THE NISONGER CHILD BEHAVIOR RATING FORM
TIQ VERSION (NCBRFTIQ)
PARENT VERSION
Child's Name: __________________________________
Child's Date of Birth: ______ /______ /_______
Rater's Name: __________________________________
Date of Rating: ______ /______ /_______
month
month
day
year
day
year
Relation of Rater to Child: parent [1] other [9]: _______________________________________________
(please specify)
I. Please describe any special circumstances or mediating factors that may have affected the child's behavior in
the recent past (the last month or two) or prevented you from making complete ratings.
II. POSITIVE SOCIAL. Please describe the child's behavior as it was at home over the last month.
Not
True
[0]
Somewhat or
Sometimes True
[1]
Very or
Often True
[2]
4. Initiated positive interactions
5. Participated in group activities
6. Resisted provocation, was tolerant
7. Shared with or helped others
8. Stayed on task
9. Was cheerful or happy
10. Was patient, able to delay
IN THE LAST MONTH, THIS CHILD HAS:
1. Accepted redirection
2. Expressed ideas clearly
3. Followed rules
PAGE 1
Completely or
Always True
[3]
(OVER)
Nisonger CBRFTIQ: Parent
III. PROBLEM BEHAVIOR. For each item that describes the child's behavior as it was over the last month, circle the:
0.... if the behavior did not occur or was not a problem
1.... if the behavior occurred occasionally or was a mild problem
2.... if the behavior occurred quite often or was a moderate problem
3.... if the behavior occurred a lot or was a severe problem
For each problem that occurred, circle only the score that best describes the behavior.
PLEASE DO NOT SKIP ANY QUESTIONS. IF YOU DO NOT KNOW THE ANSWER OR HAVE NOT HAD A CHANCE TO
OBSERVE THE CHILD FOR A GIVEN TIME, CIRCLE THE ZERO.
1. Apathetic or unmotivated ................................... 0 1
2. Argues with parents, teachers, or
other adults .......................................................... 0 1
3. Clings to adults, too dependent ........................... 0 1
4. Cruelty or meanness to others ............................. 0 1
5. Crying, tearful episodes ...................................... 0 1
6. Defiant, challenges adult authority ..................... 0 1
7. Knowingly destroys property ..............................0 1
8. Difficulty concentrating ...................................... 0 1
9. Disobedient ......................................................... 0 1
10. Doesn't feel guilty after misbehaving ............... 0 1
11. Easily distracted ................................................ 0 1
12. Easily frustrated ................................................ 0 1
13. Overly sensitive; feelings easily hurt ................ 0 1
14. Exaggerates abilities or achievements .............. 0 1
15. Explosive, easily angered ..................................0 1
16. Fails to finish things he/she starts ..................... 0 1
17. Feelings easily hurt ........................................... 0 1
18. Feels others are against him/her ........................0 1
19. Feels worthless or inferior ................................ 0 1
20. Fidgets, wiggles, or squirms ..............................0 1
21. Shy around others; bashful ................................0 1
22. Gets in physical fights .......................................0 1
23. Irritable ..............................................................0 1
24. Isolates self from others .................................... 0 1
25. Lying or cheating .............................................. 0 1
26. Nervous or tense ............................................... 0 1
27. Overactive, doesn't sit still ................................ 0 1
28. Overly anxious to please others ........................ 0 1
29. Overly excited, exuberant ................................. 0 1
23
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
30. Physically attacks people ......................................0
31. Refuses to talk ...................................................... 0
32. Restless, high energy level ................................... 0
33. Runs away from adults, teachers, or
other authority figures .......................................... 0
34. Says no one likes him/her .....................................0
35. Secretive, keeps things to self ...............................0
36. Self-conscious or easily embarrassed ................... 0
37. Shifts rapidly from topic to topic
when talking ......................................................... 0
38. Short attention span .............................................. 0
39. Shy or timid behavior ........................................... 0
40. Steals .................................................................... 0
41. Stubborn, has to do things own way .....................0
42. Sudden changes in mood ...................................... 0
43. Sulks, is silent and moody .................................... 0
44. Physically harms or hurts self on
purpose ................................................................. 0
45. Talks back to teacher, parents, or
other adults ........................................................... 0
46. Talks too much or too loud ...................................0
47. Temper tantrums .................................................. 0
48. Threatens people ...................................................0
49. Threatens to harm self .......................................... 0
50. Too fearful or anxious .......................................... 0
51. Underactive, slow ................................................. 0
52. Unhappy or sad .....................................................0
53. Violates rules ........................................................ 0
54. Withdrawn, uninvolved with others ..................... 0
55. Worrying .............................................................. 0
56. Argues with other children or peers ..................... 0
123
123
123
1
1
1
1
2
2
2
2
3
3
3
3
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
123
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
PAGE 2
Developed by M.G. Aman, L. Lecavalier, S. Leone, L. Park, B. Buican, and D. Coury. The Nisonger Center UCEDD, Ohio State
University, Columbus
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THE NISONGER CHILD BEHAVIOR RATING FORM
TIQ VERSION (NCBRFTIQ)
SCORE SHEET
Childs Name: ________________________________
Childs Date of Birth: _____/_____/____
month
Raters Name: ________________________________
year
Date of Rating: _____/_____/____
month
Relation of Rater to Child:
day
day
year
parent [1] other [3] ____________________________________
(please specify)
INSTRUCTIONS. Transcribe the ratings from the Nisonger CBRF and write them into the "rating"
column next to the appropriate item number "#." When all ratings have been transcribed total the
columns to obtain the subscale scores.
SOCIAL
COMPETENCE
Positive
Social
#
1
2
3
4
5
6
7
8
9
10
Total
rating
Overly
Sensitive
#
5
13
17
18
Total
rating
Oppositional
#
2
6
9
15
23
41
42
45
47
Total
rating
PROBLEM
BEHAVIORS
Conduct
HyperProblem
active
#
4
7
10
14
22
25
30
33
40
44
48
49
53
56
Total
D-Total*______
rating
#
20
27
29
32
Total
rating
Inattentive
#
8
11
12
16
37
38
46
Total
rating
ADHD-Total**_____
*D-Total is the composite of Disruptive Behavior Disorder subscales
**ADHD Total is combination of Hyperactivity and Inattention subscale scores
Withdrawn/
Dysphoric
#
1
19
21
24
26
31
34
35
36
39
43
50
51
52
54
55
Total
rating
