CDE Detailed Report
Subdomain Name: Psychiatric and Psychological Status
CRF: welcome
Displaying 101 - 150 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C55063 | Child Behavior Checklist (CBCL) - Easily frustrated scale | CBCLEasilyFrustratedScl | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be frustrated easily, as part of the Child Behavior Checklist (CBCL) | Demands must be met immediately, easily frustrated | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant/subject was born | Date (and time, if applicable and known) the participant/subject was born | Pupil's Birthdate (if known) | Date or Date & Time | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
793 | |||||||||||
| C55072 | Child Behavior Checklist (CBCL) - Overanxious to please scale | CBCLOveranxiousToPleaseScl | Scale for the child's tendency to be overly anxious/eager to please, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be overly anxious/eager to please, as part of the Child Behavior Checklist (CBCL) | Overly anxious to please | 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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| C55010 | Child Behavior Checklist (CBLC) - Occupation parent 1 type | CBLCOccupationParent1Typ | Type of occupation of parent 1, as part of the Child Behavior Checklist (CBLC) | Type of occupation of parent 1, as part of the Child Behavior Checklist (CBLC) | Parent 1 (or Father) Type of Work | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult | Supplemental | 1.00 | 2017-04-18 10:55:06.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52198 | Child Behavior Checklist (CBCL) - Deliberately harms self or attempts suicide scale | CBCLHarmSelfAttemptSuicideScl | Scale for whether the child deliberately harms themselves or attempts suicide, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child deliberately harms themselves or attempts suicide, as part of the Child Behavior Checklist (CBCL) | Deliberately harms self or attempts suicide | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 13:54:03.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55042 | Child Behavior Checklist (CBCL) - Difficulty follow direction scale | CBCLDffcltyFollwDirectnScl | Scale of the child's tendency to have difficulty following directions, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to have difficulty following directions, as part of the Child Behavior Checklist (CBCL) | Difficulty following directions | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:04:30.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52275 | Child Behavior Checklist (CBCL) - Scream a lot scale | CBCLScrmAltScl | Scale for whether the child screams a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child screams a lot, as part of the Child Behavior Checklist (CBCL) | Screams a lot | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-23 14:18:59.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52032 | Child Behavior Checklist (CBCL) - Acts too young for their age scale | CBCLActTooYoungScl | Child Behavior Checklist (CBCL) - Acts too young for their age scale | Scale for whether the child can't stand waiting, wants everything now, as part of the Child Behavior Checklist (CBCL) | Acts too young for his/her age | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-20 15:31:16.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52075 | Child Behavior Checklist (CBCL) - Drinks alcohol without parents approval description text | CBCLDrinkAlcNoParentApprovTxt | description text of the child drinking alcohol without parents' approval, as part of the Child Behavior Checklist (CBCL) | description text of the child drinking alcohol without parents' approval, as part of the Child Behavior Checklist (CBCL) | Uses alcohol or drugs for nonmedical purposes (don't include tobacco) (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 12:07:18.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55021 | Child Behavior Checklist (CBCL) - School grade repeat describe text | CBCLSchoolGradRptDscrbTxt | The free-text field related to 'School repeat grade indicator' for describing the grade repeated by the child and the reasons for doing so, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'School repeat grade indicator' for describing the grade repeated by the child and the reasons for doing so, as part of the Child Behavior Checklist (CBCL) | Yes-grades and reasons: | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:23:22.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52239 | Child Behavior Checklist (CBCL) - Cant concentrate, cant pay attention for long scale | CBCLNoConcentratPayAttentnScl | Scale for whether the child cant concentrate, cant pay attention for long, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child cant concentrate, cant pay attention for long, as part of the Child Behavior Checklist (CBCL) | Can't concentrate, can't pay attention for long | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 15:04:02.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55053 | Child Behavior Checklist (CBCL) - Other physical problems without known medical cause describe text | CBCLOthPhyPbmWoKnwMdlCsDscrTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale' for describing the other physical problems, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale' for describing the other physical problems, as part of the Child Behavior Checklist (CBCL) | Other (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 12:34:25.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52291 | Child Behavior Checklist (CBCL) - Strange ideas scale | CBCLStrngIdeaScl | Scale for whether the child has strange ideas, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has strange ideas, as part of the Child Behavior Checklist (CBCL) | Strange ideas | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 10:49:39.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52303 | Child Behavior Checklist (CBCL) - Threaten people scale | CBCLThrtnPplScl | Scale for whether the child threatens people, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child threatens people, as part of the Child Behavior Checklist (CBCL) | Threatens people | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-27 12:11:58.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52096 | Child Behavior Checklist (CBCL) - Rashes or other skin problems scale | CBCLRashSkinProbScl | Scale for whether the child has rashes or other skin problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has rashes or other skin problems without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Raches or other skin problems | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-21 16:31:13.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55032 | Child Behavior Checklist (CBCL) - Aptitude test name | CBCLAptitudeTestName | Name of the aptitude test taken by the child, as part of the Child Behavior Checklist (CBCL) | Name of the aptitude test taken by the child, as part of the Child Behavior Checklist (CBCL) | Name of test | Alphanumeric |
IQ, readiness, or aptitude tests (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2017-04-18 11:49:33.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52255 | Child Behavior Checklist (CBCL) - Complains of loneliness scale | CBCLComplainOfLonelinessScl | Scale for whether the child complains of loneliness, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child complains of loneliness, as part of the Child Behavior Checklist (CBCL) | Complains of loneliness | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 17:16:55.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C00008 | Age value | AgeVal | Value for participant's age, calculated as elapsed time since the birth of the participant | Value for participant's age, calculated as elapsed time since the birth of the participant | Pupil's Age | Numeric Values |
Record in months |
Pediatric | Supplemental | 3.10 | 2024-02-29 15:47:28.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Free-Form Entry |
0 | 1800 | month | ||||||||
| C55073 | Child Behavior Checklist (CBCL) - Dislike school scale | CBCLDislikeSchoolScl | Scale for the child's tendency to dislike school, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to dislike school, as part of the Child Behavior Checklist (CBCL) | Dislikes school | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Supplemental | 1.00 | 2016-12-22 12:57:12.0 | Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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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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| 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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| 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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| 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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| 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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| 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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| 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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| 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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| 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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| 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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| 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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| 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 |
