CBCL/1.

5-5 - Syndrome Scale Scores

ID: Testing Profiles - Anna maria Gender: F Date Filled: 2018-05-03 Clinician: Masha ivanova Informant: Daniela Fernandez Society: ASEBA Standard
Name: Anna Fernandez Age: 1 Birth Date: 2016-08-08 Agency: Burlington agency Relationship: Mother Verified: Yes

Internalizing Externalizing
100
Clinical

90

80
T

70
65

59
Normal

60
56
52 53
50 51
50
Emotionally Aggressive
Anxious / Depressed Somatic Complaints Withdrawn Sleep Problems Attention Problems
Reactive Behavior
Raw Score (Sum) 6 3 1 2 3 2 16
T Score 65-B 52 50 56 53 51 59
Percentile 93 58 <=50 73 62 54 81
1 21.DistChange 0 10.Dependent 0 1.AchesPains 0 2.ActsYoung 0 22.NotSleepAlone 0 5.Concentrate 1 8.Can'tWait
0 46.Twitching 1 33.FeelingsHurt 0 7.ThingsOut 1 4.AvoidsEye 1 38.SleepProb 1 6.Can'tSitStill 1 15.Defiant
1 16.Demanding
0 51.ShowsPanic 0 37.UpsetBySep 0 12.Constipated 1 23.NoAnswer 1 48.Nightmares 0 56.Clumsy
0 18.DestroyOther
0 79.RapidShifts 1 43.LookUnhappy 0 19.Diarrhea 0 62.RefusesActive 1 64.ResistsBed 1 59.ShiftsQuickly 1 20.Disobedient
1 82.MoodChang 0 47.Nervous 1 24.NotEat 0 67.UnrespAffect 0 74.SleepLess 0 95.Wanders 1 27.NoGuilt
1 83.Sulks 0 68.SelfConscious 0 39.Headaches 0 70.LittleAffect 0 84.TalkInSleep 1 29.Frustrated
1 35.Fights
1 92.UpsetByNew 0 87.Fearful 0 45.Nausea 0 71.LittleInterest 0 94.WakesOften
1 40.HitsOthers
1 97.Whining 1 90.Sad 0 52.PainfulBM 0 98.Withdrawn
1 42.HurtAccident
1 99.Worries 0 78.Stomachaches 1 44.AngryMoods
0 86.TooNeat 0 53.Attacks
0 93.Vomiting 1 58.Punishment
1 66.Screams
1 69.Selfish
1 81.Stubborn
1 85.Temper
1 88.Uncooperative
0 96.WantAttention

B = Borderline clinical range; C = Clinical range; Broken Lines = Borderline clinical range Printed by: ASEBA\asebatech2

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 CBCL/1.5-5 - Internalizing, Externalizing, Total Problems, Stress Problems, and Other Problems
ID: Testing Profiles - Anna maria Gender: F Date Filled: 2018-05-03 Clinician: Masha ivanova Informant: Daniela Fernandez Society: ASEBA Standard
Name: Anna Fernandez Age: 1 Birth Date: 2016-08-08 Agency: Burlington agency Relationship: Mother Verified: Yes

100 100
Other Problems
Clinical

Clinical
1 3.AfraidOfNew 1 54.PicksSkin
90 1 9.ChewNonFood 0 55.SexParts 90
0 11.SeeksHelp 0 57.EyeProb
1 13.Cries 0 60.SkinProb
80 1 14.CruelAnimal 1 61.Won'tEat 80
1 17.DestroyOwn 0 63.RocksHead
1 25.NotGetAlong 0 65.ResistToilet
T

T
70 0 26.NoFun 0 72.LittleFear 70
0 28.OutofHome 1 73.Shy
1 30.Jealous 0 75.SmearsBM
0 31.EatNonFood 0 76.SpeechProb
60 58 58 60 58
57 1 32.Fears 0 77.Stares
Normal

Normal
0 34.GetsHurt 0 80.StrangeBehav
1 36.GetIntoThings 0 89.Underactive
50 50
Internalizing Externalizing 0 41.HoldsBreath 0 91.Loud
Total Problems Stress Problems
Problems Problems 0 49.Overeating - 100.OtherProb
0 50.Overtired
Raw Score (Sum) 12 18 45 Raw Score (Sum) 3
T Score 58 57 58 T Score 58
Percentile 79 76 79 Percentile 79
0 5.Concentrate
0 45.Nausea
B = Borderline clinical range; C = Clinical range; Broken Lines = Borderline clinical range
0 47.Nervous
0 78.Stomachaches
1 81.Stubborn
Printed by: ASEBA\asebatech2 1 82.MoodChang
1 90.Sad

Copyright 2018 T.M. Achenbach ASEBA, University of Vermont 1 South Prospect St. Burlington, VT 05401-3456 www.ASEBA.org Page 2/5
 CBCL/1.5-5 - DSM-Oriented Scales
ID: Testing Profiles - Anna maria Gender: F Date Filled: 2018-05-03 Clinician: Masha ivanova Informant: Daniela Fernandez Society: ASEBA Standard
Name: Anna Fernandez Age: 1 Birth Date: 2016-08-08 Agency: Burlington agency Relationship: Mother Verified: Yes

