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Child Behavior Checklist (CBCL)
Availability
Please visit this website for more information about the instrument: Child Behavior Checklist
Classification
  
Supplemental - Highly Recommended: Mitochondrial Disease (Mito)
 
Supplemental: Epilepsy, Neuromuscular Diseases (NMD), and Traumatic Brain Injury (TBI)
 
Exploratory: Sport-Related Concussion (SRC)
Short Description of Instrument
Child Behavior Check List (CBCL):
Description: The Child Behavior Check List (CBCL) measures a child's competencies by using their parent's/caregiver's perception of their performance on three scales, which include activities, social and school. There are separate forms for ages 1.5 to 5 years (CBCL\5-15) and 6 to 18 years (CBCL\6-18), as well as separate forms to be filled out by the parent/caregiver or teacher. Scores for three competence scales and a total competence score can be computed.
 
Primary Dependent Measures: Three specific competence scales (Activities, Social, and School) and Total Competence.
 
Time Estimates: 15 minutes.
 
Vendor: Achenbach System of Empirically Based Assessment.
Comments/Special Instructions
CBCL/1.5-5:
The CBCL/1.5-5 obtains caregivers' ratings of 99 problem items and  can be completed independently by the caregiver or administered by a professional familiar with the CBCL manual. The test can be completed by paper/pencil, online, or on a scannable form. The entire test, which includes the school competence scale, lasts approximately 25-30 minutes. Skills commensurate with at least a master's degree level in psychology, social work, or special education are recommended for interpretation. The measure also includes open-ended problem-related and strengths-based questions to obtain additional qualitative information.
 
CBCL/6-18:
The CBCL/6-18 is designed for children between the ages 6-18 and is available in English and Spanish. It is a 118-item plus two open-ended item checklist asking parents, close relatives and/ or guardians asking about the child's competencies and behavioral/ emotional problems.
 
The CBCL/6-18 was revised in 2001 to include new national norms that were collected February 1999-January 2000, including new DSM-oriented scales, and to complement the preschool forms. Completed by the parent/caretaker who spends the most time with the child, the CBCL/6-18 provides ratings for 20 competence and 120 problem items paralleling the Youth Self-Report (YSR) (Ebesutani et al., 2011) and the Teacher's Report Form (TRF) (Achenbach & Rescorla, 2001). The CBCL/6-18 also includes open-ended items covering physical problems, concerns, and strengths.
 
Parents rate how true each item is now, or was within the past 6 months, using the same 3- point scale utilized on the YSR and TRF. It is one of the most widely used outcome measures.
 
Adults aged 18-59 can complete the Adult Behavior Checklist (ABCL). (Achenbach et al., 2004)
Scoring and Psychometric Properties
Scoring: The items are rated on a scale of 0 to 2, with "0 being not true (as far as you know)", "1 being somewhat true or sometimes true" and "2 being very true or often true".
 
Permissible values: Raw scores, t scores (M=50, SD=10), and percentiles are given based on test results. The value of t scores for each range varies depending on the scale; in some scales higher t scores are associated with normal functioning and on others lower t scores are associated with normal functioning.
Scoring: CBCL/1.5-5 Items are scored on the following syndrome scales: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Attention Problems, Aggressive Behavior, and Sleep Problems. Items are also scored on the following DSM-oriented scales: Affective Problems, Anxiety Problems, Pervasive Developmental Problems, Attention Deficit/Hyperactivity Problems, Stress Problems, Autism Spectrum Problems, and Oppositional Defiant Problems.
 
