Vanderbilt Assessment Scale/School Report (VAS/SR)

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Is the evaluation based on a time when the child was:
Symptoms *
NeverOccasionallyOftenVery Often
0123
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 living activities
10. Fidgets with hands or squirms in seat
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 (e.g. butts into conversations/games)
19. Loses temper
20. Actively defies and refuses to comply with adult’s requests or rules
21. Is angry or resentful
22. Is spiteful or vindictive
23. Bullies, threatens, or intimidates others
24. Initiates physical fights
25. Lies to obtain goods for favors or to avoid obligations (e.g. “cons” others)
26. Is physically cruel to people
27. Has stolen items of little to no value
28. Deliberately destroys others’ property
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
Symptoms Continued
NeverOccasionallyOftenVery Often
0123
32. Feels worthless or inferior
33. Blames self for problems; feels guilty
34. Feels lonely, unwanted, or unloved; complains that “no one lives him or her”
35. Is sad, unhappy, or depressed
Academic/Behavioral Performance *
 Excellent 1Above Average 2Average 3Somewhat of a Problem 4Problematic 5
36. Reading
37. Mathematics
38. Written expression
39. Relationship with peers
40. Following directions
41. Disrupting class
42. Assignment completion
43. Organizational skills
For Office Use Only
Total number of questions scored 2 or 3 in questions 1–9: __________________________
Total number of questions scored 2 or 3 in questions 10–18: ________________________
Total Symptom Score for questions 1–18: _______________________________________
Total number of questions scored 2 or 3 in questions 19–28: ________________________
Total number of questions scored 2 or 3 in questions 29–35: ________________________
Total number of questions scored 4 or 5 in questions 36–43: ________________________
Average Performance Score:
Center Associates
9 N. 4th Ave.
Marshalltown, IA  50158