CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: Behavioral Function
CRF: Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6

Displaying 1 - 50 of 174
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C52196 Child Behavior Checklist (CBCL) - Poorly coordinated or clumsy scale CBCLPoorCoordinationClumsyScl Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is poorly coordinated or clumsy, as part of the Child Behavior Checklist (CBCL) Poorly coordinated or clumsy 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 13:51:42.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C55041 Child Behavior Checklist (CBCL) - Destroy property belong others scale CBCLDstryPrprtyBlngOthrScl Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) Scale of the child's tendency to destroy property belonging to others, as part of the Child Behavior Checklist (CBCL) Destroys property belonging to 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 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

C52273 Child Behavior Checklist (CBCL) - Overtired without good reason scale CBCLOvertiredNoGoodReasonScl Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) Scale for whether the child gets overtired without good reason, as part of the Child Behavior Checklist (CBCL) Overtired without good reason 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 11:40:37.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C52015 Child Behavior Checklist (CBCL) - Argues a lot scale CBCLArgueALotScl Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) Scale for whether the child argues a lot, as part of the Child Behavior Checklist (CBCL) Argues 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 2016-12-20 13:51:27.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C52317 Child Behavior Checklist (CBCL) - Worry scale CBCLWorryScl Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) Scale for whether the child worries, as part of the Child Behavior Checklist (CBCL) Worries 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 13:19:50.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C52238 Child Behavior Checklist (CBCL) - Hears sound or voices that arent there description text CBCLHearSoundVoicesNotThereTxt description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) description text of the sounds or voices that aren't there that the child hears, as part of the Child Behavior Checklist (CBCL) Hears sounds or voices 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 Exploratory 1.00 2016-12-22 15:00:34.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

C55052 Child Behavior Checklist (CBCL) - Vomit no known medical cause scale CBCLVomitNoKnwnMdclCausScl Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to vomit without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Vomiting, throwing up 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

C52290 Child Behavior Checklist (CBCL) - Strange behavior scale CBCLStrngBhvrScl Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) Scale for whether the child displays strange behavior, as part of the Child Behavior Checklist (CBCL) Strange behavior 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 10:47:05.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C52070 Child Behavior Checklist (CBCL) - Best thing description text CBCLBestThingDescTxt description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) description text of the best things about the child, as part of the Child Behavior Checklist (CBCL) Please describe the best things 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 2016-12-21 11:58:14.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

C55020 Child Behavior Checklist (CBLC) - Child referral education assistance describe text CBLCChildRefrlAsstnceDscrbTxt The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) The free-text field related to 'Child Behavior Checklist (CBLC) - Child referral education assistance indicator' for describing educational assistance for which the child was referred, as part of the Child Behavior Checklist (CBLC) Yes—what kind and when? 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 2017-04-18 11:21:12.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

C55031 Child Behavior Checklist (CBCL) - Achievement test most recent status CBCLAchvmntTestMstRcntStatus The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) The field related to 'Child Behavior Checklist (CBCL) - Achievement test most recent name' for specifying the status of the child's performance on the named achievement test, as part of the Child Behavior Checklist (CBCL) Percentile or grade level obtained 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 50

Free-Form Entry

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

C52254 Child Behavior Checklist (CBCL) - Nervous movements or twitching description text CBCLNervousMovementTwitchTxt description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) description text of the child's nervous movements or twitches, as part of the Child Behavior Checklist (CBCL) Nervous movements or twitching (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 17:13:04.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 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

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 Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Exploratory 3.00 2013-07-25 08:54:08.2 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Free-Form Entry

793
C52302 Child Behavior Checklist (CBCL) - Thinks about sex too much scale CBCLThnkAbtSxTooMchScl Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) Scale for whether the child thnks about sex too much, as part of the Child Behavior Checklist (CBCL) Seems preoccupied with sex 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 12:07:39.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C52095 Child Behavior Checklist (CBCL) - Disobedient at school scale CBCLDisobedientAtSchoolScl Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) Scale for whether the child is disobedient at school, as part of the Child Behavior Checklist (CBCL) Disobedient at 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 16:23:55.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-22 13:54:03.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 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

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 Exploratory 1.00 2016-12-23 14:18:59.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-20 15:31:16.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2017-04-18 10:55:06.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2016-12-22 15:04:02.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2017-04-18 12:34:25.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2016-12-27 10:49:39.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-21 12:07:18.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2017-04-18 11:23:22.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 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

C55071 Child Behavior Checklist (CBCL) - Fail perform assigned task scale CBCLFailPerformAssignTaskScl Scale for the child's tendency to fail to perform assigned tasks, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to fail to perform assigned tasks, as part of the Child Behavior Checklist (CBCL) Fails to carry out assigned tasks 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

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 Exploratory 1.00 2016-12-22 17:16:55.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

C00008 Age value AgeVal Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. Pupil's Age Numeric Values

Record in months

Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Exploratory 3.00 2013-08-28 16:08:00.453 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Free-Form Entry

0 1800 month
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 Exploratory 1.00 2016-12-27 12:11:58.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-21 16:31:13.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-22 13:56:33.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 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

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 Exploratory 1.00 2016-12-27 09:06:24.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-20 15:35:51.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2017-04-18 10:55:06.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2016-12-22 15:50:04.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2017-04-18 12:37:05.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2016-12-27 10:53:29.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-21 12:10:58.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2017-04-18 11:29:14.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 50

Free-Form Entry

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 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

Free-Form Entry

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 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

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 Exploratory 1.00 2016-12-22 17:19:39.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Exploratory 3.00 2013-07-25 08:54:08.2 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

3134878
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 Exploratory 1.00 2016-12-27 12:21:01.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

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 Exploratory 1.00 2016-12-22 10:57:13.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points 255

Free-Form Entry

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 Exploratory 1.00 2016-12-22 14:03:30.0 Child Behavior Checklist (CBCL) Teacher Report Form for Ages 6?18 Behavioral Function Outcomes and End Points

Single Pre-Defined Value Selected

CSV