Vanderbilt Assessment -

Vanderbilt Assessment

Copyright 52002 American Academy of Paediatrics and National Initiative for Children’s Healthcare Quality Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD. Revised – 1102. The information contained in this publication should not be used as a substitute for the medical care and advice of your paediatrician. There may be variations in treatment that your paediatrician may recommend based on individual facts and circumstances.

Vanderbilt Assessment Scale - Parents Version

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Step 1
Step 2

Today's date

Child's first name

Child's last name

Date of birth

Parent/s or carer/s names

Parent/s or carer/s phone numbers

Is this evaluation based on a time when the child

Was on medication

Was not on medication

Not sure

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.

1. Does not pay attention to details or makes careless mistakes with, for example, homework

Never

Occasionally

Often

Very Often

2. Has difficulty keeping attention to what needs to be done

Never

Occasionally

Often

Very Often

3. Does not seem to listen when spoken to directly

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)

Never

Occasionally

Often

Very Often

5. Has difficulty organizing tasks and activities

Never

Occasionally

Often

Very Often

6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort

Never

Occasionally

Often

Very Often

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

Never

Occasionally

Often

Very Often

8. Is easily distracted by noises or other stimuli

Never

Occasionally

Often

Very Often

9. Is forgetful in daily activities

Never

Occasionally

Often

Very Often

10. Fidgets with hands or feet or squirms in seat

Never

Occasionally

Often

Very Often

11. Leaves seat when remaining seated is expected

Never

Occasionally

Often

Very Often

12. Runs about or climbs too much when remaining seated is expected

Never

Occasionally

Often

Very Often

13. Has difficulty playing or beginning quiet play activities

Never

Occasionally

Often

Very Often

14. Is "on the go" or often acts as if "driven by a motor"

Never

Occasionally

Often

Very Often

15. Talks too much

Never

Occasionally

Often

Very Often

16. Blurts out answers before questions have been completed

Never

Occasionally

Often

Very Often

17. Has difficulty waiting his or her turn

Never

Occasionally

Often

Very Often

18. Interrupts or intrudes in on others' conversations and/or activities

Never

Occasionally

Often

Very Often

19. Argues with adults

Never

Occasionally

Often

Very Often

20. Loses temper

Never

Occasionally

Often

Very Often

21. Actively defies or refuses to go along with adults' requests or rules

Never

Occasionally

Often

Very Often

22. Deliberately annoys people

Never

Occasionally

Often

Very Often

23. Blames others for his or her mistakes or misbehaviors

Never

Occasionally

Often

Very Often

24. Is touchy or easily annoyed by others

Never

Occasionally

Often

Very Often

25. Is angry or resentful

Never

Occasionally

Often

Very Often

26. Is spiteful and wants to get even

Never

Occasionally

Often

Very Often

27. Bullies, threatens, or intimidates others

Never

Occasionally

Often

Very Often

28. Starts physical fights

Never

Occasionally

Often

Very Often

29. Lies to get out of trouble or to avoid obligations (ie, "cons" others)

Never

Occasionally

Often

Very Often

30. Is truant from school (skips school) without permission

Never

Occasionally

Often

Very Often

31. Is physically cruel to people

Never

Occasionally

Often

Very Often

32. Has stolen things that have value

Never

Occasionally

Often

Very Often

33. Deliberately destroys others' property

Never

Occasionally

Often

Very Often

34. Has used a weapon that can cause serious harm (bat, knife, brick, gun)

Never

Occasionally

Often

Very Often

35. Is physically cruel to animals

Never

Occasionally

Often

Very Often

36. Has deliberately set fires to cause damage

Never

Occasionally

Often

Very Often

37. Has broken into someone else's home, business, or car

Never

Occasionally

Often

Very Often

38. Has stayed out at night without permission

Never

Occasionally

Often

Very Often

39. Has run away from home overnight

Never

Occasionally

Often

Very Often

40. Has forced someone into sexual activity

Never

Occasionally

Often

Very Often

41. Is fearful, anxious, or worried

Never

Occasionally

Often

Very Often

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

Never

Occasionally

Often

Very Often

43. Feels worthless or inferior

Never

Occasionally

Often

Very Often

44. Blames self for problems, feels guilty

Never

Occasionally

Often

Very Often

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

Never

Occasionally

Often

Very Often

46. Is sad, unhappy, or depressed

Never

Occasionally

Often

Very Often

47. Is self-conscious or easily embarrassed

Never

Occasionally

Often

Very Often

Performance

48. Overall school performance

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

49. Reading

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

50. Writing

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

51. Mathematics

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

52. Relationship with parents

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

53. Relationship with siblings

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

No Siblings

54. Relationship with peers

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

55. Participation in organised activities (eg, teams)

Excellent

Above Average

Average

Somewhat of a Problem

Problematic

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