Vanderbilt Teacher Scales (on-line version) from JeffTurley.com

Student Date
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School District Grade

The NICHQ (National Initiative for Children's Healthcare Quality) and American Academy of Pediatrics (AAP) have sponsored a set of tools for evaluating children for behavioral and emotional problems at school.  Please complete the questionnaire based on your direct observations of this student in a school setting. 

This form is designed for on-line submission.  If you would like to download a PDF version for manual completion, go to:  

Vanderbilt Teacher Scales (manual version) PDF

 

never

occasionally

often

very often

1.      fails to give attention to details or makes careless mistakes in schoolwork

 

 

 

 

2.      has difficulty sustaining attention to tasks

 

 

 

 

3.      does not seem to listen when spoken to directly

 

 

 

 

4.      does not follow through on instructions and fails to finish schoolwork

 

 

 

 

5.      has difficulty organizing tasks/activities

 

 

 

 

6.      avoids tasks that require sustained mental effort

 

 

 

 

7.      loses things necessary for activities

 

 

 

 

8.      is easily distracted by extraneous stimuli

 

 

 

 

9.      is forgetful in daily activities

 

 

 

 

10.  fidgets with hands or feet or squirms

 

 

 

 

11.  leaves seat when remaining seated is expected

 

 

 

 

12.  runs about or climbs excessively when 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 waiting in line

 

 

 

 

18.  interrupts or intrudes on others

 

 

 

 

19.  loses temper

 

 

 

 

20.  actively defies or refuses to comply with adult's requests or rules

 

 

 

 

21.  is angry or resentful

 

 

 

 

22.  is spiteful and vindictive

 

 

 

 

23.  bullies, threatens, or intimidates others

 

 

 

 

24.  initiates physical fights

 

 

 

 

25.  lies to obtain goods for favors or to avoid obligations ("cons" others)

 

 

 

 

26.  is physically cruel to people

 

 

 

 

27.  has stolen items of nontrivial value

 

 

 

 

28.  deliberately destroys others' property

 

 

 

 

29.  is fearful, anxious or worried

 

 

 

 

30.  is self-conscious and 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

 

 

 

 

35.  is sad, unhappy, or depressed

 

 

 

 

School Performance and Demeanor

  Excellent Above average Average Somewhat of a problem Problematic
Reading
Math
Written Expression
Relationships with peers
Following directions
Disrupting classes
Completing assignments
Organizational skills

Your comments:

If the student is known to be taking medication, are you aware of any side-effects?