CDE Detailed Report
Subdomain Name: 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 / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C52237 | Child Behavior Checklist (CBCL) - Fears they might think or do something bad scale | CBCLFearThinkDoBadThingScl | Scale for whether the child fears they might think or do something bad, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fears they might think or do something bad, as part of the Child Behavior Checklist (CBCL) | Fears he/she might thing or do something bad | 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 14:57:56.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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 |
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| C55051 | Child Behavior Checklist (CBCL) - Stomachache no known medical cause scale | CBCLStmchachNoKnwnMdclCausScl | Scale for whether the child has stomachaches without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has stomachaches without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Stomachaches | 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 |
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| C52289 | Child Behavior Checklist (CBCL) - Stores up many things scale | CBCLStrUpMnyThngScl | Scale for whether the child stores up too many things he/she doesn't need, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child stores up too many things he/she doesn't need, as part of the Child Behavior Checklist (CBCL) | Stores up too many things he/she doesn't need | 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 10:43:23.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52065 | Child Behavior Checklist (CBCL) - Nervous movements or twitching scale | CBCLNervousMovemenTwitchScl | Scale for whether the child makes nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child makes nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Nervous movements or twitching | 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 11:52:01.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55019 | Child Behavior Checklist (CBLC) - Child referral education assistance code | CBLCChildRefrlEductnAsstncCode | Code for whether, to the respondent's knowledge, the child has ever been referred for educational assistance outside of a regular classroom, such as special class placement, services, or tutoring, as part of the Child Behavior Checklist (CBLC) | Code for whether, to the respondent's knowledge, the child has ever been referred for educational assistance outside of a regular classroom, such as special class placement, services, or tutoring, as part of the Child Behavior Checklist (CBLC) | Has he/she ever been referred for special class placement, services, or tutoring? | Don't know;0;1 | Don't know;No;Yes—what kind and when? | 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. |
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 11:15:38.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55030 | Child Behavior Checklist (CBCL) - Achievement test most recent date | CBCLAchvmntTestMstRcntDate | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the date of the named achievement test, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the date of the named achievement test, as part of the Child Behavior Checklist (CBCL) | Date | Date or Date & Time |
Most recent achievement test scores (optional) |
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 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
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| C52252 | Child Behavior Checklist (CBCL) - Obsessions scale | CBCLObsessionsScl | Scale for whether the child can't get their mind off certain thoughts, obsessions, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child can't get their mind off certain thoughts, obsessions, as part of the Child Behavior Checklist (CBCL) | Can't get his/her mind off certain thoughts' obsessions | 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 17:07:22.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55062 | Child Behavior Checklist (CBCL) - Explosive unpredictable behavior scale | CBCLExplsvUnprdctablBehavrScl | Scale for the child's tendency to exhibit explosive or unpredictable behavior, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to exhibit explosive or unpredictable behavior, as part of the Child Behavior Checklist (CBCL) | Explosive and unpredictable behavior | 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 |
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| C52301 | Child Behavior Checklist (CBCL) - Temper tantrum hot temper scale | CBCLTmprTntrmHtTmprScl | Scale for whether the child has temper tantrums or a hot temper, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has temper tantrums or a hot temper, as part of the Child Behavior Checklist (CBCL) | Temper tantrums or hot temper | 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 12:00:41.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52094 | Child Behavior Checklist (CBCL) - Gets hurt a lot, accident-prone scale | CBCLHurtALotAccidentProneScl | Scale for whether the child gets hurt a lot, is accident-prone, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets hurt a lot, is accident-prone, as part of the Child Behavior Checklist (CBCL) | Gets hurt a lot, accident-prone | 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 16:13:08.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52196 | Child Behavior Checklist (CBCL) - Poorly coordinated or clumsy scale | CBCLPoorCoordinationClumsyScl | Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) | Poorly coordinated or clumsy | 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 13:51:42.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55041 | Child Behavior Checklist (CBCL) - Destroy property belong others scale | CBCLDstryPrprtyBlngOthrScl | Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) | Destroys property belonging to others | 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 |
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| C52273 | Child Behavior Checklist (CBCL) - Overtired without good reason scale | CBCLOvertiredNoGoodReasonScl | Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) | Overtired without good reason | 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 11:40:37.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52015 | Child Behavior Checklist (CBCL) - Argues a lot scale | CBCLArgueALotScl | Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) | Argues a lot | 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 13:51:27.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52317 | Child Behavior Checklist (CBCL) - Worry scale | CBCLWorryScl | Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) | Worries | 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 13:19:50.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55020 | Child Behavior Checklist (CBLC) - Child referral education assistance describe text | CBLCChildRefrlAsstnceDscrbTxt | The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) | The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) | Yes-what kind and when? | 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. |
