Vanderbilt Assessment Scale—Teacher Informant #6176
Adapted from the Vanderbilt Rating Scale by Mark L. Wolraich, MD
Student:____________________________ Gender: ________ Age: ________ School year: _____
Completed by: ___________________________ Date: ____________________________________
Directions Each rating should be considered in the context of what is appropriate for the
age of the student. When completing this form, please think about the student's behaviours
in the past 6 months. Is this evaluation based on a time when the student:
was on medication was not on medication not sure?
Symptoms Never Occa- Often Very
(0) sionally (2) Often
(1) (3)
1. Fails to pay attention to details or makes
careless mistakes in schoolwork
2. Has difficulty sustaining attention to tasks or
activities
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails
to finish schoolwork (not due to refusal or failure
to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or is reluctant to engage in tasks
that require sustained mental effort
7. Loses things necessary for tasks or activities
(e.g., toys, school assignments, pencils, books,
or tools)
8. Is distracted by extraneous stimuli
9. Is forgetful in daily activities
10. Fidgets with hands or feet or squirms in seat
11. Leaves seat in classroom or in other situations in
which remaining seated is expected
12. Runs about or climbs excessively in situations in
which remaining seated is expected
13. Has difficulty playing or engaging in leisure
activities quietly
14. Is “on the go” or often acts as if “driven by a
motor”
15. Talks excessively
16. Blurts out answers before questions have been
completed
17. Has difficulty awaiting turn
18. Interrupts or intrudes on others (e.g., butts into
conversations/games)
19. Loses temper
20. Actively defies or refuses to go along with adult
requests or rules
21. Is angry or resentful
22. Is spiteful and wants to get even
23. Bullies, threatens, or intimidates others
24. Initiates physical fights
25. Lies to get out of trouble or to avoid obligations
(ie, "cons" others)
26. Is physically cruel to people
27. Has stolen things that have value
28. Deliberately destroys others’ property
29. Is fearful, anxious, or worried
30. Is self-conscious or easily embarrassed
31. Is afraid to try new things for fear of making
mistakes
32. Feels worthless or inferior
33. Blames self for problems; feels guilty
34. Feels lonely, unwanted, or unloved; complains
that “no one loves him or her”
35. Is sad, unhappy, or depressed
Performance:
Excellent Above Average Somewhat of Problematic
Academic Average a Problem
Performance
36. Reading
37. Mathematics
38. Written Expression
Performance:
Excellent Above Average Somewhat of Problematic
Classroom Average a Problem
Behavior
39. Relationship with peers
40. Following directions
41. Disrupting class
42. Assignment completion
43. Organizational skills
Comments:
