel soft? [Childname], feel the swab, what does it feel like to you?” (“Voy a colocar suavemente este hisopo de algodón dentro de su boca, entre las encías inferiores y la mejilla durante unos segundos. Rotaré el hisopo mientras cuento hasta 10 en cada lado”.)

• Put on the gloves

• Take out the swab. Tell mom, “I am going to gently place this cotton swab inside your mouth, between your bottom gums and cheek for a few seconds.  I will rotate the swab while I count to 10 on each side.”

• Place sponge as far back in the mouth as comfortable and rub along the lower gums (see close up image) in a circular motion. Gently rotate the swab against the gums and cheek 10 times. This is should take 10 seconds. If possible, avoid rubbing the teeth.

• Gently repeat the motion on the opposite side of the mouth along the lower gums for an additional 10 times. If the child is watching, you can encourage them to count to 10 out loud with you.

• Carefully unscrew the blue cap from the collection tube without touching the sponge. Be sure to hold the tube upright to prevent the liquid inside the tube from spilling.

• Turn the cap upside down (ensuring the sponge does not come into contact with the surface of the tube) and insert the sponge into the tube and close cap tightly.

• Invert the capped tube and shake vigorously 10 times. (You can also ask the child to help here : “Do you want to help me and be a scientist? We have to shake this 1o times!” (¿quieres ayudarme y ser un científico? Tenemos que moverlo 10 veces)

• R2 will have the sample bag open for you. Place the capped tube inside and close the bag.

• R2 will note the time and will take the bag from there.

• Say to the child, “Now it is your turn!” (Ahora es tu turno!) Repeat all the previous steps.

• Ensure the sponge tip does NOT come into contact with any surface prior to collection. Be sure to wash with water if the solution comes in contact with eyes or skin. Do NOT ingest. 

• Give child sticker

• NOTE:  If child refuses at first, don't proactively offer snacks and water yet

  • • Ask for mom’s permission to re-approach child for epi separately after MEFS, or, if mom prefers to be present for epi after MEFS, make plan to get mom if child consents to epi then

    • Get started on their battery and then reoffer chance to do epi and earn a sticker after MEFS and then offer water and snacks as needed afterwards

    • Some (but not exhaustive) strategies for anxious/reluctant children: can offer child to help collect mom’s epi if child seems nervous

R2:

• Show mom the epigenetics video; answer any questions

• If mom agrees to sample collection, ask her:

  • • when was the last time she and the child ate or drank – record it

    • Record current time 

      • Go get R1 and the child for epi collection

        • • When R1 is ready, hand them gloves.

          • While they are putting them on, open the epi packet halfway and offer it to R1 (ensuring you do not touch it or let the swab fall out). R1 should be able to easily grab it.

          •  As R1 swabs, open the specimen bag and have it ready for them to place the tube into.

          • Place the collection tube inside the bag, and peel off the blue liner to close the bag

          • Hand R1 the child’s swab packet. Repeat the last 2 steps.

          • Ensure that you are placing the samples into the properly labeled specimen bags.

          • Place both samples in a safe place (site specific). You will retrieve them after the visit (see Post-Visit Protocol).

General Instructions:

• Moms should cut the nails when possible.

• If can’t collect fingernails, offer toenails.

• If R1 does the cutting, avoid cutting too close to the skin to avoid cutting or nicking the participant.

• If an accidental nick or cut causes bleeding, apply pressure, antibiotic ointment, and bandage, if necessary.

• Nail polish needs to be removed; non-ethanol nail polish remover must be used (e.g., isopropyl alcohol or acetone). Nails can also be filed or buffed to remove nail polish.

• The required length is greater than 2mm from all 10 fingers. We can collect nails up to 9mm in length (average 3-month growth). If nails are ever longer than that (e.g., 10mm) the oldest part of the nail (oldest 1mm) can be cut to have a 2-9mm length of sample. 

• Do not collect nails if a participant has gel or artificial nails or the nail has an unusual appearance for any reason.

• Optimally we need to collect one single, substantial clipping per finger, rather than lots of little pieces. However, the nails are grinded down for analysis, so every bit counts. 

• Nails should be dry before collection.

Consent & Assent 

• Read consent/assent text on REDCap - "Nail Cort" form.

• Ask the mother for consent then ask the child.

Cortisol Questions

• R1: 

  • After mom gives consent and child gives assent, ask mom the Nail Cort Questions on RedCap to determine if you should go ahead with collection. Follow the instructions in the RedCap questionnaire. If RedCap says you should NOT collect nails, let mom know and move on with the next activity. You can say: "Unfortunately, we cannot collect your child’s nails at this time. We will move on to the next activity." (Desafortunadamente, no podemos recolectar las uñas de su hijo en este momento. Pasaremos a la siguiente actividad.).

Collection Procedure

• R1:

  • Ask the child to use hand wipe (or wash hands if hands are very dirty) prior to clipping.

  • Ask the mom to wipe the clippers with non-ethanol-based antiseptic pad.

  • If nails seem long, measure them to make sure they are less than 6mm. You can measure it from above or below the nail using the transparent ruler.

  • If nails are longer than 6mm, the top 3mm can be trimmed and discarded. 

  • Only the 3mm from the bed of the nail should be included in the collection.  

  • Ask mom to do the clipping. RA should only clip if mom is uncomfortable. 

  • If RA is doing the clipping, put on rubber gloves.

  • Place the labeled foil sheet on the table as a tray to catch the nail clippings. The participant label should be facing the table.  

  • One hand at a time, have mom clip each fingernail, dumping the nail onto the foil sheet. Clipping should be collected from all 5 fingers of both hands. 

  • Pay attention to any clipping that might fly away and be ready to find them and place them on the foil sheet. 

  • If a clipping is dropped and easily recoverable, feel free to do so. However, if there is any question as to whose clipping it is, do not include.

  • If mom or RA are unable to collect all 10, indicate this and why on the R1 form.

  • Once clipping is complete, make sure to remove any nails from the nail clipper’s chamber.

  • Fold the foil with all clippings inside and carefully place it inside the labeled zip-lock bag.

  • Note in R1 form if any nails were lost in the clipping process. 

Post Collection: Documentation and Storage

• • Check zip-lock bag is securely closed and that no nails fall out. 

  • Remove as much air as possible from the zip-lock bag.     

  • Make sure the zip-lock bag is correctly labeled and stored with the other samples.  

  • Clean the table where the nail sample was collected. 

  • Clean nail clipper and nail file (if used).

  • Soak nail clipper for 10 minutes in control 3. 

  • Thoroughly dry it to prevent rusting.

  • Store with rest of materials. 

  • Complete Nail Cortisol Section of the Post-visit Form on REDCap.

• • Say, “Today, we'll do fun things like looking at pictures, answering questions, and playing with blocks. Some things might be easy, and some might be hard. It's okay if you don't get everything right or finish everything. Just do your best! Do you have any questions?”

Make sure you know:

• If the participant uses more than one finger to tap the response options at the same time, prompt them by saying, “Tap only one picture/button at a time.” If the participant continues to use more than one finger to tap both response options at the same time, make a note on REDCap.

• Say, “For our first activity, we’ll use this iPad. The iPad is going to tell you how to play the game.”

