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Running head: CBCL ANALYSIS

Child Behavior Checklist Analysis

Elizabeth Bullard

Department of Counseling, Wake Forest University

CNS 736: Appraisal Procedures for Counseling

Dr. George Stoupas

February 17, 2023

The Child Behavior Checklist is a test instrument that combines a behavior problems

checklist with a social competency checklist. It is designed to assess children and adolescents

ages four through 18, and the parent or guardian completes the assessment based on their

knowledge of their child (Achenbach, 2013). The reliability and validity of the CBCL fare

favorably, and it is one of the most robust and heavily researched test instruments in the

literature (Doll & Furlong, 1998). The CBCL also demonstrates multicultural robustness, as

evidenced by research conducted in over 30 diverse societies (Rescorla et al., 2007; Ivanova et

al. 2007; Viola, Garrido, & Rescorla 2011). Moreover, clinicians should utilize a culturally-

responsive, gender-affirming, and critical lens when administering the test, especially when

assessing transgender and gender non-conforming youth (Rider et al., 2019). Several subscales

based on items in the CBCL have also been developed to aid clinicians in the diagnosis of

specific disorders, such as bipolar disorder (Papachristou et al., 201) and obsessive-compulsive

disorder (Storch et al., 2006; Geller et al., 2006).

Overview of Content, Scoring, and Norms

The CBCL consists of a behavior problems checklist and a social competency checklist.

The behavior problems portion contains 113 items of various behaviors, such as “argues a lot,”

“cruel to animals,” “bites fingernails,” and “nausea, feels sick” (Achenbach, 2001, p. 3). The

instrument prompts the child’s parent or guardian to judge the child’s exhibition of each behavior

in the past six months on a Likert scale from zero (not true) to two (very true or often true). The

social competency portion of the assessment asks the parent to list aspects of their child’s social

life, including sports, hobbies, clubs, and organizations they take part in, jobs or chores they
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CBCL ANALYSIS
have, relationships with friends and family members, and performance in academic subjects

(Achenbach, 2001). Altogether, the measure takes about 15 to 20 minutes to complete.

Test administrators score the CBCL based on several subscales represented in the test,

including:

(a) three competence scales (Activities, Social, and School); (b) a total competence scale

score; (c) eight syndrome scales (Aggressive Behavior, Attention Problems, Delinquent

Behavior, Social Problems, Somatic Complaints, Thought Problems, Anxious/Depressed,

and Withdrawn); (d) an Internalizing problem scale score; (e) an Externalizing problem

scale score; and (f) a Total problem scale score (Doll & Furlong, 1998, Content and

Scoring section).

Raw scores and their corresponding T scores may be either hand-tallied or scored by computer

programs. Directions for hand-scoring the test can be found in the manual, and it is an extremely

tedious process. Clinicians are encouraged to purchase the computer scoring program to make

for a swifter scoring process (Doll & Furlong, 1998). Twenty of the test items require subjective

scoring, and test administrators should refer to the test manual appendix to determine which

questions require special scoring attention (Doll & Furlong, 1998). Scores are derived from

normative data drawn from a representative sample of 2,368 children in 48 states of the United

States, with respect to ethnicity, SES, and geographical region (Doll & Furlong, 1998). Thus, the

normative data provides clinicians with information to “distinguish between typical children and

those having significant behavioral disturbances” (Doll & Furlong, 1998, para. 1).

Reliability and Validity

The reliability of the CBCL fares favorably for most scales of the test. The internal

consistencies for the Externalizing, Internalizing, and Total Problems scales range from .88
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CBCL ANALYSIS
to .96 for all gender and age groups (Doll & Furlong, 1998). Regarding the syndrome scales, the

internal consistency of the Aggressive subscale is .92, and the Anxious-Depressed and Attention

subscales range from .83 to .88 (Doll and Furlong, 1998). However, the reliability of several

scales proves inadequate, including Thought Problems syndrome scale (lower than .70) and Sex

Problems syndrome scale for ages four to 11 (.54 for girls and .56 for boys) (Doll & Furlong,

1998). The Social Competence scale exhibits an even lower internal consistency ranging

from .57 to .64 across all age and gender groups, and the Activities subscale has an internal

consistency ranging from .42 to .54 (Doll & Furlong, 1998).

