Vanderbilt Screening for Parents

ADD/ADHD Vanderbilt Screening—PARENT Informant

Instruction: 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.

Child Name

First Name

Last Name

Symptoms

Never = 0 | Occasionally = 1 | Often = 2 | Very Often = 3

1) Does not pay attention to details or makes careless mistakes with, for example, homeworks

Never Very often

2) Has difficulty keeping attention to what needs to be done

Never Very often

3) Does not seem to listen when spoken to directly

Never Very often

4) Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand)

Never Very often

5) Has difficulty organizing tasks and activities

Never Very often

6) Avoids, dislikes, or does not want to start tasks that require ongoing mental effort

Never Very often

7) Loses things necessary for tasks or activities (toys, assignments, pencils, or books)

Never Very often

8) Is easily distracted by noises or other stimuli

Never Very often

9) Is forgetful in daily activities

Never Very often

10) Fidgets with hands or feet or squirms in seat

Never Very often

11) Leaves seat when remaining seated is expected

Never Very often

12) Runs about or climbs too much when remaining seated is expected

Never Very often

13) Has difficulty playing or beginning quiet play activities

Never Very often

14) Is “on the go” or often acts as if “driven by a motor”

Never Very often

15) Talks too much

Never Very often

16) Blurts out answers before questions have been completed

Never Very often

17) Has difficulty waiting his or her turn

Never Very often

18) Interrupts or intrudes in on others’ conversations and/or activities

Never Very often

19) Argues with adults

Never Very often

20) Loses temper

Never Very often

21) Actively defies or refuses to go along with adults’ requests or rules

Never Very often

22) Deliberately annoys people

Never Very often

23) Blames others for his or her mistakes or misbehaviors

Never Very often

24) Is touchy or easily annoyed by others

Never Very often

25) Is angry or resentful

Never Very often

26) Is spiteful and wants to get even

Never Very often

27) Bullies, threatens, or intimidates others

Never Very often

28) Starts physical fights

Never Very often

29) Lies to get out of trouble or to avoid obligations (ie,“cons” others)

Never Very often

30) Is truant from school (skips school) without permission

Never Very often

31) Is physically cruel to people

Never Very often

32) Has stolen things that have value

Never Very often

33) Deliberately destroys others’ property

Never Very often

34) Has used a weapon that can cause serious harm (bat, knife, brick, gun)

Never Very often

35) Is physically cruel to animals

Never Very often

36) Has deliberately set fires to cause damage

Never Very often

37) Has broken into someone else’s home, business, or car

Never Very often

38) Has stayed out at night without permission

Never Very often

39) Has run away from home overnight

Never Very often

40) Has force someone against their will

Never Very often

41) Is fearful, anxious, or worried

Never Very often

42) Is afraid to try new things for fear of making mistakes

Never Very often

43) Feels worthless or inferior

Never Very often

44) Blames self for problems, feels guilty

Never Very often

45) Feels lonely, unwanted, or unloved; complains that “no one loves him or her”

Never Very often

46) Is sad, unhappy, or depressed

Never Very often

47) Is self-conscious or easily embarrassed

Never Very often

Performance

Excellent = 1 | Above Average = 2 | Average = 3 | Somewhat of a Problem = 4 | Problematic = 5

Vanderbilt Screening for Parents

ADD/ADHD Vanderbilt Screening—PARENT Informant

Symptoms

Performance

Sometimes, it is not just a phase…