Vanderbilt Parent Initial Assessment Form

Johns Creek Pediatrics

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.

Symptoms

Kindly refer to the following scale below when answering this section of the form.

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

Performance

Kindly refer to the following scale below when answering this section of the form.

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

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