According to Doll & Furlong (1998), the validity of the CBCL is difficult to determine

because it is “the standard in the field of child psychopathology against which the validity of

other instruments is often measured” (Validity section). The validity for the CBCL is

demonstrated through its ability to predict clinical diagnoses, referral for services, and poor

social outcomes (Doll & Furlong, 1998). In many aspects, clinicians consider the CBCL to be

“one long validity study, extending from the mid-1960s into the present, deriving an empirically

defensible description of the behaviors that distinguish between children with and without

behavioral disturbances” (Doll & Furlong, 1998, para. 10).

Strengths and Limitations

The CBCL “is unquestionably the most well-articulated and well-established of its kind”

(Doll & Furlong, 1998, Areas of Strength section). Over 1,700 empirical studies have been

conducted about the CBCL by researchers, and it has been translated into 50 different languages.

The materials are user-friendly and cost-effective (Doll & Furlong, 1998). In addition to the

parent-rating form, the CBCL is also a part of a multi-informant assessment, including a parallel
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CBCL ANALYSIS
Youth Self-Report and Teacher Report forms. The availability of these additional forms makes

the CBCL even more reliable (Doll & Furlong, 1998).

On the other hand, there are also several aspects of the test to regard with caution. The

test focuses on the child’s deficiencies, thus, lacking a strengths-based approach (Doll &

Furlong, 1998). Although the Social Competence section of the test attempts to integrate

strengths-based assessment content, it clearly falls short, as demonstrated by its low internal

consistency estimates (Doll & Furlong, 1998). Also, the Social Competence scale seems to

measure social incompetence, rather than social competence, which further demonstrates its

inability to incorporate a strengths-based approach (Doll & Furlong, 1998). Moreover, since the

parent or guardian completes the CBCL, they may not be aware of some of their child’s

behaviors, which poses another limitation of the instrument when used alone. This illuminates

the importance of utilizing the Youth Self-Report and Teacher report forms in conjunction with

the parent reported CBCL.

Multicultural Robustness

Many studies have been conducted to test the CBCL’s multicultural robustness, which is

“established through systematic research demonstrating that an instrument performs similarly

across many societies” (Rescorla et al., 2007, p. 130). One study conducted by Rescorla et al.

(2007), utilized general population samples of children ages six through 16 from 31 diverse

societies (N = 55,508). The societies included in the study include: “12 from Western Europe,

five from Eastern Europe, six from Asia, one from Africa, three from the Middle East, two from

the Caribbean, plus Australia and the United States” (Rescorla et al., 2007, p. 131). The findings

suggest strong support of multicultural robustness in regard to “internal consistency reliability,

mean scale scores across societies, gender and age effects, and mean item scores” (p. 138). One
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CBCL ANALYSIS
limitation of this study is that it only included parent reports. The inclusion of the youth self-

report scales and the teacher report scales would have yielded a higher internal consistency

(Rescorla et al., 2007). Another limitation is that it did not include data from South American

societies.

In a similar study conducted by Ivanova et al. (2007), researchers tested the eight-

syndrome structure of the CBCL in 30 different societies. The results supported the use of the

CBCL in each society, including those in Asia, Africa, Australia, the Caribbean, Eastern Europe,

Western Europe, Southern Europe, Northern Europe, the Middle East, and North America

(Ivanova et al., 2007). Again, this study did not include societies in South America, which poses

a limitation.

Viola, Garrido, and Rescorla (2011) set out to fill this gap in the literature by including a

South American country to further test the CBCL’s multicultural robustness. The sample in this

study included a sample of 1,374 six- to 11-year-olds recruited from 65 schools in Uruguay.

Viola, Garrido, and Rescorla (2011) report that the “mean item ratings, factor structure, internal

consistency of scales, and age, gender, referral status, and SES effects for Uruguayan children

were very consistent with those reported for U.S. children” (p. 907). The results suggest the

multicultural robustness found in Rescorla et al.’s (2007) study also extends to Uruguay. Further

studies should be conducted to test the generalizability to more South American countries.

