Assessment

Vanderbilt ADHD Assessment

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Vanderbilt ADHD Assessment

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Child's Name
Jane Martinez
Date of Birth
03/15/1985
Relationship to Child
Select relationship...
Fails to give attention to details
Option A
Option B
Option C
Difficulty sustaining attention in tasks
Option A
Option B
Option C
Does not seem to listen when spoken to
Option A
Option B
Option C
Difficulty organizing tasks and activities
Option A
Option B
Option C
Easily distracted by extraneous stimuli
Option A
Option B
Option C
Fidgets with hands or feet
Option A
Option B
Option C
Leaves seat when remaining seated is expected
Option A
Option B
Option C
Runs or climbs in inappropriate situations
Option A
Option B
Option C
Talks excessively
Option A
Option B
Option C
Blurts out answers before questions are completed
Option A
Option B
Option C
Difficulty waiting turn
Option A
Option B
Option C
Academic Performance
Option A
Option B
Option C
Classroom Behavior
Option A
Option B
Option C
Peer Relationships
Option A
Option B
Option C
Organizational Skills
Option A
Option B
Option C
Submit
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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

How to use the Vanderbilt ADHD Assessment

Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Vanderbilt ADHD Assessment from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.

Setup steps

  1. 1Choose the template. Find the Vanderbilt ADHD Assessment in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 18 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

Is the Vanderbilt ADHD Assessment HIPAA compliant?

Yes. All Formisoft templates, including the Vanderbilt ADHD Assessment, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 18 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.

Does this template work on mobile devices?

Yes. The Vanderbilt ADHD Assessment is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

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