CDE Detailed Report
Subdomain Name: Psychiatric and Psychological Status
CRF: Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18
Displaying 51 - 100 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 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
C55075 | Child Behavior Checklist (CBCL) - Unclean personal appearance scale | CBCLUncleanPersonalApearancScl | Scale for the child's tendency to have an unclean personal appearance, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to have an unclean personal appearance, as part of the Child Behavior Checklist (CBCL) | Unclean personal appearance | 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 performed | 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 |
||||||||
C52175 | Child Behavior Checklist (CBCL) - Bites fingernails scale | CBCLBitesFingernailsScl | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Bites fingernails | 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 13:11:36.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55038 | Child Behavior Checklist (CBCL) - Defy talk back scale | CBCLDefyTalkBackScl | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Defiant, talks back to staff | 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 |
||||||||
C52286 | Child Behavior Checklist (CBCL) - Stares blankly scale | CBCLStrBlnkScl | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Stares blankly | 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 10:35:32.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52059 | Child Behavior Checklist (CBCL) - Daydreams or gets lost in their thoughts scale | CBCLDaydreamLostInThoughtScl | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Daydreams or gets lost in his/her thoughts | 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 11:44:21.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55017 | Child Behavior Checklist (CBLC) - Child time in class service week duration | CBLCChildTimeInClassSvcWkDur | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | How much time does he/she spend in your class or service per week? | Numeric Values |
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 | Adult;Pediatric | Supplemental | 1.00 | 2017-04-18 11:11:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
0.1 | 30 | Hours per week | |||||||
C52229 | Child Behavior Checklist (CBCL) - Bragging boasting scale | CBCLBragBoastScl | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Bragging, boasting | 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 14:35:01.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55049 | Child Behavior Checklist (CBCL) - Problems with eyes describe text | CBCLProblemWithEyesDescribeTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | Eye problems (not if corrected by glasses) (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 12:27:18.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
C55065 | Child Behavior Checklist (CBCL) - Feel hurt criticism scale | CBCLFeelHurtCriticismScl | Scale for the child's tendency to feel hurt by criticism, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to feel hurt by criticism, as part of the Child Behavior Checklist (CBCL) | Feels hurt when criticized | 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 |
||||||||
C55060 | Child Behavior Checklist (CBCL) - Behave irresponsible scale | CBCLBehavIrresponsibleScl | Scale for the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Behaves irresponsibly | 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 |
||||||||
C52299 | Child Behavior Checklist (CBCL) - Talks too much scale | CBCLTlkTooMchScl | Scale for whether the child talks too much, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child talks too much, as part of the Child Behavior Checklist (CBCL) | Talks too much | 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 11:51:50.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52092 | Child Behavior Checklist (CBCL) - Confused or seems to be in a fog scale | CBCLConfusedInAFogScl | Scale for whether the child is confused or seems to be in a fog, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is confused or seems to be in a fog, as part of the Child Behavior Checklist (CBCL) | Confused or seems to be in a fog | 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.s |
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 16:06:05.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55028 | Child Behavior Checklist (CBCL) - Achievement test most recent name | CBCLAchvmntTestMstRcntName | Name of the most recent achievement test in a subject, as part of the Child Behavior Checklist (CBCL) | Name of the most recent achievement test in a subject, as part of the Child Behavior Checklist (CBCL) | Name of test | 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 | 255 |
Free-Form Entry |
|||||||||
C52250 | Child Behavior Checklist (CBCL) - Feels or complains that no one loves them scale | CBCLComplainNoOneLoveThemScl | Scale for whether the child feels or complains that no one loves them, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels or complains that no one loves them, as part of the Child Behavior Checklist (CBCL) | Feels or complains that no one loves 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 | 2016-12-22 16:57:52.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52270 | Child Behavior Checklist (CBCL) - Biggest concerns description text | CBCLBiggestConcernDescTxt | Description text of what concerns the respondent has most about the child, as part of the Child Behavior Checklist (CBCL) | Description text of what concerns the respondent has most about the child, as part of the Child Behavior Checklist (CBCL) | What concerns you most 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 | 2016-12-23 11:31:06.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
C55076 | Child Behavior Checklist (CBLC) - School grade repeat code | CBLCSchoolGradeRepeatCode | Code for the respondent's knowledge of whether the child has repeated a grade, as part of the Child Behavior Checklist (CBLC) | Code for the respondent's knowledge of whether the child has repeated a grade, as part of the Child Behavior Checklist (CBLC) | Has he/she repeadted any grades? | Don't know;0;1 | Don't know;No;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 14:58:20.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C21117 | Subject name | SubjectName | Name of subject/participant | Name of subject/participan | Pupil's full name, First Middle Last | Alphanumeric | Pediatric | Supplemental | 1.00 | 2015-06-12 15:16:39.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||||
C52314 | Child Behavior Checklist (CBCL) - Whining scale | CBCLWhngScl | Scale for whether the child whines, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child whines, as part of the Child Behavior Checklist (CBCL) | Whining | 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 13:02:17.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52184 | Child Behavior Checklist (CBCL) - Illness or disability indicator | CBCLIllnessDisabilityInd | Indicator that the child has an illness or disability (either physical or mental), as part of the Child Behavior Checklist (CBCL) | Indicator that the child has an illness or disability (either physical or mental), as part of the Child Behavior Checklist (CBCL) | Does this pupil have any illness or disability (either mental or physical)? | No;Yes | No;Yes | 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 13:26:35.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
C55039 | Child Behavior Checklist (CBCL) - Cry often scale | CBCLCryOftenScl | Scale of the child's tendency to cry often, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to cry often, as part of the Child Behavior Checklist (CBCL) | Cries 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 | 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 |
||||||||
C52288 | Child Behavior Checklist (CBCL) - Steals outside home scale | CBCLStlOutHmeScl | Scale for whether the child steals outside the home, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child steals outside the home, as part of the Child Behavior Checklist (CBCL) | Steals | 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 10:40:44.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52062 | Child Behavior Checklist (CBCL) - Doesn?t get along with other kids scale | CBCLNoGetAlongOthrKidsScl | Scale for whether the child doesnt get along with other kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child doesnt get along with other kids, as part of the Child Behavior Checklist (CBCL) | Doesn't get along with 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 | 2016-12-21 11:47:51.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55018 | Child Behavior Checklist (CBLC) - School class service type | CBLCSchoolClassServiceTyp | Type of class or service provided by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | Type of class or service provided by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | What kind of class or service is it? | Alphanumeric |
Please be specific, e.g., regular 5th grade, 7th grade math, learning disability, counseling, etc. |
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 11:14:09.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
C52232 | Child Behavior Checklist (CBCL) - Other problems description text | CBCLOthrProbTxt | description text of the child's other problems not already listed, as part of the Child Behavior Checklist (CBCL) | description text of the child's other problems not already listed, as part of the Child Behavior Checklist (CBCL) | Please write in any problems the pupil has that were not listed above. | 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 14:37:32.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
C55050 | Child Behavior Checklist (CBCL) - Talk out of turn scale | CBCLTalkOutOfTurnScl | Scale for the child's tendency to talk out of turn, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to talk out of turn, as part of the Child Behavior Checklist (CBCL) | Talks out of turn | 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 |
||||||||
C55066 | Child Behavior Checklist (CBCL) - Stores up many things describe text | CBCLStoreUpManyThingDescribTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Stores up many things scale' for describing the child's tendency to keep unneded things, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Stores up many things scale' for describing the child's tendency to keep unneded things, as part of the Child Behavior Checklist (CBCL) | Stores up too many things he/she doesn't need (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 12:58:28.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
C55061 | Child Behavior Checklist (CBCL) - Behave irresponsible describe text | CBCLBehavIresponsibleDescrbTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Behave irresponsible scale' for describing the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Behave irresponsible scale' for describing the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Behaves irresponsibly (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 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
C52300 | Child Behavior Checklist (CBCL) - Teases a lot scale | CBCLTsALotScl | Scale for whether the child teases a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child teases a lot, as part of the Child Behavior Checklist (CBCL) | Teases 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 | 2016-12-27 11:56:08.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52093 | Child Behavior Checklist (CBCL) - Fear certain animal situation place other than school scale | CBCLFearsAnimalSituatnPlaceScl | Scale for whether the child fears certain animals, situations, or places, other than school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fears certain animals, situations, or places, other than school, as part of the Child Behavior Checklist (CBCL) | Fears certain animals, situations, or places other than 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 16:10:24.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55029 | Child Behavior Checklist (CBCL) - Achievement test most recent subject text | CBCLAchvmntTestMstRcntSbjctTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the subject of the named achievement test, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the subject of the named achievement test, as part of the Child Behavior Checklist (CBCL) | Subject | 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 | 255 |
Free-Form Entry |
|||||||||
C52251 | Child Behavior Checklist (CBCL) - Poor school work scale | CBCLPoorSchoolWorkScl | Scale for whether the child does poor school work, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child does poor school work, as part of the Child Behavior Checklist (CBCL) | Poor school 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 17:00:09.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52271 | Child Behavior Checklist (CBCL) - Refuses to talk scale | CBCLRefuseToTalkScl | Scale for whether the child refuses to talk, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child refuses to talk, as part of the Child Behavior Checklist (CBCL) | Refuses to talk | 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 11:35:43.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52006 | Child Behavior Checklist (CBCL) - Prefer being with younger kid scale | CBCLPreferBeWithYoungerKidsScl | Scale for whether the child Prefers being with younger kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child Prefers being with younger kids, as part of the Child Behavior Checklist (CBCL) | Prefers being with younger children | 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 13:39:37.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52316 | Child Behavior Checklist (CBCL) - Withdrawn does not get involved scale | CBCLWthdrwnDsntGtInvOthScl | Scale for whether the child is withdrawn, doesn't give involved with others, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is withdrawn, doesn't give involved with others, as part of the Child Behavior Checklist (CBCL) | Withdrawn, doesn't get involved with 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 | 2016-12-27 13:11:42.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C52192 | Child Behavior Checklist (CBCL) - Cruelty, bullying, or meanness to others scale | CBCLCrueltyBullyMeanToOthrsScl | Scale for whether the child displays cruelty, bullying, or meanness to others, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child displays cruelty, bullying, or meanness to others, as part of the Child Behavior Checklist (CBCL) | Cruelty, bullying, or meanness 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 | 2016-12-22 13:41:56.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
C55040 | Child Behavior Checklist (CBCL) - Fidget scale | CBCLFidgetScl | Scale of the child's tendency to fidget, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to fidget, as part of the Child Behavior Checklist (CBCL) | Fidgets | 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 |
||||||||
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 |
||||||||
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 |
||||||||
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 |
||||||||
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 |
||||||||
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 |
||||||||
C55067 | Child Behavior Checklist (CBCL) - Strange behavior describe text | CBCLStrangeBehaviorDescribeTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Strange behavior scale' for describing the child's strange behavior, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Strange behavior scale' for describing the child's strange behavior, as part of the Child Behavior Checklist (CBCL) | Strange behavior (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 13:00:07.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
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 |
||||||||
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 |
||||||||
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 |
||||||||
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 |
||||||||||
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 |
||||||||
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 |