Vanderbilt ADHD Assessment
Screening

Vanderbilt ADHD Assessment

2 pages18 fieldsHIPAA-ready

Form preview

formisoft.com/f/vanderbilt-adhd
Vanderbilt ADHD Assessment
Child's Name
Date of Birth
Relationship to Child
Select...
Fails to give attention to details
Difficulty sustaining attention in tasks
Does not seem to listen when spoken to
Difficulty organizing tasks and activities
Easily distracted by extraneous stimuli
Fidgets with hands or feet
Leaves seat when remaining seated is expected
Runs or climbs in inappropriate situations
Talks excessively
Blurts out answers before questions are completed
Difficulty waiting turn
Academic Performance
Classroom Behavior
Peer Relationships
Organizational Skills
Submit

The Vanderbilt ADHD Assessment form digitizes the Vanderbilt ADHD Diagnostic Rating Scale, one of the most widely used parent- and teacher-report instruments for evaluating attention deficit hyperactivity disorder in children ages 6 to 12. Developed at Vanderbilt University, this assessment aligns directly with DSM-5 diagnostic criteria and covers two core symptom domains: inattention (difficulty sustaining attention, not listening, losing things, being easily distracted) and hyperactivity-impulsivity (fidgeting, leaving seat, running or climbing inappropriately, talking excessively, interrupting). Each symptom is rated on a four-point frequency scale from never to very often.

Beyond the core ADHD symptom items, the Vanderbilt scale includes screening items for common comorbid conditions including oppositional defiant disorder, conduct disorder, and anxiety or depression. A performance section assesses academic achievement, classroom behavior, organizational skills, and peer relationships, providing the functional impairment evidence required for a DSM-5 ADHD diagnosis. The digital version automatically tallies symptom counts and performance impairment scores, helping clinicians determine whether DSM-5 thresholds are met for predominantly inattentive, predominantly hyperactive-impulsive, or combined presentation.

This template is essential for pediatric practices, child psychiatry clinics, developmental-behavioral pediatrics, and school-based health centers. The Vanderbilt is recommended by the American Academy of Pediatrics as a first-line ADHD assessment tool and is freely available for clinical use. The form supports both initial diagnostic evaluation and ongoing medication monitoring by tracking symptom severity and side effects over time. Having both parent and teacher versions available ensures that symptom documentation spans multiple settings, a key diagnostic requirement for ADHD.

What's included

  • DSM-5 aligned inattention and hyperactivity-impulsivity symptom items
  • Comorbid screening for oppositional defiant and conduct disorders
  • Anxiety and depression screening items for differential diagnosis
  • Academic and behavioral performance impairment assessment
  • Automatic symptom count and presentation type determination
  • Parent and teacher report format support for cross-setting validation

Who uses this template

  • Pediatric practices conducting initial ADHD diagnostic evaluations
  • Child psychiatry clinics monitoring medication response and side effects
  • School-based health centers supporting educational accommodation referrals
  • Developmental-behavioral pediatrics assessing comorbid conditions

All form fields

18 fields across 2 pages. Customize any field after signing up.

Child's NameText
Date of BirthDate
Relationship to ChildDropdown
Fails to give attention to detailsMultiple Choice
Difficulty sustaining attention in tasksMultiple Choice
Does not seem to listen when spoken toMultiple Choice
Difficulty organizing tasks and activitiesMultiple Choice
Easily distracted by extraneous stimuliMultiple Choice
Fidgets with hands or feetMultiple Choice
Leaves seat when remaining seated is expectedMultiple Choice
Runs or climbs in inappropriate situationsMultiple Choice
Talks excessivelyMultiple Choice
Blurts out answers before questions are completedMultiple Choice
Difficulty waiting turnMultiple Choice
Academic PerformanceMultiple Choice
Classroom BehaviorMultiple Choice
Peer RelationshipsMultiple Choice
Organizational SkillsMultiple Choice

Use this template

Sign up and start customizing the Vanderbilt ADHD Assessment for your practice. 30-day money-back guarantee.

$79.99/mo · Cancel anytime · HIPAA compliant

Related templates