CDE Detailed Report

Disease: Traumatic Brain Injury
Sub-Domain: Psychiatric and Psychological Status
CRF: Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18

Displaying 1 - 50 of 174
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C00035 Gender type GenderTyp Self-reported gender of the participant/subject Self-reported gender of the participant/subjec Pupil's Gender Alphanumeric Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

2200604
C52307 Child Behavior Checklist (CBCL) - Underactive slow moving lack energy scale CBCLUndrctvSlwMvLckEngScl Scale for whether the child is underactive, slow moving, or lacks energy, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is underactive, slow moving, or lacks energy, as part of the Child Behavior Checklist (CBCL) Underactive, slow moving, or lacks energy 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 12:29:18.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55068 Child Behavior Checklist (CBCL) - Strange ideas describe text CBCLStrangeIdeaDescribeText The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) Strange ideas (describe) Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 13:01:53.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52149 Child Behavior Checklist (CBCL) - Problems with eyes scale CBCLProbWithEyesScl Scale for whether the child has problems with eyes (not if corrected by glasses) without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has problems with eyes (not if corrected by glasses) without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Eye problems (not if corrected by glasses) 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:23:22.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55035 Child Behavior Checklist (CBCL) - Illness or disability describe text CBCLIllnessDisabilityDescrbTxt The free-text field related to 'Child Behavior Checklist (CBCL) - Illness or disability indicator' for describing the illness or disability, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Illness or disability indicator' for describing the illness or disability, as part of the Child Behavior Checklist (CBCL) Yes—please describe Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:00:22.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 4000

Free-Form Entry

C52261 Child Behavior Checklist (CBCL) - Feels others are out to get them scale CBCLFeelOthrsOutToGetThemScl Scale for whether the child feels others are out to get them, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels others are out to get them, as part of the Child Behavior Checklist (CBCL) Feels others are out to get him/her 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-23 10:52:32.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52281 Child Behavior Checklist (CBCL) - Showing off or clowning scale CBCLShwOffClownScl Scale for whether the child shows off or clowns, as part of the Child Behavior Checklist (CBCL) Scale for whether the child shows off or clowns, as part of the Child Behavior Checklist (CBCL) Showing off or clowning 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 09:54:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52038 Child Behavior Checklist (CBCL) - Overweight scale CBCLOverweightScl Scale for whether the child is overweight, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is overweight, as part of the Child Behavior Checklist (CBCL) Overweight 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-20 16:57:47.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55014 Child Behavior Checklist (CBLC) - Respondent school role other text CBLCRespondentSchoolRoleOTH The free-text field related to 'Child Behavior Checklist (CBLC) - Respondent school role type' specifying other text, as part of the Child Behavior Checklist (CBLC) The free-text field related to 'Child Behavior Checklist (CBLC) - Respondent school role type' specifying other text, as part of the Child Behavior Checklist (CBLC) Your role at the school: Other (specify): Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Adult Supplemental 1.00 2017-04-18 11:00:27.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52217 Child Behavior Checklist (CBCL) - Clings to adults or too dependent scale CBCLClingAdultTooDependentScl Scale for whether the child clings to adults or is too dependent, as part of the Child Behavior Checklist (CBCL) Scale for whether the child clings to adults or is too dependent, as part of the Child Behavior Checklist (CBCL) Clings to adults or too dependent 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 14:18:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55046 Child Behavior Checklist (CBCL) - Overconform rules scale CBCLOverconformRulesScl Scale for the child's tendency to overconform to rules, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to overconform to rules, as part of the Child Behavior Checklist (CBCL) Overconforms to rules 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52295 Child Behavior Checklist (CBCL) - Suspicious scale CBCLSuspcsScl Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) Suspicious 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 11:27:52.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52089 Child Behavior Checklist (CBCL) - Feels they have to be perfect scale CBCLFeelThyHaveBePrfctScl Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) Feels he/she has to be perfect 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 14:37:57.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55025 Child Behavior Checklist (CBCL) - Behave appropriate relative pupil typical same age code CBLCBhvAptRelPplTypSamAgeCode Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) How appropriately is he/she behaving? 4;1;2;3;5;6;7 About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more Numeric Values

Compared to typical pupils of the same age

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52244 Child Behavior Checklist (CBCL) - Breaks rules at home, school, or elsewhere scale CBCLBreaksRulesScl Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) Breaks school rules 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 16:16:24.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55057 Child Behavior Checklist (CBCL) - Disrupt class discipline scale CBCLDisruptClassDisciplineScl Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) Disrupts class discipline 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C17733 Person completing form name PrsnCompletingFormName Name of person completing the form Name of person completing the form This form filled out by: Alphanumeric Adult Supplemental 3.00 2013-08-30 17:06:52.8 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52308 Child Behavior Checklist (CBCL) - Unhappy sad depressed scale CBCLUnhppySdDepScl Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) Unhappy, sad, or depressed 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 12:32:31.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55069 Child Behavior Checklist (CBCL) - Underachievement scale CBCLUnderachievementScl Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Underachieving, not workinig up to potential 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52154 Child Behavior Checklist (CBCL) - Feels dizzy or lightheaded scale CBCLFeelDizzyLightheadedScl Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) Feels dizzy or lightheaded 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:46:56.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55036 Child Behavior Checklist (CBCL) - Odd noise in class scale CBCLOddNoiseInClassScl Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) Hums or makes other odd noises in class. 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52262 Child Behavior Checklist (CBCL) - Doesn?t seem to feel guilty after misbehaving scale CBCLNoGuiltyAfterMisbehavScl Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) Doesn't seem to feel guilty after misbehaving 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-23 10:57:25.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52282 Child Behavior Checklist (CBCL) - Too shy timid scale CBCLTooShyTmdScl Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) Too shy or timid 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 10:06:29.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52039 Child Behavior Checklist (CBCL) - Hangs around with others who get in trouble scale CBCLHangWthOthrsGetInTroublScl Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) Hangs around with others who get in trouble 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-20 17:02:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55015 Child Behavior Checklist (CBLC) - Know child month duration CBLCKnowChildMonthDur Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) For how many months have you known this pupil? Numeric Values Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Adult;Pediatric Supplemental 1.00 2017-04-18 11:06:20.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Free-Form Entry

