Child Behavior Checklist (CBCL)

Child Behavior Checklist for ages 1.5 to 5 years old

Child’s full name:

Parent’s usual type of work, even if not working now. Please be

specific– for example, auto mechanic, high school teacher,

homemaker, laborer, lathe operator, salesman, army sergeant.

Middle First Last

Child’s gender: Child’s age: Child’s ethnic Parent 1 (or Mother) type of work:
group or race:

Parent 2 (or Father) type of work:

Your relation to child:

Assessment date: Child’s birthdate:
Parent 1 (or mother)

Parent 2 (or father)

(MM/DD/YYYY) (MM/DD/YYYY)
Other (specify):
Please fill out this form to reflect your view of the child’s behavior even if other people might not agree. Feel free to write additional
comments beside each item and in the space provided on page 2. Be sure to answer all items.

Below is a list of items that describe children. For each item that describes the child now or within the past 2 months, please select 2 if
the item is very true or often true of the child. Select 1 if the item is somewhat or sometimes true of the child. If the item is not true
of the child, select 0. Please answer all items as well as you can, even if some do not seem to apply to the child .

0 = Not true (as far as you know); 1 = Somewhat true or sometimes true; 2 = Very true or often true

0 1 2 Statements
1. Aches or pains (without medical cause; do not include stomach or headaches)
2. Acts too young for age.
3. Afraid to try new things.
4. Avoids looking others in the eye.
5. Can’t concentrate, can’t pay attention for long
6. Can’t sit still, restless, or hyperactive
7. Can’t stand having things out of place
8. Can’t stand waiting; wants everything now
9. Chews on things that aren’t edible
10. Clings to adults or too dependent
11. Constantly seeks help
12. Constipated, doesn’t move bowels (when not sick)
13. Cries a lot
14. Cruel to animals
15. Defiant

16. Demands must be met immediately

17. Destroys his/her own things

18. Destroys things belonging his/her family or other children

19. Diarrhea or loose bowels (when not sick)

20. Disobedient

21. Disturbed by any change in routine

22. Doesn’t want to sleep alone

23. Doesn’t answer when people talk to him/her

24. Doesn’t eat well

25. Doesn’t get along with other children

26. Doesn’t know how to have fun; acts like a little adult

27. Doesn’t seem to feel guilty after misbehaving

28. Doesn’t want to go out of home

29. Easily frustrated

30. Easily jealous

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 0 1 2 Statements
31. Eats or drinks things that are not food– don’t include sweets (describe):
32. Fears certain animals, situations, or places (describe):
33. Feelings are easily hurt
34. Gets hurt a lot, accident-prone
35. Gets in many fights
36. Gets into everything
37. Gets too upset when separated from parents
38. Has trouble getting to sleep
39. Headaches (without medical cause)
40. Hits others
41. Holds his/her breath
42. Hurts animals or people without meaning to
43. Looks unhappy without good reason
44. Angry moods
45. Nausea, feels sick (without medical cause)
46. Nervous movements or twitching (describe):
47. Nervous, highstrung, or tense
48. Nightmares
49. Overeating
50. Overtired
51. Shows panic for no good reason
52. Painful bowel movements (without medical cause)
53. Physically attacks people
54. Picks nose, skin, and other parts of body (describe):
55. Plays with own sex parts too much
56. Poorly coordinated or clumsy
57. Problems with eyes (without medical cause) (describe):
58. Punishment doesn’t change his/her behavior
59. Quickly shifts from one activity to another
60. Rashes or other skin problems (without medical causes)
61. Refuses to eat
62. Refuses to play active games
63. Repeatedly rocks head or body
64. Resists going to bed at night
65. Resists toilet training (describe):
66. Screams a lot
67. Seems unresponsive to affection
68. Self-conscious or easily embarrassed
69. Selfish or won’t share
70. Shows little affection toward people
71. Shows little interest in things around him/her
72. Shows too little fear of getting hurt
73. oo shy or timid
T

74. Sleeps less than most kids during day and/or night (describe):
75. Smears or plays with bowel movements
76. Speech problem (describe):
77. Stares into space or seems preoccupied
78. Stomachaches or cramps (without medical cause)
79. Rapid shifts between sadness and excitement
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 0 1 2 Statements
80. Strange behavior (describe):
81. Stubborn, sullen, or irritable
82. Sudden changes in mood or feelings
83. Sulks a lot
84. Talks or cries out in sleep
85. Temper tantrums or hot temper
86. Too concerned with neatness or cleanliness
87. Too fearful or anxious
88. Uncooperative
89. Underactive, slow moving, lacks energy
90. Unhappy, sad, or depressed
91. Unusually loud
92. Upset by new people or situations (describe):
93. Vomiting, throwing up (without medical cause)
94. Wakes up often at night
95. Wanders away
96. Wants a lot of attention
97. Whining
98. Withdrawn, doesn’t get involved with others
99. Worries
100. Please write in any problems the child has that were not listed above:

**Please be sure you have answered all items. Underline any you are concerned about.

Does the child have any illness or disability (either physical or mental)?
No Yes, please describe:

What concerns you most about the child?

