NICHQ Vanderbilt Assessment Scale
PARENT Informant

Is this evaluation based on a time when the child  
Was on medication    Was not on medication    Not sure   

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

Please SelectNeverOccasionallyOftenVery Often      2. Has difficulty keeping attention to what needs to be done  

Please SelectNeverOccasionallyOftenVery Often      3. Does not seem to listen when spoken to directly  

Please SelectNeverOccasionallyOftenVery Often      4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand) 

Please SelectNeverOccasionallyOftenVery Often      5. Has difficulty organizing tasks and activities  

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

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

Please SelectNeverOccasionallyOftenVery Often      8. Is easily distracted by noises or other stimuli  

Please SelectNeverOccasionallyOftenVery Often      9. Is forgetful in daily activities  

Please SelectNeverOccasionallyOftenVery Often    10. Fidgets with hands or feet or squirms in seat  

Please SelectNeverOccasionallyOftenVery Often    11. Leaves seat when remaining seated is expected  

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

Please SelectNeverOccasionallyOftenVery Often    13. Has difficulty playing or beginning quiet play activities  

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

Please SelectNeverOccasionallyOftenVery Often    15. Talks too much  

Please SelectNeverOccasionallyOftenVery Often    16. Blurts out answers before questions have been completed  

Please SelectNeverOccasionallyOftenVery Often    17. Has difficulty awaiting his or her turn  

Please SelectNeverOccasionallyOftenVery Often    18. Interrupts or intrudes in on others’ conversations and/or activities  

Please SelectNeverOccasionallyOftenVery Often    19. Argues with adults  

Please SelectNeverOccasionallyOftenVery Often    20. Loses temper  

Please SelectNeverOccasionallyOftenVery Often    21. Actively defies or refuses to go along with adults’ requests or rules  

Please SelectNeverOccasionallyOftenVery Often    22. Deliberately annoys people  

Please SelectNeverOccasionallyOftenVery Often    23. Blames others for his or her mistakes or misbehaviors  

Please SelectNeverOccasionallyOftenVery Often    24. Is touchy or easily annoyed by others  

Please SelectNeverOccasionallyOftenVery Often    25. Is angry or resentful  

Please SelectNeverOccasionallyOftenVery Often    26. Is spiteful and wants to get even  

Please SelectNeverOccasionallyOftenVery Often    27. Bullies, threatens or intimidates others  

Please SelectNeverOccasionallyOftenVery Often    28. Starts physical fights  

Please SelectNeverOccasionallyOftenVery Often    29. Lies to get out of trouble or to avoid obligations (ie, “cons” others)  

Please SelectNeverOccasionallyOftenVery Often    30. Is truant from school (skips school) without permission  

Please SelectNeverOccasionallyOftenVery Often    31. Is physically cruel to people  

Please SelectNeverOccasionallyOftenVery Often    32. Has stolen things that have value  

Please SelectNeverOccasionallyOftenVery Often    33. Deliberately destroys others’ property  

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

Please SelectNeverOccasionallyOftenVery Often    35. Is physically cruel to animals  

Please SelectNeverOccasionallyOftenVery Often    36. Has deliberately set fires to cause damage  

Please SelectNeverOccasionallyOftenVery Often    37. Has broken into someone else’s home, business or car  

Please SelectNeverOccasionallyOftenVery Often    38. Has stayed out at night without permission  

Please SelectNeverOccasionallyOftenVery Often    39. Has run away from home overnight  

Please SelectNeverOccasionallyOftenVery Often    40. Has forced someone into sexual activity  

Please SelectNeverOccasionallyOftenVery Often    41. Is fearful, anxious or worried  

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

Please SelectNeverOccasionallyOftenVery Often    43. Feels worthless or inferior  

Please SelectNeverOccasionallyOftenVery Often    44. Blames self for problems, feels guilty  

Please SelectNeverOccasionallyOftenVery Often    45. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”  

Please SelectNeverOccasionallyOftenVery Often    46. Is sad, unhappy or depressed  

Please SelectNeverOccasionallyOftenVery Often    47. Is self-conscious or easily embarrassed  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    48. Overall school performance  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    49. Reading  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    50. Writing  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    51. Mathematics  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    52. Relationship with parents  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    53. Relationship with siblings  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    54. Relationship with peers  

Please SelectExcellentAbove AverageAverageSomewhat of a ProblemProblematic    55. Participation in organized activities (eg, teams)  

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, may be appropriate.

Copyright ©2002 American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality