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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 childre...
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Niels Bilenberg
University of Southern Denmark
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Kristensen S, Henriksen TB, Bilenberg N. 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. Nord J Psychiatry 2010;64:203-209.
Background: Psychometric instruments are used increasingly within research and clinical settings,
and therefore standardization has become an important prerequisite, even for investigating very
young children. Currently, there are no standardized psychometric instruments available for assess-
ment of preschool children in Denmark. Aims: The aim was to achieve Danish national norm scores
For personal use only.
for the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the Caregiver Report Form
(C-TRF). Methods: The study was based on an age- and gender-stratified cohort sample of 1750
children aged 1½–5 years born at Aarhus University Hospital, Denmark. The CBCL/1½–5 and
C-TRF were mailed to parents, who were asked to pass on the C-TRF to the preschool care-
giver. The national standard register data gave access to information on socio-economic status,
family type, ethnicity and parental educational level for analysis of participation and representa-
tion. Results: A total number of 850 (49%) families replied, and 624 caregivers replied. The mean
Total Problem Score (TPS) with 95% confidence interval was 17.3 (16.3–18.3) for parents’ reports.
Age-and gender-specific scale score findings for Danish preschoolers and schoolchildren were compa-
rable. No differences were found in the mean TPS within subgroups related to parental socio-demo-
graphic features. Conclusion: On the basis of a large sample, Danish national norm scores and
profiles of the ASEBA Preschool Forms were established; the scores of descendents must, however,
be assessed with some caution. With this reservation, the CBCL/1½–5 and C-TRF forms are now
available in Danish and can be recommended for use in clinical and research settings.
• CBCL 1½–5, Epidemiology, Normative data, Preschool Child, Psychometrics.
Solvejg Kristensen, Department of Child and Adolescent Psychiatry, Research unit, University of
Southern Denmark, 5000 Odense C, Denmark, E-mail: solkri@rm.dk; Accepted 29 October 2009.
© 2010 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As) DOI: 10.3109/08039480903456595
S. KRISTENSEN ET AL.
In 2000, the ASEBA Preschool Forms & Profiles was The CBCL/1½–5 requests supplementary information
introduced. It includes a Parent Report Form (Child Behav- about the health of the child. The C-TRF requests informa-
ior Checklist for Ages 1.5–5; CBCL/1½–5), a Caregiver- tion about kind of day care and the role of the respondent
Teacher Report Form (C-TRF) and a Language Development in relation to the child, including how well the respon-
Survey (LDS). It is an extension of the former CBCL/2–3 dent knows the child and in which context the child is
based on the CBCL/4–18 (6, 22). The CBCL/2–3 has been evaluated.
used to assess substantial samples in the Netherlands,
Finland, Iceland, Canada and the USA (23, 24). Scores and scales on CBCL and C-TRF
In Denmark, the CBCL/4–16 was tested and standard- Scores on the Preschool Forms are hierarchically ordered.
ized in 1999 (7). It is now used for assessment and detec- According to the American standardization, the lowest level
tion of early signs of psychopathology within clinical comprises the 100 problem items, and each item is scored
settings, quality assessment and as outcome measure of 0–1–2 on specific aspects of behavioural, emotional and
child behaviour in epidemiological studies (25, 26). For
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discussion, according to agreement with Achenbach & DSM-Oriented Scales were described by mean, standard
Rescorla (6). deviation (s) and 95% confidence intervals (95% CI). Inter-
nal consistency of the scales was analysed using Cronbach
Other data sources alpha (α).
All persons living in Denmark are registered according to Analyses of participation and representation were carried
numerous variables via the unique Danish personal iden- out using chi-square tests and t-tests. Analyses of parental
tification number (CPR) in the Danish Civil Registration educational level, attachment to the labour market and age
System (CRS). At the time of the study, the CPR gave were performed for mothers and fathers separately, whereas
access to information on: status of parental education and analysis of family type was performed related to the child.
occupation, family structure, and both parents’ age and Comparisons across age, gender, demographic factors
native country. and scale scores were made using non-parametric statis-
Information from the CRS was obtained for the moth- tical tests (Mann–Whitney and Kruskal–Wallis). The level
ers and fathers of the 1750 possible participants and for of two-sided statistical significance was set at P⬍0.05.
