Vanderbilt ADHD Scale Scoring: Parent and Teacher Assessment Guide
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How is the Vanderbilt ADHD rating scale scored?
Count the symptom items rated 2 or 3 (often or very often). Six of the nine inattentive items (1 to 9) or six of the nine hyperactive items (10 to 18) meet the symptom count, but ADHD criteria also require a 4 or 5 on at least one performance item. The other sections screen for comorbid conditions.
The NICHQ Vanderbilt Assessment Scales are parent and teacher rating forms used to assess ADHD symptoms and impairment in children. The initial (diagnostic) scales cover the 18 core ADHD symptoms, screens for oppositional-defiant, conduct and anxiety or depression symptoms, and a performance section. Shorter follow-up scales are used to track treatment.
This guide sets out the scoring rules from the published scoring instructions, the item ranges for the parent and teacher forms, how to use the follow-up scales, and where the result goes in a SOAP note or DAP note. The scales are copyrighted by the American Academy of Pediatrics and NICHQ, so this page does not reproduce the items and has no scorer: use your own copy of the forms.
NICHQ Vanderbilt Assessment Scales at a glance
| Detail | What the sources say |
|---|---|
| What it is | Parent and teacher rating scales with two components: symptom assessment and impairment in performance. |
| Copyright | American Academy of Pediatrics and the National Initiative for Children's Healthcare Quality (NICHQ), 2002. The current forms are in the AAP toolkit Caring for Children With ADHD. |
| Versions | Parent initial, teacher initial, parent follow-up and teacher follow-up. |
| Symptom item scores | A positive response is a 2 or 3 (often, very often). |
| Performance item scores | Scored 1 to 5, with 4 and 5 showing a problem in performance. |
| Core ADHD items | Inattentive items 1 to 9 and hyperactive/impulsive items 10 to 18 on every version. |
| Parent initial performance items | 48 to 55. |
| Teacher initial performance items | 36 to 43. |
| Use | The instructions say the scales should not be used alone to make any diagnosis. |
Vanderbilt initial scale scoring rules
| Screen | Parent initial scale | Teacher initial scale |
|---|---|---|
| Predominantly inattentive | 2 or 3 on 6 of 9 items (1 to 9), and 4 or 5 on any performance item (48 to 55) | 2 or 3 on 6 of 9 items (1 to 9), and 4 or 5 on any performance item (36 to 43) |
| Predominantly hyperactive/impulsive | 2 or 3 on 6 of 9 items (10 to 18), and 4 or 5 on any performance item | 2 or 3 on 6 of 9 items (10 to 18), and 4 or 5 on any performance item |
| Combined | Both of the above | Both of the above |
| Oppositional-defiant | 2 or 3 on 4 of 8 items (19 to 26), and 4 or 5 on any performance item | Combined with conduct: 2 or 3 on 3 of 10 items (19 to 28), and 4 or 5 on any performance item |
| Conduct | 2 or 3 on 3 of 14 items (27 to 40), and 4 or 5 on any performance item | See the combined screen above |
| Anxiety/depression | 2 or 3 on 3 of 7 items (41 to 47), and 4 or 5 on any performance item | 2 or 3 on 3 of 7 items (29 to 35), and 4 or 5 on any performance item |
How do you count positive Vanderbilt answers?
On each symptom item, a 2 or 3 (often or very often) is a positive response. The scoring instructions suggest drawing a line straight down the page and counting the positive answers in each segment. The form has a place to record the number of positives in each segment and a total score for the first 18 symptoms, which you get by adding up the ratings on items 1 to 18.
The instructions say that to meet DSM-IV criteria, a child must have at least 6 positive responses to the inattentive 9 or the hyperactive 9 core symptoms, or both. Count the two segments separately: five positives on items 1 to 9 plus four on items 10 to 18 does not meet the count for either.
Why do the performance items matter?
The second section of each initial scale rates performance from 1 to 5. The instructions say that to meet criteria for ADHD there must be at least one performance item scored 4 or 5: there must be impairment, not just symptoms. A child with six or more positive symptom answers and no performance item at 4 or 5 does not meet the scale criteria.
The form also asks for the number of performance positives (4s and 5s) and an average performance score: add the performance ratings and divide by the number of performance items answered.
How do the comorbidity screens work?
The initial scales also screen for three other conditions, each counted from its own segment of items and each also requiring a 4 or 5 on any performance item. The parent form screens oppositional-defiant (4 of items 19 to 26), conduct (3 of items 27 to 40) and anxiety or depression (3 of items 41 to 47) symptoms. The teacher form combines oppositional-defiant and conduct into one screen (3 of items 19 to 28) and screens anxiety or depression with items 29 to 35.
A positive comorbidity screen is a prompt for further assessment, not a diagnosis. Anxiety and depression can also affect attention, so a positive anxiety or depression screen is worth following up with a measure such as the GAD-7 or the PHQ-A for adolescents where it fits the child's age.
