CDE Detailed Report
Sub-Domain: Behavioral Function
CRF: Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18
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 / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C17992 | Additional comment text | AddtnalCommntTxt | Text describing any additional information about the participant or the participant's family history | Text describing any additional information about the participant or the participant's family history | Please feel free to write any comments about this pupil's work, behavior, or potential. | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 3.00 | 2013-07-16 14:01:43.01 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
| C52309 | Child Behavior Checklist (CBCL) - Unusually loud scale | CBCLUnslLdScl | Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is unsually loud, as part of the Child Behavior Checklist (CBCL) | Unusually loud | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 12:37:04.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52161 | Child Behavior Checklist (CBCL) - Nausea feel sick scale | CBCLNauseaFeelSickScl | Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has nausea, feels sick, without known medical cause, as part of the Child Behavior Checklist (CBCL) | Physical problems without known medical cause: Nausea, feels sick | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55037 | Child Behavior Checklist (CBCL) - Enjoy very little scale | CBCLEnjoyVeryLittleScl | Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to enjoy very little, as part of the Child Behavior Checklist (CBCL) | There is very little that he/she enjoys. | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:04:30.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52265 | Child Behavior Checklist (CBCL) - Restless hyperactive scale | CBCLRestlessHyperactivScl | Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child cant sit still, restless, or hyperactive, as part of the Child Behavior Checklist (CBCL) | Can't sit still, restless, or hyperactive | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-23 11:09:14.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52285 | Child Behavior Checklist (CBCL) - Speech problem scale | CBCLSpchPrblmScl | Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child has a speech problem, as part of the Child Behavior Checklist (CBCL) | Speech problem | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 10:32:44.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52056 | Child Behavior Checklist (CBCL) - Feels worthless or inferior scale | CBCLFeelsWorthlessScl | Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels worthless or inferior, as part of the Child Behavior Checklist (CBCL) | Feels worthless or inferior | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 11:40:35.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55016 | Child Behavior Checklist (CBLC) - Familiar child degree code | CBLCFamiliarChildDegreeCode | Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) | Code for the degree of familiarity of the respondent to the child, as part of the Child Behavior Checklist (CBLC) | How well do you know him/her? | 1;2;3 | Not Well;Moderately Well;Very Well | Numeric Values | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult;Pediatric | Exploratory | 1.00 | 2017-04-18 11:09:18.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
| C52222 | Child Behavior Checklist (CBCL) - Destroys their own things scale | CBCLDestroysOwnThingsScl | Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child destroys their own things, as part of the Child Behavior Checklist (CBCL) | Destroys his/her own things | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 14:29:41.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55048 | Child Behavior Checklist (CBCL) - Overly fearful anxious scale | CBCLOverlyFearfulAnxiousScl | Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be overly fearful or anxious, as part of the Child Behavior Checklist (CBCL) | Too fearful or anxious | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:04:30.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | 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 | Exploratory | 1.00 | 2017-04-18 13:01:53.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| C52297 | Child Behavior Checklist (CBCL) - Talk kill self scale | CBCLTlkKillSlfScl | Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child talks about killing self, as part of the Child Behavior Checklist (CBCL) | Talks about killing self | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 11:42:22.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52091 | Child Behavior Checklist (CBCL) - Prefers being with older kids scale | CBCLPreferBeWithOlderKidsScl | Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child prefers being with older kids, as part of the Child Behavior Checklist (CBCL) | Prefers being with older children or youths | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 16:00:59.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55027 | Child Behavior Checklist (CBCL) - Happiness relative pupil typical same age code | CBLCHpinesRelPplTypSamAgeCode | Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | Code for the child's happiness relative to typical pupils of the same age, as part of the Child Behavior Checklist (CBCL) | How happy is he/she? | 4;1;2;3;5;6;7 | About average;Much less;Somewhat less;Slightly less;Slightly more;Somewhat more;Much more | Numeric Values |
