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NICHQ Vanderbilt Assessment Scale-PARENT Informant

  • NICHQ Vanderbilt Assessment Scale-PARENT Informant

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Directions: Each rating should be considered in the context of what is appropriate for the age of your child.
    When completing this form, please think about your child's behavior in the past 6 months.
  • Symptoms

  • Performance

  • 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 19-26: _______________
    Total number of questions scored 2 or 3 in questions 27-40:_______________
    Total number of questions scored 2 or 3 in questions 41-47: _______________
    Total number of questions scored 4 or 5 in questions 48-55: _______________
    Average Performance Score: _______________
  • This field is for validation purposes and should be left unchanged.