LGBTQIA+ Concerns

When scoring the CBCL, clinicians must decide whether to score the test using a male or

female scoring template, which poses a dilemma for transgender and gender nonconforming

(TGNC) clients. The templates differ in several aspects, such as the female template

demonstrating higher mean scores in areas of externalizing problems, thought problems,

the other hand, the male template reveals higher mean scores for internalizing problems and

anxious / depressed problems than the female template (Rider et al., 2019). When testing TGNC

clients, clinicians can exercise caution by “scoring both templates, and, on a case-by-case basis,

choose which template is most appropriate” (Rider et al., 2019, p. 298).

Moreover, clinicians must be culturally sensitive and gender-affirming when assessing

TGNC youth. The failure to utilize a culturally-responsive, gender-affirming, and critical lens

can “potentially perpetuate pathologizing of gender identities and expressions” (Rider et al.,

2019, p. 298). For example, parents may indicate that “their child displays strange behaviors and

ideas in reference to their child’s gender non-conformity, which may artificially elevate the

thought problems syndrome scale” (Rider et al., 2019, p. 298).

Another issue pertains to the conflation of birth-assigned sex and gender identity (Rider

et al., 2019). The test requires the parent to state whether the child is male or female, which “may

lead to confusion at best and the perpetuation of microaggressions at worst” for parents of TGNC

youth (Rider et al., 2019, p. 299). Being forced to check the box for either male or female can be

a distressing experience for youth who do not identify as boy nor girl, further stigmatizing

TGNC youth (Rider et al., 2019). Clinicians must carefully consider how to approach this aspect

of the test in a gender-affirming manner, in order to uphold the fundamental ethical principle of

nonmaleficence and exercise cultural sensitivity (APA, 2014).

CBCL Subscales

Several subscales have been developed utilizing items of the CBCL to screen for

disorders such as autism spectrum disorder, bipolar disorder, obsessive-compulsive disorder, and

posttraumatic stress disorder. Researchers create these subscales by independently screening

particular disorders (Papachristou et al., 2013). Two of the scales – Mania Scale and Obsessive-

Compulsive Scale – are discussed below.

Mania Scale

The CBCL-Mania Scale was developed to screen children for bipolar disorder. Nineteen

items from the CBCL were selected for the CBCL-MS, which correspond with DSM criteria for

mania. The items selected include symptoms such as, “gets in many fights,” “sudden changes in

mood or feelings,” “sleeps less than most kids,” “teases a lot,” and “talks too much”

(Papachristou et al., 2013, p. 3). Research suggests a higher score on the CBCL-MS was

predicative of a future diagnosis of bipolar disorder (Papachristou et al., 2013).

Obsessive-Compulsive Scale

Research supports the use of the Obsessive-Compulsive Scale to identify youth with

obsessive-compulsive disorder. The items on the CBCL that comprise the OCS include,

“worries,” “feels he/she might think or do something bad,” “feels too guilty,” “strange ideas,”

can’t get his/her mind off certain thoughts; obsessions,” and “repeats certain acts over and over;

compulsions” (Storch et al., 2006, p. 479). A study by Storch et al. (2006) demonstrated the

OCS’s ability to “successfully discriminated between youth with OCD and those with an

internalizing or externalizing disorder” (p. 482). The data suggest reliability and validity of

predicting the diagnosis of obsessive-compulsive disorder in children, but it would be beneficial

for future studies to examine additional aspects, such as factor structure, inter-parent reliability,

and temporal stability (Storch et al., 2006). Furthermore, the findings in a study conducted by

Geller et al. (2006) support the use of the OCS in identifying youth with OCD. The items in the
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CBCL ANALYSIS
OCS scale had a Cronbach’s α of 0.87, suggesting a good internal consistency (Geller et al.,

2006).

Conclusion

The Child Behavior Checklist is one of the most robust and intensely research

instruments in assessing children and adolescents (Doll & Furlong, 1998). The reliability and

validity of the CBCL fare favorably, and the instrument also demonstrates multicultural

robustness in over 30 diverse societies (Rescorla et al., 2007; Ivanova et al. 2007; Viola, Garrido,

& Rescorla 2011). Moreover, clinicians should utilize a culturally-responsive, gender-affirming,

and critical lens when administering the test, especially when assessing transgender and gender

non-conforming youth (Rider et al., 2019). Several subscales based on items in the CBCL have

also been developed to aid clinicians in the diagnosis of specific disorders, such as bipolar

disorder (Papachristou et al., 201) and obsessive-compulsive disorder (Storch et al., 2006; Geller

et al., 2006). Overall, the CBCL is one of the most utilized instruments in assessing children, and

the favorable reliability and validity demonstrates its success in helping clinicians provide care

for their child clients.

