CDE Detailed Report
Subdomain Name: Psychiatric and Psychological Status
CRF: Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C52202 | Child Behavior Checklist (CBCL) - Hears sound voice not there scale | CBCLHearSountVoiceNotThereScl | Scale for whether the child hears sound or voices that arenÃâ?Ââ?Ââ½t there, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child hears sound or voices that arent there, as part of the Child Behavior Checklist (CBCL) | Hears sounds or voices that aren't there | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 13:56:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55043 | Child Behavior Checklist (CBCL) - Disturb other pupil scale | CBCLDisturbOtherPupilScl | Scale of the child's tendency to disturb other pupils, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to disturb other pupils, as part of the Child Behavior Checklist (CBCL) | Disturbs other pupils | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:04:30.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52276 | Child Behavior Checklist (CBCL) - Secretive keep thing self scale | CBCLScrtvKpThSlfScl | Scale for whether the child is secretive, keeps things to self, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is secretive, keeps things to self, as part of the Child Behavior Checklist (CBCL) | Secretive, keeps things to self | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 09:06:24.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52033 | Child Behavior Checklist (CBCL) - Feels too guilty scale | CBCLFeelTooGuiltyScl | Scale for whether the child feels too guilty, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels too guilty, as part of the Child Behavior Checklist (CBCL) | Feels too guily | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-20 15:35:51.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55011 | Child Behavior Checklist (CBLC) - Occupation parent 2 type | CBLCOccupationParent2Typ | Type of occupation of parent 2, as part of the Child Behavior Checklist (CBLC) | Type of occupation of parent 2, as part of the Child Behavior Checklist (CBLC) | Parent 2 (or Mother) Type of Work | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult | Supplemental | 1.00 | 2017-04-18 10:55:06.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55022 | Child Behavior Checklist (CBCL) - Academic performance subject type | CBLCAcdmcPrfrmncSbjctTyp | Type of academic subject for which the respondent is rating the child's performance, as part of the Child Behavior Checklist (CBCL) | Type of academic subject for which the respondent is rating the child's performance, as part of the Child Behavior Checklist (CBCL) | Academic subject | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:29:14.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 50 |
Free-Form Entry |
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| C52240 | Child Behavior Checklist (CBCL) - Gets in many fights scale | CBCLGetsInManyFightsScl | Scale for whether the child gets in many fights, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets in many fights, as part of the Child Behavior Checklist (CBCL) | Gets in many fights | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 15:50:04.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55054 | Child Behavior Checklist (CBCL) - Pick nose skin other parts body describe text | CBCLPckNosSknOthPtsBodyDscrTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale' for describing the child's tendency to pick at his or her nose, skin, or other body parts, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale' for describing the child's tendency to pick at his or her nose, skin, or other body parts, as part of the Child Behavior Checklist (CBCL) | Picks nose, skin, or other parts of body (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:37:05.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52292 | Child Behavior Checklist (CBCL) - Stubborn sullen irritable scale | CBCLStbbrnSllnIrrScl | Scale for whether the child is stubborn, sullen or irritable, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is stubborn, sullen or irritable, as part of the Child Behavior Checklist (CBCL) | Stubborn, sullen, or irritable | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 10:53:29.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52079 | Child Behavior Checklist (CBCL) - Pick nose skin other parts body scale | CBCLPickNoseSkinBodyScl | Scale for whether the child picks their nose, skin, or other parts of body, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child picks their nose, skin, or other parts of body, as part of the Child Behavior Checklist (CBCL) | Picks nose, skin, or other parts of body | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 12:10:58.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52104 | Child Behavior Checklist (CBCL) - Cant get their mind off certain thoughts, obsessions description text | CBCLObsessionsTxt | description text of the thoughts, obsessions, that the child can't get off their mind, as part of the Child Behavior Checklist (CBCL) | description text of the thoughts, obsessions, that the child can't get off their mind, as part of the Child Behavior Checklist (CBCL) | Can't get his/her mind off certain thoughts, obsessions (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 10:57:13.0 | 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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| C55033 | Child Behavior Checklist (CBCL) - Aptitude test date | CBCLAptitudeTestDate | The field related to 'Child Behavior Checklist (CBCL) - Aptitude test name' for specifying the date on which the named aptitude test was taken, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Aptitude test name' for specifying the date on which the named aptitude test was taken, as part of the Child Behavior Checklist (CBCL) | Date | Date or Date & Time |
IQ, readiness, or aptitude tests (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
