NICHQ Vanderbilt Assessment Follow-Up(Teacher Informant)

Please correct the errors described below.

Directions:

is this evaluation based on a time when the child

Symptoms


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


2. Has difficulty keeping attention to what needs to be done


3. Does not seem to listen when spoken to directly


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


5. Has difficulty organizing tasks and activities


6. Avoid, dislikes, or does not want to start task that require ongoing mental effort


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


8. Is easily distracted by noises or other stimuli


9. Is forget in daily activities


10. Fidgers with hands or feet or squirms in seat


11. Leaves seat when remaining seated is expected


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


13. Has difficulty playing or beginning quiet play activities


14. Is "on the go" or often acts as if "driven by a motor"


15. Talks too much


16. Blurts out answers before questions have been completed


17. Has difficulty waiting his or her turn


18. Interrupts or intrudes in on other's conversations and/or activities

Performance


19. Reading


20. Mathematics


21. Writing Expression


22. Relationship with peers


23. Following Direction


24. Disrupting Class


25. Assignment completion


26. Organizational skills

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 Socially withdrawn - Decreased interaction with others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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