V2 Vanderbilt Assessment Scale

Vanderbilt Assessment Scale - Parent
Patient Name*

First NameLast Name
Name of the person filling out this form*

First NameLast Name
What is your relationship to the patient (e.g. parent, guardian, teacher)?*
Directions: Each rating should be considered in the context of what is appropriate for the age of your child. When completing this form, please think about your child's behaviors in the past 6 months.
Is this evaluation based on a time when your child*

Was on medicationWas not on medicationUnsureOther
In the past 6 months, has your child showed symptoms of...
1) Not paying attention to details or making careless mistakes with, for example, homework*

NeverOccasionallyOftenVery Often
2) Having difficult keeping attention to what needs to be done*

NeverOccasionallyOftenVery Often
3) Not seeming to listen when spoken to directly*

NeverOccasionallyOftenVery Often
4) Not following through when given directions and fails to finish activities (not due to refusal or failure to understand)*

NeverOccasionallyOftenVery Often
5) Having difficulty organizing tasks and activities*

NeverOccasionallyOftenVery Often
6) Avoiding, disliking, or not wanting to start tasks that require ongoing mental effort*

NeverOccasionallyOftenVery Often
7) Losing things necessary for tasks or activities (toys, assignments, pencils, or books)*

NeverOccasionallyOftenVery Often
8) Becoming easily distracted by noises or other stimuli*

NeverOccasionallyOftenVery Often
9) Becoming forgetful in daily activities*

NeverOccasionallyOftenVery Often
10) Fidgeting with hands or feet or squirms in seat*

NeverOccasionallyOftenVery Often
11) Leaving their seat when remaining seated is expected*

NeverOccasionallyOftenVery Often
12) Running about or climbing too much when remaining seated is expected*

NeverOccasionallyOftenVery Often
13) Having difficulty playing or beginning quiet play activities*

NeverOccasionallyOftenVery Often
14) Often acting as if "driven by a motor" or "on the go"*

NeverOccasionallyOftenVery Often
15) Talking too much*

NeverOccasionallyOftenVery Often
16) Blurting out answers before questions have been completed*

NeverOccasionallyOftenVery Often
17) Having difficulty waiting his or her turn*

NeverOccasionallyOftenVery Often
18) Interrupting or intruding in on others' conversations and/or activities*

NeverOccasionallyOftenVery Often
19) Arguing with adults*

NeverOccasionallyOftenVery Often
20) Losing their temper*

NeverOccasionallyOftenVery Often
21) Actively defying or refusing to go along with adults' requests or rules*

NeverOccasionallyOftenVery Often
22) Deliberately annoying people*

NeverOccasionallyOftenVery Often
23) Blaming others for his or her mistakes or misbehaviors*

NeverOccasionallyOftenVery Often
24) Becoming touchy or easily annoyed by others*

NeverOccasionallyOftenVery Often
25) Becoming angry or resentful*

NeverOccasionallyOftenVery Often
26) Becoming spiteful and want to get even*

NeverOccasionallyOftenVery Often
27) Bullying, threatening, or intimidating others*

NeverOccasionallyOftenVery Often
28) Starting physical fights*

NeverOccasionallyOftenVery Often
29) Lying to get out of trouble or to avoid obligations (ie, "cons" others)*

NeverOccasionallyOftenVery Often
30) Becoming truant from school (skips school) without permission*

NeverOccasionallyOftenVery Often
31) Becoming physically cruel to people*

NeverOccasionallyOftenVery Often
32) Stealing things that have value*

NeverOccasionallyOftenVery Often
33) Deliberately destroying others' property*

NeverOccasionallyOftenVery Often
34) Using a weapon that can cause serious harm (bat, knife, brick, gun)*

NeverOccasionallyOftenVery Often
35) Becoming physically cruel to animals*

NeverOccasionallyOftenVery Often
36) Deliberately setting fires to cause damage*

NeverOccasionallyOftenVery Often
37) Breaking into someone else's home, business, or car*

NeverOccasionallyOftenVery Often
38) Staying out at night without permission*

NeverOccasionallyOftenVery Often
39) Running away from home overnight*

NeverOccasionallyOftenVery Often
40) Forcing someone into sexual activity*

NeverOccasionallyOftenVery Often
41) Acting fearful, anxious, worried*

NeverOccasionallyOftenVery Often
42) Acting afraid to try new things for fear of making mistakes*

NeverOccasionallyOftenVery Often
43) Feeling worthless or inferior*

NeverOccasionallyOftenVery Often
44) Blaming self for problems, feeling guilty*

NeverOccasionallyOftenVery Often
45) Feeling lonely, unwanted, or unloved; complaining that "no one loves him or her"*

NeverOccasionallyOftenVery Often
46) Behaving sad, unhappy or depressed*

NeverOccasionallyOftenVery Often
47) Acting self conscious or easily embarrassed*

NeverOccasionallyOftenVery Often
In the past 6 months, reflect on your child's performance...
48. Overall school performance*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
49. Reading*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
50. Writing*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
51. Mathematics*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
52. Relationship with parents*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
53. Relationship with siblings*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
54. Relationship with peers*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
55. Participation in organized activities (eg, teams)*

ExcellentAbove AverageAverageSomewhat of a ProblemProblematic
Should be Empty:

Vanderbilt Assessment Scale - Parent