Vanderbilt Assessment Scale (Patients 6-18) TEACHER TO COMPLETE

Vanderbilt Assessment Scale (Patients 6-18) TEACHER TO COMPLETE
Teacher's/ Name

First NameLast Name
Class Time
Class Name/Period
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Name

First NameLast Name
Child's Grade Level
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
Please indicate the number of weeks or months you have been able to evaluate the behaviors:
Is this evaluation based on a time when the child

Symptoms: questions 1-9

Rows	Never	Occasionally	Often	Very Often
1. Fails to give attention to details or makes careless mistakes in schoolwork
2. Has difficulty sustaining attention to tasks or activities
3. Does not seem to listen when spoken to directly
4. Does not follow through when given directions and fails to finish schoolwork (not due to refusal or failure to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort
7. Loses things necessary for tasks or activities (school assignments, pencils, or books)
8. Is easily distracted by extraneous stimuli
9. Is forgetful in daily activities

Total number of questions scored "OFTEN" or "VERY OFTEN" in questions 1–9: (right 2 columns)

Rows	Never	Occasionally	Often	Very Often
10. Fidgets with hands or feet or squirms in seat
11.Leaves seat in classroom or in other situations in which remaining remaining seated is expected
12. Runs about or climbs excessively in situations in which remaining seated is expected
13. Has difficulty playing or engaging in leisure activities quietly
14. Is “on the go” or often acts as if “driven by a motor”
15. Talks too excessively
16. Blurts out answers before questions have been completed
17. Has difficulty waiting in line
18. Interrupts or intrudes in on others (eg, butts into conversations/games)

Rows	Never	Occasionally	Often	Very Often
19. Loses temper
20. Actively defies or refuses to go along with adults’ requests or rules
21. Is angry or resentful
22. Is spiteful and vindictive
23. Bullies, threatens, or intimidates others
24. Initiates physical fights
25. Lies to obtain goods for favors or to avoid obligations (eg, “cons” others)
26. Is physically cruel to people
27. Has stolen items of nontrivial value
28. Deliberately destroys others’ property

Rows	Never	Occasionally	Often	Very Often
29. Is fearful, anxious, or worried
30. Is self-conscious or easily embarrassed
31. Is afraid to try new things for fear of making mistakes
32. Feels worthless or inferior
33. Blames self for problems; feels guilty
34. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”
35. Is sad, unhappy, or depressed