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| C52256 | Child Behavior Checklist (CBCL) - Repeats certain acts over and over, compulsions scale | CBCLRepeatActsCompulsionsScl | Scale for whether the child repeats certain acts over and over, compulsions, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child repeats certain acts over and over, compulsions, as part of the Child Behavior Checklist (CBCL) | Repeats certain acts over and over, compulsions | 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 17:19:39.0 | 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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| C00012 | Education level USA type | EduLvlUSATyp | Highest grade or level of school participant/subject has completed or the highest degree received | Highest grade or level of school participant/subject has completed or the highest degree received | Grade in School | 1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade, no diploma;Some college, no degree;High school graduate;Associate degree: academic program;Associate degree: occupational/technical/vocational program;Bachelor's degree (e.g., BA, AB, BS, BBA) | 1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade, no diploma;Some college, no degree;High school graduate;Associate degree: academic program;Associate degree: occupational/technical/vocational program;Bachelor's degree (e.g., BA, AB, BS, BBA) | Alphanumeric | 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 |
Single Pre-Defined Value Selected |
3134878 | |||||||||
| C55074 | Child Behavior Checklist (CBCL) - Fear make mistake scale | CBCLFearMakeMistakeScl | Scale for the child's tendency to fear to make mistakes, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to fear to make mistakes, as part of the Child Behavior Checklist (CBCL) | Is afraid of making mistakes | 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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| C52305 | Child Behavior Checklist (CBCL) - Smoke chew sniff tobacco scale | CBCLSmkeChwSnffTobScl | Scale for whether the childsmokes, chews, or sniffs tobacco, as part of the Child Behavior Checklist (CBCL) | Scale for whether the childsmokes, chews, or sniffs tobacco, as part of the Child Behavior Checklist (CBCL) | Smokes, chews, or sniffs 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 12:21:01.0 | 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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| C55012 | Child Behavior Checklist (CBLC) - Respondent gender category | CBLCRespondentGenderCategory | Category for the respondent's gender, as part of the Child Behavior Checklist (CBLC) | Category for the respondent's gender, as part of the Child Behavior Checklist (CBLC) | Your gender: | Female;Male | Female;Male | 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 10:58:02.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52206 | Child Behavior Checklist (CBCL) - Fears going to school scale | CBCLFearsGoSchoolScl | Scale for whether the child fears going to school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fears going to school, as part of the Child Behavior Checklist (CBCL) | Fears going to school | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 14:03:30.0 | 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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| C55044 | Child Behavior Checklist (CBCL) - Fear certain animal situation place other than school describe text | CBLCFrCtnAlSnPcOthThnSchDscTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Fear certain animal situation place other than school scale' for describing the child's fears, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Fear certain animal situation place other than school scale' for describing the child's fears, as part of the Child Behavior Checklist (CBCL) | Fears certain animals, situations, or places other than school (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 12:19:48.0 | 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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| C52277 | Child Behavior Checklist (CBCL) - Sees things not there scale | CBCLSeeThgNotThrScl | Scale for whether the child sees things that aren't there, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child sees things that aren't there, as part of the Child Behavior Checklist (CBCL) | Sees things that aren't there | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 09:10:20.0 | 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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| C52035 | Child Behavior Checklist (CBCL) - Nervous, high-strung, or tense scale | CBCLNervousHighstrungTenseScl | Scale for whether the child is nervous, high-strung, or tense, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is nervous, high-strung, or tense, as part of the Child Behavior Checklist (CBCL) | Nervous, high-strung, or tense scale | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-20 15:53:57.0 | 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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| C55023 | Child Behavior Checklist (CBCL) - Academic performance subject code | CBLCAcdmcPrfrmncSbjctCode | Code for the academic performance of the child in the subject captured in 'Child Behavior Checklist (CBCL) - Academic performance subject type', as part of the Child Behavior Checklist (CBCL) | Code for the academic performance of the child in the subject captured in 'Child Behavior Checklist (CBCL) - Academic performance subject type', as part of the Child Behavior Checklist (CBCL) | Current academic performance | 1;3;4;5;2 | Far below grade;At grade level;Somewhat above grade;Far above grade;Somewhat below grade | 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 | Pediatric | Supplemental | 1.00 | 2017-04-18 11:31:38.0 | 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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| C52242 | Child Behavior Checklist (CBCL) - Gets teased a lot scale | CBCLGetsTeasedALotScl | Scale for whether the child gets teased a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child gets teased a lot, as part of the Child Behavior Checklist (CBCL) | Gets teased 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 | 2016-12-22 15:56:36.0 | 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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| C55055 | Child Behavior Checklist (CBCL) - Sleep class scale | CBCLSleepClassScl | Scale for the child's tendency to sleep in class, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to sleep in class, as part of the Child Behavior Checklist (CBCL) | Sleeps 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 | 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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| 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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| C52293 | Child Behavior Checklist (CBCL) - Sudden changes mood feelings scale | CBCLSuddnChngMdFlngScl | Scale for whether the child has sudden changes in mood or feelings, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has sudden changes in mood or feelings, as part of the Child Behavior Checklist (CBCL) | Sudden changes in mood or feelings | 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 11:01:01.0 | 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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| C52085 | Child Behavior Checklist (CBCL) - Fails to finish things they start scale | CBCLFailFinishThingStartScl | Scale for whether the child fails to finish things they start, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fails to finish things they start, as part of the Child Behavior Checklist (CBCL) | Fails to finish things he/she starts. | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 12:39:02.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52106 | Child Behavior Checklist (CBCL) - Inattentive or easily distracted scale | CBCLInattentiveScl | Scale for whether the child is inattentive or easily distracted, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is inattentive or easily distracted, as part of the Child Behavior Checklist (CBCL) | Inattentive or easily distracted | 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 11:04:25.0 | 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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| C55034 | Child Behavior Checklist (CBCL) - Aptitude test score | CBCLAptitudeTestScore | The field related to 'Child Behavior Checklist (CBCL) - Aptitude test name' for specifying the child's score on the named aptitude test, as part of the Child Behavior Checklist (CBCL) | The field related to 'Child Behavior Checklist (CBCL) - Aptitude test name' for specifying the child's score on the named aptitude test, as part of the Child Behavior Checklist (CBCL) | IQ or equivalent scores | Numeric Values |
IQ, readiness, or aptitude tests (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
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| C52258 | Child Behavior Checklist (CBCL) - Not liked by other kids scale | CBCLNotLikedByOthrKidsScl | Scale for whether the child is not liked by other kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is not liked by other kids, as part of the Child Behavior Checklist (CBCL) | Not liked by 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 | 2016-12-23 10:39:18.0 | 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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| C00020 | Ethnicity USA category | EthnUSACat | Category of ethnicity the participant/subject most closely identifies with | Category of ethnicity the participant/subject most closely identifies with | Pupil's Ethnic Group or Race | Hispanic or Latino;Not Hispanic or Latino;Unknown;Not reported;Other, specify | A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term "Spanish origin" can also be used in addition to "Hispanic or Latino.";A person not meeting the definition for Hispanic or Latino.;Could not be determined or unsure;Not reported;Other, specify | Alphanumeric | Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
2192217 | |||||||||
| 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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| C52306 | Child Behavior Checklist (CBCL) - Truancy skips school scale | CBCLTrncySkpSchlScl | Scale for whether the child displays truancy, or skips school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child displays truancy, or skips school, as part of the Child Behavior Checklist (CBCL) | Truancy or unexplained absence | 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 12:25:56.0 | 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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| C55013 | Child Behavior Checklist (CBLC) - Respondent school role type | CBLCRespondentSchoolRoleTyp | Type of role performed by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | Type of role performed by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | Your role at the school: | Counselor;Administrator;Classroom Teacher;Teacher's Aide;Special Educator;Other, specify | Counselor;Administrator;Classroom Teacher;Teacher's Aide;Special Educator;Other, specify | 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 11:00:27.0 | 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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| C52209 | Child Behavior Checklist (CBCL) - Aches or pains scale | CBCLAchesPainsScl | Scale for whether the child has aches or pains (not stomach or headaches) without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has aches or pains (not stomach or headaches) without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Aches or pains (not stomach or headaches) | 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 14:07:23.0 | 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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| C55045 | Child Behavior Checklist (CBCL) - Prefer be alone scale | CBCLPreferBeAloneScl | Scale for the child's tendency to prefer being alone, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to prefer being alone, as part of the Child Behavior Checklist (CBCL) | Would rather be alone than 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 | 