Child Behavior Questionnaire

CBCL 4 – 18 (1991)
(T.M. Achenbach, Translated by J. Paulo Almeida)

Nome

Scale filled by (1-Mother; 2-Father; 3-Other): 1 2 3

Date of Birth: ___ / ___ / ___ ___________
1-male; 2-female: 1 2
Years of schooling: ____________ Evaluation date: ___ / ___ / ___
Father's profession: _________________ Mother's profession: ______________

Here is a list of statements that describe children. For each statement that
describe your child NOW or in the LAST 6 MONTHS:
- Mark a cross (x) on the 2 be a affirmation é VERY TRUE or
Frequently true regarding your child;
- Mark an X in 1 if the statement is SOMETIMES TRUE;
- If the statement IS NOT TRUE, mark a cross on 0.
- Please respond to all statements as best as you can, even if some.
sometimes seem not to apply to your child.
- EMPHASIZE ANYTHING THAT CONCERNS YOU.

0 1 2 Acts too childishly for their age

Do you have allergies?
0 1 2

0 1 2 3. Discuss a lot
0 1 2 4. You have asthma

0 1 2 Behaves as if they were of the opposite sex

0 1 2 [Link] your needs outside the bathroom
0 1 2 He shows himself to be vain, boastful
8. Cannot concentrate, cannot pay attention very much
0 1 2
time
9. Unable to drive certain thoughts away from the mind; obsessions or
0 1 2 Christmas (describe):

0 1 2 10. Can't stay seated quietly, is very active or restless.

0 1 2 11. Clings to adults or is very dependent
0 1 2 12. Complains of being very lonely
0 1 2 13. It gets confusing, seems to not know where it is.
0 1 2 Cries a lot
0 1 2 It is cruel to animals
0 1 2 16. Shows cruelty, threatens or is harmful to others
0 1 2 17. Daydreams or gets lost in his thoughts
0 1 2 18. Deliberately harms oneself or has already attempted suicide
0 1 2 Requires a lot of attention
0 1 2 20. Destroys its own things
0 1 2 21. Destroys objects belonging to the family or other children
0 1 2 22. Is disobedient at home
0 1 2 23. Is disobedient at school
0 1 2 24. Does not eat well
0 1 2 25. Does not get along with the other children
0 1 2 26. Does not seem to feel guilty after behaving badly
0 1 2 27. Becomes jealous easily, is envious.
28. Eat or drink things that are not meant to be eaten.
0 1 2
________________________________________________________________
29. Fear of certain animals, situations, or places, without
0 1 2 include a school (describe):

0 1 2 30. Afraid to go to school

0 1 2 31. Are you afraid to think about bad things?
0 1 2 You think it should be perfect
0 1 2 He feels or complains that nobody likes him.
0 1 2 34. Feels that others are chasing him, that they want to catch him off guard
0 1 2 35. Feel worthless, inferior, or despicable
0 1 2 He/she gets hurt a lot, has a tendency for accidents.
0 1 2 Gets into many fights
0 1 2 It is often mocked, they make little of it
0 1 2 You are with children who get into trouble
40. Hears sounds or voices that do not exist

0 1 2
_____________________________________________________________
0 1 2 He is impulsive, acts without thinking.
0 1 2 42. Likes to be alone
0 1 2 43. Lies or cheats
0 1 2 44. Bite your nails
0 1 2 He is nervous, very excited or tense
46. It movements nervous you Tiques (descreva):
0 1 2 ________________________

0 1 2 [Link] nightmares
0 1 2 The other children do not like him.
0 1 2 [Link], obstipation
0 1 2 50. He is too fearful or anxious.
0 1 2 51. Feels dizzy
0 1 2 Feel excessively guilty
0 1 2 53. Like the others
0 1 2 Tires too much
0 1 2 55. It weighs extra
56. Has physical problems with no known medical cause:
0 1 2 pains
0 1 2 headaches
0 1 2 c) nausea, feels nauseous
d) problems com a view (descreva):
0 1 2
_____________________________________
0 1 2 e) blisters or other skin problems
0 1 2 stomach pains
0 1 2 g) vomiting
h) others problems (describe):
0 1 2
__________________________________________
0 1 2 Physically attack other people

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0 1 2 58. Takes things out of the nose, scratches the skin or other parts of the body
0 1 2 59. Moves or plays with their sexual organs in public
0 1 2 60. Moves or plays too much with their sexual organs
0 1 2 61. Your school work is weak
0 1 2 62. He is clumsy, awkward, or lacks coordination.
0 1 2 Prefers to play with older children
0 1 2 64. Prefers to play with younger children
0 1 2 65. Refuses to speak
66. Repeats the same actions or gestures several times; compulsions
0 1 2 (describe):

0 1 2 67. He/She has already run away from home.

0 1 2 Shout a lot
0 1 2 69. He is reserved, keeps things to himself.
0 1 2 70. Sees things that do not exist, that are not present
0 1 2 72. Provokes fires
73. You problems sexual (describe):
0 1 2

0 1 2 He/she likes to "show off", to act silly.