• R1 should still be sitting next to the child with the NIH Toolbox Version 3 app open.

• Go to the tab “Assessments”, click on the arrow next to “Not yet started” and then “Start Assessment”.

• The screen will show: “The assessment will now begin. Please make sure the participant is ready, then touch the Start button to continue.”

• Ask the child “Are you ready?”; then slide to continue. 

• Starting now, the tablet will provide instructions through audio. The examiner is required to point to some pictures or buttons or to slide to continue to the test items, as instructed below:

• The instructions are presented on the screen and via audio: “You are going to see two pictures on the screen. Sometimes, the pictures are the same and sometimes, the pictures are not the same. If the pictures are the SAME, tap YES.” The Yes button at the bottom of the screen flashes four times. Point to the Yes button. Then the audio continues: “If the pictures are NOT the same, tap NO.” The No button at the bottom of the screen flashes four times. Point to the No button. Then the audio continues: “Use only one finger to tap.”

• When the participant indicates that they are ready, tap the Next button in the upper right corner.

• There are three practice items. Each practice item has two pictures in the middle of the screen, with the Yes and No buttons at the bottom of the screen. 

• As each practice item appears on the screen, the audio says: “Are these the same?” If the participant responds correctly, the audio says: “That’s right!”

• If the participant does not respond within 10 seconds, the audio prompts the participant:

“Are these the same?” If the participant responds incorrectly, the response they selected turns red and the audio says either: “These pictures are the same, so you should tap YES” (Yes button flashes four times) OR “These pictures are NOT the same, so you should tap NO” (No button flashes four times). 

• Then that practice item is presented a second time. Based on the participant’s response, the audio will either say: “That’s right!” or provide corrective feedback. Then the test automatically advances to the next practice item or to the transition screen that appears after the last practice item.

• Regardless of performance on the practice items, all participants move on to the live items.

• After the participant completes the three practice items, the test advances to the transition screen for the live items. The audio says: “Now you’ll do some more. Go as fast as you can without making mistakes. Are you ready?” When the participant indicates that they are ready, slide the purple button all the way to the right to begin the live items.

• The participant is given 80 seconds to respond to as many of the 133 live items as possible.

• After completing the task, the screen will show 'Flanker - Slide to Continue.' 

• Give child sticker.

• NOTES:

  • If the participant uses two fingers to tap both response options at the same time, prompt them by saying, “Tap only one button at a time.” If the participant continues to use two fingers to tap both response options at the same time, write down this information in the “Notes”.

  • If the participant needs a reminder to stay on task, provide one or more succinct prompts, such as: “Look at the screen,” “Are these the same?” “Yes or no?” “Remember to tap a button,” or “Remember to go as fast as you can.”

  • Give child sticker.

• Make sure you know:

  • Participants are asked to focus on a particular stimulus while inhibiting attention to the stimuli flanking it.

  • The instructions are presented on the screen and via audio. 

  • After each instruction is presented, the correct arrow will flash on the bottom of the screen.

  • Demonstrate how to perform the task by pointing to the appropriate button. 

  • To automatically move to the next screen, tap the flashing arrow button or the Next button in the upper right corner.

  • If the participant uses more than one finger to tap the response options at the same time, prompt them by saying, “Tap only one picture/button at a time.” If the participant continues to use more than one finger to tap both response options at the same time, make a note on REDCap.

• R1 should be sitting next to the child with the NIH Toolbox app open to the “Flanker - Slide to Continue” screen. 

• Ask the child “Are you ready?”; then slide to continue.

• The first instruction screen says: “You will see a row of fish pointing different ways. You should choose the button that matches the way the MIDDLE fish is pointing.” A red circle around the middle fish will flash for 3 seconds, and then the arrow at the bottom of the screen that matches the direction of the middle fish will begin flashing. Point to the middle fish and then to the flashing arrow. Then tap the Next button.

• The second instruction screen says: “If the MIDDLE fish is pointing this way (red circle around middle fish flashes), choose this button (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button. 

• The third instruction screen flips the direction of the fish and says: “If the MIDDLE fish is pointing this way (red circle around middle fish flashes), choose this button (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button. 

• The fourth and last instruction screen shows the middle fish pointing in a different direction than the other fish and says: “Sometimes all the fish will point the same way. Sometimes the MIDDLE fish will point a different way like this (red circle around middle fish flashes): You should always choose the button that matches the way the MIDDLE fish is pointing (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button.

• After the instructions are presented, the test advances to a transition screen to begin the practice items, which says: “Now you try. Keep your eyes on the star. Go as fast as you can without making mistakes. Are you ready to practice?”

• When the participant indicates that they are ready, slide the purple button all the way to the right to begin the practice items. 

• There are five practice items. Before each practice item, a screen with a star in the middle flashes briefly to help the participant focus on the center of the screen. 

• After the participant responds to each of the five practice items, the audio provides feedback. If the participant responds correctly by tapping the correct arrow button, the audio says: “Great job!” Then, the test automatically advances to the next practice item or to the transition screen that appears after the last practice item. If the participant responds incorrectly by tapping the incorrect arrow button, the incorrect arrow button will change color to red and the audio will provide corrective feedback: “The fish is pointing this way, so you should choose this button.” The correct arrow button stays blue and will flash. The test automatically advances to the next practice item or to the transition screen that appears after the last practice item.

• Regardless of performance on the practice items, all participants move on to the live items. 

• After the participant completes the five practice items, the test advances to the transition screen for the live items, which says: “Now you’re ready to do this without me. Keep your eyes on the star in the middle of the screen. Go as fast as you can without making mistakes. Are you ready?”

• When the participant indicates that they are ready, slide the purple button all the way to the right to begin the live items. If the participant uses two fingers to tap both response options at the same time, prompt them by saying, “Tap only one button at a time.” If the participant continues to use two fingers to tap both response options at the same time, the test should be considered invalid. 

• All 30 live items are administered automatically, regardless of the number of errors the participant made on the practice items.

• Give child sticker.

• Make sure you know:

  • Starting point: Item 1

  • Basal: Item 1

  • Ceiling: 6 consecutive incorrect highest-numbered items.

  • Instructions are in English, even if the child speaks Spanish. Do not translate.

  • Should test by complete pages.

  • Always keep the Scoring Sheet (physical or REDCap form) out of the child’s view.

  • Know the exact pronunciation of each item before administering the test. The correct pronunciation is in parentheses following more difficult items in the Test Book. For additional help with pronunciation, refer to a standard dictionary. 

  • Do not tell or help the examinee with any letters or words during this test.

  • If the child asks you to repeat the question, you can repeat the instructions as many times as needed.

  • Do not allow the child to flip the stimulus booklet themselves. “I will flip the pages for you.”

  • Item 6: If child responds incorrectly or doesn’t respond: Score item 0. Point to letter and say: “This letter is R”. Point to the letter again and say: “Now you tell me the name of this letter”. Do not tell subject any other letters.

• Seat across the child.

• Set up REDCap – “WJ Letter-Word Identification”

• Set up the WJ Test Book so that the page with administration instructions (page 3) faces you, while the blank page faces the child as straight as possible (you should also be able to see the stimuli).

• Point to the blank page and say: “In this activity, we’re going to use this book and I’m going to ask you to look at this side, ok?”

• Follow the standardized instructions on the Test Book/REDCap. Read the instructions (in light blue) clearly and at a moderate pace.

• Score 0 for words that are not read fluently on the last attempt. 

• If the response to a specific item is unclear, do not ask the child to repeat the specific item. Instead, allow the child to complete the entire page and then ask him/her to repeat all of the items on that page. Score only the item in question; do not rescore the other items.

• If the child skips one letter/word, go back to the word after the child reads the other words on the page. Score only the item in question; do not rescore the other items.

• If the examinee pronounces words letter by letter or syllable by syllable instead of reading them fluently, tell the examinee, “First read the word silently and then say the whole word smoothly.” Give this instruction only once during administration of this test.

• If the child gives more than one response, score the last response. 

• If the child says s/he doesn't know the answer to that question say, “It’s ok. Try your best guess.” Wait up to 5 seconds then say: “Let’s try another one.”

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• Give child sticker.

• Make sure you know:

• Starting point: Item 1.

• Basal: Item 1.

• Ceiling: 5 consecutive incorrect highest-numbered items.

• Instructions are in English, even if the child speaks Spanish. Do not translate.

• Should test by complete pages.

• Always keep the Scoring Sheet (physical or REDCap form) out of the child’s view.

• Do not allow the child to flip the stimulus booklet themselves. “I will flip the pages for you.”

• Seat across the child.

• Set up REDCap – “WJ Applied Problems”

• Set up the WJ Test Book so that the page with administration instructions (page 37) faces you, while the blank page faces the child as straight as possible (you should also be able to see the stimuli).

• Follow the standardized instructions on the Test Book or REDCap. Read the instructions clearly and at a moderate pace.

• Run your fingers across pictures when indicated on the Test Book.

• Unit labels (e.g., hours, inches, dollars) are not required unless specified in the correct key. If a unit label is required, both the answer and the label must be correct to receive credit. If a unit label is not required and the examinee provides a correct answer and a correct label, score the item as correct. However, if the child provides an incorrect unit label, required or not, score the item as incorrect.

• Place a blank sheet of paper and pencil on the table. If the examinee requests or appears to need it, provide the worksheet in the Response Booklet and a pencil with eraser prior to being prompted to do so. In all cases, provide the Response Booklet and a pencil as directed at Item 25. 

• Any question may be repeated during the test whenever the examinee requests. 

• Because the aim of this test is not to evaluate the person’s reading ability, read all items to the examinee.

• Encourages child to try their best guess if child does not respond in 20 seconds or says “I don’t know”, say, “Take your best guess”. If no answer say, “Let’s try another one” and move on to the next item.

• Children can either say the response aloud or show the numbers using their fingers; UNLESS the instruction is “tell me…” or “point to”. In this case, they should do as instructed. If the child responds another way, you should ask “tell me…” or “point to” as in the instructions.

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• Give child sticker.

• Make sure you know:

  • Starting point: Practice items, then Item 35 (basket) if ages 5.0-5.11 or Item 45 (starfish) if ages 6.0-6.11.

  • Basal: 8 consecutive correct responses. If a basal is not established on the first eight (8) items administered, work backward until eight (8) consecutive correct responses are made. Then return to where you left off and work forward until six (6) consecutive incorrect responses are made. (DO NOT RE-ADMINISTER ITEMS).

  • Ceiling: 6 consecutive incorrect responses.

  • Always keep the Scoring Sheet (physical or REDCap form) out of the child’s view.

  • Do not allow the child to flip the stimulus booklet themselves. “I will flip the pages for you.”

  • Only responses on the record form are acceptable.

  • Give the child no more than 20 seconds per item.

  • Responses with the root word are scored as correct, regardless of inflectional endings indicating number or tense.

• Seat across the child.

• Set up REDCap – “EOWPVT (Monolingual English)”.

• The automatic age should show ages 5.0 or 6.0 years old. If it is not, go to the A6 Scheduling Script Form and determine if the child is 5 or 6. Tell SC immediately if the calculator is not working.

• Say: “I am going to show you some pictures, and I want you to tell me the ONE word that names each picture. Let's practice first.”

• Open the stimulus book to the first practice page. 

• Make sure the book is placed in front of the child as straight as possible (you should also be able to see the stimuli).

• Administer the practice items to all examinees (Items A to D).

  • If they get the answer correct, say: “Good job! Let’s do another one.”

  • The child may not name the examples correctly, but a one-word response must be obtained. If any given response is more than one word (correct or incorrect), remind the child to “Use just one word” to name what is in the picture. Let the child try again.

  • Only for the practice items: If it is incorrect because the wrong word was used to describe the picture, say: “That was a good try, but this is a [insert the correct word from the protocol]. Let’s try another one.” 

• The test items begin on plate Number 35 (basket) (REDCap/Record Form shows “Age 5.0 - 5.11 starts here” OR Number 45 (starfish) “Age 6.0 - 6.11 starts here”).

• Use a prompt for each item – as indicated on REDCap. This identifies the elements in the illustration to which the examinee is to respond. For most items, the prompt "What is this?" is appropriate. For items in which a different prompt should be used, the prompt is listed with the item. If a prompt is not listed with the item, the prompt "What is this?" should be used.

• For responses indicating that the examinee is not attending to the appropriate feature of the illustration, use a verbal cue that directs the examinee's attention. Different cues are used for object, action, and concept items. Refer to the Manual (ENG) for instructions and examples of appropriate cues.

• When a cue is required, the cue should be offered only once.

• If child says they “I don’t know”, say, “Take your best guess”. If they say it again, mark it as incorrect and continue testing.

• Even when prompted to use just one word, a correct answer may be given as part of a phrase (e.g., “That’s a dog”). That answer is considered correct but continue to remind the child to use “Just one word”.

• Continue until REDcap indicates that ceiling has been reached.When ceiling is reached, say: “Thank you so much for playing that game with me!”.

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist/REDCap why not.

• Give child sticker.

• Make sure you know:

  • Starting point: Practice items, then Item 25 (leaf).

  • Basal: 8 consecutive correct responses. If a basal is not established on the first eight (8) items administered, work backward until eight (8) consecutive correct responses are made. Then return to where you left off and work forward until six (6) consecutive incorrect responses are made. (DO NOT RE-ADMINISTER ITEMS).

  • Ceiling: 6 consecutive incorrect responses.

  • Always keep the Scoring Sheet (physical or REDCap form) out of the child’s view.

  • Do not allow the child to flip the stimulus booklet themselves. “I will flip the pages for you.”

  • Only responses on the record form are acceptable.

  • Give the child no more than 20 seconds per item.

  • Responses with the root word are scored as correct, regardless of inflectional endings indicating number or tense.

• Set up REDCap – “EOWPVT (Bilingual Spanish)”.

• Open the stimulus book to the first practice page. 

• Make sure the book is placed in front of the child as straight as possible (you should also be able to see the stimuli).

• Administer the example items (Items A to D).

• Give the instructions in their dominant language (established during scheduling or throughout the assessment). You may switch between languages as needed. Do not repeat the prompt in another language if child responds incorrectly.

• Say: "I am going to show you some pictures. I want you to tell me the one word that names the thing or group of things in each picture. Let's practice first." ("Te mostraré algunas imágenes. Quiero que me digas la palabra que nombra la cosa o el grupo de cosas en cada imagen. Vamos a practicar.")

