NICHQ Vanderbilt Assessment Follow-up—TEACHER Informant
Teacher’s Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________ Today’s Date: ___________ Child’s 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 child’s 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 Occasionally 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Often 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 not sure? Very Often 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Symptoms 1. Does not pay attention to details or makes careless mistakes with, for example, homework 2. Has difficulty keeping attention to what needs to be done 3. Does not seem to listen when spoken to directly 4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand) 5. Has difficulty organizing tasks and activities 6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort 7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books) 8. Is easily distracted by noises or other stimuli 9. Is forgetful in daily activities 10. Fidgets with hands or feet or squirms in seat 11. Leaves seat when remaining seated is expected 12. Runs about or climbs too much when remaining seated is expected 13. Has difficulty playing or beginning quiet play activities 14. Is “on the go” or often acts as if “driven by a motor” 15. Talks too much 16. Blurts out answers before questions have been completed 17. Has difficulty waiting his or her turn 18. Interrupts or intrudes in on others’ conversations and/or activities
Never 0 0 0 0 0 0...