100
Printed by:
Clinical

ASEBA\asebatech2
90

80
T

70
63
61
59
Normal

60

51 52
50
Autism Spectrum Attention Deficit / Oppositional Defiant
Depressive Problems Anxiety Problems
Problems Hyperactivity Problems Problems
Raw Score (Sum) 5 3 5 5 6
T Score 63 51 61 52 59
Percentile 90 54 87 58 81
1 13.Cries 0 10.Dependent 1 4.AvoidsEye 0 5.Concentrate 1 15.Defiant
1 24.NotEat 0 22.NotSleepAlone 0 7.ThingsOut 1 6.Can'tSitStill 1 20.Disobedient B = Borderline clinical
1 38.SleepProb 0 28.OutofHome 1 21.DistChange 1 8.Can'tWait 1 44.AngryMoods range; C = Clinical range;
1 43.LookUnhappy 1 32.Fears 1 23.NoAnswer 1 16.Demanding 1 81.Stubborn Broken Lines = Borderline
0 49.Overeating 0 37.UpsetBySep 1 25.NotGetAlong 1 36.GetIntoThings 1 85.Temper clinical range
0 50.Overtired 0 47.Nervous 0 63.RocksHead 1 59.ShiftsQuickly 1 88.Uncooperative
0 71.LittleInterest 1 48.Nightmares 0 67.UnrespAffect
0 74.SleepLess 0 51.ShowsPanic 0 70.LittleAffect
0 89.Underactive 0 87.Fearful 0 76.SpeechProb
1 90.Sad 1 99.Worries 0 80.StrangeBehav
1 92.UpsetByNew
0 98.Withdrawn

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 CBCL/1.5-5 - Language Development Survey for Ages 18-35 Months
ID: Testing Profiles - Anna maria Gender: F Date Filled: 2018-05-03 Clinician: Masha ivanova Informant: Daniela Fernandez Society: ASEBA Standard
Name: Anna Fernandez Age: 1 Birth Date: 2016-08-08 Agency: Burlington agency Relationship: Mother Verified: Yes

Printed by: ASEBA\asebatech2

I.Born Early No V.Delayed Speech in family No
II.Birth Weight 6 VI.Worried about development No
III.Ear Infection 6-8 VII.Says words spontaneously Yes - Please
IV.Non-English spoken Yes VIII.Combines Words Yes

Average Length Of Phrases: 2.8 Vocabulary Score: 114

Average Length Of Phrases Vocabulary Score

Average Length of Phrases displayed only for ages Vocabulary Score displayed only for ages 18-23 months, 24-29
24-29 months and 30-35 months. months, and 30-35 months.
80 85
75 80
70 75
70
65
65
60 60
60
55 55
50 50
45 45
40 40
35
35
30
30 25
25 20
20 15
24-29 months 30-35 months 18-23 months 24-29 months 30-35 months

Avg. Length Total Words 114

Percentile Percentile 60

Scores <= 20th percentile suggest delayed phrase development Scores <= 15th percentile suggest delayed phrase development

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 CBCL 1.5-5 - Narrative Report And Critical Items
ID: Testing Date Filled: 2018-05-03
Name: Anna Fernandez Clinician: Masha ivanova
Gender: F Informant: Daniela Fernandez
Age: 1 Relationship: Mother
Birth Date: 2016-08-08 Printed by: ASEBA\asebatech2 Agency: Burlington agency

The Child Behavior Checklist for Ages 1 1/2-5 (CBCL 1.5-5) was completed by Daniela Fernandez, Anna's mother, to obtain her
perception of Anna's problems.

On the CBCL 1.5-5 problem scales, Anna's Internalizing Problems, Externalizing Problems, Total Problems and Stress Problems
scores were all in the normal range for girls aged 1. Her scores on the Anxious / Depressed, Somatic Complaints, Withdrawn,
Sleep Problems, Attention Problems and Aggressive Behavior syndromes were in the normal range. Her score on the Emotionally
Reactive syndrome was in the borderline clinical range (93rd to 97th percentile). These results indicate that Daniela Fernandez,
Anna's mother reported more problems than are typically reported for girls aged 1, particularly problems of Emotionally Reactive
nature.

On the CBCL/1.5-5 - DSM-Oriented Scales, Anna's scores on all rated scales were in the normal range.

On the CBCL/1.5-5 - Language Development Survey for Ages 18-35 Months, Anna's Vocabulary score for 18-23 months was at
the 60th percentile, which suggests normal vocabulary development for children aged 18-23 months.

Copyright 2018 T.M. Achenbach ASEBA, University of Vermont 1 South Prospect St. Burlington, VT 05401-3456 www.ASEBA.org Page 5/5