Vanderbilt ADHD rating scales: which edition and how to score it

A school asks you to “run the Vanderbilt” on a nine-year-old. The pediatrician emails a PDF, a parent brings another downloaded from somewhere, and a search turns up half a dozen more, some in Spanish. Same name, different instruments: there are three editions of the NICHQ Vanderbilt Assessment Scales, with different contents and different licences. That is where most of what goes wrong with this scale begins.

Three editions, three different answers about licensing

NICHQ says it on its own page: “Since the first edition, there have been two subsequent editions: the 2nd Edition (2011) and 3rd Edition (2019).”

Edition	Year	Where it legitimately comes from	Cost	What you may do with it
1st	2002	NICHQ download page	Free	NICHQ permits the download and asks for a reference to NICHQ in publications
2nd	2011 (© 2012)	Forms posted openly on aap.org	Free to download	“All Rights Reserved”: no reuse licence granted
3rd	2019	AAP Bookstore	USD 155 (member 125)	Single user; institutional licence required for multi-user access or EHR integration

The current edition is not free. NICHQ itself points you to buy it — the 3rd edition “can be purchased from the American Academy of Pediatrics (AAP) Bookstore” — and the AAP dates it 3 October 2019 and calls it “completely updated and revised for new diagnostic criteria.”

Downloadable is not licensed. NICHQ’s explicit permission is worded for the first edition; we found no AAP page granting permission to use or distribute the second, whose forms reserve all rights even though they sit in the open. That distinction runs through everything in psychological test licensing. And we say nothing here about the third edition’s contents: we could not read them.

What each form contains

These are informant-report forms: an adult who observes the child fills them in, and NICHQ places them with children “between the ages of 6- and 12-years”; the symptom structure holds up in samples reaching age 17, but no accuracy figure supports presenting them as validated in adolescents. In the second edition, symptoms are rated 0–3 (“Never / Occasionally / Often / Very Often”): 47 parent items in five blocks — inattention (1–9), hyperactivity/impulsivity (10–18), oppositional-defiant (19–26), conduct (27–40) and anxiety/depression (41–47) — and 35 teacher items, where oppositional and conduct items are merged (19–28) and anxiety/depression sits at 29–35. Performance is rated separately, on a 1–5 scale (“Excellent” to “Problematic”): seven items on the parent form (48–54) and eight on the teacher form (36–43).

The recall window differs by informant: parents rate “your child’s behaviors in the past 6 months”; teachers rate behavior “since the beginning of the school year” and note how many weeks or months they have observed the child. The parent form also asks whether the rated period was on or off medication.

The teacher’s performance block is why that form is not redundant: following directions, disrupting class, assignment completion and organizational skills are classroom behaviors a parent is not positioned to see. The one domain it shares with the parent form is peer relationships. Before the form goes to the school, settle who authorizes the evaluation and who may receive information about a minor: that belongs in informed consent with minors.

Scoring: first-edition rules, in a DSM-IV frame

The rules below come from the free first-edition PDF, and its own text is anchored in DSM-IV: “To meet DSM-IV criteria for the diagnosis, one must have at least 6 positive responses to either the inattentive 9 or hyperactive 9 core symptoms, or both.” The free second-edition forms print the tally boxes but not the instructions, and we located no published scoring rules for the second or third edition: your report should name the edition you scored.

Symptom criterion: six of nine items rated 2 or 3 in inattention (1–9), or six of nine in hyperactivity/impulsivity (10–18); the combined presentation requires both. The rule is the same on the parent and teacher forms.

Performance criterion — the half almost everyone skips. It is not a suggestion: “there must be at least one item of the Performance set in which the child scores a 4 or 5; ie, there must be impairment, not just symptoms to meet diagnostic criteria.” Without that item, a high symptom count does not complete the rule.

The comorbidity screens use different denominators, and parent and teacher forms do not match:

Screen	Form	Symptom rule (1st ed.)
Oppositional-defiant	Parent	4 of 8 in items 19–26
Conduct	Parent	3 of 14 in items 27–40
Anxiety/depression	Parent	3 of 7 in items 41–47
Oppositional/conduct	Teacher	3 of 10 in items 19–28
Anxiety/depression	Teacher	3 of 7 in items 29–35

All five also require a performance item at 4 or 5.

One concrete trap: in the first edition the parent performance block ran from 48 to 55 and included “Overall school performance”; in the second that item was dropped and the block became 48–54. A scoring sheet from another edition misaligns the numbering.

And the warning printed at the top of the instructions: “These scales should NOT be used alone to make any diagnosis.”

What the score cannot tell you

The accuracy figures come from community studies of Wolraich’s VADPRS and VADTRS scales, of which the NICHQ forms are a declared adaptation: they describe the family, not the form you printed. In Bard et al. (2013), the parent scale produced sensitivity of .80, specificity of .75, positive predictive value of .19 and NPV of .98 against a case definition combining the teacher scale with a DISC-IV parent interview; internal consistency was .91 to .94. In Wolraich et al. (2013), the teacher scale produced sensitivity of .69, specificity of .84, PPV of .32 and NPV of .96, and the authors draw the conclusion themselves: “The low predictive validity further demonstrates the need for multiple observers in establishing the diagnosis.”

