CDE Detailed Report

Disease: Traumatic Brain Injury
Subdomain Name: Psychiatric and Psychological Status
CRF: Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18

Displaying 51 - 100 of 174
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C52090 Child Behavior Checklist (CBCL) - Other physical problems without known medical cause scale CBCLOthrPhysicalProbScl Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Scale for whether the child has other physical problems without known medical cause, as part of the Child Behavior Checklist (CBCL) Physical problems without known medical cause: Other 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

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

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

Single Pre-Defined Value Selected

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

Compared to typical pupils of the same age

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

Single Pre-Defined Value Selected

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

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

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

Single Pre-Defined Value Selected

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

Free-Form Entry

C55067 Child Behavior Checklist (CBCL) - Strange behavior describe text CBCLStrangeBehaviorDescribeTxt The free-text field related to 'Child Behavior Checklist (CBCL) - Strange behavior scale' for describing the child's strange behavior, as part of the Child Behavior Checklist (CBCL) The free-text field related to 'Child Behavior Checklist (CBCL) - Strange behavior scale' for describing the child's strange behavior, as part of the Child Behavior Checklist (CBCL) Strange behavior (describe) Alphanumeric Copyright 2001 T. Achenbach, ASEBA, University of Vermont, 1 South Prospect St., Burlington, VT 05401-3456 www.ASEBA.org Pediatric Supplemental 1.00 2017-04-18 13:00:07.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

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

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

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

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 12:37:04.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-23 11:09:14.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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.

Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

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 Supplemental 1.00 2016-12-21 11:40:35.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:09:18.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 14:29:41.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 10:32:44.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-21 16:00:59.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:40:11.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 16:26:49.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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

Free-Form Entry

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 Supplemental 1.00 2016-12-27 11:42:22.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 12:40:00.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 13:11:36.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-23 11:12:42.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed The date of assessment of the examination being performed Today's Date Date or Date & Time Pediatric Supplemental 1.00 2014-06-18 08:10:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Free-Form Entry

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 Supplemental 1.00 2016-12-21 11:44:21.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:11:33.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status 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 Supplemental 1.00 2016-12-22 14:35:01.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 12:27:18.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

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 Supplemental 1.00 2016-12-27 10:35:32.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-21 16:06:05.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:49:33.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

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 Supplemental 1.00 2016-12-22 16:57:52.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 12:57:12.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

C55069 Child Behavior Checklist (CBCL) - Underachievement scale CBCLUnderachievementScl Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Scale for the child's tendency to underachieve or not work up to his or her potential, as part of the Child Behavior Checklist (CBCL) Underachieving, not workinig up to potential 0;1;2 Not True (as far as you know);Somewhat or Sometimes True;Very True or Often True Numeric Values

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

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

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 11:51:50.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 13:02:17.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-22 13:26:35.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-23 11:31:06.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 4000

Free-Form Entry

C21117 Subject name SubjectName Name of subject/participant Name of subject/participan Pupil's full name, First Middle Last Alphanumeric Pediatric Supplemental 1.00 2015-06-12 15:16:39.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

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 Supplemental 1.00 2016-12-21 11:47:51.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:14:09.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status 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 Supplemental 1.00 2016-12-22 14:37:32.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status 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 Supplemental 1.00 2017-04-18 12:04:30.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-27 10:40:44.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2016-12-21 16:10:24.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points

Single Pre-Defined Value Selected

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 Supplemental 1.00 2017-04-18 11:49:33.0 Child Behaviors Checklist (CBCL) Teacher Report Form for Ages 6-18 Psychiatric and Psychological Status Outcomes and End Points 255

Free-Form Entry

CSV