Compared to typical pupils of the same age |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 11:40:11.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52247 | Child Behavior Checklist (CBCL) - Impulsive or acts without thinking scale | CBCLImpulsiveActNoThinkScl | Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is impulsive or acts without thinking, as part of the Child Behavior Checklist (CBCL) | Impulsive or acts without thinking | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 16:26:49.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55059 | Child Behavior Checklist (CBCL) - Produce messy work scale | CBCLProduceMessyWorkScl | Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to produce messy work, as part of the Child Behavior Checklist (CBCL) | Messy work | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C19500 | Assessment performed date | AssessmentPerformedDate | The date of assessment of the examination being performed | The date of assessment of the examination being performe | Today's Date | Date or Date & Time | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2014-06-18 08:10:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C52310 | Child Behavior Checklist (CBCL) - Use drug nonmedical purpose scale | CBCLUsDrgNonMdPrpScl | Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child uses drugs for nonmedical purposes, as part of the Child Behavior Checklist (CBCL) | Uses alcohol or drugs for nonmedical purposes (don't include tobacco) | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 12:40:00.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52175 | Child Behavior Checklist (CBCL) - Bites fingernails scale | CBCLBitesFingernailsScl | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child bites their fingernails, as part of the Child Behavior Checklist (CBCL) | Bites fingernails | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 13:11:36.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55038 | Child Behavior Checklist (CBCL) - Defy talk back scale | CBCLDefyTalkBackScl | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to talk back or be defiant, as part of the Child Behavior Checklist (CBCL) | Defiant, talks back to staff | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:04:30.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52266 | Child Behavior Checklist (CBCL) - Demands a lot of attention scale | CBCLDemandALotOfAttentionScl | Scale for whether the child demands a lot of attention, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child demands a lot of attention, as part of the Child Behavior Checklist (CBCL) | Demands a lot of attention | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-23 11:12:42.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52286 | Child Behavior Checklist (CBCL) - Stares blankly scale | CBCLStrBlnkScl | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child stares blankly, as part of the Child Behavior Checklist (CBCL) | Stares blankly | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 10:35:32.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52059 | Child Behavior Checklist (CBCL) - Daydreams or gets lost in their thoughts scale | CBCLDaydreamLostInThoughtScl | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child daydreams or gets lost in their thoughts, as part of the Child Behavior Checklist (CBCL) | Daydreams or gets lost in his/her thoughts | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 11:44:21.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55017 | Child Behavior Checklist (CBLC) - Child time in class service week duration | CBLCChildTimeInClassSvcWkDur | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | Duration in hours per week that the child spends in the respondent's class or service, as part of the Child Behavior Checklist (CBLC) | How much time does he/she spend in your class or service per week? | Numeric Values |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Adult;Pediatric | Exploratory | 1.00 | 2017-04-18 11:11:33.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Free-Form Entry |
0.1 | 30 | Hours per week | |||||||
| C52229 | Child Behavior Checklist (CBCL) - Bragging boasting scale | CBCLBragBoastScl | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child brags, boasts, as part of the Child Behavior Checklist (CBCL) | Bragging, boasting | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 14:35:01.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55049 | Child Behavior Checklist (CBCL) - Problems with eyes describe text | CBCLProblemWithEyesDescribeTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Problems with eyes scale' for describing the child's eye problems that are not corrected by glasses, as part of the Child Behavior Checklist (CBCL) | Eye problems (not if corrected by glasses) (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:27:18.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| 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 | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52299 | Child Behavior Checklist (CBCL) - Talks too much scale | CBCLTlkTooMchScl | Scale for whether the child talks too much, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child talks too much, as part of the Child Behavior Checklist (CBCL) | Talks too much | 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 | Exploratory | 1.00 | 2016-12-27 11:51:50.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52092 | Child Behavior Checklist (CBCL) - Confused or seems to be in a fog scale | CBCLConfusedInAFogScl | Scale for whether the child is confused or seems to be in a fog, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is confused or seems to be in a fog, as part of the Child Behavior Checklist (CBCL) | Confused or seems to be in a fog | 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.s |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 16:06:05.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55028 | Child Behavior Checklist (CBCL) - Achievement test most recent name | CBCLAchvmntTestMstRcntName | Name of the most recent achievement test in a subject, as part of the Child Behavior Checklist (CBCL) | Name of the most recent achievement test in a subject, as part of the Child Behavior Checklist (CBCL) | Name of test | Alphanumeric |
