CBCL - Child Behbior Check list

Parent form on child behavior (2-3 years)

Achenbach and Edelbrock, 88

Child's name. :................................................. .............. Parents' usual type of work (even if they are not working
Sex: Age: Ethnic group/ now):
 Man Race: (Please be as specific as you can - for example, car mechanic,
 Woman university professor, builder, shop assistant...)

Father's job: ................................................ ...................

Mother's job: ........................................... ................

Today's date: Child's date of birth: This form has been completed by:
 Mother
 Father
 Other (name and relationship to the
child):................................

Please complete this form to reflect YOUR view of the child's behavior, even if others may not agree with you. Feel free to
write additional comments next to each item and in the space provided.
Below is a list of phrases that describe children. They all refer to the child's behavior NOW OR IN THE PAST 2 MONTHS .
Please mark each question as follows:
Mark 0 if what is described rarely applies or is false in relation to your child.
Mark 1 if it applies only sometimes or in part .
Circle 2 if what is described most often applies to your child or is true .

1. Pain and discomfort (without medical

0 1 2 0 1 2
cause)
2. He acts too immature for his age 24. You don't eat well (describe):
0 1 2 0 1 2
____________________________________
3. Fear of trying new things 0 1 2 25. Doesn't want to go with other children 0 1 2
4. Avoid looking others in the eyes 26. He doesn't know how to have fun, he acts
0 1 2 0 1 2
like a little adult.
5. Can't concentrate, pay attention for a long 27. He doesn't seem to feel guilty after
0 1 2 0 1 2
time misbehaving.
6. Can't sit still, restless 0 1 2 28. He doesn't want to leave the house 0 1 2
7. Does not tolerate things out of place 0 1 2 29. Gets frustrated easily 0 1 2
8. You can't stand waiting, you want things 30. Easily jealous, envious
0 1 2 0 1 2
and immediately
9. Chew things that are not edible 31. Eat or drink things that are not food -
0 1 2 candy not included (describe): 0 1 2
____________________________________
10. Attached to adults or too dependent 32. You are afraid of certain animals,
0 1 2 situations or places (describe): 0 1 2
____________________________________
11. Constantly seek help 0 1 2 33. Your feelings are hurt easily 0 1 2
12. He is constipated 0 1 2 34. Hits oneself often, prone to accidents 0 1 2
13. Cry a lot 0 1 2 35. He gets into a lot of fights 0 1 2
14. He is cruel to animals 0 1 2 36. He gets into everything 0 1 2
15. Challenging 37. He gets very upset when he is separated
0 1 2 0 1 2
from his parents.
16. Your demands must be met immediately 0 1 2 38. You have trouble falling asleep 0 1 2
17. Destroys his own things 39. You have headaches (without medical
0 1 2 0 1 2
cause)
18. Destroys things belonging to his family or 40. Hit others
0 1 2 0 1 2
other children
19. Diarrhea or stains your underwear or 41. Hold your breath
0 1 2 0 1 2
panties without being sick
20. Disobedient 0 1 2 42. Harms animals or people for no reason 0 1 2
21. He becomes disturbed by any change in 43. He seems unhappy for no reason.
0 1 2 0 1 2
his routine
22. Doesn't want to sleep alone 0 1 2 44. Angry moods 0 1 2
23. Does not answer when spoken to 45. Nausea, feel sick (without medical
0 1 2 0 1 2
causes)
 CBCL - Child Behbior Check list
Parent form on child behavior (2-3 years)
Achenbach and Edelbrock, 88