  • Correct, say: “Good job! Let’s do another one.”

  • The child may not name the examples correctly, but a one-word response must be obtained. If any given response is more than one word (correct or incorrect), remind the child to “Use just one word” to name what is in the picture. Let the child try again.

  • Only for the practice items: If it is incorrect because the wrong word was used to describe the picture, say: “That was a good try, but this is a [insert the correct word from the protocol]. Let’s try another one.” 

• The test items begin on plate Number 25 (hoja/leaf) (REDCap/Record Form shows “Age 5.0 - 6.11 starts here”).

• Use a prompt for each item. This identifies the elements in the illustration to which the examinee is to respond. For the majority of items, the prompt "What is this?" ("¿Qué es esto?" ) is appropriate. For items in which a different prompt should be used, the prompt is listed with the item. If a prompt is not listed with the item, the prompt "What is this?" ("¿Qué es esto?" ) should be used.

• For responses indicating that the examinee is not attending to the appropriate feature of the illustration, use a verbal cue that directs the examinee's attention. Different cues are used for object, action, and concept items. Refer to the Manual (Bilingual) for instructions and examples of appropriate cues. Use only one cue per item.

• Continue until REDcap has indicated that the ceiling is reached. When ceiling is reached, say: “Thank you so much for playing that game with me!” 

• Only praises the child during the practice trials (besides, “you’re working so hard, thank you!”)

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• Give child sticker, praise for completion of activity/earning sticker.

• Make sure you know:

  • Starting point: Sample B, then Item 7

  • Basal: If a child does not obtain a perfect score on either of the first 2 items given, administer the items in reverse order until the child obtains perfect scores on 2 consecutive items.

  • Ceiling: 3 consecutives scores of 0.

  • Stopwatch and Stimuli Book needed.

    • Should use a stopwatch, not your phone for timing.

• With the exception of the sample and teaching items, the stimulus page for each item is exposed one time only. If the child asks for another exposure, say, “I can't show you again. Just try your best”.

• The child must indicate his or her choice(s) by either pointing to or saying the letter(s) of the selected response option(s). If the child responds with any other type of verbalization (e.g., names the pictures), say, “Show me”.

• If the child asks if his or her responses must be provided in a specific order (e.g ., alphabetical), say, “You don't have to point to the pictures in order”.

• Items 1, 2, 7, and 8 are teaching items. Corrective feedback is provided if the child does not obtain a perfect score. Provide no further assistance on this subtest.

• Correct responses for Items 7-35 require the selection of multiple response options. The selection of an incorrect response option results in a score of 0, even if the other selected response options are correct.

• Only praises the child during the practice trials (besides, “you’re working so hard, thank you!”)

• Do not shorten or eliminate the instruction for any item: “Look at this picture”

• “Point to the picture I just showed you” can be shortened at item 10 if you are sure the child understood the instruction.

• Sample Item B

  • Expose Sample Item B stimulus page and say, “Look at this picture”. Begin timing and allow 5 seconds.

  • Turn to Sample Item B response page and say, “Point to the picture I just showed you.”

    • Correct response [B]: Say, “That's right”. Proceed to Item 7.

    • Incorrect response: Expose Item 7 stimulus page. Say, “I showed you these pictures”. Expose Item 7 response page. Say, “So you should point to these (point to response options C and D)”. Proceed to Item 7.

• Item 7

  • Expose Item 7 stimulus page and say, “Look at these pictures”. Begin timing and allow 5 seconds.

  • Turn to Item 7 response page and say, “Point to the pictures I just showed you.”

    • Correct response: Proceed to the next Item.

    • Incorrect response [C and D]: Say, “That's not quite right”. Expose Sample Item B stimulus page. Say, “I showed you these pictures”. Expose Sample Item B response page. Say, “So you should point to these (point to response options A and B)”. Go to item 6 and administer the items in reverse order until the child obtains perfect scores on 2 consecutive items.

• Item 8

  • Expose Item 8 stimulus page and say, “Look at these pictures”. Begin timing and allow 5 seconds.

  • Turn to Item 8 response page and say, “Point to the pictures I just showed you”. 

    • Correct response [A and B]: Proceed to the next item.

    • Incorrect response: Expose Item 8 stimulus page and say, “I showed you these pictures”. Expose Item 8 response page and say, “So you should point to these (point to response options A and B)”. Proceed to the next item. Proceed to the next appropriate item if the discontinue criterion has not been met.

• Items 9-35

  • Expose the stimulus page and say, “Look at these pictures”. Begin timing and allow 5 seconds. Do not shorten or eliminate this instruction.

  • Turn to the item response page and say, “Point to the pictures I just showed you”. This instruction may be shortened or eliminated when the child understands the task.

  • Proceed to the next item if the discontinue criterion has not been met.

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• Give child sticker.

• Make sure you know:

  • Starting point: 

    • Ages 5-5:11: Sample Items A-C, then Item 4 

    • Ages 6-7:7: Sample Items A-C, then Item 7 

  • Basal:  If a child aged >= 5 does not obtain a perfect score on either of the first 2 items given, administer the items in reverse order until the child obtains perfect scores on 2 consecutive items.

  • Ceiling: 3 consecutives scores of 0.

  • Stimuli Book needed.

  • If the child has not responded within approximately 30 seconds, prompt him or her by saying, “Do you have an answer?”

  • Always point across the response options and question mark. If the child gives an incorrect answer on the practice items, move our finger through the stimuli grid as well (see below).

  • If child responds “I don't know” initially, but later answers a more difficult item correctly, re-administer the earlier item immediately. 

  • The instructions can be shortened at item 10 if you are sure the child understood the instruction.

• Sample Item A

  • Turn to Sample Item A in the Stimulus Book and say, “Look at this picture. Which one here (point across response options) goes here (point to question mark)?”

    • Correct response: Say, “That's right.” Proceed to Sample Item B.

    • Incorrect response: Say, “That's not quite right. All of these umbrellas are yellow (point to umbrellas in grid). This one (point ot response option 2) is also yellow, so it goes here (point to box with question mark)”. Proceed to Sample Item B.

• Sample Item B

  • Turn to Sample Item B in the Stimulus Book and say, “Look at this picture. Which one here (point across response options) goes here (point to question mark)?”

    • Correct response: Say, “That's right”. Proceed to Sample Item C.

    • Incorrect response: Say, “That's not quite right. These two flowers are pink (point to pink flowers in grid). Here is a white flower (point to white flower in grid). We need another white flower, so this one (point to response option 3) goes here (point to box with question mark)”. Proceed to Sample Item C.

• Sample Item C

  • Turn to Sample Item C in the Stimulus Book and say, “Look at this picture. Which one here (point across response options) goes here (point to question mark)?”

    • Correct response: Say, “That's right”. Proceed to the appropriate start point. 

    • Incorrect response: Say, “That's not quite right. Here are two teddy bears (point to teddy bears in the grid). Here is a ball (point to ball in grid). We need another ball, so this one (point to response option 1) goes here (point to box with question mark)”. Proceed to the appropriate start point.

• Items 1-26

  • Turn to the appropriate item in the Stimulus Book and say, “Look at this picture. Which one here (point across response options) goes here (point to question mark)?”