References

Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and the 1991 Profile.

Burlington, VT: University of Vermont Department of Psychiatry.

American Counseling Association. (2014). 2014 ACA code of

ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-

code-of-ethics-finaladdress.pdf

Doll, B. J., & Furlong, M. J. (1998). Child Behavior Checklist. The Thirteenth Mental

Measurements Yearbook.

Geller, D. A., Doyle, R., Shaw, D., Mullin, B., Coffey, B., Petty, C., Vivas, F., & Biederman, J.

(2006). A quick and reliable screening measure for OCD in youth: Reliability and

validity of the obsessive compulsive scale of the Child Behavior

Checklist. Comprehensive Psychiatry, 47(3), 234–240. https://doi-

org.wake.idm.oclc.org/10.1016/j.comppsych.2005.08.005

Ivanova, M. Y., Achenbach, T. M., Dumenci, L., Rescorla, L. A., Almqvist, F., Weintraub, S.,

Bilenberg, N., Bird, H., Chen, W. J., Dobrean, A., Döpfner, M., Erol, N., Fombonne, E.,

Fonseca, A. C., Frigerio, A., Grietens, H., Hannesdóttir, H., Kanbayashi, Y., Lambert,

M., … Verhulst, F. C. (2007). Testing the 8-syndrome structure of the Child Behavior
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Checklist in 30 societies. Journal of Clinical Child and Adolescent Psychology, 36(3),

405–417. https://doi-org.wake.idm.oclc.org/10.1080/15374410701444363

Papachristou, E., Ormel, J., Oldehinkel, A. J., Kyriakopoulos, M., Reinares, M., Reichenberg,

A., & Frangou, S. (2013). Child Behavior Checklist—Mania Scale (CBCL-MS):

Development and evaluation of a population-based screening scale for bipolar

disorder. PLoS ONE, 8(8).

https://doi-org.wake.idm.oclc.org/10.1371/journal.pone.0069459

Rider, G. N., Berg, D., Pardo, S. T., Olson-Kennedy, J., Sharp, C., Tran, K. M., Calvetti, S., &

Keo-Meier, C. L. (2019). Using the Child Behavior Checklist (CBCL) with

transgender/gender nonconforming children and adolescents. Clinical Practice in

Pediatric Psychology, 7(3), 291–301.

https://doi-org.wake.idm.oclc.org/10.1037/cpp0000296

Rescorla, L., Achenbach, T., Ivanova, M. Y., Dumenci, L., Almqvist, F., Bilenberg, N., Bird, H.,

Chen, W., Dobrean, A., Döpfner, M., Erol, N., Fombonne, E., Fonseca, A., Frigerio, A.,

Grietens, H., Hannesdottir, H., Kanbayashi, Y., Lambert, M., Larsson, B., … Verhulst, F.

(2007). Behavioral and emotional problems reported by parents of children ages 6 to 16

in 31 societies. Journal of Emotional and Behavioral Disorders, 15(3), 130–142.

https://doi-org.wake.idm.oclc.org/10.1177/10634266070150030101

Storch, E. A., Murphy, T. K., Bagner, D. M., Johns, N. B., Baumeister, A. L., Goodman, W. K.,

& Geffken, G. R. (2006). Reliability and validity of the Child Behavior Checklist

Obsessive-Compulsive Scale. Journal of Anxiety Disorders, 20(4), 473–485. https://doi-

org.wake.idm.oclc.org/10.1016/j.janxdis.2005.06.002
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Viola, L., Garrido, G., & Rescorla, L. (2011). Testing multicultural robustness of the Child

Behavior Checklist in a national epidemiological sample in Uruguay. Journal of

Abnormal Child Psychology, 39(6), 897–908.

https://doi-org.wake.idm.oclc.org/10.1007/s10802-011-9500-z