Vanderbilt Assessment Form

Please correct the errors described below.

NICHQ Vanderbilt Assessment Follow-up—PARENT Informant

Directions: Each rating should be considered in the context of what is appropriate for the age of your child. Please think about your child’s behaviors since the last assessment scale was filled out when rating his/her behaviors.

Symptoms

  • 0 - Never
  • 1 - Occasionally
  • 2 - Often
  • 3 - Very Often

Performance

  • 1 - Excellent
  • 2 - Above Average
  • 3 - Average
  • 4 - Somewhat of a Problem
  • 5 - Problematic

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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, MD. Revised - 0303

Side Effects:

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

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