CDE Detailed Report

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

Displaying 151 - 174 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
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

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

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

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

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

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

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

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

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

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

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

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
C55073 Child Behavior Checklist (CBCL) - Dislike school scale CBCLDislikeSchoolScl Scale for the child's tendency to dislike school, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to dislike school, as part of the Child Behavior Checklist (CBCL) Dislikes 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 2016-12-22 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

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

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

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

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

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

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

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

C52240 Child Behavior Checklist (CBCL) - Gets in many fights scale CBCLGetsInManyFightsScl Scale for whether the child gets in many fights, as part of the Child Behavior Checklist (CBCL) Scale for whether the child gets in many fights, as part of the Child Behavior Checklist (CBCL) Gets in many fights 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 15:50:04.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55054 Child Behavior Checklist (CBCL) - Pick nose skin other parts body describe text CBCLPckNosSknOthPtsBodyDscrTxt The free-text field related to 'Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale' for describing the child's tendency to pick at his or her nose, skin, or other body parts, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale' for describing the child's tendency to pick at his or her nose, skin, or other body parts, as part of the Child Behavior Checklist (CBCL) Picks nose, skin, or other parts of body (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 12:37:05.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52292 Child Behavior Checklist (CBCL) - Stubborn sullen irritable scale CBCLStbbrnSllnIrrScl Scale for whether the child is stubborn, sullen or irritable, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is stubborn, sullen or irritable, as part of the Child Behavior Checklist (CBCL) Stubborn, sullen, or irritable 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 10:53:29.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52079 Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale CBCLPickNoseSkinBodyScl Scale for whether the child picks their nose, skin, or other parts of body, as part of the Child Behavior Checklist (CBCL) Scale for whether the child picks their nose, skin, or other parts of body, as part of the Child Behavior Checklist (CBCL) Picks nose, skin, or other parts of body 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 12:10:58.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

CSV