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Results from the analysis of representation showed that The 12 participating descendents had a mean TPS of
in the study sample both mothers and fathers more fre- 35.6 (19.9–51.3), whereas it was 16.8 (15.8–17.7) for the
quently had more than 13 years of education (longer pro- 828 non-descendents.
fessional education or university degree), P⬍0.01. Also, Boys obtained a significantly higher mean TPS than
in the study sample, the fathers were more frequently girls, according to caregivers P⬍0.01. The mean TPS
not attached to the labour market than in the background was higher among the youngest children of 1½–2 years
population, P⬍0.01. than among 3–5-year-olds; the difference was statistically
Results from the analysis of attrition showed that in significant for caregiver ratings only, P⫽0.02.
non-responding families (n⫽850) both fathers and mothers The Internalising Scale comprises problems like emotional
were more frequently not attached to the labour marked, reactivity, anxiety/depression, somatic complaints without
P⬍0.05, than in responding families (n⫽900). medical cause and withdrawal from social contacts. The
Extensive investigation of the characteristics of a sub- Externalising Scale comprises problems that mainly involve
sample of n⫽300 of the 2004 sample showed that non- conflicts with other people, and with their expectations
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participation was associated with parental self-reported of the child, such as attention problems and aggressive
attitudes towards ethical issues related to CBCL/1½–5, behaviour.
and to poor parental knowledge about child well-being Mean scale scores on the TPS, and the Internalising
and behaviour in general (27). and Externalising Scales for both checklists are presented
in Tables 1 and 2, also showing gender- and age-strati-
Mean scores on the Total Problem Scale and the fied scale scores. No statistically significant differences
Internalising and Externalising Scales were found in any of the investigated age or gender
The TPS is one of the main outcomes in the literature mean Internalising scale scores.
regarding ASEBA Forms. The distribution of scores on the Parents rated externalizing problem behaviour higher
TPS showed practically identical patterns for parents and than caregivers, P⬍0.01. Boys’ externalizing behaviour
caregivers, illustrated in Fig
Fig.1. was scored higher than girls’ by caregivers, P⫽0.01.
Mean Externalising Scale scores were statistically higher
For personal use only.
Fig. 1. Distribution of scores on the Total Problem Scale (TPS) for Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the
Caregiver-Teacher Report Form (C-TRF).
Table 1. Gender-stratified scale scores for the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the Caregiver-Teacher Report
Form (C-TRF).
P⫽0.51
Girls 426 4.0 3.3 3.5–4.5 0.89
C-TRF Boys and girls 624 4.2 5.6 3.8–4.7 – 0.88
Boys 308 4.6 5.6 4.0–5.3 0.87
P⫽0.08
Girls 316 3.8 5.5 3.2–4.4 0.89
Externalising Scale scores
CBCL/1½–5 Boys and girls 850 6.7 6.0 6.3–7.1 – 0.89
Boys 424 6.8 6.1 6.3–7.4 0.89
P⫽0.42
Girls 426 6.5 5.8 5.9–7.1 0.88
C-TRF Boys and girls 624 4.8 6.1 4.3–5.3 – 0.90
Boys 308 5.8 6.6 4.7–6.2 0.91
P⫽0.01
Girls 316 4.2 5.6 3.6–4.8 0.90
clinician concerning the degree of psychopathology and In this Danish study, the CBCL for Ages 1½–5 was
the successful treatment. completed by parents of 850 children and by caregivers
Table 3 shows Danish figures of parent- and care- of 624 children, giving a parental participation rate of
giver-reported DSM-Oriented Mean Scale scores. 49%. A similarly low participation rate among parents of
preschool-aged children has previously been found on
Iceland using the former CBCL version for 2–3-year-old
Discussion children (10).
