NICHQ Vanderbilt Assessment Scales

National Institute for Children's Health Quality

NICHQ Vanderbilt Assessment Scale-PARENT Informant

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 the child

Symptoms 1. Does not pay attention to details or makes careless mistakes with, for example, homework 2. Has difficulty keeping attention to what needs to be done 3. Does not seem to listen when spoken to directly 4. Does not follow through when given directions and fails to finish activities0 (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 (toys, assignments, pencils,0 or books) 8. Is easily distracted by noises or other stimuli0 9. Is forgetful in daily activities0 10. Fidgets with hands or feet or squirms in seat0 11. Leaves seat when remaining seated is expected0 12. Runs about or climbs too much when remaining seated is expected0 13. Has difficulty playing or beginning quiet play activities0 14. Is "on the go" or often acts as if "driven by a motor"0 15. Talks too much0

Often NeverOccasionallyVery Often

16. Blurts out answers before questions have been completed 17. Has difficulty waiting his or her turn 18. Interrupts or intrudes in on others' conversations and/or activities 19. Argues with adults 20. Loses temper 21. Actively defies or refuses to go along with adults' requests or rules 22. Deliberately annoys people

23. Blames others for his or her mistakes or misbehaviors

24. Is touchy or easily annoyed by others 25. Is angry or resentful 26. Is spiteful and wants to get even

27. Bullies, threatens, or intimidates others

28. Starts physical fights 29. Lies to get out of trouble or to avoid obligations (ie, "cons" others) 30. Is truant from school (skips school) without permission 31. Is physically cruel to people 32. Has stolen things that have value

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Copyright ©2002 American Academy of Pediatrics and National Initiative for Children's Healthcare Quality Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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NICHQ Vanderbilt Assessment Scale-PARENT Informant

Symptoms (continued) 33. Deliberately destroys others' property 34. Has used a weapon that can cause serious harm (bat, knife, brick, gun) 35. Is physically cruel to animals 36. Has deliberately set fires to cause damage

Often NeverOccasionallyVery Often

37. Has broken into someone else's home, business, or car 38. Has stayed out at night without permission 39. Has run away from home overnight 40. Has forced someone into sexual activity 41. Is fearful, anxious, or worried 42. Is afraid to try new things for fear of making mistakes

43. Feels worthless or inferior

44. Blames self for problems, feels guilty

45. Feels lonely, unwanted, or unloved; complains that "no one loves him or her"0

46. Is sad, unhappy, or depressed 47. Is self-conscious or easily embarrassed

48. Overall school performance 49. Reading 50. Writing

52. Relationship with parents 53. Relationship with siblings 54. Relationship with peers 55. Participation in organized activities (eg, teams)

ProblemProblematic 45 45 45 45 45 45 45 5 4

American Academy of Pediatrics

National Institute for Children's Health Quality

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DEDICATED TO THE HEALTH OF ALL CHILDREN™

NICHQ Vanderbilt Assessment Scale-TEACHER Informant

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 1. Fails to give attention to details or makes careless mistakes in schoolwork0

was not on medication Often NeverOccasionallyVery Often

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 schoolwork0 (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 sustained0 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 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) 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)0 26. Is physically cruel to people0 27. Has stolen items of nontrivial value0 28. Deliberately destroys others' property0 29. Is fearful, anxious, or worried0 30. Is self-conscious or easily embarrassed0

31. Is afraid to try new things for fear of making mistakes

13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Copyright 2002 American Academy of Pediatrics and National Initiative for Children's Healthcare Quality Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circum- stances, may be appropriate.

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

National Institute for Children's Health Quality

McNeil Consumer & Specialty Pharm aceuticals

NICHQ Vanderbilt Assessment Scale-TEACHER Informant, continued

Often NeverOccasionallyVery Often

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"0

35. Is sad, unhappy, or depressed

Performance Academic Performance

Classroom Behavioral Performance

39. Relationship with peers 40. Following directions 41. Disrupting class 42. Assignment completion 43. Organizational skills

23 2 2 2 Somewhat of a ProblemProblematic 5 4 45 45 Somewhat of a ProblemProblematic 45 45 45 5 4 5 4

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

NICHQMcNeil Consumer & Specialty Pharm aceuticals National Institute for Children's Health Quality

NICHQ Vanderbilt Assessment Follow-up-PARENT Informant

Directions: Each rating should be considered in the context of what is appropriate for the age of your child. Please think about your child's behaviors since the last assessment scale was filled out when rating his/her behaviors.

