Vanderbilt ADHD Assessment Tool for Children with Attention Deficit Hyperactivity Disorder

Medically reviewed: 24, January 2024

Vanderbilt ADHD: A Comprehensive Assessment Tool for Children with Attention Deficit Hyperactivity Disorder

ADHD, also widely known as diagnosis – attention deficit hyperactivity disorder, is a condition that affects around 5-10% of kids all over the world. It’s basically when a child has trouble paying attention, being hyperactive, and acting impulsively, which can mess with their school, social life, emotions, and behavior. Having ADHD can seriously mess up a kid’s life, leading to problems like failing in school, not fitting in with their peers, using drugs, getting into trouble, and having mental health issues.

Dealing with ADHD involves everyone – the child, the parents, the teachers, and the healthcare professionals – coming together and taking a comprehensive and multidimensional approach to diagnosis and treatment.

A key component of this approach is the use of valid and reliable assessment tools that can measure the child’s symptoms, impairments, and comorbid conditions, as well as monitor the child’s response to interventions. One of the most widely used and recommended assessment tools for ADHD in children is the Vanderbilt ADHD Diagnostic Rating Scale (VADRS).

The VADRS is widely knwon as psychological test that Mark L. Wolraich and his colleagues at the Oklahoma Health Sciences Center made in 2002. It’s all about ADHD symptoms and assessment, using criteria from the DSM-IV and guidelines from the AAP. They made it in two versions, one for parents and one for teachers, where they ask about the child’s symptoms, problems, and other important criteria. And there are also shorter versions for parents and teachers to check on how things are going and if there are any side effects from the treatment.

The VADRS has been widely adopted and endorsed by various professional organizations, such as the AAP, the National Initiative for Children’s Healthcare Quality (NICHQ), and the Centers for Disease Control and Prevention (CDC). The VADRS ADHD assessment scale has been translated and validated in several languages and cultures, such as Spanish, French, Chinese, Korean, and Arabic. The VADRS has shown good psychometric properties, such as reliability, validity, sensitivity, and specificity, across multiple samples and settings. The VADRS has also demonstrated clinical utility, such as feasibility, acceptability, and effectiveness, in various contexts and populations.

In this article, we will provide a comprehensive overview of the VADRS, including its history, development, structure, scoring, interpretation, and application. We will also discuss the strengths and limitations of the VADRS, as well as the future directions and implications for research and practice.

History and Development of the VADRS

The VADRS was developed by Wolraich and his colleagues in response to the need for a standardized and comprehensive assessment tool for ADHD in children. Wolraich, who is a pediatrician and a researcher, had been involved in several projects and initiatives related to ADHD, such as the NICHQ ADHD Learning Collaborative, the AAP ADHD Toolkit, and the CDC ADHD Expert Panel. Wolraich noticed that there was a lack of consistency and quality in the diagnosis and treatment of ADHD among health care professionals, as well as a lack of communication and collaboration among the different stakeholders involved in the child’s care, such as the parents, the teachers, and the clinicians.

Wolraich decided to create an assessment tool that would address these gaps and challenges, by incorporating the following features:

• The tool would utilize the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for ADHD, which are universally recognized as the prevailing and extensively employed diagnostic criteria for this particular disorder.
• It includes items related to the child’s impairments in various domains, such as academic, social, emotional, and behavioral, as well as items related to common comorbid conditions, such as oppositional defiant disorder, conduct disorder, anxiety, and depression, which are often associated with ADHD.
• Survey is available in two versions: a form for a parent, and another one – for a teacher, which would allow for the collection of information from multiple sources and perspectives, as well as the comparison and integration of the data.
• This tool would have a simple and user-friendly format, which would facilitate the administration, scoring, and interpretation of the results, as well as the communication and feedback among the different parties.

