Surveys 2014 March V Vanderbilt Assessment Scale - TEACHER Informant

Vanderbilt Assessment Scale - TEACHER Informant

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Questions marked with an * are required Exit Survey

Hello Mrs. Debbie Patashnik, Please complete this online version of the NICHQ Vanderbilt Assessment Scale -TEACHER Informant for Megan A. Coughlin, 4th Grade. Megan has not been on medication at any time during this school year. Your responses will be sent to Megan's pediatrician as part of her evaluation for Attention Deficit Disorder. Thank you very much for your time and support. Please confirm that you are in fact the person completing this assessment. You can then begin the assessment by clicking on the Continue button below. When you are finished be sure to click on the Submit Responses button to save your answers.  I Confirm that his evaluation is being completed by Mrs. Debbie Patashnik, teacher of Megan Coughlin.       Class Time:       * 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 not sure       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.   SYMPTOMS 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 or activities * 3. Does not seem to listen when spoken to directly * 4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand) * 5. Has difficulty organizing tasks and activities * 6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort * 7. Loses things necessary for tasks or activities (school assignments, pencils, or books) * 8. Is easily distracted by extraneous stimuli * 9. Is forgetful in daily activities * 10. Fidgets with hands or feet or squirms in seat Never Occasionally Often Very Often * 11. Leaves seat in classroom or in other situations in which remaining seated is expected * 12. Runs about or climbs excessively in situations in which 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 (eg, butts into conversations/games)   Symptoms Never Occasionally Often Very Often * 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 (eg, “cons” others) * 26. Is physically cruel to people * 27. Has stolen items of nontrivial value * 28. Deliberately destroys others’ property Never Occasionally Often Very Often * 29. Is fearful, anxious, or worried * 30. Is self-conscious or 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; complains that “no one loves him or her” * 35. Is sad, unhappy, or depressed   Performance Academic Performance Excellent Above Average Average Somewhat of a Problem Problematic * 36. Reading * 37. Mathematics * 38. Written expression     Classroom Behavioral Performance Excellent Above Average Average Somewhat of a Problem Problematic * 39. Relationship with peers * 40. Following directions * 41. Disrupting class * 42. Assignment completion * 43. Organizational skills       Comments: