CDE Detailed Report

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

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
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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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
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

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

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

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

CSV