How are the Vanderbilt follow-up scales scored?
The parent and teacher follow-up scales have the 18 core ADHD symptoms but not the comorbidity items, the same performance section, and a side-effect reporting scale for monitoring medication. Scoring involves only a total symptom score for items 1 to 18 and the average of the performance items answered, both tracked over time as measures of improvement with treatment.
On both follow-up forms, the instructions give the total symptom score as questions 1 to 18 and the average performance score as questions 19 to 26. Record both with the date and the informant, and compare them with the previous follow-up from the same informant.
How do you document it in a progress note?
- Step 1: State which Vanderbilt version was used (parent or teacher, initial or follow-up), the informant and the date.
- Step 2: Record the number of positive answers (2 or 3) on items 1 to 9 and on items 10 to 18, and the total symptom score for items 1 to 18.
- Step 3: Record the number of performance items scored 4 or 5 and the average performance score.
- Step 4: On an initial scale, record which comorbidity screens were positive.
- Step 5: Put your interpretation in the Assessment, combining parent, teacher and clinical information, since the scales are not used alone for a diagnosis.
- Step 6: State the plan: further evaluation, a teacher form if one is missing, or a follow-up scale at a stated interval.
Where the Vanderbilt goes in each note format
| Note format | Where the scores go | Where the interpretation goes |
|---|---|---|
| SOAP | Objective: version, informant, date, positive counts, total symptom score, performance results. | Assessment: what the ratings mean with other sources and your evaluation. |
| DAP | Data: version, informant, date, positive counts, total symptom score, performance results. | Assessment: what the ratings mean with other sources and your evaluation. |
Example wording (fictional, for illustration only)
Objective: NICHQ Vanderbilt parent initial scale completed by mother on 11/03. Inattentive items 1 to 9: 7 positive; hyperactive items 10 to 18: 3 positive; total symptom score 31. Performance: 2 items scored 4. Comorbidity screens negative. Assessment: Parent ratings meet the inattentive symptom count with impairment at home and school; teacher ratings are needed before diagnostic conclusions. Plan: send the teacher initial scale and review both at the next visit.
Can you use and copy the Vanderbilt scales for free?
The scoring instructions and forms in circulation carry a 2002 copyright notice for the American Academy of Pediatrics and the National Initiative for Children's Healthcare Quality. The AAP now publishes the forms in Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians, which it sells with single-user and institutional licenses.
WellNotes could not find published terms from the AAP or NICHQ that allow the scales to be reproduced online, so this page does not reproduce the items and does not offer a scorer. Use the forms that come with your toolkit or your organization's license, and confirm the current terms with the AAP before you copy or build them into a system.
Frequently Asked Questions
What score on the Vanderbilt indicates ADHD?
There is no single total that indicates ADHD. The scale criteria are met when at least 6 of the 9 inattentive items or 6 of the 9 hyperactive items are rated 2 or 3, and at least one performance item is rated 4 or 5. The scales are not used alone to make a diagnosis.
What counts as a positive answer on the Vanderbilt?
A rating of 2 or 3 (often or very often) on a symptom item. On performance items, a 4 or 5 shows a problem.
What is the difference between the parent and teacher Vanderbilt?
Both have the same 18 core ADHD items. The parent initial form screens oppositional-defiant, conduct, and anxiety or depression symptoms separately and has performance items 48 to 55. The teacher initial form combines the oppositional-defiant and conduct screen, uses items 29 to 35 for anxiety or depression, and has performance items 36 to 43.
How do you calculate the Vanderbilt total symptom score?
Add the ratings on items 1 to 18. The total is used to track change over time, mainly on the follow-up scales, alongside the average performance score.
How do you calculate the average performance score?
Add the ratings on the performance items and divide by the number of performance items answered.
Is the Vanderbilt used for adults?
No. The Vanderbilt scales are parent and teacher ratings for children. For adults, a self-report screen such as the ASRS v1.1 is commonly used.
Does WellNotes score the Vanderbilt for me?
No. The WellNotes note app does not administer or score the Vanderbilt scales, and this page has no scorer. WellNotes drafts your session note from what you type or dictate, and you review the scores you entered.
Related references
Sources
- Scoring Instructions for the NICHQ Vanderbilt Assessment Scales (American Academy of Pediatrics and NICHQ, 2002; University of Washington copy)
- American Academy of Pediatrics: Caring for Children With ADHD, A Practical Resource Toolkit for Clinicians (3rd edition, includes the Vanderbilt forms)
This page is general reference information, not clinical, coding, or legal advice. Scoring rules and usage terms can change, so confirm them on the instrument owner's current materials and with your payer or supervisor before relying on them. WellNotes does not administer or score screening tools. The treating clinician interprets every result.
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