Please describe the best things about the child:

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Child Behavior Checklist for ages 6 to 18 years old
Child’s full name:
Parent’s usual type of work, even if not working now. Please be
specific– for example, auto mechanic, high school teacher,
Middle First Last homemaker, laborer, lathe operator, salesman, army sergeant.

Child’s gender: Child’s age: Child’s ethnic Parent 1 (or Mother) type of work:
group or race:
Parent 2 (or Father) type of work:

Assessment date: Child’s birthdate: This form is filled out by: (print full name)

Your gender:
(MM/DD/YYYY) (MM/DD/YYYY)
Is the child attending If yes, what grade is the Your relation to the child:
school? child in? Biological parent Foster parent
Yes Adoptive parent Grandparent
No Step parent Others specify:
Please fill out this form to reflect your view of the child’s behavior even if other people might not agree. Feel free to write additional
comments beside each item and in the space provided on page 2. Be sure to answer all items.
I. Please list the sports your child Compared to others of the same age, Compared to others of the same age,
most likes to take part in. For example: about how much time does he/she spend how well does he/she do each one?
swimming, baseball, skating, etc. in each?
Less than More than Don’t Less than More than Don’t
None
average Average average know average Average average know
a.
b.
c.
II. Please enlist your child’s favorite Compared to others of the same age, Compared to others of the same age,
hobbies, activities, and games other about how much time does he/she spend how well does he/she do each one?
than sports. For example: video games, in each?
dolls, reading, piano, crafts, cars,
computers, singing, etc. (Do not include
listening to radio, TV, or other media)

Less than More than Don’t Less than More than Don’t
None
average Average average know average Average average know
a.
b.
c.
III. Please list any organizations, clubs, teams, or groups Compared to others of the same age, about how much time
your child belongs to. does he/she spend in each?
Less than More than
None Average Don’t know
average average
a.
b.
c.

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 IV. Please enlist any jobs or chores your child has. For Compared to others of the same age, about how much time
example: doing dishes, babysitting, making bed, working in does he/she spend in each?
store, etc. (Include both paid and unpaid jobs and chores.)
None Less than Average More than Don’t know
average average
a.
b.
c.
1. About how many close friends does your child have? (Do not include brothers and sisters)
None 1 2 or 3 4 or more
V. 2. About how many times a week does your child do things with any friends outside of regular school
hours? (Do not include brothers and sisters)
Less than 1 1 or 2 3 or more
VI. Compared to others of his/her age, how well does your child:
Worse Average Better
Get along with his/her brothers and
sisters?
Get along with other kids?
Has no brothers or sisters
Behave with his/her parents?

Play and work alone?

1. Performance in academic subjects.

Does not attend school because:
*Check a box for each subject that child takes.

Failing
Below Average Above
average average
Reading, English, or language arts
History or social studies
Arithmetic or Mathematics
Science

2. Does your child receive special education or remedial services or attend a special class or a special
school?
VII. Yes— state the kind of services, class, or school:
No
Has your child repeated any grades?
Yes— grades and reasons:
No
4. Has your child had any academic or other problems in school?
Yes— please explain:
No
When did these problems start?
Have these problems ended?
Yes— when:
No

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 Does the child have any illness or disability (either physical or mental)?
No Yes, please describe:
What concerns you most about the child?

Please describe the best things about the child:

Below is a list of items describe children and youths. For each item that describes your child now or within the past 6 months, please
select the 2 if the item is very true or often true of your child. Select the 1 if the item is somewhat or sometimes true of your child. If
the item is not true of your child, select the 0. Please answer all the items as well as you can, even if some do not seem to apply to your
child.

0 = Not true (as far as you know); 1 = Somewhat true or sometimes true; 2 = Very true or often true
0 1 2 Statements
1. Acts too young for his/her age
2. Drinks alcohol without parents’ approval (describe):
3. Argues a lot
4. Fails to nish things he/she starts
fi

. here is very little he/she en oys

5 T j

6. Bowel movements outside the toilet

7. Bragging, boasting
8. an’t concentrate, can’t pay attention for long
C

9. an’t get his/her mind off certain thoughts; obsessions (describe):

