NICHQ Vanderbilt Assessment Scale - Parent Informant

Please correct the errors described below.

Directions: 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.

Is this evaluation based on a time when the child



Other Conditions

Tic Behaviors: To the best of your knowledge, please indicate if this child displays the following behaviors:

1. Motor Tics: Rapid, repetitive movements such as eye blinking, grimacing, nose twitching, head jerks, shoulder shrugs, arm jerks, body jerks, or rapid kicks.

2. Phonic (Vocal) Tics: Repetitive noises including but not limited to throat clearing, coughing, whistling, sniffing, snorting, screeching, barking, grunting, or repetition of words or short phrases.

3. If YES to 1 or 2, do these tics interfere with the child’s activities (like reading, writing, walking, talking, or eating)?

Previous Diagnosis and Treatment: To the best of your knowledge, please answer the following questions:

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