Parent Follow-up Vanderbilt Assessment Scale

 ECR :  


Client's Name :     Today's Date :  

Recent Behavior
Please circle the number of the phrase that best describes
your child’s behaviors in the past week.

1 -  does not pay attention to details or makes careless mistakes (homework, duties)

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, fails to finish activities
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, pencils, assignments, 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 quietly or beginning quiet 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 on others’ conversations or activities

19 - argues with adults
20 -  loses temper
21 -  actively defies or refuses to go along with adults’ requests or rules
22 -  deliberately annoys people
23 -  blames others for his or her mistakes or misbehaviors
24 -  is touchy or easily annoyed by others
25 -  is angry or resentful
26 -  is spiteful and wants to get even
27 -  is fearful, anxious or worried
28 -  is afraid to try new things for fear of making mistakes

29 - feels worthless or inferior
30 -  blames self for problems, feels guilty
31 -  feels lonely, unwanted or unloved; complains “no one loves me”
32 -  is sad, unhappy or depressed
33 -  is self-conscious or easily embarrassed

Current medications & Reason:                                                             Max Dose                         Date taken

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Document name: Parent Follow-up Vanderbilt Assessment Scale
lock iconUnique Document ID: 325e34664aaadc6246b70ef2c0ff177f68e4088f
Timestamp Audit
September 3, 2021 12:43 pm PDTParent Follow-up Vanderbilt Assessment Scale Uploaded by Adam Falk - IP