CBCL and Caregiver-Teacher Report Form: A Clinical Review

Introduction to Clinical Assessment Instruments

Clinical assessment is a term used to refer to the collection of information and the generation of conclusions in a clinical setting. When conducting a clinical assessment, clinicians use various methods, including observation, neurological tests, psychological tests, and interviews. Information collected through clinical assessment is used to draw conclusions regarding a client's or patient's problem and to identify a suitable way of helping them (Bridley & Daffin Jr., 2018). Clinical assessment is critical in the fields of psychology and mental health, as it is the basis upon which these professionals obtain a clear account of a person's condition and determine which treatment works best.

As a result, clinicians and psychologists employ a variety of clinical assessment instruments. This paper evaluates two such instruments: the Child Behavior Checklist (CBCL) and the Caregiver-Teacher Report Form, both of which are components of the Achenbach System of Empirically Based Assessment (ASEBA).

Overview of CBCL and Caregiver-Teacher Report Form

The Caregiver-Teacher Report Form and the CBCL are clinical assessment instruments used for behavior rating. As behavioral rating scales, they are used for the measurement of a target behavior. According to Bridley & Daffin Jr. (2018), behavioral assessment is carried out within the realm of behavior modification. When conducting this assessment, the target behavior is the specific behavior to be changed. The target behavior can either be in excess—meaning it needs to be reduced—or deficient—meaning it needs to be increased. Behavioral assessment incorporates the evaluation of three key components of behavior: antecedents, behaviors, and consequences. Antecedents refer to the environmental stimuli or events that generate the behavior, behaviors refer to an individual's thoughts, actions, and speech, and consequences refer to the outcome or implications of that behavior.

Both the CBCL and the Caregiver-Teacher Report Form are examples of the Achenbach System of Empirically Based Assessment (ASEBA). This system has gained international interest by influencing the global standard for multi-informant evaluation of emotional, behavioral, and social functioning across different age groups (Kristensen, Henriksen & Bilenberg, 2010). As clinical assessment instruments under ASEBA, both forms are designed to evaluate how children and young people function and behave in different situations across various social settings. They were developed following decades of research and the practical experience of Achenbach and his colleagues. Kristensen, Henriksen & Bilenberg (2010) report that both instruments have been standardized and validated in several countries worldwide.

As instruments under ASEBA, the Caregiver-Teacher Report Form and the CBCL are similarly designed to address an empirical series of emotional, behavioral, and social function problems. Each comprises 100 problem items that serve as the basis for the assessment: 99 closed-ended items and one open-ended item. The open-ended item requests respondents to provide any additional problem items not already listed (Kristensen, Henriksen & Bilenberg, 2010). Because both instruments share the same developmental foundation, they exhibit notable similarities as well as meaningful differences.

Similarities Between the Two Instruments

One of the key similarities between the Caregiver-Teacher Report Form and the CBCL is their design. Both instruments are similarly structured to address a wide range of empirical items relating to emotional, behavioral, and social function problems (Kristensen, Henriksen & Bilenberg, 2010; Liu, Cheng & Leung, 2011). As a result, they are among the few available clinical assessment instruments targeting preschoolers. Given the similarity in their designs, both instruments provide a foundational approach for evaluating childhood behavior problems across different contexts. Insights obtained from these two instruments are used to prevent the development of problem behaviors later in life by identifying concerns during early childhood. Both instruments draw their strengths in behavioral assessment from their inclusion of a wide range of problem items relating to a child's emotional, social, and behavioral development.

A further similarity between the two instruments lies in their problem areas. As noted by Kristensen, Henriksen & Bilenberg (2010), both forms comprise 99 closed-ended and one open-ended problem item. These items are specific to the developmental period of preschool-aged children. Some of the common behaviors and emotions among preschoolers covered in both instruments include defiance, aggression, fears, hyperactivity, and social anxiety. According to a study by Liu, Cheng & Leung (2011), because the two instruments comprise similar problem items, they generate six syndromes for each measure. A factor analysis of both clinical assessment instruments has confirmed their similarity in terms of these six syndromes: Anxious/Depressed, Emotionally Reactive, Attention Problems, Withdrawn, Aggressive Behavior, and Somatic Complaints.

According to Kristensen, Henriksen & Bilenberg (2010), the two instruments are also similar in terms of their scoring structures. The scores for each form are hierarchically organized, which makes it easier for clinicians to generate a formal diagnosis of behavioral, emotional, or social function problems affecting a child aged between 1.5 and 5 years. Since the tests are standardized, the formal diagnoses obtained from the test scores align with the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The diagnostic criteria established by both the Caregiver-Teacher Report Form and the CBCL are therefore consistent with DSM diagnostic categories, as the scales reflect alignment with those categories. Both instruments include items that are consistent with those identified by psychologists and psychiatrists across different cultures, further supporting their alignment with DSM diagnostic categories.

Conclusion

The Caregiver-Teacher Report Form and the CBCL are ASEBA forms of behavioral assessment targeting preschoolers aged between 1.5 and 5 years. These instruments are suitable for the behavioral assessment of this population because they are standardized and incorporate problem items consistent with DSM diagnostic categories. As a result, they are widely recommended for evaluating the behaviors of preschoolers through the use of informants. As noted by Frizzo et al. (2015), both instruments have been adapted into different ethnic and cultural contexts, making them multicultural in scope. Their wide use in evaluating behavior problems in children is largely attributable to this adaptability across different contexts.

However, the use of these instruments is limited in that neither evaluates the extent to which the informant—whether parent or caregiver—contributes to the child's behavior problems. Both instruments rest on the assumption that the insights provided by informants are accurate representations of a child's behavior problems. Clinicians should be mindful of this limitation when interpreting results and consider supplementing these tools with additional assessment methods where appropriate.

Achenbach, T.M. & Ruffle, T.M. (2000). The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatrics in Review, 21(1), 265–271.

Bridley, A. & Daffin Jr., L.W. (2018). Essentials of abnormal psychology (1st ed.). Spokane, WA: Washington State University.

Frizzo, G.B., Pedrini, J.R., de Souza, D.S., Bandeira, D.R. & Borsa, J.C. (2015). Reliability of Child Behavior Checklist and Teacher's Report Form in a sample of Brazilian children. Universitas Psychologica, 14(1), 149–159.

Kristensen, S., Henriksen, T.B. & Bilenberg, N. (2010). The Child Behavior Checklist for ages 1.5–5 (CBCL/1½–5): Assessment and analysis of parent- and caregiver-reported problems in a population-based sample of Danish preschool children. Nordic Journal of Psychiatry, 64(3), 203–209.

Liu, J., Cheng, H. & Leung, P.W.L. (2011). The application of the preschool Child Behavior Checklist and the Caregiver–Teacher Report Form to mainland Chinese children: Syndrome structure, gender differences, country effects, and inter-informant agreement. Journal of Abnormal Child Psychology, 39(2), 251–264.