The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

2wKIKoatDmAdsm7dfsriNPhjfSpKBvLhJYkvXeFRRRV39bt82uq6U7TGH5T4foz6Qzn4gd7UY9WuH4j3jJViYom8gbQQ5

Follow up Teacher Vanderbilt

Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child's behavior since the last assessment scale was filled out.

Child's Name

* must provide value

Child's Date of Birth

Teacher's Name

* must provide value

Class Time

Class Name/ Period

Today's Date

M-D-Y

Grade Level

Is this evaluation based on a time when the child

was on medication

was not on medication

not sure

reset

Please indicate the numbers of weeks or months you have been able to evaluate the behaviors

Never

Occasionally

Often

Very Often

1- Does not pay attention to details or makes careless mistakes wiht, for example, homework

reset

2- Has difficulty keeping attention to what needs to be done

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3- Does not seem to listen when spoken to directly

reset

4- Does not follow through when given directions and fails to finish activities (not due to refusal or failure ot understand)

reset

5- Has difficulty organizing tasks and activities

reset

6-Avoids , dislikes, or does not want to start tasks that require ongoinig mental effort

reset

7- Loses things necessary for tasks or activites (toys, assignments, pencils, or books)

reset

8- Is easily distracted by noises or other stimuli

reset

9- Is forgetful in daily activities

reset

10- Fidgets with ands or feet or sqirms in seat

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11- Leaves seat when remaining seated is expected

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12- Runs about or climbs too much when remaining seated is expected

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13- Has difficulty playing or beginning quiet play activities

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14- Is "on the go" or often acts as if "driven by a motor"

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15- Talks too much

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16- Blurts out answers before questions have been completed

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17- Has difficulty waiting his or her turn

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18- Interrupts or intrudes in on others' conversations and/or activies

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Excellent

Above Average

Average

Somewhat of a Problem

Problematic

19- Reading

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20- Mathematics

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21- Written Expression

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22- Relationship with peers

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23- Following direction

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24- Disrupting class

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25- Assignment completion

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26- Organizational skills

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None

Mild

Moderate

Severe

Headache

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Stomachache

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Change of appetite- explain below

reset

Trouble sleepingn

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Irritability in the late morning, late afternoon, or evening- explain below

reset

Socially withdrawn- decreased interaction with others

reset

Extreme sadness or unusual crying

reset

Dull, tired, listless behavior

reset

Tremors/ feeling shaky

reset

Repetitive movements, tics, jerking, twitching, eye blinking- explain below

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Picking at skin or fingers, nail biting, lip or cheek chewing- explain below

reset

Sees or hears things that aren't there

reset

Explain/ Comments

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