• The instructions may be shortened or eliminated when the child understands the task.

• Only praises the child during the practice trials (besides, “you’re working so hard, thank you!”)

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• Give child sticker.

• Make sure you know:

  • Starting point: 

    • Ages 4-5:11: Sample Items A & B, then Item 1

    • Ages 6-7:7:  Sample Items A & B, then Item 8 

  • Basal: If a child aged >= 6 does not obtain a perfect score on either of the first 2 items given, administer the items in reverse order until the child obtains perfect scores on 2 consecutive items.

  • Ceiling: 3 consecutives scores of 0.

  • Stimuli Book needed.

  • Provide assistance on the sample items only.

  • It is essential to point across the rows of response options, as instructed in the administration directions.

  • If the child asks the name of a picture, provide the name only.

  • The child must indicate his or her choices by naming, pointing to, or saying the numbers of the selected response options.

  • If the child's name for a picture is unclear, say, “Point to the pictures you mean”.

  • If the child does not select a picture in each row or selects more than one picture in a single row, the following prompts must be provided as often as necessary:

    • For two-row items, say, “Pick one here (point across first row), and one here (point across second row)”.

    • For three-row items, say, “Pick one here (point across first row), one here (point across second row), and one here (point across third row)”.

  • If the child has not responded within approximately 30 seconds, prompt him or her by saying, “Do you have an answer?”  If the discontinue criterion has not been met, cue the child that you are moving to the next item by saying, “Let's try another one”. Proceed to the next appropriate item.

  • If child responds “I don't know” initially, but later answers a more difficult item correctly, re-administer the earlier item immediately. 

  • Score 1 point only if the child chooses the correct responses from all rows of an item. 

• Sample Item A

  • Turn to Sample Item A in the Stimulus Book and say, “Look up here (point across first row). Look down here (point across second row). Pick one here (point across first row) that goes with one here (point across second row)”.

    • Correct response [2 and 4]: Say, That's right. This alligator (point to response option 2) goes with this turtle (point to response option 4). They are both animals. Let’s try another one”. Proceed to Sample Item B.

    • Incorrect response: Say, “That's not quite right. This alligator (point to response option 2) goes with this turtle (point to response option 4). They are both animals. Let’s try another one”. Proceed to Sample Item B.

• Sample Item B

  • Turn to Sample Item B in the Stimulus Book and say, “Pick one here (point across first row) that goes with one here (point across second row)”.

    • Correct response [2 and 3]: Say, That's right. This dog (point to response option 2) goes with this cat (point to response option 3). They are both pets. Let’s try some more”. Proceed to the start point.

    • Incorrect response: Say, “That's not quite right. This dog (point to response option 2) goes with this cat (point to response option 3). They are both pets. Let’s try some more”. Proceed to the start point.

• Items 1-26

  • Turn to the appropriate item in the Stimulus Book and say, “Pick one here (point across first row) that goes with one here (point across second row)”. The instructions may be shortened or eliminated when the child understands the task.

• Items 26-27

  • Turn to the appropriate item in the Stimulus Book and say, “Pick one here (point across first row) that goes with one here (point across second row) and one here (point across third row)”. The instructions may be shortened or eliminated when the child understands the task.

• Give child sticker.

• Check ‘Complete’ if child finishes or ‘Unverified’ if not and write down on the checklist why not.

• R1 should be sitting next to the child with the MEFS app open to the child’s info screen. Allow child to select their avatar and then select ‘Game Form A’.

• Say to the child: “I’d like to show you a fun game and ask you some questions” while you select the Level 4 card. (Me gustaría mostrarte un juego divertido y hacerte algunas preguntas.)

• Begin reading the instructions on the app and demonstrate the rules of the first trial for the child (as the app instructs). Be sure to point IN TIME with what the script says (e.g., “Blue ones go HERE *point to blue box*”)

• If the child moves their hand towards the card deck, gently block their hand by hovering yours over the bottom portion of the iPad screen, effectively blocking the child from selecting the card deck and say, “sometimes it’s going to be your turn to play, and sometimes it’s going to be my turn to play. Now, it’s my turn, but your turn is coming soon”. (“A veces será tu turno de jugar, y otras veces será mi turno de jugar. Ahora, es mi turno, pero tu turno llegará pronto”)

• Move through testing trials as the app instructs you to. Be sure that YOU are turning the cards in the card stack. You can say, “I’ll turn them” (Yo lo haré) and gently block their hand if the child starts to do it.

• Feedback is ONLY permitted during rule checks, NEVER during trial runs. You may NOT repeat the rule once the card is flipped.

• When reading the instructions of a new level, cover up the boxes and card stack with your hand to ensure that the child listens to the new set of directions.

• If child needs a break, be sure to finish the current level before leaving MEFS.

• When the game is finished, be sure to wait for the Notes box but to always document notes on MEFS on the hard-copy checklist. Be sure to hit SUBMIT before exiting the app and moving to the next game.

• NOTE: There should never be two MEFS profiles for the same child; similarly, you should never run a child twice on MEFS.

• Give child sticker if he/she has completed MEFS and praise for work

*if child did not do epi before, ask them now if they would like another chance to complete epi.

• Mom should be sitting at a desk or table with the iPad centered in front of her.

• R2 should be sitting next to the mom with the MEFS app open to the mom’s info screen. Allow mom to select their avatar and then select ‘Game Form A’.

• Say to the mom: “I’d like to show you this game and ask you some questions” (Me gustaría mostrarte este juego y hacerte algunas preguntas) while you select the Level 5 card.

• Begin reading the instructions on the app and demonstrate the rules of the first trial for the mom (as the app instructs). Be sure to point IN TIME with what the script says (e.g., “Blue ones go HERE *point to blue box*”)

• If the mom moves their hand towards the card deck, gently block their hand by hovering yours over the bottom portion of the iPad screen, effectively blocking the mom from selecting the card deck and say, “sometimes I move the cards and sometimes you’ll move the cards, for now I’ll move them.” (a veces yo muevo las cartas y otras veces tú mueves las cartas, por ahora yo las muevo)

• Move through testing trials as the app instructs you to. Be sure that YOU are turning the cards in the card stack. You can say, “I’ll turn them” (yo las muevo) and gently block their hand if the mom starts to do it.

• Feedback is ONLY permitted during rule checks, NEVER during trial runs. You may NOT repeat the rule once the card is flipped.

• When reading the instructions of a new level, cover up the boxes and card stack with your hand to ensure that the mom listens to the new set of directions.

• If mom needs a break, be sure to finish the current level before leaving MEFS.

• You may re-read the instructions on the instructions page if mom asks and on the rule check slides (before MEFS tells you, “okay, let’s play” … not on the real trials though!

• When the game is finished, be sure to wait for the Notes box and type in any notes if needed. Be sure to hit SUBMIT before exiting the app and moving to the next game.

• NOTE: There should never be two MEFS profiles for the same mom; similarly, you should never run a mom twice on MEFS.

• NOTE: If mom has very long nails and cannot appropriately use the touchscreen, use the stylus. Note it in the hard-copy checklist.