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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| C52278 | Child Behavior Checklist (CBCL) - Self conscious easily embarrassed scale | CBCLSlfCnsEslyEmbScl | Scale for whether the child is self-conscious or easily embarrassed, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is self-conscious or easily embarrassed, as part of the Child Behavior Checklist (CBCL) | Self-conscious or easily embarrassed | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 09:21:17.0 | 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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| C52037 | Child Behavior Checklist (CBCL) - Headaches scale | CBCLHeadachesScl | Scale for whether the child Physical problems without known medical cause: Headaches, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child Physical problems without known medical cause: Headaches, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Headaches | 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 16:32:50.0 | 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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| C55024 | Child Behavior Checklist (CBCL) - Work hard relative pupil typical same age code | CBLCWrkHrdRelPplTypSamAgeCode | Code for how hard the child works relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | Code for how hard the child works relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | How hard is he/she working? | 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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| C52243 | Child Behavior Checklist (CBCL) - Repeats certain acts over and over, compulsions description text | CBCLRepeatActsCompulsionsTxt | description text of the compulsions or the acts that the child repeats over and over, as part of the Child Behavior Checklist (CBCL) | description text of the compulsions or the acts that the child repeats over and over, as part of the Child Behavior Checklist (CBCL) | Repeats certain acts over and over, compulsions (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 16:02:43.0 | 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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| C55056 | Child Behavior Checklist (CBCL) - Apathy unmotivate scale | CBCLApathyUnmotivateScl | Scale for the child's tendency to exhibit apathy or lack of motivation, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to exhibit apathy or lack of motivation, as part of the Child Behavior Checklist (CBCL) | Apathetic or unmotivated | 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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| 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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| C52294 | Child Behavior Checklist (CBCL) - Sulks a lot scale | CBCLSulkALotScl | Scale for whether the child sulks a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child sulks a lot, as part of the Child Behavior Checklist (CBCL) | Sulks 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 11:24:34.0 | 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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| C52088 | Child Behavior Checklist (CBCL) - Easily jealous scale | CBCLEasilyJealousScl | Scale for whether the child easily gets jealous, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child easily gets jealous, as part of the Child Behavior Checklist (CBCL) | Easily jealous | 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 13:52:14.0 | 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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| C52149 | Child Behavior Checklist (CBCL) - Problems with eyes scale | CBCLProbWithEyesScl | Scale for whether the child has problems with eyes (not if corrected by glasses) without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has problems with eyes (not if corrected by glasses) without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Eye problems (not if corrected by glasses) | 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 12:23:22.0 | 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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| C55035 | Child Behavior Checklist (CBCL) - Illness or disability describe text | CBCLIllnessDisabilityDescrbTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Illness or disability indicator' for describing the illness or disability, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Illness or disability indicator' for describing the illness or disability, as part of the Child Behavior Checklist (CBCL) | Yes-please 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 12:00:22.0 | 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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| C52261 | Child Behavior Checklist (CBCL) - Feels others are out to get them scale | CBCLFeelOthrsOutToGetThemScl | Scale for whether the child feels others are out to get them, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels others are out to get them, as part of the Child Behavior Checklist (CBCL) | Feels others are out to get him/her | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-23 10:52:32.0 | 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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| C00035 | Gender type | GenderTyp | Self-reported gender of the participant/subject | Self-reported gender of the participant/subjec | Pupil's Gender | Alphanumeric | Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
2200604 | |||||||||||
| 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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| C52307 | Child Behavior Checklist (CBCL) - Underactive slow moving lack energy scale | CBCLUndrctvSlwMvLckEngScl | Scale for whether the child is underactive, slow moving, or lacks energy, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is underactive, slow moving, or lacks energy, as part of the Child Behavior Checklist (CBCL) | Underactive, slow moving, or lacks energy | 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 12:29:18.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
