Vanderbilt Scale Form PDF Details

In today's educational and health landscapes, the comprehension and monitoring of children's behavior and academic performance have become pivotal. Among the tools at the forefront of facilitating these assessments is the Vanderbilt Assessment Scale, specifically designed for teachers, which offers a comprehensive method to evaluate the behavior and academic achievements of children. This scale requires teachers to observe and note a wide array of behaviors and academic skills, from attention and organizational abilities to relationships with peers and classroom behavior. It presents a structured approach, asking teachers to rate behaviors based on how often they occur, ranging from "Never" to "Very Often," and to evaluate academic performance from "Excellent" to "Problematic." The form encourages a detailed observation period since the beginning of the school year, considering whether the child's evaluation is influenced by medication. This ensures a nuanced understanding of a child's capabilities and challenges. By providing a standardized format for feedback, the Vanderbilt Assessment Scale empowers educators to contribute valuable insights into a child's development, which can then inform tailored strategies for intervention, support, and enrichment. It underscores the importance of a collaborative approach in fostering an environment that supports every child's unique path to learning and growth.

QuestionAnswer
Form NameVanderbilt Scale Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvanderbilt assessment scale, vanderbilt forms, vanderbilt form, vanderbilt adhd forms

Form Preview Example

NICHQ Vanderbilt Assessment Scale—TEACHER Informant

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________

TodayÕs Date: ___________ ChildÕs 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 childs behavior since the beginning of the school year. Please indicate the number of weeks or months you have been able to evaluate the behaviors: ___________.

 

Is this evaluation based on a time when the child

was on medication was not on medication not sure?

 

 

 

 

 

 

 

 

Symptoms

 

Never

Occasionally

Often

Very Often

 

1.

Fails to give attention to details or makes careless mistakes in schoolwork

0

1

2

3

 

 

 

 

 

 

 

 

2.

Has difficulty sustaining attention to tasks or activities

0

1

2

3

 

 

 

 

 

 

 

 

 

3.

Does not seem to listen when spoken to directly

 

0

1

2

3

 

 

 

 

 

 

 

 

4.

Does not follow through on instructions and fails to finish schoolwork

0

1

2

3

 

 

(not due to oppositional behavior or failure to understand)

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Has difficulty organizing tasks and activities

 

0

1

2

3

 

 

 

 

 

 

 

 

6.

Avoids, dislikes, or is reluctant to engage in tasks that require sustained

0

1

2

3

 

 

mental effort

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Loses things necessary for tasks or activities (school assignments,

0

1

2

3

 

 

pencils, or books)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Is easily distracted by extraneous stimuli

 

0

1

2

3

 

 

 

 

 

 

 

 

 

9.

Is forgetful in daily activities

 

0

1

2

3

 

 

 

 

 

 

 

 

 

10.

Fidgets with hands or feet or squirms in seat

 

0

1

2

3

 

 

 

 

 

 

 

 

11.

Leaves seat in classroom or in other situations in which remaining

0

1

2

3

 

 

seated is expected

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

Runs about or climbs excessively in situations in which remaining

0

1

2

3

 

 

seated is expected

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Has difficulty playing or engaging in leisure activities quietly

0

1

2

3

 

 

 

 

 

 

 

 

 

14.

Is Òon the goÓ or often acts as if Òdriven by a motorÓ

 

0

1

2

3

 

 

 

 

 

 

 

 

 

15.

Talks excessively

 

0

1

2

3

 

 

 

 

 

 

 

 

16.

Blurts out answers before questions have been completed

0

1

2

3

 

 

 

 

 

 

 

 

 

17.

Has difficulty waiting in line

 

0

1

2

3

 

 

 

 

 

 

 

 

18.

Interrupts or intrudes on others (eg, butts into conversations/games)

0

1

2

3

 

 

 

 

 

 

 

 

 

19.

Loses temper

 

0

1

2

3

 

 

 

 

 

 

 

 

20.

Actively defies or refuses to comply with adultÕs requests or rules

0

1

2

3

 

 

 

 

 

 

 

 

 

21.

