The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies.

1. Thomas M. Achenbach, PhD* 2. Thomas M. Ruffle, MD†

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2. *Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT.

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4. †Vermont Child Development Clinic, Burlington, VT.

After completing this article, readers should be able to:

1. List the types of behavioral and emotional problems that primary care physicians who work with children must address.

2. Describe the data required from parents, children, teachers, and child care practitioners for assessment of behavioral and emotional problems.

3. Describe systems of questionnaires that can be used for obtaining standardized assessment data.

Primary care physicians who work with children must deal with a great variety of behavioral and emotional problems. The system described in this article provides low-cost, standardized assessment and documentation of such problems and requires little effort by the physician.

Primary care physicians are under increasing pressure to obtain standardized documentation for the conditions they encounter. The most obvious pressures stem from managed care. Among the most frequently imposed expectations of primary care physicians are to: Be gatekeepers for most forms of care needed by patients. Offer increasingly diverse services to more patients while limiting the time spent with each patient. Provide extensive documentation for assessments of patients and for treatment and referral. To fulfill these expectations, physicians need cost-effective procedures for obtaining, using, and transmitting information about patients.

Children’s behavioral and emotional problems pose special challenges for meeting such managed care requirements. Certain types of behavioral problems, such as those ascribed to attention deficit hyperactivity disorder (ADHD), are widely publicized as candidates for medical management. Concerned parents, therefore, may request that pediatricians and family practitioners evaluate their children for ADHD. To assess ADHD and other behavioral and emotional problems, physicians need information from people who see children in their everyday contexts. Parents and parent-surrogates are the primary sources of such information for most children. Older children can contribute useful information about their own functioning. Teachers are especially important sources of information when children’s functioning in school is relevant, such as …