CDE Detailed Report
Subdomain Name: Psychiatric and Psychological Status
CRF: Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6
Displaying 1 - 50 of 174
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| C52065 | Child Behavior Checklist (CBCL) - Nervous movements or twitching scale | CBCLNervousMovemenTwitchScl | Scale for whether the child makes nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child makes nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Nervous movements or twitching | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 11:52:01.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55019 | Child Behavior Checklist (CBLC) - Child referral education assistance code | CBLCChildRefrlEductnAsstncCode | Code for whether, to the respondent's knowledge, the child has ever been referred for educational assistance outside of a regular classroom, such as special class placement, services, or tutoring, as part of the Child Behavior Checklist (CBLC) | Code for whether, to the respondent's knowledge, the child has ever been referred for educational assistance outside of a regular classroom, such as special class placement, services, or tutoring, as part of the Child Behavior Checklist (CBLC) | Has he/she ever been referred for special class placement, services, or tutoring? | Don't know;0;1 | Don't know;No;Yes—what kind and when? | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:15:38.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52237 | Child Behavior Checklist (CBCL) - Fears they might think or do something bad scale | CBCLFearThinkDoBadThingScl | Scale for whether the child fears they might think or do something bad, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fears they might think or do something bad, as part of the Child Behavior Checklist (CBCL) | Fears he/she might thing or do something bad | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 14:57:56.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55051 | Child Behavior Checklist (CBCL) - Stomachache no known medical cause scale | CBCLStmchachNoKnwnMdclCausScl | Scale for whether the child has stomachaches without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has stomachaches without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Stomachaches | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52289 | Child Behavior Checklist (CBCL) - Stores up many things scale | CBCLStrUpMnyThngScl | Scale for whether the child stores up too many things he/she doesn't need, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child stores up too many things he/she doesn't need, as part of the Child Behavior Checklist (CBCL) | Stores up too many things he/she doesn't need | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 10:43:23.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52094 | Child Behavior Checklist (CBCL) - Gets hurt a lot, accident-prone scale | CBCLHurtALotAccidentProneScl | Scale for whether the child gets hurt a lot, is accident-prone, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets hurt a lot, is accident-prone, as part of the Child Behavior Checklist (CBCL) | Gets hurt a lot, accident-prone | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 16:13:08.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55030 | Child Behavior Checklist (CBCL) - Achievement test most recent date | CBCLAchvmntTestMstRcntDate | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the date of the named achievement test, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the date of the named achievement test, as part of the Child Behavior Checklist (CBCL) | Date | Date or Date & Time |
Most recent achievement test scores (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
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| C52252 | Child Behavior Checklist (CBCL) - Obsessions scale | CBCLObsessionsScl | Scale for whether the child can't get their mind off certain thoughts, obsessions, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child can't get their mind off certain thoughts, obsessions, as part of the Child Behavior Checklist (CBCL) | Can't get his/her mind off certain thoughts' obsessions | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 17:07:22.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55062 | Child Behavior Checklist (CBCL) - Explosive unpredictable behavior scale | CBCLExplsvUnprdctablBehavrScl | Scale for the child's tendency to exhibit explosive or unpredictable behavior, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to exhibit explosive or unpredictable behavior, as part of the Child Behavior Checklist (CBCL) | Explosive and unpredictable behavior | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52301 | Child Behavior Checklist (CBCL) - Temper tantrum hot temper scale | CBCLTmprTntrmHtTmprScl | Scale for whether the child has temper tantrums or a hot temper, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has temper tantrums or a hot temper, as part of the Child Behavior Checklist (CBCL) | Temper tantrums or hot temper | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 12:00:41.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52317 | Child Behavior Checklist (CBCL) - Worry scale | CBCLWorryScl | Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) | Worries | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 13:19:50.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52196 | Child Behavior Checklist (CBCL) - Poorly coordinated or clumsy scale | CBCLPoorCoordinationClumsyScl | Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) | Poorly coordinated or clumsy | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 13:51:42.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55041 | Child Behavior Checklist (CBCL) - Destroy property belong others scale | CBCLDstryPrprtyBlngOthrScl | Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) | Destroys property belonging to others | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:04:30.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55068 | Child Behavior Checklist (CBCL) - Strange ideas describe text | CBCLStrangeIdeaDescribeText | The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) | Strange ideas (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 13:01:53.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52273 | Child Behavior Checklist (CBCL) - Overtired without good reason scale | CBCLOvertiredNoGoodReasonScl | Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) | Overtired without good reason | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-23 11:40:37.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52015 | Child Behavior Checklist (CBCL) - Argues a lot scale | CBCLArgueALotScl | Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) | Argues a lot | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-20 13:51:27.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52070 | Child Behavior Checklist (CBCL) - Best thing description text | CBCLBestThingDescTxt | description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) | description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) | Please describe the best things about this pupil: | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 11:58:14.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55020 | Child Behavior Checklist (CBLC) - Child referral education assistance describe text | CBLCChildRefrlAsstnceDscrbTxt | The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) | The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) | Yes-what kind and when? | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:21:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52238 | Child Behavior Checklist (CBCL) - Hears sound or voices that arent there description text | CBCLHearSoundVoicesNotThereTxt | description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) | description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) | Hears sounds or voices that aren't there (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 15:00:34.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55052 | Child Behavior Checklist (CBCL) - Vomit no known medical cause scale | CBCLVomitNoKnwnMdclCausScl | Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Vomiting, throwing up | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52290 | Child Behavior Checklist (CBCL) - Strange behavior scale | CBCLStrngBhvrScl | Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) | Strange behavior | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 10:47:05.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52302 | Child Behavior Checklist (CBCL) - Thinks about sex too much scale | CBCLThnkAbtSxTooMchScl | Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) | Seems preoccupied with sex | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 12:07:39.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52095 | Child Behavior Checklist (CBCL) - Disobedient at school scale | CBCLDisobedientAtSchoolScl | Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) | Disobedient at school | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 16:23:55.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55031 | Child Behavior Checklist (CBCL) - Achievement test most recent status | CBCLAchvmntTestMstRcntStatus | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) | Percentile or grade level obtained | Alphanumeric |
Most recent achievement test scores (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 50 |
Free-Form Entry |
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| C52254 | Child Behavior Checklist (CBCL) - Nervous movements or twitching description text | CBCLNervousMovementTwitchTxt | description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) | Nervous movements or twitching (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 17:13:04.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55063 | Child Behavior Checklist (CBCL) - Easily frustrated scale | CBCLEasilyFrustratedScl | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Demands must be met immediately, easily frustrated | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant/subject was born | Date (and time, if applicable and known) the participant/subject was born | Pupil's Birthdate (if known) | Date or Date & Time | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
793 | |||||||||||
| 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 |