Most recent achievement test scores (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 11:49:33.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
| C52250 | Child Behavior Checklist (CBCL) - Feels or complains that no one loves them scale | CBCLComplainNoOneLoveThemScl | Scale for whether the child feels or complains that no one loves them, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child feels or complains that no one loves them, as part of the Child Behavior Checklist (CBCL) | Feels or complains that no one loves 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 | Exploratory | 1.00 | 2016-12-22 16:57:52.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55060 | Child Behavior Checklist (CBCL) - Behave irresponsible scale | CBCLBehavIrresponsibleScl | Scale for the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Behaves irresponsibly | 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 | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C21117 | Subject name | SubjectName | Name of subject/participant | Name of subject/participan | Pupil's full name, First Middle Last | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2015-06-12 15:16:39.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| C52314 | Child Behavior Checklist (CBCL) - Whining scale | CBCLWhngScl | Scale for whether the child whines, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child whines, as part of the Child Behavior Checklist (CBCL) | Whining | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 13:02:17.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52184 | Child Behavior Checklist (CBCL) - Illness or disability indicator | CBCLIllnessDisabilityInd | Indicator that the child has an illness or disability (either physical or mental), as part of the Child Behavior Checklist (CBCL) | Indicator that the child has an illness or disability (either physical or mental), as part of the Child Behavior Checklist (CBCL) | Does this pupil have any illness or disability (either mental or physical)? | No;Yes | No;Yes | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 13:26:35.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
| C55039 | Child Behavior Checklist (CBCL) - Cry often scale | CBCLCryOftenScl | Scale of the child's tendency to cry often, as part of the Child Behavior Checklist (CBCL) | Scale of the child's tendency to cry often, as part of the Child Behavior Checklist (CBCL) | Cries a lot | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:04:30.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52270 | Child Behavior Checklist (CBCL) - Biggest concerns description text | CBCLBiggestConcernDescTxt | Description text of what concerns the respondent has most about the child, as part of the Child Behavior Checklist (CBCL) | Description text of what concerns the respondent has most about the child, as part of the Child Behavior Checklist (CBCL) | What concerns you most about this pupil? | Alphanumeric |
Your answers will be used to compare the pupil with other pupils whose teachers have completed similar forms. The information on this form will also be used for comparison with other information about this pupil. Please answer as well as you can, even if you lack full information. Scores on individual items will be combined to identify general patterns of behavior. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-23 11:31:06.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
| C52288 | Child Behavior Checklist (CBCL) - Steals outside home scale | CBCLStlOutHmeScl | Scale for whether the child steals outside the home, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child steals outside the home, as part of the Child Behavior Checklist (CBCL) | Steals | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 10:40:44.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52062 | Child Behavior Checklist (CBCL) - Doesn?t get along with other kids scale | CBCLNoGetAlongOthrKidsScl | Scale for whether the child doesnt get along with other kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child doesnt get along with other kids, as part of the Child Behavior Checklist (CBCL) | Doesn't get along with other pupils | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 11:47:51.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55018 | Child Behavior Checklist (CBLC) - School class service type | CBLCSchoolClassServiceTyp | Type of class or service provided by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | Type of class or service provided by the respondent at the child's school, as part of the Child Behavior Checklist (CBLC) | What kind of class or service is it? | Alphanumeric |
Please be specific, e.g., regular 5th grade, 7th grade math, learning disability, counseling, etc. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 11:14:09.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
