Vanderbilt Parent Rating Scale

Today's Date* This field is required.

Date

Child's Name* This field is required.

Child's Date of Birth* This field is required.

Date

Name of Person filling the form:* This field is required.

Relationship of Person filling the form to the child:* This field is required.

Mother

Father

Both parents filled it together

Stepmother

Stepfather

Grandparent

Other

This evaluation based on a time when the child* This field is required.

was on medication

was not on medication

not sure

Interpretation of average scores below

Average Score	Interpretation
0	Never
1	Occasionally
2	Often
3	Very often

Average Score on Inattentive Subtype Questions (Items 1-9):

Average Score on Hyperactive/Impulsive Subtype Questions (Items 10-18):

Average Score on Oppositional-Defiant Disorder Questions (Items 19-26):

Average Score on Conduct Disorder Questions (Items 27-40):

Average Score on Anxiety/Depression Questions (Items 41-47):

Interpretation of performance scores below

Average Score	Interpretation
1	Excellent
2	Above Average
3	Average
4	Somewhat of a Problem
5	Problematic

Average Score on Performance Questions (Items 48-55):

DIRECTIONS: In the next 47 items, please select the option that best reflects how often you've observed each symptom or behavior in your child over the past month.

1. Does not pay attention to details or makes careless mistakes.* This field is required.

Never

Occasionally

Often

Very often

2. Has difficulty keeping attention to what needs to be done.* This field is required.

Never

Occasionally

Often

Very often

3. Does not seem to listen when spoken to directly.* This field is required.

Never

Occasionally

Often

Very often

4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand).* This field is required.

Never

Occasionally

Often

Very often

5. Has difficulty organizing tasks and activities.* This field is required.

Never

Occasionally

Often

Very often

6. Avoids, dislikes, or does not want to start tasks that require on going* This field is required.

Never

Occasionally

Often

Very often

7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books).* This field is required.

Never

Occasionally

Often

Very often

8. Is easily distracted by noises or other stimuli.* This field is required.

Never

Occasionally

Often

Very often

9. Is forgetful in daily activities.* This field is required.

Never

Occasionally

Often

Very often

10. Fidgets with hands or feet or squirms in seat.* This field is required.

Never

Occasionally

Often

Very often

11. Leaves seat when remaining seated is expected.* This field is required.

Never

Occasionally

Often

Very often

12. Runs about or climbs too much when remaining seated is expected.* This field is required.

Never

Occasionally

Often

Very often

13. Has difficulty playing or beginning quiet play activities.* This field is required.

Never

Occasionally

Often

Very often

14. Is “on the go” or often acts as if “driven by a motor” .* This field is required.

Never

Occasionally

Often

Very often

15. Talks too much.* This field is required.

Never

Occasionally

Often

Very often

16. Blurts out answers before questions have been completed.* This field is required.

Never

Occasionally

Often

Very often

17. Has difficulty waiting his or her turn.* This field is required.

Never

Occasionally

Often

Very often

18. Interrupts or intrudes in on others’ conversations and/or activities.* This field is required.

Never

Occasionally

Often

Very often

19. Argues with adults.* This field is required.

Never

Occasionally

Often

Very often

20. Loses temper.* This field is required.

Never

Occasionally

Often

Very often

21. Actively defies or refuses to go along with adults’ requests or rules.* This field is required.

Never

Occasionally

Often

Very often

22. Deliberately annoys people.* This field is required.

Never

Occasionally

Often

Very often

23. Blames others for his or her mistakes or misbehaviors.* This field is required.

Never

Occasionally

Often

Very often

24. Is touchy or easily annoyed by others.* This field is required.

Never

Occasionally

Often

Very often

25. Is angry or resentful.* This field is required.

Never

Occasionally

Often

Very often

26. Is spiteful and wants to get even.* This field is required.

Never

Occasionally

Often

Very often

27. Bullies, threatens, or intimidates others.* This field is required.

Never

Occasionally

Often

Very often

28. Starts physical fights.* This field is required.

Never

Occasionally

Often

Very often

29. Lies to get out of trouble or to avoid obligations (ie,“cons” others).* This field is required.

Never

Occasionally

Often

Very often

30. Is truant from school (skips school) without permission.* This field is required.

Never

Occasionally

Often

Very often

31. Is physically cruel to people.* This field is required.

Never

Occasionally

Often

Very often

32. Has stolen things that have value.* This field is required.

Never

Occasionally

Often

Very often

33. Deliberately destroys others’ property.* This field is required.

Never

Occasionally

Often

Very often

34. Has used a weapon that can cause serious harm (bat, knife, brick, gun).* This field is required.

Never

Occasionally

Often

Very often

35. Is physically cruel to animals.* This field is required.

Never

Occasionally

Often

Very often

36. Has deliberately set fires to cause damage.* This field is required.

Never

Occasionally

Often

Very often

37. Has broken into someone else’s home, business, or car.* This field is required.

Never

Occasionally

Often

Very often

38. Has stayed out at night without permission.* This field is required.

Never

Occasionally

Often

Very often

39. Has run away from home overnight.* This field is required.

Never

Occasionally

Often

Very often

40. Has forced someone into sexual activity.* This field is required.

Never

Occasionally

Often

Very often

41. Is fearful, anxious, or worried.* This field is required.

Never

Occasionally

Often

Very often

42. Is afraid to try new things for fear of making mistakes.* This field is required.

Never

Occasionally

Often

Very often

43. Feels worthless or inferior.* This field is required.

Never

Occasionally

Often

Very often

44. Blames self for problems, feels guilty.* This field is required.

Never

Occasionally

Often

Very often

45. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”.* This field is required.

Never

Occasionally

Often

Very often

46. Is sad, unhappy, or depressed.* This field is required.

Never

Occasionally

Often

Very often

47. Is self-conscious or easily embarrassed.* This field is required.

Never

Occasionally

Often

Very often

DIRECTIONS: In the next 4 items, please rate your child's academic performance.

48. Overall school performance* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

49. Reading* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

50. Writing* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

51. Mathematics* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

DIRECTIONS: In the next 4 items, please rate your child's ability to manage relationships.

52. Relationship with parents.* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

53. Relationship with siblings.* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

54. Relationship with peers.* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic

55. Participation in organized activities (eg, teams).* This field is required.

Excellent

Above average

Average

Somewhat of a problem

Problematic