CDE Detailed Report

Disease: content
Subdomain Name: Psychiatric and Psychological Status
CRF: welcome

Displaying 151 - 174 of 174
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C52038 Child Behavior Checklist (CBCL) - Overweight scale CBCLOverweightScl Scale for whether the child is overweight, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is overweight, as part of the Child Behavior Checklist (CBCL) Overweight 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 16:57:47.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55014 Child Behavior Checklist (CBLC) - Respondent school role other text CBLCRespondentSchoolRoleOTH The free-text field related to 'Child Behavior Checklist (CBLC) - Respondent school role type' specifying other text, as part of the Child Behavior Checklist (CBLC) The free-text field related to 'Child Behavior Checklist (CBLC) - Respondent school role type' specifying other text, as part of the Child Behavior Checklist (CBLC) Your role at the school: 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 255

Free-Form Entry

C52244 Child Behavior Checklist (CBCL) - Breaks rules at home, school, or elsewhere scale CBCLBreaksRulesScl Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) Scale for whether the child breaks rules at home, school, or elsewhere, as part of the Child Behavior Checklist (CBCL) Breaks school rules 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 16:16:24.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55057 Child Behavior Checklist (CBCL) - Disrupt class discipline scale CBCLDisruptClassDisciplineScl Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to disrupt class discipline, as part of the Child Behavior Checklist (CBCL) Disrupts class discipline 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52295 Child Behavior Checklist (CBCL) - Suspicious scale CBCLSuspcsScl Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is suspicious, as part of the Child Behavior Checklist (CBCL) Suspicious 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 11:27:52.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55068 Child Behavior Checklist (CBCL) - Strange ideas describe text CBCLStrangeIdeaDescribeText The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Strange ideas scale' for describing the child's strange ideas, as part of the Child Behavior Checklist (CBCL) Strange ideas (describe) Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 13:01:53.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52089 Child Behavior Checklist (CBCL) - Feels they have to be perfect scale CBCLFeelThyHaveBePrfctScl Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels they have to be perfect, as part of the Child Behavior Checklist (CBCL) Feels he/she has to be perfect 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 14:37:57.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55025 Child Behavior Checklist (CBCL) - Behave appropriate relative pupil typical same age code CBLCBhvAptRelPplTypSamAgeCode Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) Code for the appropriateness of the child's behavior relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) How appropriately is he/she behaving? 4;1;2;3;5;6;7 About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more Numeric Values

Compared to typical pupils of the same age

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55036 Child Behavior Checklist (CBCL) - Odd noise in class scale CBCLOddNoiseInClassScl Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) Scale of the child's tendency to make odd noises in class, as part of the Child Behavior Checklist (CBCL) Hums or makes other odd noises in class. 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52262 Child Behavior Checklist (CBCL) - Doesn?t seem to feel guilty after misbehaving scale CBCLNoGuiltyAfterMisbehavScl Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) Scale for whether the child doesnt seem to feel guilty after misbehaving, as part of the Child Behavior Checklist (CBCL) Doesn't seem to feel guilty after misbehaving 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-23 10:57:25.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C17733 Person completing form name PrsnCompletingFormName Name of person completing the form Name of person completing the form This form filled out by: Alphanumeric Adult Supplemental 3.00 2013-08-30 17:06:52.8 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52308 Child Behavior Checklist (CBCL) - Unhappy sad depressed scale CBCLUnhppySdDepScl Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) Scale for whether the child isunhappy, sad or depressed, as part of the Child Behavior Checklist (CBCL) Unhappy, sad, or depressed 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 12:32:31.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52154 Child Behavior Checklist (CBCL) - Feels dizzy or lightheaded scale CBCLFeelDizzyLightheadedScl Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) Scale for whether the child feels dizzy or lightheaded, as part of the Child Behavior Checklist (CBCL) Feels dizzy or lightheaded 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 12:46:56.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52219 Child Behavior Checklist (CBCL) - Lying or cheating scale CBCLLyingCheatingScl Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) Scale for whether the child lies or cheats, as part of the Child Behavior Checklist (CBCL) Lying or cheating 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 14:20:38.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55047 Child Behavior Checklist (CBCL) - Difficulty learn scale CBCLDifficultyLearnScl Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to have difficulty learning, as part of the Child Behavior Checklist (CBCL) Has difficulty learning 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52282 Child Behavior Checklist (CBCL) - Too shy timid scale CBCLTooShyTmdScl Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is too shy or timid, as part of the Child Behavior Checklist (CBCL) Too shy or timid 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 10:06:29.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52039 Child Behavior Checklist (CBCL) - Hangs around with others who get in trouble scale CBCLHangWthOthrsGetInTroublScl Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) Scale for whether the child hangs around with others who get in trouble, as part of the Child Behavior Checklist (CBCL) Hangs around with others who get in trouble 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-20 17:02:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55015 Child Behavior Checklist (CBLC) - Know child month duration CBLCKnowChildMonthDur Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) Duration in months for which the respondent has known the child, as part of the Child Behavior Checklist (CBLC) For how many months have you known this pupil? Numeric Values Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Adult;Pediatric Supplemental 1.00 2017-04-18 11:06:20.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Free-Form Entry

Months
C55026 Child Behavior Checklist (CBCL) - Learn amount relative pupil typical same age code CBLCLrnAmtRelPplTypSamAgeCode Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) Code for the amount that the child is learning relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) How much is he/she learning? 4;1;2;3;5;6;7 About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more Numeric Values

Compared to typical pupils of the same age

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C52245 Child Behavior Checklist (CBCL) - Physically attacks people scale CBCLPhysicallyAttackPeopleScl Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) Scale for whether the child physically attacks people, as part of the Child Behavior Checklist (CBCL) Physically attacks people 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-22 16:20:27.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55058 Child Behavior Checklist (CBCL) - Sees things not there describe text CBLCSeeThingsNotThereDescrbTxt The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Sees things not there scale' for describing the child's tendency to see things that are not there, as part of the Child Behavior Checklist (CBCL) Sees things that aren't there (describe) Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 12:43:53.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

C52296 Child Behavior Checklist (CBCL) - Swear obscene language scale CBCLSwrObsLngScl Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) Scale for whether the child swears or uses obscene language, as part of the Child Behavior Checklist (CBCL) Swearing or obscene language 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-27 11:32:04.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55069 Child Behavior Checklist (CBCL) - Underachievement scale CBCLUnderachievementScl Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Underachieving, not workinig up to potential 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

C52090 Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale CBCLOthrPhysicalProbScl Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Other 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil.

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2016-12-21 15:49:17.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

CSV