Vanderbilt ADHD Diagnostic Rating Scale VADRS
Vanderbilt ADHD Diagnostic Rating Scale VADRS overview
Creator and Context
The Vanderbilt ADHD Diagnostic Rating Scales were developed by Mark Wolraich. The forms most widely used in practice are the NICHQ Vanderbilt Assessment Scales, published by the American Academy of Pediatrics and the National Initiative for Children's Healthcare Quality in 2002, with scoring instructions updated for DSM-5.
There is a parent version and a teacher version, each combining ADHD symptom items, comorbidity screening items and performance items.
Presenting Conditions
The parent scale covers inattention, hyperactivity and impulsivity, oppositional defiant disorder, conduct disorder, anxiety and depression, and eight performance items covering school work and relationships.
The teacher scale covers inattention, hyperactivity and impulsivity, oppositional defiant and conduct problems, anxiety and depression, plus academic and classroom behavioural performance items and a learning disability screen.
Administration
Self completed by the parent or the teacher. The parent initial scale has 55 items and the teacher initial scale has 43. Symptom items are rated Never (0), Occasionally (1), Often (2) or Very Often (3). Performance items are rated from Excellent (1) to Problematic (5). Parents rate the past six months. Teachers rate behaviour since the beginning of the school year, and record how long they have observed the child.
Desired Audience
Parents and teachers of school aged children. The validation studies covered the 6 to 12 year old age group. The AAP notes that because the scales collect DSM-5 criteria they are applicable to other groups, particularly preschoolers, but the evidence base is strongest for 6 to 12.
The Vanderbilt is built for the way ADHD is actually assessed: across settings, with impairment evidence, and with the comorbidities that change the plan. It is the standard instrument in paediatric ADHD assessment in the US and is widely used elsewhere for the same reason.
Considerations
The AAP is explicit that these scales should not be used alone to make a diagnosis of ADHD without confirming and elaborating the information through interviews with at least the primary caregivers and the patient.
Validation covers ages 6 to 12.
The teacher recall window of since the beginning of the school year means early term ratings rest on limited observation.
The comorbidity sections are screens, not diagnoses.
Multiple editions of the form circulate with different performance item ranges and impairment rules. Check which edition you are using before scoring.
How to score the Vanderbilt ADHD Diagnostic Rating Scale VADRS
Conducting the assessment
The informant rates every symptom item on the four point frequency scale and every performance item on the five point performance scale. A symptom counts as positive when rated 2 or 3, and impairment counts as positive when a performance item is rated 4 or 5.
Interpretation
Interpretation combines a symptom count with an impairment requirement.
Under the current AAP scoring instructions:
Predominantly inattentive presentation: 6 of the 9 inattention items rated 2 or 3, plus a performance rating of 4 on at least two items or 5 on at least one.
Predominantly hyperactive and impulsive presentation: 6 of the 9 hyperactivity and impulsivity items rated 2 or 3, plus the same impairment criterion.
Combined presentation: both symptom criteria met.
Oppositional defiant disorder (parent): 4 of 8 items rated 2 or 3, plus the impairment criterion.
Conduct disorder (parent): 3 of 14 items rated 2 or 3, plus the impairment criterion.
Anxiety and depression: 3 of 7 items rated 2 or 3, plus the impairment criterion.
For monitoring, use the mean rating per item on the inattention and hyperactivity blocks and compare against baseline.
Clinical Considerations
Collect both parent and teacher forms. ADHD requires evidence of impairment in more than one setting, and a single informant cannot establish that.
Take the comorbidity screens seriously. Anxiety, ODD and learning difficulties change the treatment plan and frequently coexist with ADHD.
Use the follow up scales, including the side effect checklist, when monitoring medication.
Vanderbilt ADHD Diagnostic Rating Scale VADRS use cases
Multi setting assessment of ADHD symptoms in children
Screening for common comorbidities including ODD, conduct disorder, anxiety and depression
Documenting functional impairment across school and home
Monitoring response to treatment using the follow up scales
Category
ADHD
Research Summary
Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a referred population. Journal of Pediatric Psychology, 28(8), 559 to 568.
Wolraich, M. L., Feurer, I. D., Hannah, J. N., Baumgaertel, A., & Pinnock, T. Y. (1998). Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV. Journal of Abnormal Child Psychology, 26(2), 141 to 152.
Bard, D. E., Wolraich, M. L., Neas, B., Doffing, M., & Beck, L. (2013). The psychometric properties of the Vanderbilt ADHD Diagnostic Parent and Teacher Rating Scale in a community population. Journal of Developmental and Behavioral Pediatrics, 34(2), 72 to 82.
Other Assessment Guides
Adult ADHD Self Report Scale ASRS v1.1
A guide to the WHO Adult ADHD Self Report Scale (ASRS v1.1). Covers the six question screener, both scoring methods including the updated 0 to 24 approach, and when to escalate to full assessment.
SNAP-IV Teacher and Parent Rating Scale
A guide to the SNAP-IV parent and teacher rating scale for ADHD and oppositional symptoms. Covers average rating per item scoring, the rater specific cut offs and version differences.
Wender Utah Rating Scale WURS-25
A guide to the WURS-25, the retrospective self report of childhood ADHD symptoms in adults. Covers scoring, the difference between the 36 and 46 cut offs, and why it must be paired with a current symptom measure.
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