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 - adam.falk@options.org IP 206.192.252.48