CBCL/6-18
Scoring: This scale has several sub scores, including Aggressive Behavior, Anxious/Depressed, Attention Problems, Delinquent Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, Withdrawn, Externalizing, Internalizing, Total Problems, plus DSM-oriented scales. The CBCL/6-18 yields scores on internalizing, externalizing, and total problems as well as scores on DSM-IV related scales.
Psychometric Properties:
CBCL/1.5-5:
The CBCL/1.5-5 psychometric norms are based on ratings of 1,728 children normed on a national (U.S.) sample of 700 children.( National Child Traumatic Stress Network, 2023a). It has good reliability (Achenbach and Rescorla, 2000) and validity (Ha et al., 2011; Ivanova, et al., 2010; Pandolfi et al., 2009; Tan et al., 2007). See Achenbach and Rescorla (2000) for test-retest reliability and content validity information.
CBCL/6-18:
The CBCL/6-18 psychometric norms are based on rating of 1,753  children from 40 US states. Two age groups were constructed (6-11) and (12-18) and genders were separated. (National Child Traumatic Stress Network, 2023b) It has good reliability and validity. (Achenbach and Rescorla, 2001) See Achenbach and Rescorla (2001) for reliability and validity information.
Rationale/Justification
Rationale: "The CBCL School Competence subscale asks parents to rate their child's performance in several academic subjects from failing to above average, and children with TBI have been rated as having lower academic performance than typically developing children." - McCauley et al., 2012.
 
Strengths: The scale has several sub scores, including Aggressive Behavior, Anxious/Depressed, Attention Problems, Delinquent Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, Withdrawn, Externalizing, Internalizing, Total Problems, plus DSM-oriented scales. Assessments can be completed in multiple environments in home by caregiver and in school by teachers. The assessment is well researched and widely used and is inexpensive to administer and score. (National Child Traumatic Stress Network, 2023b)
 
Weaknesses: The CBCL is a long assessment that can be time consuming to complete. There is the potential for self-report bias and there is no assessment of profile validity. (National Child Traumatic Stress Network, 2023a,b; Aebi et al., 2010) The CBCL is only available in English and Spanish and has not been specifically utilized in the Spanish population and as such its psychometric properties for this group are therefore unknown.
 
Sport-Related Concussion Specific: The CBCL is very well studied and has been used in pediatric concussion studies but not specifically in sport concussion studies. In more recent studies of mild TBI, it has been used to identify premorbid behavioral or emotional risk factors rather than post-injury effects. The School Competence Scale is part of the Total Competence Score of the CBCL and examines academic functioning with respect to performance in various subjects and implementation any academic interventions. CBCL Total Competence Score has been studied as a predictor of outcome in a pediatric ED concussion population (not specific to sport concussion). Teacher form not used as extensively as the parent measure.
 
Specific to Mitochondrial Disease: Not validated in people with mitochondrial disorders, however children and adults with mitochondrial disorders are at risk for behavioral disturbances, therefore it may be a useful tool. The CBCL has been used as a screening tool for social and emotional problems with similar type of multi-systemic disorders, congenital disorders of glycosylation that have primary neurological involvement.
References
  
Key References:
Achenbach, T. (1991). Manual for Child Behavior Checklist/ 4-18 and 1991 Profile. University of Vermont, Dept. of Psychiatry: Burlington, VT.
 
Achenbach TM, Rescorla LA. Manual for the ASEBA Preschool Forms & Profiles. University of Vermont, Research Center for Children, Youth, and Families; Burlington, VT: 2000.
 
Achenbach, T.M. & Rescorla, L.A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
 
Achenbach TM, Newhouse PA, Rescorla LA. Manual for the ASEBA Older Adult Forms & Profiles. University of Vermont, Research Center for Children, Youth, and Families; Burlington, VT: 2004.
 
Additional References:
 
Aebi M, Winkler Metzke C, Steinhausen HC. Accuracy of the DSM-oriented attention problem scale of the child behavior checklist in diagnosing attention-deficit hyperactivity disorder. J Atten Disord. 2010 Mar;13(5):454-63.
 
Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The youth self report: applicability and validity across younger and older youths. J Clin Child Adolesc Psychol. 2011;40(2):338-46.
 
Ha EH, Kim SY, Song DH, Kwak EH, Eom SY. Discriminant Validity of the CBLC 1.5-5 in Diagnosis of Developmental Delayed Infants. J Korean Acad Child Adoles Psych. 2011;22(2): 120-27.
 
