NICHQ Vanderbilt Assessment Scale Calculator - MDApp

Instruction: 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.

Symptoms

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

1Does not pay attention to details or makes careless mistakes with, for example, homework 3 2 1 0 NeverVery often 2Has difficulty keeping attention to what needs to be done 3 2 1 0 NeverVery often 3Does not seem to listen when spoken to directly 3 2 1 0 NeverVery often 4Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand) 3 2 1 0 NeverVery often 5Has difficulty organizing tasks and activities 3 2 1 0 NeverVery often 6Avoids, dislikes, or does not want to start tasks that require ongoing mental effort 3 2 1 0 NeverVery often 7Loses things necessary for tasks or activities (toys, assignments, pencils, or books) 3 2 1 0 NeverVery often 8Is easily distracted by noises or other stimuli 3 2 1 0 NeverVery often 9Is forgetful in daily activities 3 2 1 0 NeverVery often 10Fidgets with hands or feet or squirms in seat 3 2 1 0 NeverVery often 11Leaves seat when remaining seated is expected 3 2 1 0 NeverVery often 12Runs about or climbs too much when remaining seated is expected 3 2 1 0 NeverVery often 13Has difficulty playing or beginning quiet play activities 3 2 1 0 NeverVery often 14Is “on the go” or often acts as if “driven by a motor” 3 2 1 0 NeverVery often 15Talks too much 3 2 1 0 NeverVery often 16Blurts out answers before questions have been completed 3 2 1 0 NeverVery often 17Has difficulty waiting his or her turn 3 2 1 0 NeverVery often 18Interrupts or intrudes in on others’ conversations and/or activities 3 2 1 0 NeverVery often 19Argues with adults 3 2 1 0 NeverVery often 20Loses temper 3 2 1 0 NeverVery often 21Actively defies or refuses to go along with adults’ requests or rules 3 2 1 0 NeverVery often 22Deliberately annoys people 3 2 1 0 NeverVery often 23Blames others for his or her mistakes or misbehaviors 3 2 1 0 NeverVery often 24Is touchy or easily annoyed by others 3 2 1 0 NeverVery often 25Is angry or resentful 3 2 1 0 NeverVery often 26Is spiteful and wants to get even 3 2 1 0 NeverVery often 27Bullies, threatens, or intimidates others 3 2 1 0 NeverVery often 28Starts physical fights 3 2 1 0 NeverVery often 29Lies to get out of trouble or to avoid obligations (i.e. “cons” others) 3 2 1 0 NeverVery often 30Is truant from school (skips school) without permission 3 2 1 0 NeverVery often 31Is physically cruel to people 3 2 1 0 NeverVery often 32Has stolen things that have value 3 2 1 0 NeverVery often 33Deliberately destroys others’ property 3 2 1 0 NeverVery often 34Has used a weapon that can cause serious harm (bat, knife, brick, gun) 3 2 1 0 NeverVery often 35Is physically cruel to animals 3 2 1 0 NeverVery often 36Has deliberately set fires to cause damage 3 2 1 0 NeverVery often 37Has broken into someone else’s home, business, or car 3 2 1 0 NeverVery often 38Has stayed out at night without permission 3 2 1 0 NeverVery often 39Has run away from home overnight 3 2 1 0 NeverVery often 40Has forced someone into sexual activity 3 2 1 0 NeverVery often 41Is fearful, anxious, or worried 3 2 1 0 NeverVery often 42Is afraid to try new things for fear of making mistakes 3 2 1 0 NeverVery often 43Feels worthless or inferior 3 2 1 0 NeverVery often 44Blames self for problems, feels guilty 3 2 1 0 NeverVery often 45Feels lonely, unwanted, or unloved; complains that “no one loves him or her” 3 2 1 0 NeverVery often 46Is sad, unhappy, or depressed 3 2 1 0 NeverVery often 47Is self-conscious or easily embarrassed 3 2 1 0 NeverVery often

Performance

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

48Overall school performance 5 4 3 2 1 ExcellentProblematic 49Reading 5 4 3 2 1 ExcellentProblematic 50Writing 5 4 3 2 1 ExcellentProblematic 51Mathematics 5 4 3 2 1 ExcellentProblematic 52Relationship with parents 5 4 3 2 1 ExcellentProblematic 53Relationship with siblings 5 4 3 2 1 ExcellentProblematic 54Relationship with peers 5 4 3 2 1 ExcellentProblematic 55Participation in organized activities (e.g. teams) 5 4 3 2 1 ExcellentProblematic Embed Print Share

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