NICHQ Vanderbilt Assessment Follow-Up(Teacher Informant)

Please correct the errors described below.


is this evaluation based on a time when the child



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.
Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, M.D. Revised - 0303

Side Effects: Has your child experienced any of the following side effects or problems in the past week?

1. Headache

2. Stomachache

3. Change of appetite (Explain Below)

4. Trouble sleeping

5. Irritability in the late morning, late afternoon, or evening (Explain Below)

6. Socially withdrawn - Decreased interaction with others

7. Extreme sadness or unusual crying

8. Dull, tired, listless behavior

9. Tremors/feeling shaky

10. Repetitive movements, tics, jerking, twitching, eye blinking (Explain below)

11. Picking at skin or fingers, nail biting, lip or cheek chewing (Explain below)

12. Sees or hears things that aren't there

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