NICHQ Vanderbilt Assessment Scale - TEACHER Informant
Teacher's Name
Class Time
Class Name/Period
Today's Date
Child's Full Name
Grade Level
Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child's behaviour since the beginning of the school year. Please indicate the number of weeks or months you have been able to evaluate the behaviours:
Is this evaluation based on a time when the child
*
was on medication
was not on medication
not sure?
Symptoms
*
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Fails to give attention to details or makes careless mistakes in schoolwork
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Has difficulty sustaining attention to tasks or activities
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Does not seem to listen when spoken to directly
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Does not follow through when given directions and fails to finish schoolwork (not due to oppositional behaviour or failure to understand)
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Has difficulty organising tasks and activities
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Loses things necessary for tasks or activities (school assignments, pencils, or books)
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is easily distracted by extraneous stimuli
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is forgetful in daily activities
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Fidgets with hands or feet or squirms in seat
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Leaves seat in classroom or in other situations in which remaining seated is expected
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Runs about or climbs excessively in situations in which remaining seated is expected
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Has difficulty playing or engaging in leisure activities quietly
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is "on the go" or often acts as if "driven by a motor"
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Talks excessively
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Blurts out answers before questions have been completed
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Has difficulty waiting in line
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Interrupts of intrudes on others' (e.g., butts into conversations/games)
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Loses temper
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Actively defies or refuses to comply with adults' requests or rules
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is angry or resentful
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is spiteful and vindicative
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Bullies, threatens, or intimidates others
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Initiates physical fights
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Lies to obtain goods for favours or to avoid obligations (e.g., "cons" others)
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is physically cruel to people
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Has stolen things that nontrivial value
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Deliberately destroys others' property
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is fearful, anxious, or worried
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is self-conscious or easily embarrassed
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is afraid to try new things for fear of making mistakes
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Feels worthless or inferior
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Blames self for problems; feels guilty
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Feels lonely, unwanted, or unloved; complains that "no one loves them"
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Is sad, unhappy, or depressed
Never (0)
Occasionally (1)
Often (2)
Very Often (3)
Performance
*
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Reading
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Mathematics
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Written expression
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Classroom Behavioural Performance
*
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Relationship with peers
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Following directions
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Disrupting class
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Assignment completion
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Organisational skills
Excellent (1)
Above Average (2)
Average (3)
Somewhat of a Problem (4)
Problematic (5)
Comments
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