0 1 2 75. Is he shy or embarrassed
0 1 2 Sleeps less than most children
Sleeps more than most children, during the day and/or during
0 1 2 a night (describe):

0 1 2 Gets dirty or plays with feces

[Link] language problems or articulation difficulties
0 1 2
____________________________________________________________
0 1 2 80. Staring blankly, without expression
0 1 2 81. Steal things at home
0 1 2 82. Steal things outside the house
83. Keeps and collects things that are not needed
0 1 2
____________________________________________________________
84. Has strange behaviors
0 1 2
____________________________________________________________
85. Tem ideas strange No text to translate.
0 1 2

0 1 2 He is stubborn, bad-tempered, or irritable.

0 1 2 87. Have sudden changes in mood or feelings
0 1 2 88. To love a lot
0 1 2 89. He is distrustful
0 1 2 Uses profanity or has obscene language
0 1 2 [Link] about killing oneself

[Link] or walks during sleep

0 1 2
(describe): ____________________________________________________________
0 1 2 Talks too much
0 1 2 94. It's very annoying, it makes a lot of mockery.
0 1 2 Has temper tantrums, exalted temperament
0 1 2 Thinks too much about sex
0 1 2 Threatens people
0 1 2 98. Booger on the finger
0 1 2 99. Worries too much about cleanliness and tidiness
100. You difficulties in me to sleep (describe):
0 1 2 ______________________________

0 1 2 [Link] from school for trivial reasons, skips school

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0 1 2 He is not very active, moves slowly, lacks energy.
0 1 2 103. Unhappy, sad or depressed
0 1 2 104. It is noisy, speaks unusually loudly
105. Consume alcohol or drugs (describe):
0 1 2
________________________________
0 1 2 Commits acts of vandalism
0 1 2 107. One urinates during the day
0 1 2 108. Bedwetting
0 1 2 You are always whining
0 1 2 110. I wished to be of the opposite sex
111. Introverted, does not mix or establish relationships with others (isolates-
0 1 2
se)
0 1 2 112. He is worried
113. Please indicate other problems of your child that have not been addressed.

referred to above:
0 1 2
0 1 2 _______________________________________________________________________

I. Please list your child's favorite sports. For example: swimming, soccer,
patinagem,skate, andar de bicicleta, pesca, etc.
Compared to other children of the same age, how much time does it approximately take?
to practice each one? (NS - I don't know; 0 - Below average; 1 - Average; 2 - Above average).
Compared to other children of the same age, to what extent are you able to succeed?
in each one? (NS - I don't know; 0 - Below average; 1 - Average; 2 - Above average).

time to do well
a. NS 0 1 2 NS 0 1 2
b. NS 0 1 2 NS 0 1 2
c. NS 0 1 2 NS 0 1 2

II. Please list the favorite hobbies, activities and games of your child that do not
they are sports. For example: stamps, dolls, books, piano, crafts, singing, etc.
(Do not include listening to the radio or watching television).

Compared to other children of the same age, how much time does it approximately take?
practice each one? (NS - Not sure; 0 - Below average; 1 - Average; 2 - Above average).

Compared to other children of the same age, to what extent are you able to excel in each?
Um?
(NS - I don't know; 0 - Below average; 1 - Average; 2 - Above average)

time to do well
a. NS 0 1 2 NS 0 1 2
b. NS 0 1 2 NS 0 1 2
c. NS 0 1 2 NS 0 1 2

III. Please list any organizations, clubs, teams, or groups that your child is part of.
belonging.
Compared to other children of the same age, how active is each of them?
(NS - I don't know; 0 - Below average; 1 - Average; 2 - Above average).

a. NS 0 1 2
b. NS 0 1 2

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 c. NS 0 1 2

IV. Please list any jobs or tasks of your child. For example: washing the...
dishes, taking care of children, making the bed, etc. (including both paid and unpaid work)
payments
In comparison with other children of the same age, to what degree is he/she active in each one?

(NS - I don't know; 0 - Below average; 1 - Average; 2 - Above average).

a. NS 0 1 2
b. NS 0 1 2
c. NS 0 1 2

V.
How many close friends does your child have approximately? Do not include
brothers or sisters.
none ___ a friend two or three friends four or more

2. Does your child have activities with friends outside of class hours?
approximately how many times a week? Do not include brothers and sisters.
___ less than once a week ___ once or twice a week ___ three or more times

VI. In comparison with other children of your age, to what extent:

(respond as follows: 0 – worst; 1 – close to average; 2 – better)

a. Can you relate appropriately to your brothers and sisters? 0 1 2

b. Can you relate appropriately to other children? 0 1 2
c. Can he/she behave appropriately towards the parents? 0 1 2
d. Can you have fun and work for yourself? 0 1 2

VII.
1. For children aged 6 or older - performance in school subjects (If the
child does not go to school, indicate the reasons:
Mouse results

a. Portuguese 0 1 2 3
b. French or English 0 1 2 3
c. Mathematics 0 1 2 3
d. History 0 1 2 3

Other school subjects – for example: Physical-Chemistry, Biology, Geography, Education

Visual.

e. 0 1 2 3
f. 0 1 2 3
g. 0 1 2 3

Does your child attend any special education institution or class?

___ No ___ Sim What type of establishment or class?

Has your son/daughter repeated any year?

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 No ___ Yes (Which and why? ___________________________________________________________
)
4. Did your son/daughter have any problems at school, in learning or otherwise?
___ No ___ Yes What type of problem?

When they started these problems?

The mentioned problems yes are they done?

Does your child have any illness, physical or mental disability?

___ No ___ Sim (Describe it) for favor