The translation and cultural adaptation of the Child Behavior Checklist for use in Israel (Hebrew), Korea, the US (Spanish), India (Malayalam and Kannada), and Spain

Diane Wild,¹ Tamzin Furtado,¹ Mallik Angalakuditi^2
1Oxford Outcomes, Oxford, UK; ²Eisai Inc., Woodcliff Lake, NJ, USA

Background: The Child Behavior Checklist (CBCL) is a caregiver rating scale for assessing the behavioral profile of children. It was developed in the US, and has been extensively translated and used in a large number of studies internationally.
Objective: The objective of this study was to translate the CBCL into six languages using a rigorous translation methodology, placing particular emphasis on cultural adaptation and ensuring that the measure has content validity with carers of children with epilepsy.
Methods: A rigorous translation and cultural adaptation methodology was used. This is a process which includes two forward translations, reconciliation, two back-translations, and cognitive debriefing interviews with five carers of children with epilepsy in each country. In addition, a series of open-ended questions were asked of the carers in order to provide evidence of content validity.
Results: A number of cultural adaptations were made during the translation process. This included adaptations to the examples of sports and hobbies. An addition of “milk delivery” was made to the job examples in the Malayalam translation. In addition, two sexual problem items were removed from the Hebrew translation for Israel.
Conclusion: An additional six translations of the CBCL are now available for use in multinational studies. These translations have evidence of content validity for use with parents of children with epilepsy and have been appropriately culturally adapted so that they are acceptable for use in the target countries. The study highlights the importance of a rigorous translation process and the process of cultural adaptation.

Keywords: epilepsy, multinational studies, content validity