Wolraich and his colleagues conducted several studies to develop and validate the VADRS, using various samples of children with and without ADHD, as well as their parents and teachers. They compared the VADRS with other existing measures of ADHD, such as the Conners Rating Scales, the Child Behavior Checklist, and the ADHD Rating Scale. It is known, that the VADRS had good psychometric properties, such as reliability, validity, sensitivity, and specificity, as well as clinical utility, such as feasibility, acceptability, and effectiveness.

The very first edition of the VADRS was published in 2002, and made it freely available online through the NICHQ website. They also published several articles and book chapters describing the VADRS and its applications, revised and updated the VADRS in 2011 and 2019, to reflect the changes in the diagnostic criteria for ADHD from the DSM-IV to the DSM-5, as well as the changes in the clinical practice guidelines for ADHD from the AAP. The latest edition of the VADRS can be purchased from the AAP bookstore.

Vanderbilt Assessment: Structure and Scoring of the Vanderbilt questionnaire for parents

The VADRS consists of two versions: a parent form and a teacher form, each containing questions related to the child’s symptoms, impairments, and comorbid conditions. The VADRS also has shorter follow-up versions for parents and teachers, which are used to monitor the child’s progress and side effects of treatment. The VADRS is designed to be administered to children between the ages of 6 and 12, who are suspected or diagnosed with ADHD.

The parent form of the VADRS contains 55 questions, divided into four sections:

Section A: ADHD Diagnostic Criteria

This section contains 18 questions that correspond to the nine inattentive and nine hyperactive-impulsive symptoms of ADHD, as defined by the DSM-5.

The parent is requested to provide a rating on the frequency of each symptom exhibited by the child over a span of the previous 6 months, using a 4-point Likert scale, ranging from 0 (never) to 3 (very often). The total score for this section ranges from 0 to 54, with higher scores indicating more severe ADHD symptoms.

Section B: Performance

This section contains 8 questions that measure the child’s impairments in various domains, such as academic, social, emotional, and behavioral, as well as the parent’s perception of the child’s self-esteem and relationship with the family. The parent is asked to rate how well the child performs in each domain, where answers should be ranged from 1 (above average) to 4 (poor). Scores are ranged from 8 to 32, with higher scores indicating more severe impairments.

Section C: Other Symptoms

This section contains 12 questions that measure the child’s symptoms of common comorbid conditions, such as oppositional defiant disorder, conduct disorder, anxiety, and depression. The parent is asked to rate how often the child has shown those symptoms in the past half a year, ranging from 0 (never) to 3 (very often). The total score for this section are – from 0 to 36, with higher scores indicating more severe comorbid symptoms.

Section D: Impairment

This section contains 17 questions that measure the child’s level of impairment in various settings and activities, such as home, school, peers, hobbies, and chores. The parent is asked to rate how much the child’s behavior interferes with each setting and activity, using a 4-point Likert scale, ranging from 0 (not at all) to 3 (very much). The total score for this section ranges from 0 to 51, with higher scores indicating more severe impairment.

Vanderbilt questionnaire for teachers

The teacher form of the VADRS contains 43 questions, divided into three sections:

Section A: ADHD Diagnostic Criteria

This section contains 18 questions that correspond to the nine inattentive and nine hyperactive-impulsive symptoms of ADHD, as defined by the DSM-5.

The teacher is requested to evaluate the frequency at which the child has exhibited each symptom over the course of the previous six months, ranging from 0 (never) to 3 (very often). The total score for this section ranges from 0 to 54, with higher scores indicating more severe ADHD symptoms.

Section B: Performance

This section contains 8 questions that measure the child’s impairments in various domains, such as academic, social, emotional, and behavioral, as well as the teacher’s perception of the child’s self-esteem and relationship with the classmates. The teacher is asked to rate how well the child performs in each domain. The teacher has to rate how well the child performs in each domain, using a 4-point Likert scale, ranging from 1 (above average) to 4 (poor).
The range of possible scores for this section is from 8 to 32, and a higher score signifies a greater level of impairment.

