Psychologist Thomas Achenbach developed a series of questionnaires that evaluate children's behavioral and emotional functioning, social problems and competencies. The most commonly used questionnaire, the Child Behavior Check List, CBCL, is used for children ages six to 18. Teachers or parents rate the child, or the child rates himself, and several standardized scores are calculated that identify if the child manifests clinically significant problems. Versions of the CBCL are also available for children ages 1.5 to five years, for youth between the ages of 11 and 18 and for young adults ages 18 to 30. The varied forms of these questionnaires list 100 to 113 problem behaviors.
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The CBCL and its variants are widely used around the world for clinical and research purposes and have been translated into over 75 languages. They have been used in over 6,000 professional publications and are considered to be valid and reliable indicators of children's behavioral and emotional functioning. One of the useful features of the CBCL questionnaires and their scoring system is they allow for the comparison of ratings by different observers, such as mother, father, teacher and child.
Just under one-third of the CBCL questions evaluate internalizing behavior: behaviors where children direct emotions and feelings inward. Three kinds of internalizing behaviors measured by the CBCL include somatic complaints, anxious/depressed behavior and withdrawn behavior. Somatic problems include feeling tired, aches, nausea, vomiting, headaches, dizziness and complaints about skin, stomach or eye problems. Children with significant medical issues, including for example, lung disease, tend to score high on the internalizing subscale and particularly on the somatic problems subscale of the CBCL, reports PsychosomaticMedicine.org. Withdrawn behaviors are addressed by questions regarding social withdrawal, shyness, staring, sulking and sadness. Problems with anxiety/depression are identified by questions regarding crying, fear, loneliness, nervousness, worthlessness, suspiciousness, guilt, fear and worries. Children who obtain clinically high scores on the anxious/depressed scale are likely to have depression or anxiety disorders, notes the Archives of Disease in Childhood.
Some children tend to direct emotional problems outward which manifests as aggressive or delinquent behavior. These are considered externalizing behaviors. Delinquent externalizing behaviors assessed by the CBCL include cheating, lying, setting fires, swearing, truancy, stealing and vandalism. The CBCL assesses several types of aggressive behaviors, including bragging, arguing, screaming, showing off, attention-seeking, teasing, being demanding, threatening behavior and displaying a temper. Children who obtain high scores on the externalizing behavior subscale of the CBCL tend to be diagnosed with conduct disorder or oppositional defiant disorder as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV.
Social, Attention and Thought Problems
Achenbach's CBCL also assesses social, thought and attention problems. Social problems include acting young, being clingy, not getting along with peers, clumsiness and preferring to play with younger children. Thought problems include seeing or hearing things, repeating acts and strange ideas and behavior. Children displaying these problems may have thought disorders such as schizophrenia or may have obsessive compulsive disorder. The CBCL assesses attention problems potentially indicative of the DSM-IV diagnosis of attention deficit hyperactivity disorder, including concentration difficulties, problems sitting still, impulsivity, day dreaming, nervousness and poor performance in school.
Additional Problem Behaviors
The CBCL also assesses several other behavioral problems, such as sleep problems, eating problems, accidents and talking about suicide. Additional problems assessed include nail-biting, whining, speech problems, sexual problems, picking at skin and more. These behavioral problems may not indicate any specific diagnosis but can be symptomatic of a variety of psychiatric, behavioral or emotional maladies, including developmental or emotional disorders.
Although considered useful as a screening and research tool, the CBCL does not substitute a proper evaluation and diagnosis by a trained clinician.