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 11:21:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52238 | Child Behavior Checklist (CBCL) - Hears sound or voices that arent there description text | CBCLHearSoundVoicesNotThereTxt | description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) | description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) | Hears sounds or voices 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 | 2016-12-22 15:00:34.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55071 | Child Behavior Checklist (CBCL) - Fail perform assigned task scale | CBCLFailPerformAssignTaskScl | Scale for the child's tendency to fail to perform assigned tasks, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to fail to perform assigned tasks, as part of the Child Behavior Checklist (CBCL) | Fails to carry out assigned tasks | 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 |
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| C55052 | Child Behavior Checklist (CBCL) - Vomit no known medical cause scale | CBCLVomitNoKnwnMdclCausScl | Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Vomiting, throwing up | 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 |
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| C52290 | Child Behavior Checklist (CBCL) - Strange behavior scale | CBCLStrngBhvrScl | Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) | Strange behavior | 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 10:47:05.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52070 | Child Behavior Checklist (CBCL) - Best thing description text | CBCLBestThingDescTxt | description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) | description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) | Please describe the best things about this pupil: | 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. |
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 11:58:14.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55031 | Child Behavior Checklist (CBCL) - Achievement test most recent status | CBCLAchvmntTestMstRcntStatus | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) | Percentile or grade level obtained | Alphanumeric |
Most recent achievement test scores (optional) |
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 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 50 |
Free-Form Entry |
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| C52254 | Child Behavior Checklist (CBCL) - Nervous movements or twitching description text | CBCLNervousMovementTwitchTxt | description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Nervous movements or twitching (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 | 2016-12-22 17:13:04.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55063 | Child Behavior Checklist (CBCL) - Easily frustrated scale | CBCLEasilyFrustratedScl | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Demands must be met immediately, easily frustrated | 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 |
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| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant/subject was born | Date (and time, if applicable and known) the participant/subject was born | Pupil's Birthdate (if known) | Date or Date & Time | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
793 | |||||||||||
| C52302 | Child Behavior Checklist (CBCL) - Thinks about sex too much scale | CBCLThnkAbtSxTooMchScl | Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) | Seems preoccupied with sex | 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 12:07:39.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52095 | Child Behavior Checklist (CBCL) - Disobedient at school scale | CBCLDisobedientAtSchoolScl | Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) | Disobedient at school | 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 16:23:55.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52198 | Child Behavior Checklist (CBCL) - Deliberately harms self or attempts suicide scale | CBCLHarmSelfAttemptSuicideScl | Scale for whether the child deliberately harms themselves or attempts suicide, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child deliberately harms themselves or attempts suicide, as part of the Child Behavior Checklist (CBCL) | Deliberately harms self or attempts suicide | 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 13:54:03.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55042 | Child Behavior Checklist (CBCL) - Difficulty follow direction scale | CBCLDffcltyFollwDirectnScl | Scale of the child's tendency to have difficulty following directions, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to have difficulty following directions, as part of the Child Behavior Checklist (CBCL) | Difficulty following directions | 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 |
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| C52275 | Child Behavior Checklist (CBCL) - Scream a lot scale | CBCLScrmAltScl | Scale for whether the child screams a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child screams a lot, as part of the Child Behavior Checklist (CBCL) | Screams a lot | 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 14:18:59.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52032 | Child Behavior Checklist (CBCL) - Acts too young for their age scale | CBCLActTooYoungScl | Child Behavior Checklist (CBCL) - Acts too young for their age scale | Scale for whether the child can't stand waiting, wants everything now, as part of the Child Behavior Checklist (CBCL) | Acts too young for his/her age | 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 15:31:16.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55010 | Child Behavior Checklist (CBLC) - Occupation parent 1 type | CBLCOccupationParent1Typ | Type of occupation of parent 1, as part of the Child Behavior Checklist (CBLC) | Type of occupation of parent 1, as part of the Child Behavior Checklist (CBLC) | Parent 1 (or Father) Type of Work | 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 10:55:06.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55021 | Child Behavior Checklist (CBCL) - School grade repeat describe text | CBCLSchoolGradRptDscrbTxt | The free-text field related to 'School repeat grade indicator' for describing the grade repeated by the child and the reasons for doing so, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'School repeat grade indicator' for describing the grade repeated by the child and the reasons for doing so, as part of the Child Behavior Checklist (CBCL) | Yes-grades and reasons: | 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. |