Holmes C, Levy M, Smith A, Pinne S, Neese P. A Model for Creating a Supportive Trauma-Informed Culture for Children in Preschool Settings. J Child Fam Stud. 2015;24(6):1650-1659.
 
Ivanova MY, Achenbach TM, Rescorla LA, Harder VS, Ang RP, Bilenberg N, Bjarnadottir G, Capron C, De Pauw SS, Dias P, Dobrean A, Doepfner M, Duyme M, Eapen V, Erol N, Esmaeili EM, Ezpeleta L, Frigerio A, Gonçalves MM, Gudmundsson HS, Jeng SF, Jetishi P, Jusiene R, Kim YA, Kristensen S, Lecannelier F, Leung PW, Liu J, Montirosso R, Oh KJ, Plueck J, Pomalima R, Shahini M, Silva JR, Simsek Z, Sourander A, Valverde J, Van Leeuwen KG, Woo BS, Wu YT, Zubrick SR, Verhulst FC. Preschool psychopathology reported by parents in 23 societies: testing the seven-syndrome model of the child behavior checklist for ages 1.5-5. J Am Acad Child Adolesc Psychiatry. 2010 Dec;49(12):1215-24.
 
Nakamura BJ, Ebesutani C, Bernstein A, Chorpita BF. A Psychometric Analysis of the Child Behavior Checklist DSM-Oriented Scales. J Psychopathol Behav Assess. 2009 Dec 09;31:178-89.
 
National Child Traumatic Stress Network. (2023a) Child Behavior Checklist for ages 1.5-5. Available from: https://www.nctsn.org/measures/child-behavior-checklist-ages-15-5 Accessed: 07 December 2023.
 
National Child Traumatic Stress Network. (2023b) Child Behavior Checklist for ages 6-18. Available from: https://www.nctsn.org/measures/child-behavior-checklist-ages-6-18 Accessed: 07 December 2023.
 
Pandolfi V, Magyar CI, Dill CA. Confirmatory factor analysis of the child behavior checklist 1.5-5 in a sample of children with autism spectrum disorders. J Autism Dev Disord. 2009 Jul;39(7):986-95.
 
Reynolds, CR., Fletcher-Janzen, E. (2007) Encyclopedia of Special Education. John Wiley & Sons: Inc. Hoboken, New Jersey.
 
Tan TX, Dedrick RF, Marfo K. Factor structure and clinical implications of child behavior checklist/1.5-5 ratings in a sample of girls adopted from China. J Pediatr Psychol. 2007 Aug;32(7):807-18.
 
TBI-Specific:
Ewing-Cobbs L, Barnes M, Fletcher J, Levin H Swank P, Song, J. Modeling of longitudinal academic achievement scores after pediatric traumatic brain injury. Dev Neuropsychol. 2004;25(1-2):107-133.
 
Fletcher JM, Ewing-Cobbs L, Miner ME, Levin HS, Eisenberg HM. Behavioral changes after closed head injury in children. J Consult Clin Psychol. 1990 Feb;58(1):93-8.
 
McCauley SR, Wilde EA, Anderson VA, Bedell G, Beers SR, Campbell TF, Chapman SB, Ewing-Cobbs L, Gerring JP, Gioia GA, Levin HS, Michaud LJ, Prasad MR, Swaine BR, Turkstra LS, Wade SL, Yeates KO; Pediatric TBI Outcomes Workgroup. Recommendations for the use of common outcome measures in pediatric traumatic brain injury research. J Neurotrauma. 2012 Mar 1;29(4):678-705.
 
Sport-Related Concussion-Specific References:
McNally KA, Bangert B, Dietrich A, Nuss K, Rusin J, Wright M, Taylor HG, Yeates KO. Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology. 2013 Jan;27(1):1-12.
 
van de Loo KF, van Dongen L, Mohamed M, Gardeitchik T, Kouwenberg TW, Wortmann SB, Rodenburg RJ, Lefeber DJ, Morava E, Verhaak CM. Socio-emotional Problems in Children with CDG. JIMD Rep. 2013;11:139-48.
 
Document last updated October 2024