NICHQ- Vanderbilt Assessment Scale- Teacher

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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.

Child's Name: *

Your Name: *

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

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

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

2. Has difficulty sustaining attention to tasks or activities
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

3. Does not seem to listen when spoken to directly
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

5. Has difficulty organizing tasks and activities
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

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

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

8. Is easily distracted by extraneous stimuli
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

9. Is forgetful in daily activities
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

10. Fidgets with hands or feet or squirms in seat
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

11. Leaves seat in classroom or in other situations in which remaining seated is expected
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

12. Runs about or climbs excessively in situations in which remaining seated is expected
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

13. Has difficulty playing or engaging in leisure activities quietly
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

14. Is “on the go” or often acts as if “driven by a motor”
*

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

15. Talks excessively *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

16. Blurts out answers before questions have been completed *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

17. Has difficulty waiting in line *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

18. Interrupts or intrudes on others (eg, butts into conversations/games) *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

19. Loses temper *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

20. Actively defies or refuses to comply with adult’s requests or rules *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

21. Is angry or resentful *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

22. Is spiteful and vindictive *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

23. Bullies, threatens, or intimidates others *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

24. Initiates physical fights *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

25. Lies to obtain goods for favors or to avoid obligations (eg, “cons” others) *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

26. Is physically cruel to people *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

27. Has stolen items of nontrivial value *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

28. Deliberately destroys others’ property *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

29. Is fearful, anxious, or worried *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

30. Is self-conscious or easily embarrassed *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

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

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

32. Feels worthless or inferior *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

33. Blames self for problems; feels guilty *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

34. Feels lonely, unwanted, or unloved; complains that “no one loves him or her” *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

35. Is sad, unhappy, or depressed *

Never (0)

Occasionally (1)

Often (2)

Very Often (3)

Academic Performance

36. Reading

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

37. Writing

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

38. Written Expression

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

Classroom Behavioral Performance

39. Relationships with peers

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

40. Following directions

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

41. Disrupting class

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

42. Assignment completion

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

43. Organizational skills

Excellent (1)

Above Average (2)

Average (3)

Somewhat of a problem (4)

Problematic (5)

Clear selection

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