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 11:23:22.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52239 | Child Behavior Checklist (CBCL) - Cant concentrate, cant pay attention for long scale | CBCLNoConcentratPayAttentnScl | Scale for whether the child cant concentrate, cant pay attention for long, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child cant concentrate, cant pay attention for long, as part of the Child Behavior Checklist (CBCL) | Can't concentrate, can't pay attention for long | 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 15:04:02.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55072 | Child Behavior Checklist (CBCL) - Overanxious to please scale | CBCLOveranxiousToPleaseScl | Scale for the child's tendency to be overly anxious/eager to please, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be overly anxious/eager to please, as part of the Child Behavior Checklist (CBCL) | Overly anxious to please | 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 |
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| C55053 | Child Behavior Checklist (CBCL) - Other physical problems without known medical cause describe text | CBCLOthPhyPbmWoKnwMdlCsDscrTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale' for describing the other physical problems, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale' for describing the other physical problems, as part of the Child Behavior Checklist (CBCL) | Other (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 12:34:25.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52291 | Child Behavior Checklist (CBCL) - Strange ideas scale | CBCLStrngIdeaScl | Scale for whether the child has strange ideas, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has strange ideas, as part of the Child Behavior Checklist (CBCL) | Strange ideas | 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 10:49:39.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52075 | Child Behavior Checklist (CBCL) - Drinks alcohol without parents approval description text | CBCLDrinkAlcNoParentApprovTxt | description text of the child drinking alcohol without parents' approval, as part of the Child Behavior Checklist (CBCL) | description text of the child drinking alcohol without parents' approval, as part of the Child Behavior Checklist (CBCL) | Uses alcohol or drugs for nonmedical purposes (don't include tobacco) (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 | 2016-12-21 12:07:18.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55032 | Child Behavior Checklist (CBCL) - Aptitude test name | CBCLAptitudeTestName | Name of the aptitude test taken by the child, as part of the Child Behavior Checklist (CBCL) | Name of the aptitude test taken by the child, as part of the Child Behavior Checklist (CBCL) | Name of test | Alphanumeric |
IQ, readiness, or aptitude tests (optional) |
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 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52255 | Child Behavior Checklist (CBCL) - Complains of loneliness scale | CBCLComplainOfLonelinessScl | Scale for whether the child complains of loneliness, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child complains of loneliness, as part of the Child Behavior Checklist (CBCL) | Complains of loneliness | 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 17:16:55.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C00008 | Age value | AgeVal | Value for participant's age, calculated as elapsed time since the birth of the participant | Value for participant's age, calculated as elapsed time since the birth of the participant | Pupil's Age | Numeric Values |
Record in months |
Pediatric | Supplemental | 3.10 | 2024-02-29 15:47:28.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
0 | 1800 | month | ||||||||
| C52303 | Child Behavior Checklist (CBCL) - Threaten people scale | CBCLThrtnPplScl | Scale for whether the child threatens people, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child threatens people, as part of the Child Behavior Checklist (CBCL) | Threatens 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 | 2016-12-27 12:11:58.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52096 | Child Behavior Checklist (CBCL) - Rashes or other skin problems scale | CBCLRashSkinProbScl | Scale for whether the child has rashes or other skin problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has rashes or other skin problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Raches or other skin problems | 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 16:31:13.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52202 | Child Behavior Checklist (CBCL) - Hears sound voice not there scale | CBCLHearSountVoiceNotThereScl | Scale for whether the child hears sound or voices that arenÃâ?Ââ?Ââ½t there, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child hears sound or voices that arent there, as part of the Child Behavior Checklist (CBCL) | Hears sounds or voices that aren't there | 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 13:56:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55043 | Child Behavior Checklist (CBCL) - Disturb other pupil scale | CBCLDisturbOtherPupilScl | Scale of the child's tendency to disturb other pupils, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to disturb other pupils, as part of the Child Behavior Checklist (CBCL) | Disturbs other pupils | 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 |
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| C52276 | Child Behavior Checklist (CBCL) - Secretive keep thing self scale | CBCLScrtvKpThSlfScl | Scale for whether the child is secretive, keeps things to self, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is secretive, keeps things to self, as part of the Child Behavior Checklist (CBCL) | Secretive, keeps things to 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 09:06:24.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52033 | Child Behavior Checklist (CBCL) - Feels too guilty scale | CBCLFeelTooGuiltyScl | Scale for whether the child feels too guilty, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels too guilty, as part of the Child Behavior Checklist (CBCL) | Feels too guily | 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 15:35:51.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55011 | Child Behavior Checklist (CBLC) - Occupation parent 2 type | CBLCOccupationParent2Typ | Type of occupation of parent 2, as part of the Child Behavior Checklist (CBLC) | Type of occupation of parent 2, as part of the Child Behavior Checklist (CBLC) | Parent 2 (or Mother) Type of Work | 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 10:55:06.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55022 | Child Behavior Checklist (CBCL) - Academic performance subject type | CBLCAcdmcPrfrmncSbjctTyp | Type of academic subject for which the respondent is rating the child's performance, as part of the Child Behavior Checklist (CBCL) | Type of academic subject for which the respondent is rating the child's performance, as part of the Child Behavior Checklist (CBCL) | Academic subject | 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 11:29:14.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 50 |
Free-Form Entry |
