
Form preview

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.
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

Vanderbilt ADHD Assessment Screening
Vanderbilt ADHD Assessment Scale for evaluating attention deficit hyperactivity disorder symptoms in children ages 6-12. Parent-reported questionnaire covering inattention, hyperactivity, and behavioral comorbidities.

ACE (Adverse Childhood Experiences) Screening
Standardized Adverse Childhood Experiences (ACE) screening questionnaire assessing 10 categories of childhood adversity. Used to identify trauma history and inform trauma-informed care approaches.
CRAFFT Adolescent Substance Abuse Screening
CRAFFT 2.1 screening tool designed for adolescents aged 12-21 to identify substance use risks including alcohol, cannabis, and other drugs. Validated brief screening instrument recommended by the AAP.