Teacher Questionnaire

Check all that apply for each category.

Rows	Rarely	Sometimes	Often	Always
have trouble identifying letter or numbers?
understand written concepts when first presented?
recall information learned earlier?
have difficulty learning new tasks that require reading?
have a problem learning when the task requires reading or writing numbers?

NICHQ VANDERBILT ASSESSMENT SCALE
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.

Rows	Never	Occasionally	Often	Very Often
Fails to give attention to details or makes careless mistakes in schoolwork
Has difficulty sustaining attention to tasks or activities
Does not seem to listen when spoken to directly
Does not follow through on instruction and fails to finish schoolwork (not due to oppositional behavior or failure to understand)
Has difficulty organizing tasks and activities
Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort
Loses things necessary for tasks or activities (school assignments, pencils, or books)
Is easily distracted by extraneous stimuli
Is forgetful in daily activities
Fidgets with hands or feet or squirms in seat
Leaves seat in classroom or in other situations in which remaining seated is expected
Runs about or climbs excessively in situations in which remaining seated is expected
Has difficulty playing or engaging in leisure activities quietly
Is “on the go” or often acts as if “driven by a motor”
Talks excessively
Blurts out answers before questions have been completed
Has difficulty waiting in line
Interrupts or intrudes on others (e.g., butts into conversations or games)
Loses temper
Actively defies or refuses to comply with adults’ requests or rules
Is angry or resentful
Is spiteful and vindictive
Bullies, threatens, or intimidates others
Initiates physical fights
Lies to obtain goods for favors or to avoid obligations (i.e., “cons” others)
Is physically cruel to people
Has stolen items of nontrivial value
Deliberately destroys others’ property
Is fearful, anxious, or worried
Is self-conscious or easily embarrassed
Is afraid to try new things for fear of making mistakes
Feels worthless or inferior
Blames self for problems, feels guilty
Feels lonely, unwanted, or unloved; complains that “no one loves him/her”
Is sad, unhappy, or depressed

Rows	Never	Rarely	Occasionally	Frequently	Very Frequently
share fun activities with others?
use language that was immature for his/her age?
use an odd way of speaking?
become obsessed with details?
insist on doing things the same way each time?
play with others?
notice social cues?
show an interest in the ideas of others?
understand age-appropriate humor or jokes?
focus on one subject for too much time?
need things to happen just as expected?
insist on certain routines?
become upset if routines were changed?
show good peer interactions?
respond when spoken to by other children?

Teacher Questionnaire

Academic Performance

Classroom Behavioral Performance