| C52232 | Child Behavior Checklist (CBCL) - Other problems description text | CBCLOthrProbTxt | description text of the child's other problems not already listed, as part of the Child Behavior Checklist (CBCL) | description text of the child's other problems not already listed, as part of the Child Behavior Checklist (CBCL) | Please write in any problems the pupil has that were not listed above. | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 14:37:32.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| C55050 | Child Behavior Checklist (CBCL) - Talk out of turn scale | CBCLTalkOutOfTurnScl | Scale for the child's tendency to talk out of turn, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to talk out of turn, as part of the Child Behavior Checklist (CBCL) | Talks out of turn | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 12:04:30.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55070 | Child Behavior Checklist (CBCL) - Tardiness scale | CBCLTardinessScl | Scale for the child's tendency to be tardy to school or class, as part of the Child Behavior Checklist (CBCL) | Scale for the child's tendency to be tardy to school or class, as part of the Child Behavior Checklist (CBCL) | Tardy to school or 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 | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52300 | Child Behavior Checklist (CBCL) - Teases a lot scale | CBCLTsALotScl | Scale for whether the child teases a lot, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child teases a lot, as part of the Child Behavior Checklist (CBCL) | Teases a lot | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 11:56:08.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52093 | Child Behavior Checklist (CBCL) - Fear certain animal situation place other than school scale | CBCLFearsAnimalSituatnPlaceScl | Scale for whether the child fears certain animals, situations, or places, other than school, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child fears certain animals, situations, or places, other than school, as part of the Child Behavior Checklist (CBCL) | Fears certain animals, situations, or places other than school | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-21 16:10:24.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55029 | Child Behavior Checklist (CBCL) - Achievement test most recent subject text | CBCLAchvmntTestMstRcntSbjctTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the subject of the named achievement test, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the subject of the named achievement test, as part of the Child Behavior Checklist (CBCL) | Subject | Alphanumeric |
Most recent achievement test scores (optional) |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2017-04-18 11:49:33.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
| C52251 | Child Behavior Checklist (CBCL) - Poor school work scale | CBCLPoorSchoolWorkScl | Scale for whether the child does poor school work, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child does poor school work, as part of the Child Behavior Checklist (CBCL) | Poor school work | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 17:00:09.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55061 | Child Behavior Checklist (CBCL) - Behave irresponsible describe text | CBCLBehavIresponsibleDescrbTxt | The free-text field related to 'Child Behavior Checklist (CBCL) - Behave irresponsible scale' for describing the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | The free-text field related to 'Child Behavior Checklist (CBCL) - Behave irresponsible scale' for describing the child's tendency to behave irresponsibly, as part of the Child Behavior Checklist (CBCL) | Behaves irresponsibly (describe) | Alphanumeric | Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-22 12:57:12.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| C52006 | Child Behavior Checklist (CBCL) - Prefer being with younger kid scale | CBCLPreferBeWithYoungerKidsScl | Scale for whether the child Prefers being with younger kids, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child Prefers being with younger kids, as part of the Child Behavior Checklist (CBCL) | Prefers being with younger children | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-20 13:39:37.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C52316 | Child Behavior Checklist (CBCL) - Withdrawn does not get involved scale | CBCLWthdrwnDsntGtInvOthScl | Scale for whether the child is withdrawn, doesn't give involved with others, as part of the Child Behavior Checklist (CBCL) | Scale for whether the child is withdrawn, doesn't give involved with others, as part of the Child Behavior Checklist (CBCL) | Withdrawn, doesn't get involved with others | 0;1;2 | Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True | Numeric Values |
For each item that describes the pupil *now or within the past 2 months*, please circle the 2 if the item is *very true or often true* of the pupil. Circle the 1 if the item is *somewhat or sometimes true* of the pupil. If the item is *not true* of the pupil, circle the 0. Please andser all the items as well as you can, even if some do not seem to apply to this pupil. |
Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org | Pediatric | Exploratory | 1.00 | 2016-12-27 13:11:42.0 | Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6-18 | Behavioral Function | Outcomes and End Points |
Single Pre-Defined Value Selected |
