Vanderbilt ADHD Assessment (Teacher)

NICHQ Vanderbilt Assessment Scale — TEACHER Informant

Information

Teacher's Name This field is required

Class Time This field is required

Class Name/Period This field is required

Today's Date This field is required

Child's Name This field is required

Child's Date of Birth (if known) This field is required

Grade Level This field is required

Number of weeks or months you have been able to evaluate the behaviors This field is required

Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child’s behavior since the beginning of the school year.

Is this evaluation based on a time when the child… *

was on medication was not on medication not sure

Please choose one

Symptoms

0 = Never · 1 = Occasionally · 2 = Often · 3 = Very Often

1. Fails to give attention to details or makes careless mistakes in schoolwork

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

2. Has difficulty sustaining attention to tasks or activities

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

3. Does not seem to listen when spoken to directly

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

5. Has difficulty organizing tasks and activities

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

7. Loses things necessary for tasks or activities (school assignments, pencils, or books)

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

8. Is easily distracted by extraneous stimuli

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

9. Is forgetful in daily activities

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

10. Fidgets with hands or feet or squirms in seat

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

11. Leaves seat in classroom or in other situations in which remaining seated is expected

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

12. Runs about or climbs excessively in situations in which remaining seated is expected

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

13. Has difficulty playing or engaging in leisure activities quietly

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

14. Is “on the go” or often acts as if “driven by a motor”

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

15. Talks excessively

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

16. Blurts out answers before questions have been completed

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

17. Has difficulty waiting in line

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

18. Interrupts or intrudes on others (eg, butts into conversations/games)

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

19. Loses temper

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

20. Actively defies or refuses to comply with adult’s requests or rules

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

21. Is angry or resentful

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

22. Is spiteful and vindictive

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

23. Bullies, threatens, or intimidates others

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

24. Initiates physical fights

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

25. Lies to obtain goods for favors or to avoid obligations (eg, “cons” others)

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

26. Is physically cruel to people

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

27. Has stolen items of nontrivial value

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

28. Deliberately destroys others’ property

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

29. Is fearful, anxious, or worried

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

30. Is self-conscious or easily embarrassed

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

31. Is afraid to try new things for fear of making mistakes

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

32. Feels worthless or inferior

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

33. Blames self for problems; feels guilty

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

34. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

35. Is sad, unhappy, or depressed

0 Never 1 Occasionally 2 Often 3 Very Often

Please choose one

Performance

1 = Excellent · 2 = Above Average · 3 = Average · 4 = Somewhat of a Problem · 5 = Problematic

Academic Performance

36. Reading

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

37. Mathematics

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

38. Written expression

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

Classroom Behavioral Performance

39. Relationship with peers

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

40. Following directions

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

41. Disrupting class

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

42. Assignment completion

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

43. Organizational skills

1 Excellent 2 Above Average 3 Average 4 Somewhat of a Problem 5 Problematic

Please choose one

Comments

Anything else you would like the provider to know (optional)

Prefer paper? Download the blank printable form

Copyright ©2002 American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality. Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD. The information contained in this form should not be used as a substitute for the medical care and advice of your pediatrician.

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