Vanderbilt Follow-up - Parent

  • Vanderbilt Assessment Follow-Up – Parent Version

  • Today's Date:*
     - -
  • Is this evaluation based on a time the child*

  • 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.

  • Part 1: Symptoms (Questions 1–18)

    Rating Scale:

    Never = 0
    Occasionally = 1
    Often = 2
    Very Often = 3

  • 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 on instructions 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”*
  • 15. Talks too much*
  • 16. Blurts out answers before questions have been completed*
  • 17. Has difficulty waiting for his or her turn*
  • 18. Interrupts or intrudes on others’ conversations and/or activities*

  • Section 2: Performance – Items 19–26

    Rating Scale:

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

  • 19. Overall school performance*
  • 20. Reading*
  • 21. Writing*
  • 22. Mathematics*
  • 23. Relationship with parents*
  • 24. Relationship with siblings*
  • 25. Relationship with peers*
  • 26. Participation in organized activities (e.g., teams, clubs)*

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

  • Headache*
  • Stomachache*
  • Change in 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  • Socially withdrawn - decreased interaction with others *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*
  • Should be Empty: