ADHD Initial Parent/Guardian Evaluation

NICHQ Vanderbilt Assessment Scale-PARENT Informant

Sistema NICHQ Vanderbilt de Evaluación. Cuestionario para PADRES

Today,s Date/Fecha de hoy

Date

Childs Name / Nombre del niño/a*

Date of Birth / Fecha de nacimiento*

Parents Name / Nombre del padre yo de la madre*

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.

Instrucciones: Conteste basándose en lo que considera apropiado para un niño de esa edad. Al completar este cuestionario, piense por favor en la conducta de su niño durante los últimos seis meses.

This evaluation based on a time when the child / Esta evaluacion se refiere a un periodo en el que se hijo(a)*

Was on medication / Tomaba medicamentosWas not on medication / No tomaba medicamentosNot sure/ No lo recuerda

What medication, if any, is the child taking? // ¿Qué medicamento, si es que toma alguno, está tomando el niño?

INATTENTION SCORE: Total number of questions scored 2 or 3 in Inattention questions (6 out of 9 AND 4 or 5 in any Performance questions 48-55):

HYPERACTIVITY SCORE: 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 48-55):

OPPOSITIONAL DEFIANCE SCORE: Total number of questions scored 2 or 3 in Oppositional Defiant questions (4 out of 8 AND score a 4 or 5 in any Performance questions 48-55):

CONDUCT DISORDER SCORE: Total number of questions scored 2 or 3 in Conduct Disorder questions 27-40 (3 out of 14 AND score a 4 or 5 in any Performance questions 48-55):

ANXIETY/DEPRESSION SCORE: Total number of questions scored 2 or 3 in Depression questions 41-47 (3 out of 7 AND score a 4 or 5 in any Performance questions 48-55)

PERFORMANCE SCORE: Total number of questions scored 4 or 5 any Performance questions 48-55

INATTENTION*

	Never	Occa-sionally	Often	Very Often
1. Does not pay attention to details or makes careless mistakes with, for example, homework / No pone atencion a los detalles o comete errores por descuido, como por ejemplo, cuado hace la tarea
2. Has difficulty keeping attention to what needs to be done / De le dificulta mantenerse atento al llevar a cabo sus actividades
3. Does not seem to listen when spoken to directly / Parece no estar escuchando cuando se le habla directamente
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand) / No sigue las instrucciones hasta el final y no concluye sus actividads (no porque se rehuse a seguirlas o porque no las comprenda)
5. Has difficulty organizing tasks and activities / Tiene dificultad al organizar sus tareas diarias y actividades
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort / Evita, le disgusta o no quiere comenzar actividades que requieren un mayor esfuerzo mental
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books) / Pierde cosas que son indispensables para cumplir con sus tareas o actividades (juguetes, tareas de la escuela, lapices o libros)
8. Is easily distracted by noises or other stimuli / Se distrae facilmente con ruidos u otros estimulos externos
9. Is forgetful in daily activities / Es olvidadizo(a) en sus actividades cotidianas

HYPERACTIVITY*

	Never	Occa-sionally	Often	Very Often
10. Fidgets with hands or feet or squirms in seat / Mueve constantement las manos or los pies o no se esta quieto(a) en su asiento
11. Leaves seat when remaining seated is expected / Se pone de pie cuando debiera permanecer sentado(a)
12. Runs about or climbs too much when remaining seated is expected / Corre o camina por todos lados cuando debiera permanecer sentado
13. Has difficulty playing or beginning quiet play activities / Se le dificulta jugar o empezar actividades recreativas mas tranquilas
14. Is "on the go" or often acts as if "driven by a motor" / Esta en constante movimiento o actua como si "tuviera un motor por dentro"
15. Talks too much / Habla demasiado
16. Blurts out answers before questions have been completed / Responde precitadamente, incluso antes de escuchar la pregunta completa
17. Has difficulty waiting his or her turn / Tiene dificultad al esperar su turno
18. Interrupts or intrudes in on others' conversations and/or activities / Interrumpe o se entromete en conversaciones o actividades ajenas

OPPOSITIONAL DEFIANCE DISORDER*

	Never	Occa-sionally	Often	Very Often
19. Argues with adults / Discute con adultos
20. Loses temper / Se enfurece con facilidad
21. Actively defies or refuses to go along with adults' requests or rules / Desafia abiertamente o se niega a cumplir la ordenes o las reglas de los adultos
22. Deliberately annoys people / Molesta adrede a los demas
23. Blames others for his or her mistakes or misbehaviors / Culpa a otros de sus propios errores o se mal comportamiento
24. Is touchy or easily annoyed by others / Se ofende o se molesta facilmente conotros
25. Is angry or resentful / Esta enojado(a) or resentido(a)
26. Is spiteful and wants to get even / Es rensoroso y vengativo

CONDUCT DISORDER*

	Never	Occa-sionally	Often	Very Often
27. Bullies, threatens, or intimidates / others / Reta, amenaza o intimida o otros
28. Starts physical fights / Comienza pelas de contacto fisico
29. Lies to get out of trouble or to avoid obligations (ie, "cons" others) / Miente con el fin de salir de apuros o para eludir sus obligaciones
30. Is truant from school (skips school) without permission / Falta a la escuela sin permiso
31. Is physically cruel to people / Es fisicamente cruel con los demas
32. Has stolen things that have value / Ha robado cosas de valor
33. Deliberately destroys others' property / Destruye deliberadamente la propiedad ajena
34. Has used a weapon that can cause serious harm (bat, knife, brick, gun) / Has usado un objeto que puede herir a alguien (bate, cuchillo, ladrillo, pistola)
35. Is physically cruel to animals / Tortura animales
36. Has deliberately set fires to cause damage / Ha provocado fuegos par causar danos
37. Has broken into someone else's home, business, or car / Ha entrado a una casa, un negocio on un carro ajeno
38. Has stayed out at night without permission / Ha permanecido fuera de la casa sin permiso durante la noche
39. Has run away from home overnight / Se has escapado de la casa durante la noche
40. Has forced someone into sexual activity / ha obligado a alguien a sostener algun tipo de actividade sexual

ANXIETY/DEPRESSION*

	Never	Occasionally	Often	Very Often
41. Is fearful, anxious, or worried / Siente miedo, ansiedad o esta preocupado
42. Is afraid to try new things for fear of making mistakes / Teme hacer nuevas coasa por temor a cometer
43. Feels worthless or inferior / Se desprecia a si mismo se siento inferior
44. Blames self for problems, feels guilty / Siente que los problemas son responsabilidad suya y se siente culpable
45. Feels lonely, unwanted, or unloved; complains that "no one loves him or her" / Se siente solo(a), rechazado(a), o sin amor; se queja de que nadie lo quiere
46. Is sad, unhappy, or depressed / Se siente triste, infeliz o deprimido(a)
47. Is self-conscious or easily embarrassed / Esta al pendiente de sus actos o se averguenza facilmente

PERFORMANCE*

	Excellent	Above Average	Average	Somewhat of a problem	Problematic
48. Overall school performance / Comportamiento general en la escuela
49. Reading / Lectura
50. Writting / Escritura
51. Mathematics / Matematicas
52. Relationship with parents / Relacion con sus padres
53. Relationship with siblings / Relacion con sus hermanos
54. Relationship with peers / Relacion son sus compañeros
55. Participation in organized activities (for example: teams) / Participacion en actividades organizadas (ejemplo: equipos deportivos)

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