Is this evaluation based on a time when the child

Symptoms 1. Does not pay attention to details or makes careless mistakes with, for example, homework 2. Has difficulty keeping attention to what needs to be done 3. Does not seem to listen when spoken to directly 4. Does not follow through when given directions and fails to finish activities (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

Often NeverOccasionallyVery Often

7. Loses things necessary for tasks or activities (toys, assignments, pencils,0 or books)

8. Is easily distracted by noises or other stimuli 9. Is forgetful in daily activities 10. Fidgets with hands or feet or squirms in seat 11. Leaves seat when remaining seated is expected 12. Runs about or climbs too much when remaining seated is expected 13. Has difficulty playing or beginning quiet play activities 14. Is "on the go" or often acts as if "driven by a motor"

16. Blurts out answers before questions have been completed 17. Has difficulty waiting his or her turn 18. Interrupts or intrudes in on others' conversations and/or activities

Somewhat of a ProblemProblematic

19. Overall school performance 20. Reading 21. Writing

23. Relationship with parents 24. Relationship with siblings 25. Relationship with peers 26. Participation in organized activities (eg, teams)

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright ©2002 American Academy of Pediatrics and National Initiative for Children's Healthcare Quality Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

McNeil Consumer & Specialty Pharmaceuticals

National Institute for Children's Health Quality

NICHQ Vanderbilt Assessment Follow-up-PARENT Informant, continued

Side Effects: Has your child experienced any of the following side effects or problems in the past week?

Are these side effects currently a problem? Mild ModerateSevere None

Change of appetite-explain below Trouble sleeping Irritability in the late morning, late afternoon, or evening-explain below Socially withdrawn-decreased interaction with others Extreme sadness or unusual crying

Dull, tired, listless behavior

Tremors/feeling shaky Repetitive movements, tics, jerking, twitching, eye blinking-explain below Picking at skin or fingers, nail biting, lip or cheek chewing-explain below Sees or hears things that aren't there

Adapted from the Pittsburgh side effects scale, developed by William E. Pelham, Jr, PhD.

American Academy of Pediatrics

National Institute for Children's Health Quality

McNeil Consumer & Specialty Pharma ceuticals

DEDICATED TO THE HEALTH OF ALL CHILDREN™

NICHQ Vanderbilt Assessment Follow-up-TEACHER Informant

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 last assessment scale was filled out. 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 1. Does not pay attention to details or makes careless mistakes with, for example, homework 2. Has difficulty keeping attention to what needs to be done 3. Does not seem to listen when spoken to directly 4. Does not follow through when given directions and fails to finish activities (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 (toys, assignments, pencils, or books) 8. Is easily distracted by noises or other stimuli 9. Is forgetful in daily activities 10. Fidgets with hands or feet or squirms in seat 11. Leaves seat when remaining seated is expected 12. Runs about or climbs too much when remaining seated is expected 13. Has difficulty playing or beginning quiet play activities 14. Is "on the go" or often acts as if "driven by a motor"

Often NeverOccasionallyVery Often

16. Blurts out answers before questions have been completed 17. Has difficulty waiting his or her turn 18. Interrupts or intrudes in on others' conversations and/or activities

21. Written expression 22. Relationship with peers 23. Following direction 24. Disrupting class 25. Assignment completion 26. Organizational skills

Somewhat of a ProblemProblematic 45 45 45 45 45 45 5 4 45

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circum- stances, may be appropriate.

Copyright ©2002 American Academy of Pediatrics and National Initiative for Children's Healthcare Quality Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

McNeil Consumer & Specialty Pharmaceuticals

National Institute for Children's Health Quality

NICHQ Vanderbilt Assessment Follow-up-TEACHER Informant, continued

Side Effects: Has the child experienced any of the following side effects or problems in the past week?

Are these side effects currently a problem? Mild NoneModerateSevere

Change of appetite-explain below Trouble sleeping Irritability in the late morning, late afternoon, or evening-explain below Socially withdrawn-decreased interaction with others Extreme sadness or unusual crying Dull, tired, listless behavior Tremors/feeling shaky Repetitive movements, tics, jerking, twitching, eye blinking-explain below Picking at skin or fingers, nail biting, lip or cheek chewing-explain below Sees or hears things that aren't there Explain/Comments:

Adapted from the Pittsburgh side effects scale, developed by William E. Pelham, Jr, PhD.