Section C: Other Symptoms the child has

In this particular section, there are a total of 17 questions which aim to evaluate the child’s symptoms related to various common comorbid conditions in addition to oppositional defiant disorder, conduct disorder, anxiety, and depression are also prevalent mental health conditions.

The teacher provides a rating for the frequency with which the child has exhibited each symptom within the last 6 months. This rating is based on a 4-point Likert scale, where a score of 0 represents never displaying the symptom and a score of 3 indicates very frequent display of the symptom. The overall score for this section can range between 0 and 51, with higher scores indicating more severe comorbid symptoms in the child.

ADHD forms for teachers and parents: additional questions

The follow-up versions of the VADRS for parents and teachers contain 30 questions each, divided into two sections:

Section A: ADHD Diagnostic Criteria

In this section, there are 18 questions which directly relate to the nine symptoms of inattention and nine symptoms of hyperactivity-impulsivity as outlined by the DSM-5 criteria for ADHD. To assess the frequency of each symptom displayed by the child in the last month, the parent or teacher is required to rate them on a 4-point Likert scale, which ranges from 0 (never) to 3 (very often).

By summing up the scores for all the questions in this section, a comprehensive total score ranging from 0 to 54 can be obtained. The higher the total score, the more severe the ADHD symptoms are perceived to be.

Section B: Medication Side Effects

This section contains 12 questions that measure the child’s side effects of medication, such as appetite, sleep, mood, and behavior. The parent or teacher is asked to rate how much the child has experienced each side effect in the past month, using a 4-point Likert scale, ranging from 0 (not at all) to 3 (very much).
The score for this particular section can vary anywhere between 0 and 36.

Vanderbilt ADHD Scoring

The scoring of the VADRS is based on the following steps:

Calculate the total score for each section by adding the scores of the individual items.
Compare the total score for each section with the cut-off points for each version of the VADRS, as shown in the table below:

Interpret the results based on the following criteria:

• If the overall score for section A exceeds the designated threshold, it indicates that the child fulfills the diagnostic requirements for ADHD, either predominantly inattentive, predominantly hyperactive-impulsive, or combined type, depending on the number and distribution of the symptoms.
• If the value in the section B is above the cut-off point, it clearly shows that the child has significant impairments in various domains, such as academic, social, emotional, and behavioral, which require further evaluation and intervention.
• In section C the score should be above the cut-off point to indicate that the child has symptoms of common comorbid conditions, such as ODD, or conduct disorder, severe anxiety state, and depression, which require further evaluation and intervention.
• If the total score for section D is above the cut-off point, it usually shows that the child has a high level of impairment in various settings and activities, such as home, school, peers, hobbies, and chores, which require further evaluation and intervention.
• With the total value for section B of the follow-up version is above the cut-off point, it means that the child has side effects of medication, such as appetite, sleep, mood, and behavior, which require further evaluation and adjustment.

Vanderbilt ADHD form for download

Here you can download a form for ADHD assessment. Feel free to download it and use. This form is created by Nichq.

NICHQ-Vanderbilt-Assessment-Scales DOWNLOAD

This article is written by

Anders Svensson - psychiatrist

Dr. Anders Svensson is a distinguished psychiatrist with a multifaceted career marked by excellence in research, education, and patient care. Born and raised in Stockholm, Sweden, Dr. Svensson's journey in the field of psychiatry began at the esteemed Karolinska Institute, where he earned his medical degree. Dr. Svensson has Ph.D. in Psychiatry, during which he conducted groundbreaking research at the intersection of neurobiology and mood disorders.

In his clinical practice, Dr. Svensson has worked at prominent psychiatric institutions, including the Karolinska University Hospital.

His commitment to improving mental health literacy led him to a role as a lecturer at the Stockholm School of Medicine, where he has shared his knowledge with the next generation of healthcare professionals.

Currently, Dr. Svensson has taken on a new and exciting endeavor as a contributor to NetdoctorWeb, a reputable platform dedicated to providing reliable and accessible health information.

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