A PPV of .19 means that in a community sample most positive Vanderbilts are not ADHD. That is the arithmetic reason the 2019 AAP clinical practice guideline requires a full evaluation: DSM-5 criteria “including documentation of symptoms and impairment in more than 1 major setting,” with information from parents or guardians and from school, and alternative causes ruled out. The same guideline notes that neuropsychological testing “has not been found to improve diagnostic accuracy in most cases,” though it may help clarify learning strengths and weaknesses. Informants disagreeing is not a defect either: in Narad et al. (2015) agreement was weak for inattention and moderate-to-strong for hyperactivity/impulsivity, and each reporter provides unique, valid information.

Spanish: an official translation behind a paywall, no validation we could find

Three separate things get conflated constantly, and the distinction matters for anyone serving Spanish-speaking clients.

Translation: yes, and it is the AAP’s. The AAP’s publications site indexes, among the third-edition toolkit’s chapters, a Spanish-language Vanderbilt parent form and its follow-up. We could not open them — they sit behind the purchase — and we do not know who translated them or which variety of Spanish they use. Do not assume it is Mexican Spanish.

Validation in Spanish: we found none. Searches of PubMed, Crossref and Europe PMC return validations of the Vanderbilt in Arabic and in Czech, and Spanish validations of a different Vanderbilt instrument — a set of fatigue scales from audiology — but none of the Spanish ADHD Vanderbilt. In Arabic and Czech someone did the work; in Spanish we did not find it.

Validation in Mexico: we found none either. No diagnostic accuracy, no factor structure, no reliability. And there is a measured signal: in Bauer et al. (2016) Hispanic parents were less likely to report anxiety symptoms, and the authors conclude that the scale detects anxiety at a lower rate among Hispanic pediatric patients.

And the trap. The Spanish Vanderbilt PDFs circulating in search results are hosted on document-sharing sites and on clinic and university servers: none comes from the rights holder or an authorized distributor, which is why we do not link them. The problem is not only legal: opening one of those files, you cannot tell which edition you are holding, who translated it, or whether the scoring sheet matches the form.

Scope of practice: what you can sign

Three rules in the APA ethics code land directly on this instrument. Standard 9.01(b): when an adequate examination is not practical, the psychologist documents the efforts made, clarifies the probable impact of that limited information on the reliability and validity of the opinions, and appropriately limits the nature and extent of the conclusions. Standard 9.02(b) asks for instruments “whose validity and reliability have been established for use with members of the population tested” and, where they have not been, for the psychologist to “describe the strengths and limitations of test results and interpretation.” Standard 9.06 requires taking linguistic and cultural differences into account when interpreting, and stating the limitations of the interpretation.

Translated into what you write: a Vanderbilt is an informant-reported screening result, in an edition and a language you must name, and — for Spanish-speaking clients — without established validation in that population. It is not “has ADHD.” Holding that distance is the craft of a psychological report.

The prescribing boundary deserves saying without apology: the follow-up forms keep the 18 core symptoms and add a medication side-effect scale adapted from Pelham’s Pittsburgh side effects scale. A non-prescribing clinician can collect it and hand it to the prescriber; reading it as a medication decision is not theirs.

And because there is an anxiety/depression block: any disclosure of suicidal ideation or self-harm calls for an immediate clinical risk assessment under your own protocol and training. This guide will not hand you a step-by-step protocol, and be wary of any blog that does. Make sure the family knows the crisis line serving your client’s location, plus local emergency services.

Where the result lives in the record

Record-keeping obligations come from the jurisdiction you practice in, so verify the rules where you work. In Mexico, for example, NOM-004-SSA3-2012 never mentions the Vanderbilt but does say where a result like this falls: the clinical history must include prior and current results of laboratory, imaging “and other” studies (6.1.3) and expressly contemplates content belonging to the field of the psychologist (6.1.2). Numeral 5.10 fixes each note’s formalities — date, time, full name and signature — and 5.11 requires legible technical language. The evolution note in 6.2 is written by the physician per the text of the norm; your job is to record the result so it can be carried forward. The rest is in the guide to Mexico’s clinical record standard for psychologists.

Drafting judgment, not a rule: record edition and language, who completed the form, the observation window, the raw counts per block, and whether the performance criterion was met.

“Vanderbilt parent form, 2nd ed. in English, completed by the mother; 6-month window. Inattention 7/9 rated 2 or 3; hyperactivity/impulsivity 3/9. One performance item at 4. Teacher form pending. Screening result; not a diagnosis.”

Keep the data point where it does work

The Vanderbilt is useful in exactly what a clinician needs: symptom counts from two informants and an impairment check. It demands precision about edition, language and scope, and a result that does not end up on a loose sheet: gesell.ai keeps structured charts — intake, clinical history, treatment plan and session notes — so the result you scored sits dated alongside the rest of the case, and includes built-in validated scales with automatic scoring, PHQ-9 and GAD-7 among them, always as decision support you evaluate. For instruments with official translations and local data, the PHQ-9 guide; for turning repeated measurement into a trajectory, measuring therapy progress.