Post on 15-Mar-2020
CARING FOR CHILDREN WITH ADHD: A RESOURCE TOOLKIT FOR CLINICIANS, 2ND EDITION
MONITORING AND FOLLOW-UP Page 1 of 3
Symptoms Never Occasionally Often VeryOften
1. Failstogiveattentiontodetailsormakescarelessmistakesinschoolwork
2. Hasdifficultysustainingattentiontotasksoractivities
3. Doesnotseemtolistenwhenspokentodirectly
4. Doesnotfollowthroughoninstructionsandfailstofinishschoolwork (notduetooppositionalbehaviororfailuretounderstand)
5. Hasdifficultyorganizingtasksandactivities 0 1 2 3
6. Avoids,dislikes,orisreluctanttoengageintasksthatrequiresustained mentaleffort
7. Losesthingsnecessaryfortasksoractivities(schoolassignments, pencils,books)
8. Iseasilydistractedbyextraneousstimuli
9. Isforgetfulindailyactivities
10. Fidgetswithhandsorfeetorsquirmsinseat
11. Leavesseatinclassroomorinothersituationsinwhichremaining seatedisexpected
12. Runsaboutorclimbsexcessivelyinsituationsinwhichremaining seatedisexpected
13. Hasdifficultyplayingorengaginginleisureactivitiesquietly
14. Is“onthego”oroftenactsasif“drivenbyamotor”
15. Talksexcessively
16. Blurtsoutanswersbeforequestionshavebeencompleted
17. Hasdifficultywaitinginline
18. Interruptsorintrudesinonothers(eg,buttsintoconversations/games)
19. Losestemper
20. Activitydefiesorrefusestocomplywithadults’requestsorrules
21. Isangryorresentful
NICHQ Vanderbilt Assessment Follow-up: Teacher InformantChild’sName:
Child’sDateofBirth:
Teacher’sName:
Today’sDate:
ClassTime:
ClassName/Period:
GradeLevel:
Directions:Eachratingshouldbeconsideredinthecontextofwhatisappropriatefortheageofthechildyouareratingandshouldreflectthatchild’sbehaviorsincethelastassessmentwasfilledout.Pleaseindicatethenumberofweeksormonthsyouhavebeenabletoevaluatethebehaviors:.
ForOfficeUseOnly
__________/9
ForOfficeUseOnly
__________/9
NICHQ Vanderbilt Assessment Follow-up: Teacher Informant
MONITORING AND FOLLOW-UP Page 2 of 3
Symptoms(continued) Never Occasionally Often VeryOften
22. Isspitefulandvindictive
23. Bullies,threatens,orintimidatesothers
24. Initiatesphysicalfights
25. Liestoobtaingoodsforfavorsortoavoidobligations(eg,“cons”others)
26. Isphysicallycrueltopeople
27. Hasstolenitemsofnontrivialvalue
28. Deliberatelydestroysothers’property
Somewhat Above ofa AcademicPerformance Excellent Average Average Problem Problematic
29. Reading
30. Mathematics
31. Writtenexpression
ClassroomBehavioralPerformance
32. Relationshipwithpeers
33. Followingdirections
34. Disruptingclass
35. Assignmentcompletion
36. Organizationalskills
AdaptedfromtheVanderbiltRatingScalesdevelopedbyMarkL.Wolraich,MD.
AdaptedfromthePittsburghsideeffectsscale,developedbyWilliamE.Pelham,Jr,PhD.Availablefordownloadingatnocostinexpandedformatathttp://ccf.FIU.edu.
SideEffects:Hasthechildexperiencedanyofthefollowingsideeffect Arethesesideeffectscurrentlyaproblem?orproblemsinthepastweek? None Mild Moderate Severe
Headache
Stomachache
Changeofappetite——explainbelow
Troublesleeping
Irritabilityinthelatemorning,lateafternoon,orevening——explainbelow
Sociallywithdrawn——decreasedinteractionwithothers
Extremesadnessorunusualcrying
Dull,tired,listlessbehavior
Tremors/feelingshaky
Repetitivemovements,tics,jerking,twitching,eyeblinking——explainbelow
Pickingatskinorfingers,nailbiting,liporcheckchewing——explainbelow
Seesorhearsthingsthataren’tthere
Explain/Comments:
Pleasereturnthisformto:
Mailingaddress: Faxnumber:
ForOfficeUseOnly
__________/10
ForOfficeUseOnly
5s:_________/5
ForOfficeUseOnly
5s:_________/3
ForOfficeUseOnly
4s:_________/5
ForOfficeUseOnly
4s:_________/3
NICHQ Vanderbilt Assessment Follow-up: Teacher Informant
MONITORING AND FOLLOW-UP Page 3 of 3
Therecommendationsinthispublicationdonotindicateanexclusivecourseoftreatmentorserveasastandardofmedicalcare.Variations,takingintoaccountindividualcircumstances,maybeappropriate.OriginaldocumentincludedaspartofCaring for Children With ADHD: A Resource Toolkit for Clinicians, 2ndEdition.Copyright©2012AmericanAcademyofPediatrics.AllRightsReserved.TheAmericanAcademyofPediatricsdoesnotrevieworendorseanymodificationsmadetothisdocumentandinnoeventshalltheAAPbeliableforanysuchchanges.
ForOfficeUseOnly
Totalnumberofquestionsscored2or3inquestions1––9:_____________
Totalnumberofquestionsscored2or3inquestions10–—18:_____________
Totalnumberofquestionsscored2or3inquestions19–—28:_____________
Totalnumberofquestionsscored4inquestions29–—31:_____________
Totalnumberofquestionsscored5inquestions29–—31:_____________
Totalnumberofquestionsscored4inquestions32–—36:_____________
Totalnumberofquestionsscored5inquestions32–—36:_____________