• Open up REDcap to the first page of the survey = “Confirm Parent Information”

• GET IT INTO SURVEY VIEW

• Ensure mom has the answer booklet in front of her

• Read the beginning of a question and answer choices whenever they are NOT in brackets. Then, use your discretion as to if you read the answer choices again (e.g., if mom is answering the same thing every time, re-gives options)

• Ask mom each question and record each response; be sure to mark each page as ‘Complete’ before moving to the next section

• If mom changes her mind or RA realizes he/she made a mistake after submitting responses during maternal survey, note the correct answer in the RA checklist and alert SC afterward the visit to directly edit the redcap survey

• After finishing the “Child Tactics Scale” follow the instructions on REDCap. Say, “Now, this next part will be a bit different. I'm going to describe a situation that is not real but one that I want you to imagine yourself in and to consider how you would handle it. You don't have to answer these questions out loud. Just listen and try to picture yourself in this context.” (“Ahora, la siguiente parte será un poco diferente. Voy a describir una situación que no es real, pero quiero que imagine y que considere cómo lo manejaría. No es necesario que responda a estas preguntas en voz alta. Simplemente escuche e intente imaginarse a sí mismo en este contexto.”)

• Read it at a pace such that the mom can listen and reflect on it as you read: “Imagine that an unforeseen event requires of you an immediate $1,000 expense. Are there ways in which you may be able to come up with that amount of money on a very short notice?” (“Imagine que un imprevisto requiere de usted un gasto inmediato de $1,000. ¿Existen formas en las que pueda conseguir esa cantidad de dinero en muy poco tiempo?”)

• Pause for 2 seconds

• Say: “How would you go about it?” (“¿Cómo lo haría?”)

• Pause for 2 seconds 

• Say: “How stressful would it be to manage this?” (“¿Qué tan estresante sería manejar esto?”)

• Pause for 2 seconds

• Say:  “I'll give you a minute to think about it.” (“Le daré un minuto para pensar sobre esto.”)

• Give the mom one minute to think about it.

• During this minute, set up Flanker on the iPad. When done, keep yourself busy playing around with the tablet or notebook. Avoid looking at the mom.

• After 1 minute, say: “Thank you. We're almost done. Let’s pause for a moment to do this activity, a game.” (“Gracias. Ya casi hemos terminado. Hagamos una pausa por un momento para hacer esta actividad, un juego.”)

• Get the iPad and start Flanker immediately. If mom asks any questions, say that you will answer her questions after the game.

• Make sure you know:

  • Choose the app (NIH Toolbox Version 3) according to mother’s preferred language (English or Spanish).

  • Participants are asked to focus on a particular stimulus while inhibiting attention to the stimuli flanking it.

  • The instructions are presented on the screen and via audio. 

  • After each instruction is presented, the correct arrow will flash on the bottom of the screen.

  • Demonstrate how to perform the task by pointing to the appropriate button. 

  • To automatically move to the next screen, tap the flashing arrow button or the Next button in the upper right corner.

• After reading the text in the "Scarcity Prime" REDCap form, set up Flanker while the mother thinks about the prime questions for 1 minute, say: “Thank you. We're almost done. Let’s pause for a moment to do this activity, a game.” (“Gracias. Ya casi hemos terminado. Hagamos una pausa por un momento para hacer esta actividad, un juego.”)

• Get the iPad and start Flanker immediately. If mom asks any questions, say that you will answer her questions after the game.

• R1 should be sitting next to the child with the NIH Toolbox app open to the “Flanker - Slide to Continue” screen. 

• Ask the child “Are you ready?”; then slide to continue.

• The first instruction screen says: “You will see a row of fish pointing different ways. You should choose the button that matches the way the MIDDLE fish is pointing.” A red circle around the middle fish will flash for 3 seconds, and then the arrow at the bottom of the screen that matches the direction of the middle fish will begin flashing. Point to the middle fish and then to the flashing arrow. Then tap the Next button.

• The second instruction screen says: “If the MIDDLE fish is pointing this way (red circle around middle fish flashes), choose this button (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button. 

• The third instruction screen flips the direction of the fish and says: “If the MIDDLE fish is pointing this way (red circle around middle fish flashes), choose this button (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button. 

• The fourth and last instruction screen shows the middle fish pointing in a different direction than the other fish and says: “Sometimes all the fish will point the same way. Sometimes the MIDDLE fish will point a different way like this (red circle around middle fish flashes): You should always choose the button that matches the way the MIDDLE fish is pointing (button on bottom flashes).” Point to the middle fish as the red circle flashes, and then point to the matching arrow. Then tap the Next button.

• After the instructions are presented, the test advances to a transition screen to begin the practice items, which says: “Now you try. Keep your eyes on the star. Go as fast as you can without making mistakes. Are you ready to practice?”

• When the participant indicates that they are ready, slide the purple button all the way to the right to begin the practice items. 

• There are five practice items. Before each practice item, a screen with a star in the middle flashes briefly to help the participant focus on the center of the screen. 

• After the participant responds to each of the five practice items, the audio provides feedback. If the participant responds correctly by tapping the correct arrow button, the audio says: “Great job!” Then, the test automatically advances to the next practice item or to the transition screen that appears after the last practice item. If the participant responds incorrectly by tapping the incorrect arrow button, the incorrect arrow button will change color to red and the audio will provide corrective feedback: “The fish is pointing this way, so you should choose this button.” The correct arrow button stays blue and will flash. The test automatically advances to the next practice item or to the transition screen that appears after the last practice item.

• Regardless of performance on the practice items, all participants move on to the live items. 

• After the participant completes the five practice items, the test advances to the transition screen for the live items, which says: “Now you’re ready to do this without me. Keep your eyes on the star in the middle of the screen. Go as fast as you can without making mistakes. Are you ready?”

• When the participant indicates that they are ready, slide the purple button all the way to the right to begin the live items. If the participant uses two fingers to tap both response options at the same time, prompt them by saying, “Tap only one button at a time.” If the participant continues to use two fingers to tap both response options at the same time, the test should be considered invalid. 

• All 30 live items are administered automatically, regardless of the number of errors the participant made on the practice items.

R1:

• Say to mom and child, “Now we are going to walk over to the scale together and take your and [child’s name’s] height and weight.” (Ahora vamos a tomar la altura y el peso de usted y de [childname]”.)

• Have both mom and child keep their shoes on. NOTE: If mom is wearing heels, ensure she takes them off before she gets on the scale.

• Lift the height bar as far as you can reach it and have mom step on the scale, with her back facing the scale.

• Check that she is standing up straight with her feet together.

• Bring the height bar down so that it touches the top of her head.

• Say, “okay great, mom, you can step off for just a second!” (bien, ahora puedes bajarte por un segundo) – this will inform R2 that they can record the height of mom.

• Bring down that bar to its normal position.

• Have mom step on the scale one more time and move the weights over to the right until the scale is balanced. Be sure to be measuring in pounds. Say, “okay great” – this will inform R2 that they can record the weight of the mom.

• Say, “thank you mom, you can step off and you are all done with this!” (gracias Mamá, ahora puedes bajarte que ya terminamos con esto)

  • • Be sure that you are not vocalizing mom’s weight aloud – just gesture to R2 to record the weight if they are not already looking at the scale.

• Say to the child, “Now it is your turn! “We are going to measure how big and strong you are getting with this scale, can you step on it for me?” (¡Ahora es tu turno! “Vamos a medir qué tan grande y fuerte eress ¿Puedes pararte aquí?”)