Assessment of the preschool child generally involves The analysis of representation, comparing the sample
variations in behaviour displayed by most children to of the 1750 children to a matched sample of the Danish
some extent during their development. The behavioural background population using socio-demographic vari-
and emotional problems vary in severity and duration, ables, shows possible selection bias regarding parental
and may also be more prevalent in specific settings. occupational and educational status. However, because
Although we do not know at present how predictive no significant differences were found in the mean TPS
parent- and caregiver-reported problems are for psy- across these variables, as published in a recent paper
chopathology later in life, it is still vital to identify and comparing features of responders and non-responders
offer early and adequate help to preschool children (27), we consider the possible selection bias of minor
presenting problems of concern, as both the child, importance, but we want to emphasize that further stud-
its parents, siblings and caregivers may suffer consider- ies to validate the Danish norm scores are planned.
able distress, and secondary problems may arise as a The present study is the first publication on national
consequence. norms of the CBCL/1½–5 and C-TRF from outside the
Psychometric instruments facilitate early identification USA. The study design offers some possibility of com-
of problem behaviour in the preschool child. The CBCL parison with American scores, although different ways of
for Ages 1½–5 provides a structured overview of behav- sampling were used to achieve the national norms
iour, social and emotional function. Generally speaking, scores.
psychometric instruments for use in clinical work and in Mean TPS was 17.3 (16.3–18.3). Both parents and
research should balance the following demands: reliable caregivers rated declining TPS with increasing age. This
and valid data collection, and feasibility for families and trend has also been found in the USA, both for pre-
caregivers, ensuring a sufficiently high representative school and school-aged children, and for Danish school-
cooperation and participation. aged children (4, 6, 7). No differences were found in the
Table 2. Age-stratified scale scores for Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the Caregiver-Teacher Report Form
(C-TRF).
P⫽0.86
3–5 374 4.2 5.7 3.7–4.8
Externalising Scale scores
CBCL/1½–5 1½–2 353 7.8 5.5 7.2–8.3
P⬍0.01
3–5 497 5.9 6.1 5.4–6.5
C-TRF 1½–2 250 5.9 6.3 5.1–6.7
P⬍0.01
3–5 374 4.1 5.9 3.5–4.7
TPS related to parental age, educational status, occupa- children, which is parallel to findings of the younger
tion or family type. Boys had a significantly higher mean groups of Danish school-aged children and the younger
TPS than girls according to the ratings of caregivers; this groups of American children who scored higher than the
is equivalent to the findings in the American norm scores older groups of children (4, 6, 7).
For personal use only.
(4, 6). According to parents’ rating, boys also had a slightly The mean TPS of descendents was twice as high as
higher mean TPS than girls. This finding was not statis- for non-descendents; however, the number of participating
tically significant, though it may have clinical relevance. descendents was very low and the result must be interpreted
Comparison of national norm scores is not included in and used with great caution.
this paper. A large cross-cultural comparison study of In a recent cross-national comparison of national
ASEBA preschool data, where Danish data are included is mean TPS scores obtained using the school age version
in preparation. Danish national ASEBA preschool norm of the CBCL, the Danish national norm score was in the
scores are significantly lower than the established American lower third of the 31 countries investigated (20). Thus it
norm scores, which also was the case for school age remains uncertain whether the differences found are
children (20). related to true cultural differences, i.e. whether they
A higher mean TPS was found for the youngest chil- reflect more problem behaviour among descendents, or
dren of 1½–2 years than among the older 3–5-year-old whether they reflect differences in how informants
Table 3. DSM-oriented scale scores for Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the Caregiver-Teacher Report
Form (C-TRF).
(parents) perceive and rate children. In one culture, a Checklist—An analysis of a clinical and field sample. Z Kinder
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