Vanderbilt Documentation: Scoring, Interpretation & Sample Note

It matters. The 2002 first edition (free from NICHQ) used any single performance rating of 4 or 5 as impairment, a 14-behavior parent conduct section, and a single combined symptom sum on its follow-up forms. The 2011 second edition adopted the two-4s-or-one-5 impairment rule but kept the 14-behavior conduct section. The 2019 third-edition AAP toolkit (scoring instructions copyright 2020) is DSM-5 aligned, has a 15-behavior parent conduct screen, uses two 4s or one 5, and tracks follow-up as separate inattentive and hyperactive-impulsive means; a fourth edition is in development. Freely circulating PDFs on hospital and university sites are mostly first- and second-edition copies. Name the edition or exact source in the chart, and never apply the 2002 impairment rule to a current form; the impairment rule alone cannot tell you which edition you hold, because the second and third share it.

You need evidence of symptoms and impairment in more than one major setting; you do not need two positive Vanderbilt forms. The AAP guideline draws that evidence from parents or guardians, teachers, other school personnel, and involved mental health clinicians, and it names no instrument, so a missing teacher form does not automatically block a diagnosis when reliable school-setting information arrives another way (a second teacher, counselor, or school psychologist; report cards, behavior plans, disciplinary or psychoeducational records; direct school communication). Document the attempts and dates, the alternate source, and whether the more-than-one-setting criterion is established, uncertain, or not met. When only a parent form exists and no second-setting evidence does, chart a positive parent screen and a pending evaluation, not a completed diagnosis. Return rates are a structural problem: a 195-child study of parent-return agreements found teacher forms came back 71% of the time before and 76% after, no significant change.

Do not choose one by default and do not average them. Preserve each informant's counts and impairment findings, describe the setting-specific pattern, and treat the disagreement as information: parents rate higher than teachers on average, agreement is weak for inattention and stronger for hyperactivity-impulsivity across 6,659 children, and different observers validly see different contexts. Then investigate: classroom structure and size, academic level and homework conflict, sleep, anxiety, learning, family stress, medication timing if applicable, observation opportunity, another teacher or activity setting, and school records. If credible information shows impairment only at home, the more-than-one-setting criterion is not yet established; the home concern may still warrant intervention and differential assessment, and the chart says exactly that.

The 2002 first edition is free to download from NICHQ, which asks for a reference to NICHQ in publications and grants no license to re-typeset, modify, remove notices, or redistribute without limit; the PDF carries the 2002 AAP and NICHQ copyright. The 2019 third-edition toolkit is sold and licensed by the AAP, and its product page states that the single-user license does not support EHR integration and that an institutional license is required for multi-user access or EMR and EHR integration; AAP permissions require exact reproduction with written consent for changes, and Spanish forms are part of the licensed toolkit. No NICHQ or AAP source publishes a carve-out for a free public website that reproduces the items and scores responses, so a tool that displays item wording or rebuilds the form should obtain written permission; a calculator that only accepts already-derived counts is lower-risk, not approved. Terms as stated on the NICHQ and AAP pages in August 2026; confirm before building anything.

As a screen. Record the exact numerator and denominator against the edition's threshold (the parent form separates oppositional and conduct sections and has an anxiety-depression section; the teacher form has one combined oppositional-conduct section, an anxiety-depression section, and an academic-performance flag), the impairment finding, and the words "screen positive." Then document the targeted history, severity, duration, settings, a risk inquiry when clinically indicated, collateral, the differential, and the plan for assessment, treatment, or referral. The 2012 validation study found the parent comorbidity cutoffs generally lacked adequate utility for confirming or excluding structured-interview diagnoses, with the oppositional cutoff useful mainly for ruling out oppositional defiant disorder, which is why "Vanderbilt diagnosed depression" is wrong twice over. The teacher's academic flag points to records and achievement testing, not to a learning-disorder diagnosis.

With the follow-up forms, scored differently from intake. On the current edition, calculate the mean rating for the nine inattentive and the nine hyperactive-impulsive behaviors separately and compare each with its own baseline mean; record performance change (how many 4s and 5s remain), the side-effect section, the medication, dose, dosing time, and the rater's observation interval relative to dosing, and the decision (continue, adjust, change). Use the same informants under comparable conditions, and repeat when results can inform titration, after meaningful dose changes, and periodically in maintenance; no official source fixes an interval. HEDIS timing (a prescriber follow-up within 30 days of the first dispensing for children 6 to 12, then two more visits in the continuation phase) is an encounter requirement, not a form requirement, and PDMP checks attach to the prescription under state law. Charting side effects nowhere while the dose rises is the follow-up error reviewers see most.

Choose by age, question, and setting. The Vanderbilt suits pediatric primary care and school-collateral workflows at ages 6 to 12 when DSM-aligned domain counts, an impairment rule, associated-condition screens, and follow-up with side-effect tracking are what you need; it has no response-style index and its current edition is licensed, not simply free. The Conners 4 is a norm-referenced, licensed instrument for ages 6 to 18 with parent, teacher, and self-report forms, broader content, and response-style indicators, interpreted on its own norms and never on Vanderbilt thresholds. The SNAP-IV is the free scale CADDRA names as its default parent and teacher form in Canada. The ASRS and CAARS 2 are adult instruments, not pediatric substitutes. None of them is an evaluation: the diagnostic formulation belongs in the ADHD evaluation report, and a positive scale of any kind is a reason to do one.

Yes. Give it the facts (edition, each form's informant, completion date, and medication status, the domain counts and performance ratings, the screen results, the history and records, and the plan) and it drafts the full entry: counts and impairment per informant, screens as screens, the cross-setting synthesis, the supports-not-establishes statement, and the plan with dates and owners, ready for your review. It can also check a finished note for a form charted as the diagnosis, a count without the impairment rule, an unnamed edition, averaged informants or a missing form with no trail, and follow-up scored like an intake. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.