Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway, Primary Care – Vanderbilt Score

Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway — Primary Care

Use and Interpretation of the Vanderbilt Score

  • Instruct caregivers/teachers to score based on prior 6 mos, though teachers can complete based on behavior since beginning of school year
  • Validated for ages 6-12 yrs, though commonly used outside this range
  • Each symptom is scored from 0 (never) to 3 (very often), with 2 (often) and 3 considered positive responses
  • Depending on scores within each 9-question subsections, children may be diagnosed with hyperactive, inattentive, or combined type of ADHD:
    • < 17 yrs: 6 positive responses within subsection
    • ≥ 17 yrs: 5 positive responses within subsection
  • Both parent/caregiver and teacher scores should show symptoms to diagnose ADHD:
    • When teacher scores are not available, review report cards or other school data
    • Score discrepancies usually indicate differences in function across settings. Consider behavioral strategies in the setting(s) where there are notable concerns
  • Full Scoring Instructions for Vanderbilt Assessment Scales from the AAP/NICHQ
  • Vanderbilt Assessment Scales – Parent and Teacher Informant Sheets

Diagnostic Considerations

Females
  • Less likely to present with hyperactivity-impulsivity
  • Impairments are more likely to be related to interpersonal relationships and self-esteem as opposed to behavior disruption
Preschool Children
3-5 yrs
  • There is no age adjustment for Vanderbilt scoring for younger children, so this scale must be administered and interpreted with caution in this age range
  • If not enrolled in daycare or preschool, obtain feedback of child’s behavior from other family members or leaders of activities (e.g., swim class, play groups)
Adolescents
> 12 yrs
  • Symptoms must be apparent before 12 yrs, but may not have caused significant impairment at younger ages
  • Impairment at the time of evaluation required for ADHD diagnosis
  • Hyperactivity typically wanes in adolescence while executive functioning challenges may be unmasked with increased demands