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  5. Vanderbilt Assessment Scale - TEACHER Informant
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Hello Mrs. Debbie Patashnik,


Please complete this online version of the NICHQ Vanderbilt Assessment Scale -TEACHER Informant for Megan A. Coughlin, 4th Grade. Megan has not been on medication at any time during this school year.

Your responses will be sent to Megan's pediatrician as part of her evaluation for Attention Deficit Disorder.

Thank you very much for your time and support. Please confirm that you are in fact the person completing this assessment. You can then begin the assessment by clicking on the Continue button below.

When you are finished be sure to click on the Submit Responses button to save your answers.

 
 
 
 
Class Time:
   
 
 
 
* 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
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 the child you are rating and should reflect that child’s behavior since the beginning of the school year.
 
SYMPTOMS
Never Occasionally Often Very Often
* 1. Fails to give attention to details or makes careless mistakes in schoolwork
* 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 schoolwork (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 sustained 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
Never Occasionally Often Very Often
* 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)
 
Symptoms
Never Occasionally Often Very Often
* 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)
* 26. Is physically cruel to people
* 27. Has stolen items of nontrivial value
* 28. Deliberately destroys others’ property
Never Occasionally Often Very Often
* 29. Is fearful, anxious, or worried
* 30. Is self-conscious or easily embarrassed
* 31. Is afraid to try new things for fear of making mistakes
* 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”
* 35. Is sad, unhappy, or depressed
 
Performance
Academic Performance
Excellent Above Average Average Somewhat of a Problem Problematic
* 36. Reading
* 37. Mathematics
* 38. Written expression
 
 
Classroom Behavioral Performance
Excellent Above Average Average Somewhat of a Problem Problematic
* 39. Relationship with peers
* 40. Following directions
* 41. Disrupting class
* 42. Assignment completion
* 43. Organizational skills
 
 
 
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