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The initial assessment scales, parent and teacher, have 2 compo-nents: symptom assessment and impairment in performance. On both the parent and teacher initial scales, the symptom assess-ment screens for symptoms that meet criteria for both inattentive (items 1–9) and hyperactive ADHD (items 10–18).
Parent’s Name: _____ Parent’s Phone Number: _____ 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.
The NICHQ Vanderbilt Assessment Scales are used by health care professionals to help diagnose ADHD in children between the ages of 6- and 12-years. NICHQ is proud to have published the first edition in 2002 and has been at the forefront of supporting children and families affected by ADHD.
The Vanderbilt rating scale is a screening and information gathering tool which can assist with making an ADHD diagnosis and with monitoring treatment effects over time. The Vanderbilt rating scale results alone do not make a diagnosis of ADHD or diagnose any other disorder — one must consider information from multiple sources to
“Scales and checklists help clinicians obtain information from adults, parents, teachers, and others about symptoms and functioning in various settings. Symptoms must be present in more than one setting (such as both at home and in school or work) to meet DSM-5 criteria for an ADHD disorder.”
ADHD Evaluation Form: Parent and Teacher Version (Assessment) This form can be used as an aid to help a health care provider in the diagnosis of Attention Deficit Hyperactivity Disorder. Please complete the form as instructed by the health care provider.
Parent’s Phone Number: 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.
