ADHD Teacher Initial Evaluation (Vanderbilt)

NICHQ Vanderbilt Assessment Scale-TEACHER Informant

Todays Date*

Date

Childs Name*

Grade Level*

Teachers Name*

Class Name Period*

Class Time*

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 months you have been able to evaluate the child's behaviors.*

This evaluation based on a time when the child*

Was on medicationWas not on medicationNot sure

INATTENTION:Total number of questions scored 2 or 3 in Inattention questions (6 out of 9 AND 4 or 5 in any Performance questions 36-43):

HYPERACTIVITY: Total number of questions scored 2 or 3 in hyperactivity questions (6 out of 9 AND score a 4 or 5 in any Performance questions 36-43):

OPPOSITIONAL DEFIANCE: Total number of questions scored 2 or 3 in Oppositional Defiant/Conduct Disorder questions (3 out of 10 AND score a 4 or 5 in any Performance questions 36-43):

ANXIETY/DEPRESSION: Total number of questions scored 2 or 3 in Anxiety/Depression questions 29-35 (3 out of 7 AND score a 4 or 5 in any Performance questions 36-43)

ACADEMIC/CLASSROOM BEHAVIOR PERFORMANCE: Total number of questions scored a 4 or 5 in any Performance questions 36-43)

INATTENTION*

	Never	Occa- sionally	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 on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained 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

HYPERACTIVITY*

	Never	Occa-sionally	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 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 excessively
16. Blurts out answers before questions have been completed
17. Has difficulty waiting in line
18. Interrupts or intrudes on others (eg, butts into conversations/games)

OPPOSITIONAL DEFIANT/CONDUCT DISORDER*

	Never	Occa-sionally	Often	Very Often
19. Loses temper
20. Actively defies or refuses to comply with adult's 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

ANXIETY/DEPRESSION*

	Never	Occa-sionally	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

ACADEMIC PERFORMANCE*

	Excellent	Above Average	Average	Somewhat of a problem	Problematic
36. Reading
37. Mathematics
38. Written expression

CLASSROOM BEHAVIORAL PERFORMANCE*

	Excellent	Above Average	Average	Somewhat of a problem	Problematic
39. Relationship with peers
40. Following direction
41. Disrupting class
42. Assignment completion
43. Organizational skills

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