Is angry or resentful

 

0

1

2

3

 

 

 

 

 

 

 

 

 

22.

Is spiteful and vindictive

 

0

1

2

3

 

 

 

 

 

 

 

 

 

23.

Bullies, threatens, or intimidates others

 

0

1

2

3

 

 

 

 

 

 

 

 

 

24.

Initiates physical fights

 

0

1

2

3

 

 

 

 

 

 

 

 

25.

Lies to obtain goods for favors or to avoid obligations (eg,ÒconsÓ others)

0

1

2

3

 

 

 

 

 

 

 

 

 

26.

Is physically cruel to people

 

0

1

2

3

 

 

 

 

 

 

 

 

 

27.

Has stolen items of nontrivial value

 

0

1

2

3

 

 

 

 

 

 

 

 

 

28.

Deliberately destroys othersÕproperty

 

0

1

2

3

 

 

 

 

 

 

 

 

 

29.

Is fearful, anxious, or worried

 

0

1

2

3

 

 

 

 

 

 

 

 

 

30.

Is self-conscious or easily embarrassed

 

0

1

2

3

 

 

 

 

 

 

 

 

31.

Is afraid to try new things for fear of making mistakes

0

1

2

3

 

 

 

 

 

 

 

 

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 circum- stances, may be appropriate.

Copyright ©2002 American Academy of Pediatrics and National Initiative for ChildrenÕs Healthcare Quality

Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

Revised - 1102

NICHQ Vanderbilt Assessment Scale—TEACHER Informant

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________

TodayÕs Date: ___________ ChildÕs Name: _______________________________ Grade Level: _______________________________

Symptoms (continued)Never Occasionally Often Very Often

32.

Feels worthless or inferior

 

0

1

2

3

 

 

 

 

 

 

 

33.

Blames self for problems; feels guilty

 

0

1

2

3

 

 

 

 

 

34.

Feels lonely, unwanted, or unloved; complains that Òno one loves him or herÓ 0

1

2

3

 

 

 

 

 

 

 

35.

Is sad, unhappy, or depressed

 

0

1

2

3

 

 

 

 

 

 

 

 

 

 

 

 

Somewhat

 

Performance

 

 

Above

of a

 

ACA DEMIC PERFORMANCE

Excellent

Average

Average

Problem

Problematic

 

 

 

 

 

 

 

36.

Reading

1

2

3

4

5

 

 

 

 

 

 

 

37.

Mathematics

1

2

3

4

5

 

 

 

 

 

 

 

38.

Written expression

1

2

3

4

5

 

 

 

 

 

 

 

 

 

 

 

 

Somewhat

 

 

 

 

Above

 

of a

 

CLASSROOM BEHAVIORAL PERFORMANCE

Excellent

Average

Average

Problem

Problematic

 

 

 

 

 

 

 

39.

Relationship with peers

1

2

3

4

5

 

 

 

 

 

 

 

40.

Following directions

1

2

3

4

5

 

 

 

 

 

 

 

41.

Disrupting class

1

2

3

4

5

 

 

 

 

 

 

 

42.

Assignment completion

1

2

3

4

5

 

 

 

 

 

 

 

43.

Organizational skills

1

2

3

4

5

 

 

 

 

 

 

 

Comments:

Please return this form to: __________________________________________________________________________________

Mailing address: __________________________________________________________________________________________

________________________________________________________________________________________________________

Fax number:______________________________________________________________________________________________

For Office Use Only

Total number of questions scored 2 or 3 in questions 1Ð9: ____________________________

Total number of questions scored 2 or 3 in questions 10Ð18:__________________________

Total Symptom Score for questions 1Ð18: ____________________________________________

Total number of questions scored 2 or 3 in questions 19Ð28:__________________________

Total number of questions scored 2 or 3 in questions 29Ð35:__________________________

Total number of questions scored 4 or 5 in questions 36Ð43:__________________________

Average Performance Score: ______________________________________________

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