Months
C52219 Child Behavior Checklist (CBCL) - Lying or cheating scale CBCLLyingCheatingScl Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) Lying or cheating 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 14:20:38.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55047 Child Behavior Checklist (CBCL) - Difficulty learn scale CBCLDifficultyLearnScl Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) Has difficulty learning 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52296 Child Behavior Checklist (CBCL) - Swear obscene language scale CBCLSwrObsLngScl Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) Swearing or obscene language 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 11:32:04.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52090 Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale CBCLOthrPhysicalProbScl Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Other 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 15:49:17.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55026 Child Behavior Checklist (CBCL) - Learn amount relative pupil typical same age code CBLCLrnAmtRelPplTypSamAgeCode Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) How much is he/she learning? 4;1;2;3;5;6;7 About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more Numeric Values

Compared to typical pupils of the same age

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52245 Child Behavior Checklist (CBCL) - Physically attacks people scale CBCLPhysicallyAttackPeopleScl Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) Physically attacks people 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 16:20:27.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55058 Child Behavior Checklist (CBCL) - Sees things not there describe text CBLCSeeThingsNotThereDescrbTxt The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) Sees things that aren't there (describe) Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:43:53.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C17992 Additional comment text AddtnalCommntTxt Text describing any additional information about the participant or the participant's family history Text describing any additional information about the participant or the participant's family history Please feel free to write any comments about this pupil's work, behavior, or potential. Alphanumeric

Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior.

Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52309 Child Behavior Checklist (CBCL) - Unusually loud scale CBCLUnslLdScl Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) Unusually loud 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 12:37:04.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55070 Child Behavior Checklist (CBCL) - Tardiness scale CBCLTardinessScl Scale for the child's tendency to be tardy to school or class, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to be tardy to school or class, as part of the Child Behavior Checklist (CBCL) Tardy to school or class 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52161 Child Behavior Checklist (CBCL) - Nausea feel sick scale CBCLNauseaFeelSickScl Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Nausea, feels sick 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55037 Child Behavior Checklist (CBCL) - Enjoy very little scale CBCLEnjoyVeryLittleScl Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) There is very little that he/she enjoys. 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52265 Child Behavior Checklist (CBCL) - Restless hyperactive scale CBCLRestlessHyperactivScl Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) Can't sit still, restless, or hyperactive 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-23 11:09:14.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52285 Child Behavior Checklist (CBCL) - Speech problem scale CBCLSpchPrblmScl Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) Speech problem 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 10:32:44.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52056 Child Behavior Checklist (CBCL) - Feels worthless or inferior scale CBCLFeelsWorthlessScl Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) Feels worthless or inferior 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 11:40:35.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55016 Child Behavior Checklist (CBLC) - Familiar child degree code CBLCFamiliarChildDegreeCode Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) How well do you know him/her? 1;2;3 Not Well;Moderately Well;Very Well Numeric Values Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Adult;Pediatric Supplemental 1.00 2017-04-18 11:09:18.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52222 Child Behavior Checklist (CBCL) - Destroys their own things scale CBCLDestroysOwnThingsScl Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) Destroys his/her own things 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 14:29:41.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55048 Child Behavior Checklist (CBCL) - Overly fearful anxious scale CBCLOverlyFearfulAnxiousScl Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) Too fearful or anxious 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52297 Child Behavior Checklist (CBCL) - Talk kill self scale CBCLTlkKillSlfScl Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) Talks about killing self 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 11:42:22.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52091 Child Behavior Checklist (CBCL) - Prefers being with older kids scale CBCLPreferBeWithOlderKidsScl Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) Prefers being with older children or youths 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 16:00:59.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55027 Child Behavior Checklist (CBCL) - Happiness relative pupil typical same age code CBLCHpinesRelPplTypSamAgeCode Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) How happy is he/she? 4;1;2;3;5;6;7 About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more Numeric Values

Compared to typical pupils of the same age

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52247 Child Behavior Checklist (CBCL) - Impulsive or acts without thinking scale CBCLImpulsiveActNoThinkScl Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) Impulsive or acts without thinking 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 16:26:49.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55059 Child Behavior Checklist (CBCL) - Produce messy work scale CBCLProduceMessyWorkScl Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) Messy work 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed The date of assessment of the examination being performe Today's Date Date or Date & Time Pediatric Supplemental 1.00 2014-06-18 08:10:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Free-Form Entry

C52310 Child Behavior Checklist (CBCL) - Use drug nonmedical purpose scale CBCLUsDrgNonMdPrpScl Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) Uses alcohol or drugs for nonmedical purposes (don't include tobacco) 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 12:40:00.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

CSV