Vanderbilt ADHD Assessment

Child's Name

Date of Birth

____ / ____ / ________

Relationship to Child

• Parent
• Legal guardian
• Other caregiver

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