Psychological Functioning Scale for Children and Adolescents: Teacher Rated

Name of the person rated_________________________________________

Name of the rater_______________________________________________

Rater’s role with child:___________________________________________

Today’s Date___________________________________________________

Please rate the person’s functioning in the following areas over the last month (or other specified interval), where 0 is worst and 10 is best functioning.

Please use any number in the interval 0 to 10, including, if you wish, odd numbers or decimals such as 3.8.

Negative or harmful behaviors should pull the rating down. For example, despite lots of positive behavior, a few very harmful violent behaviors, or even one action if harmful enough, would result in a very low rating on the “free of harm to others” item and on the “overall functioning” item.

0=Very undesirable, very great need for improvement.

2=Definitely undesirable, great need for improvement.

4= In the undesirable range, need for improvement.

6=OK, adequate, acceptable, but not great. Improvement is desirable.

8=Good functioning in this area. Would be just fine if pattern continued as is.

10=Excellent functioning in this area. Would be great, wonderful if pattern continued as is.

n=Not applicable, not answerable, or not known

_____F1. Being respectful and compliant with you at school.

_____F2. Being respectful and compliant with other adults at school.

_____F3. Getting along with peers at school.

_____F4. Making and keeping friends.

_____F5. Performing up to potential in schoolwork.

_____F6. Being happy, enjoying life, having fun.

_____F7. Being free, to the best of your knowledge, of psychological symptoms that distress the person himself or herself. (For example fears or depression.) (0 is worst; 10 is best.)

_____F8. Being free of symptoms that bother other people. (For example misbehavior or aggression.) (0 is worst; 10 is best.)

_____F9. Being free, as far as you know, of considering, threatening, or carrying out any act of self-harm.(0 is worst, 10 is best.)

_____F10. Being free of threatening or carrying out any act of harm to others. (0 is worst, 10 is best.)

_____F11. Being able to concentrate, stay on task, not be distracted, keep working long

enough.

_____F12. Being organized.

_____F13. Avoiding impulsive behaviors.

_____F14. Being able to sit still long enough and to be free from restlessness.

_____F15. Making other people happy, having a net positive effect on others.

_____F16. Now please rate overall functioning. Good functioning is the thoughts, feelings, and behaviors that tend to: produce happiness and well-being in both oneself and others; produce good social relations and positive achievement; and accomplish worthwhile goals. Please rate how strongly you would wish for this month's overall behavior pattern to continue.

For item 17 the scale changes to 0 to 100.

Now please rate the person’s overall functioning relative to other same-aged children you have known. Into what approximate percentile did the child’s behavior fall? (If the child’s functioning was worse than all others, percentile=0; better than all others, percentile=100; better than a quarter and worse than three-quarters, percentile=25; etc.)

_____ 17. Percentile for this child’s social and emotional functioning. (0 is worst and 100 is best.)

Vanderbilt Rating Scale. Please continue to rate behavior over the last MONTH. The scale changes to a 0 to 3 scale.

Scale is 0 to 3: 0 is best, 3 is worst

0 = Never

1 = Occasionally

2 = Often

3 = Very Often

_____V1. Fails to give attention to details or makes careless mistakes in schoolwork

_____V2. Has difficulty sustaining attention to tasks or activities

_____V3. Does not seem to listen when spoken to directly

_____V4. Does not follow through on instructions and fails to finish schoolwork

(not due to oppositional behavior or failure to understand)

_____V5. Has difficulty organizing tasks and activities

_____V6. Avoids, dislikes, or is reluctant to engage in tasks that require

sustaining mental effort

_____V7. Loses things necessary for tasks or activities (school assignments, pencils,

or books)

_____V8. Is easily distracted by extraneous stimuli

_____V9. Is forgetful in daily activities

_____V10. Fidgets with hands or feet or squirms in seat

_____V11. Leaves seat in classroom or in other situations in which remaining

seated is expected

_____V12. Runs about or climbs excessively in situations in which remaining

seated is expected

_____V13. Has difficulty playing or engaging in leisure activities quietly

_____V14. Is “on the go” or often acts as if “driven by a motor”

_____V15. Talks excessively

_____V16. Blurts out answers before questions have been completed

_____V17. Has difficulty waiting in line

_____V18. Interrupts or intrudes on others (e.g., butts into conversations or games)

_____V19. Loses temper

_____V20. Actively defies or refuses to comply with adults’ requests or rules

_____V21. Is angry or resentful

_____V22. Is spiteful and vindictive

_____V23. Bullies, threatens, or intimidates others

_____V24. Initiates physical fights

_____V25. Lies to obtain goods for favors or to avoid obligations (eg, “cons” others)

_____V26. Is physically cruel to people

_____V27. Has stolen items of nontrivial value

_____V28. Deliberately destroys others’ property

_____V29. Is fearful, anxious, or worried

_____V30. Is self-conscious or easily embarrassed

_____V31. Is afraid to try new things for fear of making mistakes

_____V32. Feels worthless or inferior

_____V33. Blames self for problems, feels guilty

_____V34. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”

_____V35. Is sad, unhappy, or depressed

Now the scale changes again, where 5 is best and 1 is worst.

PERFORMANCE

5=Excellent

4=Above average

3=Average

2=Somewhat of a problem

1=Problematic

Academic Performance

_____V36. Reading

_____V37. Mathematics

_____V38. Written expression

Classroom Behavioral Performance

_____V39. Relationships with peers

_____V40. Following directions

_____V41. Disrupting class

_____V42. Assignment completion

_____V43. Organizational skills

For purposes of follow-up communication, could you please write your email address here, if you are not responding by email:____________________________________

Narrative:

If you indicated any issues with self-harm or harm to others, please describe. Please write anything you want us to know about this child. Thank you very much for your help!