Table 1.
0 = Not True (as far as you know) | |||
---|---|---|---|
1 = Somewhat or Sometimes True | |||
2 = Very True or Often True | |||
0 | 1 | 2 | 1. Feels dizzy |
0 | 1 | 2 | 2. Overtired |
3. Physical problems without known medical cause: | |||
0 | 1 | 2 | a. Aches or pains (not stomach or headaches) |
0 | 1 | 2 | b. Headaches |
0 | 1 | 2 | c. Nausea, feels sick |
0 | 1 | 2 | d. Problems with eyes (not if corrected by glasses)
(describe): ____________________ |
0 | 1 | 2 | e. Rashes or other skin problems |
0 | 1 | 2 | f. Stomach aches or cramps |
0 | 1 | 2 | g. Vomiting, throwing up |
Reproduced by permission from Achenbach, T. M. (1991). Manual for the Child Behavior Checklist /4–18 and 1991 Profile. Burlington, Vt: University of Vermont Department of Psychiatry.