C

1 . an’t sit still, restless, or hyperactive

0 C

11. lings to adults or too dependent

C

12. omplains of loneliness

C

13. onfused or seems to be in a fog

C

1 . ries a lot
4 C

1 . ruel to animals
5 C

1 . ruelty, bullying, or meanness to others

6 C

1 . Daydreams or gets lost in his/her thoughts

7

1 . Deliberately harms self or attempts suicide

8

1 . Demands a lot of attention

9

2 . Destroys his/her own things

0

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 0 1 2 Statements
21. Destroys things belonging to his/her family or others
22. Disobedient at home
23. Disobedient at school
24. Doesn’t eat well
25. Doesn’t get along with other kids
26. Doesn’t seem to feel guilty after misbehaving
27. Easily jealous
28. Breaks rules at home, school, or elsewhere
29. Fears certain animals, situations, or places other than school (describe):
30. Fears going to school
31. Fears she/he might think or do something bad
32. Feels he/she has to be perfect
33. Feels or complains that no one loves him/her
34. Feels others are out to get him/her
35. Feels worthless or inferior
36. Gets hurt a lot, accident-prone
37. Gets in many fights
38. Gets teased a lot
39. angs around with others who get in trouble
H

40. ears sound or voices that aren’t there (describe):

H

41. mpulsive or acts without thinking

I

42. ould rather be alone than with others

W

43. ying or cheating

L

44. Bites fingernails

45. ervous, highstrung, or tense
N

46. ervous movements or twitching (describe):

N

47. ightmares
N

48. ot liked by other kids

N

49. onstipated, doesn’t move bowels

C

50. oo fearful or an ious

T x

51. Feels di y or lightheaded

zz

52. Feels too guilty

53. vereating
O

54. vertired without good reason

O

55. verweight
O

56. Physical problems without know medical cause:

a. Aches or pains (not stomach or headaches)
b. eadaches
H

c. ausea, feels sick

N

d. Problems with eyes (not if corrected by glasses) (describe):

e. Rashes or other skin problems
f. Stomachaches
g. Vomiting, throwing up
h. ther (describe):
O

57. Physically attacks people

58. Picks nose, skin, or other parts of body (describe):
59. Plays with own se parts in the public
x

60. Plays with own se parts too much

x

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 0 1 2 Statements
61. Poor school work
62. Poorly coordinated or clumsy
63. Prefers being with older kids
64. Prefers being with younger kids
65. Refuses
66. Repeats certain acts over and over; compulsions (describe):
67. Runs away from home
68. Screams a lot
69. Secretive, keeps things to self
70. Sees things that aren’t there (describe):
71. Self-conscious or easily embarrassed
72. Sets fires
73. Se ual problems (describe):
x

74. Showing off or clowning

75. oo shy or timid
T

76. Sleeps less than most kids

77. Sleeps more than most kids during day and/or night (describe):
78. nattentive or easily distracted
I

79. Speech problem (describe):

80. Stares blankly
81. Steals at home
82. Steals outside the home
83. Stores up too many things he/she doesn’t need (describe):
84. Strange behavior (describe):
85. Strange ideas (describe):
86. Stubborn, sullen, or irritable
87. Sudden changes in mood or feelings
88. Sulks a lot
89. Suspicious
90. Swearing or obscene language
91. alks about killing self
T

92. alks or walks in sleep (describe):

T

93. alks too much

T

94. eases a lot

T

95. emper tantrums or hot temper

T

96. hinks about se too much

T x

97. hreatens people

T

98. humb-sucking
T

99. Smokes, chews, sniffs tobacco

100. rouble sleeping (describe):
T

101. ruancy, skips school

T

102. nderactive, slow moving, or lacks energy

U

103. nhappy, sad or depressed

U

104. nusually loud

U

105. ses drugs for nonmedical purposes (don’t include alcohol or tobaccon) (describe):
U

106. Vandalism
107. Wets self during the day
108. Wets the bed
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 0 1 2 Statements
109. Whining
110. Wishes to be of opposite sex
111. Withdrawn, doesn’t get involved with others
112. Worries
113. Please write in any problems your child has that were not listed above:

Scoring and interpretation

Scoring and interpreting the results of the CBCL requires the use of licensed software from the Achenbach System of Empirically Based
Assessment (ASEBA).

The ASEBA software ensures accurate scoring, provides comprehensive reports, and facilitates the interpretation of the data based on
normative samples. Users must obtain the appropriate licensing to access these tools and resources, which are essential for valid and
reliable assessments.

For further information on obtaining a license or using the ASEBA software, please visit the Site and Scoring Licenses page in the official
ASEBA website or contact their support team.
References
ASEBA (2019a). Child Behavior Checklist for Ages 1½-5. https://aseba.org/wp-content/uploads/2019/02/preschoolcbcl.pdf

ASEBA (2019b). Child Behavior Checklist for Ages 6-18. https://aseba.org/wp-content/uploads/2019/02/preschoolcbcl.pdf

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