Bridges

BRIGHT FUTURES TOOL FOR PROFESSIONALS

I N S T R U C T I O N S F O R U S E

Vanderbilt ADHD Diagnostic Teacher Rating Scale

INSTRUCTIONS AND SCORING

Behaviors are counted if they are scored 2 (often) or 3 (very often).

Inattention Requires six or more counted behaviors from questions 1–9 for
indication of the predominantly inattentive subtype.

Hyperactivity/ Requires six or more counted behaviors from questions 10–18

impulsivity for indication of the predominantly hyperactive/impulsive
subtype.

Combined Requires six or more counted behaviors each on both the

subtype inattention and hyperactivity/impulsivity dimensions.

Oppositional Requires three or more counted behaviors from questions 19–28.

defiant and
conduct disorders

Anxiety or Requires three or more counted behaviors from questions 29–35.

depression
symptoms

The performance section is scored as indicating some impairment if a child scores 1 or 2 on at

least one item.

FOR MORE INFORMATION CONTACT REFERENCE FOR THE SCALE’S

Mark Wolraich, M.D. PSYCHOMETRIC PROPERTIES
Shaun Walters Endowed Professor of Wolraich ML, Feurer ID, Hannah JN, et al. 1998.
Developmental and Behavioral Pediatrics Obtaining systematic teacher reports of disruptive
behavior disorders utilizing DSM-IV. Journal of
Oklahoma University Health Sciences
Abnormal Child Psychology 26(2):141–152.
Center
1100 Northeast 13th Street
Oklahoma City, OK 73117
Phone: (405) 271-6824, ext. 123
E-mail: mark-wolraich@ouhsc.edu

The scale is available at http://peds.mc.

vanderbilt.edu/VCHWEB_1/rating~1.html.

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS

Vanderbilt ADHD Diagnostic Teacher Rating Scale

Name: Grade: ____________________

Date of Birth: ______________ Teacher:__________________________________ School: __________________________________

Each rating should be considered in the context of what is appropriate for the age of the children you are rating.

Frequency Code: 0 = Never; 1 = Occasionally; 2 = Often; 3 = Very Often

1. Fails to give attention to details or makes careless mistakes in schoolwork 0 1 2 3

2. Has difficulty sustaining attention to tasks or activities 0 1 2 3

3. Does not seem to listen when spoken to directly 0 1 2 3

4. Does not follow through on instruction and fails to finish schoolwork 0 1 2 3

(not due to oppositional behavior or failure to understand)

5. Has difficulty organizing tasks and activities 0 1 2 3

6. Avoids, dislikes, or is reluctant to engage in tasks that require 0 1 2 3

sustaining mental effort

7. Loses things necessary for tasks or activities (school assignments, pencils, 0 1 2 3

or books)

8. Is easily distracted by extraneous stimuli 0 1 2 3

9. Is forgetful in daily activities 0 1 2 3

10. Fidgets with hands or feet or squirms in seat 0 1 2 3

11. Leaves seat in classroom or in other situations in which remaining 0 1 2 3

seated is expected

12. Runs about or climbs excessively in situations in which remaining 0 1 2 3

seated is expected

13. Has difficulty playing or engaging in leisure activities quietly 0 1 2 3

14. Is “on the go” or often acts as if “driven by a motor” 0 1 2 3

15. Talks excessively 0 1 2 3

16. Blurts out answers before questions have been completed 0 1 2 3

17. Has difficulty waiting in line 0 1 2 3

18. Interrupts or intrudes on others (e.g., butts into conversations or games) 0 1 2 3

19. Loses temper 0 1 2 3

(continued on next page)

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Vanderbilt ADHD Diagnostic Teacher Rating Scale (continued)

Frequency Code: 0 = Never; 1 = Occasionally; 2 = Often; 3 = Very Often

20. Actively defies or refuses to comply with adults’ requests or rules 0 1 2 3

21. Is angry or resentful 0 1 2 3

22. Is spiteful and vindictive 0 1 2 3

23. Bullies, threatens, or intimidates others 0 1 2 3

24. Initiates physical fights 0 1 2 3

25. Lies to obtain goods for favors or to avoid obligations (i.e., “cons” others) 0 1 2 3

26. Is physically cruel to people 0 1 2 3

27. Has stolen items of nontrivial value 0 1 2 3

28. Deliberately destroys others’ property 0 1 2 3

29. Is fearful, anxious, or worried 0 1 2 3

30. Is self-conscious or easily embarrassed 0 1 2 3

31. Is afraid to try new things for fear of making mistakes 0 1 2 3

32. Feels worthless or inferior 0 1 2 3

33. Blames self for problems, feels guilty 0 1 2 3

34. Feels lonely, unwanted, or unloved; complains that “no one loves him/her” 0 1 2 3

35. Is sad, unhappy, or depressed 0 1 2 3

PERFORMANCE
Problematic Average Above Average

Academic Performance
1. Reading 1 2 3 4 5

2. Mathematics 1 2 3 4 5

3. Written expression 1 2 3 4 5

Classroom Behavioral Performance

1. Relationships with peers 1 2 3 4 5

2. Following directions/rules 1 2 3 4 5

3. Disrupting class 1 2 3 4 5

4. Assignment completion 1 2 3 4 5

5. Organizational skills 1 2 3 4 5

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS
I N S T R U C T I O N S F O R U S E