Continuation. Remember:
Mark 0 if what is described rarely applies or is false in relation to your child.
Mark 1 if it applies only sometimes or in part .
Circle 2 if what is described most often applies to your child or is true .
46. Movements, nervous gestures or tics 77. He is in the clouds or seems worried
(describe): 0 1 2 0 1 2
____________________________________
47. Nervous, very excitable or tense 78. Stomach pains or contractions (without
0 1 2 0 1 2
medical cause)
48. You have nightmares at night 79. Collects, keeps things you don't need
0 1 2 0 1 2
(describe):
49. Glutton/one, glutton/one 80. Has strange behaviors (describe):
0 1 2 0 1 2
____________________________________
50. He/she is always tired 0 1 2 81. Stubborn, sullen, irritable 0 1 2
51. Too fat 0 1 2 82. Sudden changes in mood or feelings 0 1 2
52. Intestinal pain 0 1 2 83. Gets in a bad mood frequently 0 1 2
53. Physically attacks other people 0 1 2 84. Talk or cry in your sleep 0 1 2
54. Scratches nose, skin or other parts of the 85. Irritable temper, tantrums
body (describe): 0 1 2 0 1 2
____________________________________
55. He plays with his genitals too much 86. You worry too much about order or
0 1 2 0 1 2
cleanliness
56. Poor coordination of movements or 87. Too afraid or anxious
0 1 2 0 1 2
clumsy
57. Eye problems without medical cause 88. Non-cooperative
(describe): 0 1 2 0 1 2
____________________________________
58. Punishments do not change their 89. Not very active, with slow movements or
0 1 2 0 1 2
behavior lack of energy
59. Switch quickly from one activity to another 0 1 2 90. Unhappy, sad or depressed 0 1 2
60. Rashes or other skin problems (without 91. Extraordinarily loud, shouty
0 1 2 0 1 2
medical cause)
61. Refuse food 92. You get upset when faced with new
0 1 2 people or situations (describe): 0 1 2
____________________________________
62. Reject active games 0 1 2 93. Vomiting (without medical cause) 0 1 2
63. Rock your head or body repeatedly 0 1 2 94.Wakes up often during the night 0 1 2
64. Reluctant to go to bed at night 0 1 2 95. Prowls, wanders outside the house 0 1 2
65. Resists learning to urinate or defecate in 96. Wants a lot of attention
the potty/water (describe): 0 1 2 0 1 2
____________________________________
66. Screams a lot 0 1 2 97. Complainant 0 1 2
67. Doesn't seem to respond to signs of 98. Rejecting, does not get involved with
0 1 2 0 1 2
affection others
68. Shameful 0 1 2 99. Restless, worried 0 1 2
69. Selfish, does not want to share 100. Please write down any problems your
0 1 2
child has that are not listed above:
70. Shows little affection towards others 0 1 2 to)_________________________________ 0 1 2
71. Shows little interest in the things around b)_________________________________
0 1 2 0 1 2
him
72. Shows very little fear of getting hurt 0 1 2 c)_________________________________ 0 1 2
73. Shy 0 1 2
74. Sleeps less than most children during the PLEASE MAKE SURE YOU HAVE ANSWERED ALL QUESTIONS.
day and/or night (describe): 0 1 2 UNDERLINE WHAT IS PARTICULARLY CONCERNING YOU.
____________________________________
75. Smears or plays with feces (poop) 0 1 2
76. Language problems (describe):
0 1 2
 CBCL - Child Behbior Check list
Parent form on child behavior (2-3 years)
Achenbach and Edelbrock, 88

Does your child have any illness, physical limitation or handicap?

 No  Yes - please describe

What worries you most about your child?

Please describe your child 's best qualities or things.

THE CBCL
 CBCL - Child Behbior Check list
Parent form on child behavior (2-3 years)
Achenbach and Edelbrock, 88

 Objective of collecting information on the child's skills and emotional/behavioral problems in a standardized way, in
order to help make a first diagnostic approach for the detection of psychopathological disorders.
 If information indicating the existence of a possible psychopathological disorder is obtained, it should be further
investigated using more specific instruments.

DESCRIPTION
 The CBCL consists of:
 A list of items related to emotional/behavioral problems that occur currently or in the last 2 months.
 Provides scores on:
- Total behavioral problems: sum of the direct scores of all items, and indicates, through
comparison with normative scores, whether the child's behavior is, at a global level,
clinically disturbed.
- Internalized and externalized scale:
 Internalized: emotional/behavioral problems related to anxiety and inhibiting
behavior. 2 subscales:
o Rejecting
o Anxious/depressed
- Externalized Scale: emotional/behavioral problems related to aggressive and antisocial
behaviors. 2 subscales:
 destructive behavior
 Aggressive behavior.
 Six subscales corresponding to emotional problems syndromes/
 specific behavioral.
 26 items are grouped in a subscale called “Other problems” that does not correspond to any
syndrome and another 2 items are not included in any subscale.
CBCL SUBSCALE-2-3 years. Items
 Anxious 10-33-37-43-47-50-68-73-87-90-96
 Rejecting 2-4-23-25-26-27-62-67-70-71-81-88-89-98
 Sleep problems 22-38-48-64-74-84-94
 Somatic problems 1-7-12-19-24-39-41-45-52-61-65-78-86-93
 aggressive behavior 15-16-20-29-30-35-40-44-58-66-69-82-85-91-97
 destructive behavior 5-9-14-17-18-31-36-42-59-63-75
 Other problems 3-6-8-11-13-21-28-32-34-46-49-53-54-55-56-57-60-72-
76-77-80-83-92-95-99-100
 Items not included 51-79

The form is not completely valid if data is missing in more than 8 items (not counting 100). If a parent has circled two
numbers in the same item, score 1.
Item scores:

- Only one item can be scored for each problem. If a parent has scored more than one item for
the same problem, compute only one item, the one that most accurately and specifically
describes the problem in question.
- When in doubt, rate the item as the parent did, with the following exceptions:
Item 31: eat or drink things that are not food. Score 0 for sweet or junk.
Item 46: movements, nervous gestures or tics. If it is “cannot sit still” or any other behavior described by item 6, rate only 6.
Item 57: eye problems. Do not rate: wears glasses, nearsighted... and other organically based problems.
Item 80: strange behaviors. If the parent describes a behavior that is described by another item, rate only one of them,
whichever is most specific.
Item 100: additional problems: rate this item only if the behavior described is not covered elsewhere. If the parent indicates
more than one behavior, compute only the highest score.