Logo for: Child & Family Agency of Southeastern CT, Inc Logo for: Child & Family Agency of Southeastern CT, Inc

Vanderbilt – Teacher

Vanderbilt Assessment Scale-Teacher Informant

"*" indicates required fields

NICHQ Vanderbilt Assessment Scale-TEACHER Informant
MM slash DD slash YYYY
Teacher's Name:*
Child's Name:*
MM slash DD slash YYYY
Directions: Each rating should be considered in the context of what is appropriate for the age of your child you are rating and should reflect that child’s behavior since the beginning of the school year.
Is this evaluation based on a time when the child*

Symptoms

1. Fails to give attention to details or makes careless mistakes in schoolwork*
2. Has difficulty sustaining attention to task or activites*
3. Does not seem to listen when spoken to directly*
4. Does not follow through 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 noises or other 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 in on others’(eg, butts in conversations/games)*
19. Loses temper*
20. Actively defies or refuses to comply with adult's request 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*
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*

Academic Performance

36. Reading*
37. Mathematics*
38. Written expression*

Classroom Behavioral Performance

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

For Office Use Only

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. Revised – 1102
11-19/rev1102