• Follow all steps from above for the child’s height and weight.

R2:

• R1 will welcome mom and child to the scale for documentation. Be sure to be close by.

• When R1 has mom’s height – be sure to record it by finding the number at the lowest part of the bar that moves up and down. Record in centimeters on the checklist.

• Record mom’s weight in pounds on the checklist when R1 has gotten the scale to balance. Do not do mental math here – record what the top bar is showing, and then the bottom bar (for e.g., record 250 lbs then record 35 lbs) – you can add these together before you enter the total weight into REDcap later. Do not vocalize weight aloud.

• Repeat for child’s height and weight.

• In some cases, your site may choose to switch R1 and R2s roles here. If the child has already built rapport with R1, R1 can stay in the room with the child. Consult your site coordinator about if you should stay in the room with the child or in the control room.

Capping and Impedances 

R1:

• RA’s should also leave electronics outside the room and remove all other unnecessary electronics from the room and make sure nothing else is plugged in.

• Offer mom & child a snack/bathroom break before starting EEG (if this hasn't happened already; child is allowed to eat snack while fixing impedances)

• Set expectations on the length of EEG: inform mom that the tasks will take 30+ minutes, then the lab visit will be done

• Remove rings, bracelets, watches, and tuck-in buttons on wrists before capping

• Ensure child’s earrings are either covered or removed and check the child for smart watches & earrings

• Begin soaking the cap and start the timer for 10 minutes. Bring the cap in the EEG room and plug it into the arm.

• On the MAC, on Net Station Acquisition

  • Turn ‘on’ the amplifier in the top left corner

  • Click – tools → show impedances

• If a parent is joining the EEG room, ask them to leave electronics outside the room (cellphone, watch, etc.) or to turn them off. 

• Ask mom to avoid talking to her child: "Mom, we'd like to see what (child's name) can do alone with this next game, so I'll just ask that you watch quietly in the back while we play. You're welcome to (read magazines, play a crossword puzzle, etc) while we play."

• Have the child sit in the chair.

• Ask the child to move in the chair (or physically move the chair) to face you while capping the child.

• If the child's hair is up, have mom take the child's hair down or to style child’s hair as needed (into a low pony or two low pigtails if hair is dense).

• If child is wearing earrings, ask mom to remove them or to place medical tape over them  (RA should avoid doing this)

• Measure the child’s head – first from the middle of the eyebrows (nasion) to the midline bony tip (inion) and divide by two (use a chart to help); make your first mark on the child’s scalp running front to back (red China Marker works best). Then measure from ear to ear (preauricular point), ensuring that the tape measure is going over the top of your first mark. Divide by 2 and make the cross mark on the scalp.

• Get the child ready to put on the cap. For some children, this may be showing them the cap and letting them touch it. For other children, this may mean just putting on a video. This is a moment to read the room and do what’s going to be best for that child. Our goal is to make them comfortable.

• Lay a hand towel on the child’s shoulders and give them one to hold. You can say, “when I put the hat on, there may be some drips. Here’s a towel in case you want to wipe off any water” (“la gorra se sentirá un poco húmeda. Aquí hay una toalla en caso de que quieras secarte”). However, if the child is not interested, continue on without interrupting them from watching the movie.

• Take the cap out of the solution where it has been soaking and pat the exterior dry with the towel (do not squeeze out sponges).

• Place hands in the cap, and ensure the chin strap is in front of your wrists. Take the time to adjust the cap in your hands before placing it on the child’s head.

• Tell the child to close their eyes and that you are going to count to 10 together while you put the hat on their head.

• Stand directly in front of the child to place the cap. Cz electrode should sit over the “X” mark on the head, and electrode 17 should sit on the nasion when stretched down.

  • Adjust chin toggle and tighten cap on head.

  • Cap fit: The cap should fit symmetrically over the child’s head, with the net forming symmetrical triangles all around and ears directly within ear holes. Adjust net on head as well as locking it in by using toggles until desired fit is reached. To adjust individual toggles: hold all other strings and press on intended toggle with the same hand, pull desired string with the other hand to attain fit.

• Once the cap is on, adjust electrodes where necessary. Adjust until impedances are all blue (ideally). If you can’t get all impedances blue, we want to aim to get fewer than 10 electrodes with yellow or green colors (ideally, it is better if these are on the bottom row of electrodes over other places). Using pipettes filled with EEG solution to gently saturate the electrode sponges (1-2 drops of solution), and move hair away so electrodes can make direct contact with the skull. Make sure to seat REF and COM first.

• Take child’s capping picture (front, both sides, and top).

• Take polaroid picture after asking for mother's permission.

• If you notice any electrode needs to be repaired, let the SC know.

• When impedances look good, R2 goes back to the computers. R1 will stay in the testing room to take capping pictures and polaroid picture.

• Make sure the participant is 60cm from monitor using the string/ribbon.

• Turn off lights and get ready to remove ipad.

• R2 takes a picture of the impedances to add these to the REDCap notes and then hit “Save Impedances”. 

• Switch the control box to PC mode

• On the PC open the “Age6_Baseline EEG” icon on the Desktop. In the following pop-up windows enter:

  • Subject Number: Enter the three last digits of the ID (for P550023 enter 023)

  • Click “yes”  through the rest of the pop-up windows as the information is not relevant

• Following the R1 signals through the camera, R2 will press the spacebar to continue through the resting experiment. 

• R2 should make sure Net Station Acquisition is recording and showing the DIN flags

• When Resting is complete, a pop up window will appear on Net Station Acquisition (on the MAC). 

• When the experiment is completed, click “Quit Net Station” on the MAC

R2:

• Bring soaking cap into the EEG room

• Place the iPad in front of the child and turn on a movie for them. 

• Help R1 with impedances.

• Once cap is on head and impedances are good, carry bucket out of room to weigh during resting task.

• Stay in the room with the child and mom to ensure they are sitting as still as possible.

• Run the experiment:

  • On the PC: Press the spacebar to begin the program

Resting: Eyes Open (30s), Eyes Closed (30s) for 4 minutes followed by a video

• Make sure you know:

  • Encourage children to lightly close their eyes and stay relaxed. If their eyes seem too tight, gently prompt them to relax saying “Try to relax your eyes”.

  • If mom is in the room, remind her not to talk or comment on their child’s performance.

  • If a child is completely non-compliant, e.g., with the eyes open versus eyes closed, you should take a note on REDCap.

  • There is going to be a fixation cross on the screen. It will tell you whether their eyes should be open or closed.

• Introduction: “In this activity, I’ll ask you to look at this screen first. Sometimes, I’ll ask you to keep your eyes open, and other times, I’ll ask you to close your eyes. Please try to stay as still as you can.”

• The screen will show “Open your eyes.” Say: “Now look at the screen and keep your eyes closed”.

• Make sure their eyes are closed before pressing the button to start.

• After 30 seconds, the screen will show “Close your eyes”. Say: “Now open your eyes”.

• Wait until their eyes are open before pressing the button to start.

• When the “Eyes Closed” screen shows up, say: “Okay, it's time for you to close your eyes.”

• Make sure their eyes are closed before pressing the button to start “Eyes Open”.

• Once the “Partly Cloudy” video starts, ask the mom the questions about the child's hair texture and thickness.  After mom completes this question, have the E1 answer the same question and enter it into the EEG form.

If at any point the child wants to end the task prematurely, unplug the cap before uncapping. The unplugging of the cap sends a flag that is useful for processing.

Experimenter form (post-visit) on REDcap (R1):

• Mark ‘complete’ (or ‘incomplete’) and enter in notes for the following visit elements:

  • PCI

  • WJ Letter Word Identification

  • WJ Applied Problems

  • EOWPVT

  • WPPSI-IV Picture Memory

  • WPPSI-IV Matrix Reasoning

  • WPPSI-IV Picture Concepts

  • PCI upload (be sure to also fill in that individual bubble)

  • BMI

  • Epi

  • Nails

  • EEG R1

Fill out PSRA in REDcap (R1)

Ensure all REDcap bubbles are filled in

Experimenter form (post-visit) on REDcap (R2):

• Be sure R1 has the checklist with the times and notes of everything from the visit so they can fill out the Post-Visit form on REDcap

Epigenetics – R2

• Ensure that the biohazard bags are properly labeled (using the info you wrote on the checklist) and sealed.

• Plug the scanner into the computer and open up Google Drive > BFY Age 4 Docs > BFY Epi Barcode Log

  • • Add in the new participant IDs in the correct column (PXXX_c for child and PXXX_m for mom)

    • Click on the cell where you want the barcode number to be – then scan the barcode and it will automatically populate that cell

    • Add in the Notes cell anything unusual about the sample, like discoloration, for e.g.

• Ensure epigenetic samples goes in your safe, locked space

EEG (R1)

• • Export EEG data from the Mac and PC:

    • On the Mac

      • • 1.  Zip the Resting file on the Mac

        • 2.  Move the files from the EEG computer onto the EEG-designated USB.

• Move the files from the USB onto the Noble drive under the EEG folder and save as PXXXXXX_BFY6_Rest

(EEG data file path:  NOBLE>BFY>Age4>DATA_AGE6>EEG > 0_Deposit EEG Data from Sites Here)

Open new window for USB DISK >

Drag Resting zip file (in USB) to 0_Deposit EEG Data from Sites Here; check name is formatted as follows: PXXXXXX_BFY6_Rest (e.g., P102111_BFY6_Rest)

Capping Pictures

• Move the capping pictures on the iPad into the capping pictures folder on Drive

  • Drive > BFY Capping Pictures

  • Find your site’s folder

  • File name: Year_Month_Date_PXXX (e.g., 22_11_30_P3578_1(2,3,4,5))

  • Delete photos from the iPad photo gallery once they are uploaded to the Drive

EEG (R2)

• • Bring the EEG Cap and bucket to the sink and pour out the solution, remove the cap and dab it gently on a towel.

  • Place the cap back in the bucket under the sink and rinse it until it is submerged 

  • Dunk the net in and out of the bucket ~10 times, agitating it intermittently 

  • Pour the water out and repeat the rinsing and dunking process three times 

  • Carefully rest the cord and connector around the back of your neck during this process to ensure that it stays dry

  • Sanitize the EEG Cap 

• If a disinfectant solution is already made: 

  • Soak the EEG cap in the solution in the plastic container marked "Disinfectant Only" for exactly 10 minutes. Any longer will be harmful to the cap.

  • Repeat the rinsing process detailed in step 2 and thoroughly clean the disinfectant off of the cap. 

• To make a disinfectant solution: 

  • In the cabinet marked 'EEG nets and supplies': fill the spoon marked 'EGI Disinfectant' with the Control III Disinfectant and pour it into the "Disinfectant Only" plastic container  

  • Fill the container up with water up to the bottom of the 'O' in 'Only' that is written on the front of the container. 

  • Create a new solution every two weeks. Use a dry erase marker to make a note of the next date on the lid of the container.  

• Return the cap to the hooks by the EGI station. 

PCI (R1):

• Take out SD card from the camera

• Plug into the SD card reader and plug that into the laptop

• Find the PCI video file

• Connect to VPN

• Open Noble Drive > BFY > Age_6 > DATA_Age_6 > PCI

• Upload video into this folder and name as BFY_Age6_PCI_PXXXXX

• Once you are sure the recording is on the server, place the SD card back in the camera and delete the PCI video file on the camera

• Disinfect the toys surfaces that participants interact with.

SMS:

1.  Log the visit in the sample management system (SMS):

o Go to the participant's profile

o Log a new interaction: In the new interaction form selection menu, select University Appointment. 

o Enter the date and start time of the appointment 

o Enter the incentive mode and amount

o Assign outcome of the visit:

§ Complete visit: assign when P completed her chosen activities, and no further data collection attempts need to be made

§ Partial visit: assign when P completes some but not all of her chosen activities, and further data collection needs to take place but there is no set appt time (e.g. maternal survey is completed via phone and P wants to participate in university-based activities, which will happen at an undefined later time)

§ Partial visit, appointment scheduled: assign when P completes some but not all of her chosen activities, and a follow-up appointment was scheduled. In this case, also input the next appointment into the form

o Click update.

2.  Send thank you email and text using the appropriate IRB-approved template, attach blank consent forms to the email.

o Log the interaction in SMS.

Woodcock Johnson - Riverside Scoring System

• Open a browser window to the URL: https://www.riversidescore.com. Enter your user name and password and click “Sign In”.

• To add an examinee:

  • Open the Add Examinee Information page by:

  • Hovering over the Administrative tab, then Examinees, then clicking Add or

  • Clicking Add Examinee on the My Recent Examinees bar at the bottom center of the page.

  • Complete the top, General Information, part of the page with

  • Last Name: PXXXXX

  • First Name: PXXXXX

  • Gender: From REDCap

  • DOB: From REDCap

  • Caseload Folder: BFY A6 Pilot Families

  • Examinee ID: PXXXXX

  • Click Save to save this examinee and open the new examinee's Examinee Information page.

• To add records:

  • Search Examinee

  • Click “Add Test Record”

  • Select Woodcock Johnson 

  • Click Continue

  • Go to REDCap “Wj Letter-Word Identification” and “Wj Applied Problems” to get the total scores (at the end of the form)

  • Add total scores for Letter-Word Identification and Applied Problems

  • Click “Commit Test Record”

• To create a report:

  • On the dashboard, hover over Reports and click Create Report. The Create Report page opens.

  • Product: WJ-IV

  • Report Type: Select Score Report.

  • Examinee Selection: Select an examinee. 

  • Test Record/Checklist: WJ IV Test of Achievement Form A and B a

  • Normative Basis: Age

  • Score Selection Template: Select “BFY A6 Pilot” template

  • Options: GIA scores (should be the default showed)

  • Variations: Intra-cognitive and intra-lingual  (should be the default showed)

  • Comparisons: Gf-Gc Composite/Other Ability Comparison

  • Grouping Options: List test in numerical order separately

  • Output Format: Select PDF

  • Click one of the buttons:

    • Run Report to run or save the report now. 

    • Save to My Reports to save to your dashboard to open later. 

• Go back to the REDCap “A6 Pilot” project

• Select “WJ Scores”

• Enter the requested information from the Riverside report into the fields for both Letter-Word Identification and Applied Problems