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

National Institute for Children's Health Quality

McNeil Consumer & Specialty Pharma aceuticals

Scoring Instructions for the NICHQ Vanderbilt Assessment Scales

These scales should NOT be used alone to make any diag- nosis. You must take into consideration information from multiple sources. Scores of 2 or 3 on a single Symptom question reflect often-occurring behaviors. Scores of 4 or 5 on Performance questions reflect problems in performance. The initial assessment scales, parent and teacher, have 2 compo- nents: symptom assessment and impairment in performance. On both the parent and teacher initial scales, the symptom assess- ment screens for symptoms that meet criteria for both inattentive (items 1-9) and hyperactive ADHD (items 10-18 To meet DSM-IV criteria for the diagnosis, one must have at least 6 positive responses to either the inattentive 9 or hyperactive 9 core symptoms, or both. A positive response is a 2 or 3 (often, very often) (you could draw a line straight down the page and count the positive answers in each subsegment There is a place to

record the number of positives in each subsegment, and a place for total score for the first 18 symptoms (just add them up The initial scales also have symptom screens for 3 other co- morbidities-oppositional-defiant, conduct, and anxiety/ depression. These are screened by the number of positive respon- ses in each of the segments separated by the "squares." The specific item sets and numbers of positives required for each co-morbid symptom screen set are detailed below. The second section of the scale has a set of performance measures, scored 1 to 5, with 4 and 5 being somewhat of a problem/problem- atic. To meet criteria for ADHD there must be at least one item of the Performance set in which the child scores a 4 or 5; ie, there must be impairment, not just symptoms to meet diagnostic criteria. The sheet has a place to record the number of positives (4s, 5s) and an Average Performance Score-add them up and divide by number of Performance criteria answered.

Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1-9 AND Score a 4 or 5 on any of the Performance questions 48-55 Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10-18 Score a 4 or 5 on any of the Performance questions 48-55 ADHD Combined Inattention/Hyperactivity Requires the above criteria on both inattention and hyperactivity/impulsivity Oppositional-Defiant Disorder Screen Must score a 2 or 3 on 4 out of 8 behaviors on questions 19-26 Score a 4 or 5 on any of the Performance questions 48-55

Conduct Disorder Screen Must score a 2 or 3 on 3 out of 14 behaviors on questions

Score a 4 or 5 on any of the Performance questions 48-55 Anxiety/Depression Screen Must score a 2 or 3 on 3 out of 7 behaviors on questions 41-47 Score a 4 or 5 on any of the Performance questions 48-55

Predominantly Inattentive subtype Must score a 2 or 3 on 6 out of 9 items on questions 1-9 AND Score a 4 or 5 on any of the Performance questions 36-43 Predominantly Hyperactive/Impulsive subtype Must score a 2 or 3 on 6 out of 9 items on questions 10-18 AND Score a 4 or 5 on any of the Performance questions 36-43 ADHD Combined Inattention/Hyperactivity Requires the above criteria on both inattention and hyperactivity/impulsivity Oppositional-Defiant/Conduct Disorder Screen Must score a 2 or 3 on 3 out of 10 items on questions 19-28 Score a 4 or 5 on any of the Performance questions 36-43 Anxiety/Depression Screen Must score a 2 or 3 on 3 out of 7 items on questions 29-35 Score a 4 or 5 on any of the Performance questions 36-43

The parent and teacher follow-up scales have the first 18 core ADHD symptoms, not the co-morbid symptoms. The section seg- ment has the same Performance items and impairment assessment as the initial scales, and then has a side-effect reporting scale that can be used to both assess and monitor the presence of adverse reactions to medications prescribed, if any. Scoring the follow-up scales involves only calculating a total symptom score for items 1-18 that can be tracked over time, and

the average of the Performance items answered as measures of improvement over time with treatment. Parent Assessment Follow-up Calculate Total Symptom Score for questions 1-18. Calculate Average Performance Score for questions 19-26. Teacher Assessment Follow-up Calculate Total Symptom Score for questions 1-18. Calculate Average Performance Score for questions 19-26.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circum- stances, may be appropriate.

Copyright 2002 American Academy of Pediatrics and National Initiative for Children's Healthcare Quality

American Academy of Pediatrics

DEDICATED TO THE HEALTH OF ALL CHILDREN™

National Institute for Children's Health Quality