CDE Detailed Report
Sub-Domain: Psychiatric and Psychological Status
CRF: welcome
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 / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C52244 | Child Behavior Checklist (CBCL) - Breaks rules at home, school, or elsewhere scale | CBCLBreaksRulesScl | Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) | Breaks school rules | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 16:16:24.0 | 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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| C55057 | Child Behavior Checklist (CBCL) - Disrupt class discipline scale | CBCLDisruptClassDisciplineScl | Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) | Disrupts class discipline | 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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| C52295 | Child Behavior Checklist (CBCL) - Suspicious scale | CBCLSuspcsScl | Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) | Suspicious | 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 11:27:52.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55064 | Child Behavior Checklist (CBCL) - Speech problem describe text | CBCLSpeechProblemDescribeTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Speech problem scale' for describing the child's speech problem, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Speech problem scale' for describing the child's speech problem, as part of the Child Behavior Checklist (CBCL) | Speech problem (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 12:55:52.0 | 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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| C52089 | Child Behavior Checklist (CBCL) - Feels they have to be perfect scale | CBCLFeelThyHaveBePrfctScl | Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) | Feels he/she has to be perfect | 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 14:37:57.0 | 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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| C55025 | Child Behavior Checklist (CBCL) - Behave appropriate relative pupil typical same age code | CBLCBhvAptRelPplTypSamAgeCode | Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | How appropriately is he/she behaving? | 4;1;2;3;5;6;7 | About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more | Numeric Values |
Compared to typical pupils of the same age |
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 11:40:11.0 | 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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| C52262 | Child Behavior Checklist (CBCL) - Doesn?t seem to feel guilty after misbehaving scale | CBCLNoGuiltyAfterMisbehavScl | Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) | Doesn't seem to feel guilty after misbehaving | 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 10:57:25.0 | 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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| C17733 | Person completing form name | PrsnCompletingFormName | Name of person completing the form | Name of person completing the form | This form filled out by: | Alphanumeric | Adult | Supplemental | 3.00 | 2013-08-30 17:06:52.8 | 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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| C52308 | Child Behavior Checklist (CBCL) - Unhappy sad depressed scale | CBCLUnhppySdDepScl | Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) | Unhappy, sad, or depressed | 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 12:32:31.0 | 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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| C55075 | Child Behavior Checklist (CBCL) - Unclean personal appearance scale | CBCLUncleanPersonalApearancScl | Scale for the child's tendency to have an unclean personal appearance, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to have an unclean personal appearance, as part of the Child Behavior Checklist (CBCL) | Unclean personal appearance | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52154 | Child Behavior Checklist (CBCL) - Feels dizzy or lightheaded scale | CBCLFeelDizzyLightheadedScl | Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) | Feels dizzy or lightheaded | 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 12:46:56.0 | 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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| C55036 | Child Behavior Checklist (CBCL) - Odd noise in class scale | CBCLOddNoiseInClassScl | Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) | Hums or makes other odd noises in class. | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 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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| C55047 | Child Behavior Checklist (CBCL) - Difficulty learn scale | CBCLDifficultyLearnScl | Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) | Has difficulty learning | 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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| C52282 | Child Behavior Checklist (CBCL) - Too shy timid scale | CBCLTooShyTmdScl | Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) | Too shy or timid | 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 10:06:29.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52039 | Child Behavior Checklist (CBCL) - Hangs around with others who get in trouble scale | CBCLHangWthOthrsGetInTroublScl | Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) | Hangs around with others who get in trouble | 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 17:02:12.0 | 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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| C55015 | Child Behavior Checklist (CBLC) - Know child month duration | CBLCKnowChildMonthDur | Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) | Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) | For how many months have you known this pupil? | Numeric Values | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult;Pediatric | Supplemental | 1.00 | 2017-04-18 11:06:20.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
Months | ||||||||||
| C52219 | Child Behavior Checklist (CBCL) - Lying or cheating scale | CBCLLyingCheatingScl | Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) | Lying or cheating | 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 14:20:38.0 | 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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| C52245 | Child Behavior Checklist (CBCL) - Physically attacks people scale | CBCLPhysicallyAttackPeopleScl | Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) | Physically attacks 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 | 2016-12-22 16:20:27.0 | 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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| C55058 | Child Behavior Checklist (CBCL) - Sees things not there describe text | CBLCSeeThingsNotThereDescrbTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) | Sees things 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 | 2017-04-18 12:43:53.0 | 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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| C52296 | Child Behavior Checklist (CBCL) - Swear obscene language scale | CBCLSwrObsLngScl | Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) | Swearing or obscene language | 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 11:32:04.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55065 | Child Behavior Checklist (CBCL) - Feel hurt criticism scale | CBCLFeelHurtCriticismScl | Scale for the child's tendency to feel hurt by criticism, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to feel hurt by criticism, as part of the Child Behavior Checklist (CBCL) | Feels hurt when criticized | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52090 | Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale | CBCLOthrPhysicalProbScl | Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Other | 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 15:49:17.0 | 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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| C55026 | Child Behavior Checklist (CBCL) - Learn amount relative pupil typical same age code | CBLCLrnAmtRelPplTypSamAgeCode | Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | How much is he/she learning? | 4;1;2;3;5;6;7 | About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more | Numeric Values |
Compared to typical pupils of the same age |
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 11:40:11.0 | 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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| C52265 | Child Behavior Checklist (CBCL) - Restless hyperactive scale | CBCLRestlessHyperactivScl | Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) | Can't sit still, restless, or hyperactive | 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 11:09:14.0 | 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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| C17992 | Additional comment text | AddtnalCommntTxt | Text describing any additional information about the participant or the participant's family history | Text describing any additional information about the participant or the participant's family history | Please feel free to write any comments about this pupil's work, behavior, or potential. | 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. |
Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | 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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| C52309 | Child Behavior Checklist (CBCL) - Unusually loud scale | CBCLUnslLdScl | Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) | Unusually loud | 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 12:37:04.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55076 | Child Behavior Checklist (CBLC) - School grade repeat code | CBLCSchoolGradeRepeatCode | Code for the respondent's knowledge of whether the child has repeated a grade, as part of the Child Behavior Checklist (CBLC) | Code for the respondent's knowledge of whether the child has repeated a grade, as part of the Child Behavior Checklist (CBLC) | Has he/she repeadted any grades? | Don't know;0;1 | Don't know;No;Yes—grades and reasons: | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 14:58:20.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52161 | Child Behavior Checklist (CBCL) - Nausea feel sick scale | CBCLNauseaFeelSickScl | Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Nausea, feels sick | 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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| C55037 | Child Behavior Checklist (CBCL) - Enjoy very little scale | CBCLEnjoyVeryLittleScl | Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) | There is very little that he/she enjoys. | 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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| C55048 | Child Behavior Checklist (CBCL) - Overly fearful anxious scale | CBCLOverlyFearfulAnxiousScl | Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) | Too fearful or anxious | 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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| C52285 | Child Behavior Checklist (CBCL) - Speech problem scale | CBCLSpchPrblmScl | Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) | Speech problem | 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 10:32:44.0 | 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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| C52056 | Child Behavior Checklist (CBCL) - Feels worthless or inferior scale | CBCLFeelsWorthlessScl | Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) | Feels worthless or inferior | 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 11:40:35.0 | 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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| C55016 | Child Behavior Checklist (CBLC) - Familiar child degree code | CBLCFamiliarChildDegreeCode | Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) | Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) | How well do you know him/her? | 1;2;3 | Not Well;Moderately Well;Very Well | Numeric Values | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult;Pediatric | Supplemental | 1.00 | 2017-04-18 11:09:18.0 | 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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| C52222 | Child Behavior Checklist (CBCL) - Destroys their own things scale | CBCLDestroysOwnThingsScl | Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) | Destroys his/her own things | 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 14:29:41.0 | 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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| C52247 | Child Behavior Checklist (CBCL) - Impulsive or acts without thinking scale | CBCLImpulsiveActNoThinkScl | Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) | Impulsive or acts without thinking | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 16:26:49.0 | 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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| C55059 | Child Behavior Checklist (CBCL) - Produce messy work scale | CBCLProduceMessyWorkScl | Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) | Messy 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 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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| C52297 | Child Behavior Checklist (CBCL) - Talk kill self scale | CBCLTlkKillSlfScl | Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) | Talks about killing 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 11:42:22.0 | 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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| 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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| C52091 | Child Behavior Checklist (CBCL) - Prefers being with older kids scale | CBCLPreferBeWithOlderKidsScl | Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) | Prefers being with older children or youths | 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 16:00:59.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55027 | Child Behavior Checklist (CBCL) - Happiness relative pupil typical same age code | CBLCHpinesRelPplTypSamAgeCode | Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | How happy is he/she? | 4;1;2;3;5;6;7 | About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more | Numeric Values |
Compared to typical pupils of the same age |
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 11:40:11.0 | 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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| C52266 | Child Behavior Checklist (CBCL) - Demands a lot of attention scale | CBCLDemandALotOfAttentionScl | Scale for whether the child demands a lot of attention, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child demands a lot of attention, as part of the Child Behavior Checklist (CBCL) | Demands a lot of attention | 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 11:12:42.0 | 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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| C19500 | Assessment performed date | AssessmentPerformedDate | The date of assessment of the examination being performed | The date of assessment of the examination being performe | Today's Date | Date or Date & Time | Pediatric | Supplemental | 1.00 | 2014-06-18 08:10:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
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| C52310 | Child Behavior Checklist (CBCL) - Use drug nonmedical purpose scale | CBCLUsDrgNonMdPrpScl | Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) | Uses alcohol or drugs for nonmedical purposes (don't include tobacco) | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 12:40:00.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52175 | Child Behavior Checklist (CBCL) - Bites fingernails scale | CBCLBitesFingernailsScl | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Bites fingernails | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 13:11:36.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55038 | Child Behavior Checklist (CBCL) - Defy talk back scale | CBCLDefyTalkBackScl | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Defiant, talks back to staff | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:04:30.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55049 | Child Behavior Checklist (CBCL) - Problems with eyes describe text | CBCLProblemWithEyesDescribeTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | Eye problems (not if corrected by glasses) (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:27:18.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52286 | Child Behavior Checklist (CBCL) - Stares blankly scale | CBCLStrBlnkScl | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Stares blankly | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 10:35:32.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52059 | Child Behavior Checklist (CBCL) - Daydreams or gets lost in their thoughts scale | CBCLDaydreamLostInThoughtScl | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Daydreams or gets lost in his/her thoughts | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 11:44:21.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55017 | Child Behavior Checklist (CBLC) - Child time in class service week duration | CBLCChildTimeInClassSvcWkDur | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | How much time does he/she spend in your class or service per week? | Numeric Values |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult;Pediatric | Supplemental | 1.00 | 2017-04-18 11:11:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
0.1 | 30 | Hours per week | |||||||
| C52229 | Child Behavior Checklist (CBCL) - Bragging boasting scale | CBCLBragBoastScl | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Bragging, boasting | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 14:35:01.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
