NICHQ: Teacher Informant


NICHQ Vanderbilt Assessment Scale—Teacher Informant

Teacher’s Name:     Class Time:      Class Name/Period:

Child’s Name:      Grade Level:

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 beginning of the school year. Please indicate the number of weeks or months you have been able to evaluate the behaviors: 

Is this evaluation based on a time when the child:

Symptoms

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 activities

10. Fidgets with hands or feet 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 (eg, butts into conversations/games)

19. Loses temper

20. Actively defies or refuses to comply with adult’s requests or rules

21. Is angry or resentful

22. Is spiteful and vindictive

23. Bullies, threatens, or intimidates others

24. Initiates physical fights

25. Lies to obtain goods for favors or to avoid obligations (eg, “cons” others)

26. Is physically cruel to people

27. Has stolen items of nontrivial 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

32. Feels worthless or inferior

33. Blames self for problems; feels guilty

34. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”

35. Is sad, unhappy, or depressed


Academic Performance

36. Reading

37. Mathematics

38. Written expression


Classroom Behavioral Performance

39. Relationship with peers

40. Following directions

41. Disrupting class

42. Assignment completion

43. Organizational skills

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Document name: NICHQ: Teacher Informant
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