Center for Epidemiological Studies

Depression Scale for Children (CES-DC)

The Center for Epidemiological Studies See also

Depression Scale for Children (CES-DC) is a Tool for Families: Symptoms of
20-item self-report depression inventory with Depression in Adolescents, p. 126.
possible scores ranging from 0 to 60. Each
response to an item is scored as follows: Tool for Families: Common Signs of
Depression in Children and Adolescents,
0 = “Not At All”
p. 147.
1 = “A Little”
2 = “Some”
REFERENCES
3 = “A Lot”
Weissman MM, Orvaschel H, Padian N. 1980.
However, items 4, 8, 12, and 16 are phrased Children’s symptom and social functioning self-
report scales: Comparison of mothers’ and
positively, and thus are scored in the
children’s reports. Journal of Nervous Mental
opposite order:
Disorders 168(12):736–740.
3 = “Not At All”
Faulstich ME, Carey MP, Ruggiero L, et al. 1986.
2 = “A Little” Assessment of depression in childhood and
1 = “Some” adolescence: An evaluation of the Center for
Epidemiological Studies Depression Scale for
0 = “A Lot” Children (CES-DC). American Journal of Psychiatry
143(8):1024–1027.
Higher CES-DC scores indicate increasing
levels of depression. Weissman et al. (1980),
the developers of the CES-DC, have used the
cutoff score of 15 as being suggestive of
depressive symptoms in children and
adolescents. That is, scores over 15 can be
indicative of significant levels of depressive
symptoms.

Remember that screening for depression

can be complex and is only an initial step.
Further evaluation is required for children
and adolescents identified through a
screening process. Further evaluation is also
warranted for children or adolescents who
exhibit depressive symptoms but who do
not screen positive.

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS

Center for Epidemiological Studies

Depression Scale for Children (CES-DC)
Number ____________________

Score ______________________

INSTRUCTIONS
Below is a list of the ways you might have felt or acted. Please check how much you have felt this way during the past week.

DURING THE PAST WEEK Not At All A Little Some A Lot

1. I was bothered by things that usually don’t bother me. _____ _____ _____ _____
2. I did not feel like eating, I wasn’t very hungry. _____ _____ _____ _____
3. I wasn’t able to feel happy, even when my family or _____ _____ _____ _____
friends tried to help me feel better.
4. I felt like I was just as good as other kids. _____ _____ _____ _____
5. I felt like I couldn’t pay attention to what I was doing. _____ _____ _____ _____

DURING THE PAST WEEK Not At All A Little Some A Lot

6. I felt down and unhappy. _____ _____ _____ _____
7. I felt like I was too tired to do things. _____ _____ _____ _____
8. I felt like something good was going to happen. _____ _____ _____ _____
9. I felt like things I did before didn’t work out right. _____ _____ _____ _____
10. I felt scared. _____ _____ _____ _____

DURING THE PAST WEEK Not At All A Little Some A Lot

11. I didn’t sleep as well as I usually sleep. _____ _____ _____ _____
12. I was happy. _____ _____ _____ _____
13. I was more quiet than usual. _____ _____ _____ _____
14. I felt lonely, like I didn’t have any friends. _____ _____ _____ _____
15. I felt like kids I know were not friendly or that _____ _____ _____ _____
they didn’t want to be with me.

DURING THE PAST WEEK Not At All A Little Some A Lot

16. I had a good time. _____ _____ _____ _____
17. I felt like crying. _____ _____ _____ _____
18. I felt sad. _____ _____ _____ _____
19. I felt people didn’t like me. _____ _____ _____ _____
20. It was hard to get started doing things. _____ _____ _____ _____

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS
I N S T R U C T I O N S F O R U S E

Edinburgh Postnatal Depression Scale (EPDS)

Due to copyright permissions

restrictions, this tool is not
available on the Web. Please see
print version of the publication.

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS

Edinburgh Postnatal Depression Scale (EPDS)

Name: ________________________________________________ Address: ____________________________________________

Your Date of Birth:______________________________________ ____________________________________________

Baby’s Age: ____________________________________________ Phone:

As you have recently had a baby, we would like to know how you are feeling. Please check the answer that comes
closest to how you have felt in the past 7 days, not just how you feel today.
Here is an example, already completed.

I have felt happy:

" Yes, all the time
# Yes, most of the time This would mean: “I have felt happy most of the time” during the past week.
" No, not very often Please complete the other questions in the same way.
" No, not at all

In the past 7 days:

*1. I have been able to laugh and see the funny side of things *6. Things have been getting on top of me
" As much as I always could " Yes, most of the time I haven’t been able
" Not quite so much now to cope at all
" Definitely not so much now " Yes, sometimes I haven’t been coping as
" Not at all well as usual
" No, most of the time I have coped quite well
2. I have looked forward with enjoyment to things " No, I have been coping as well as ever
" As much as I ever did
" Rather less than I used to *7. I have been so unhappy that I have had difficulty sleeping
" Definitely less than I used to " Yes, most of the time
" Hardly at all " Yes, sometimes
" Not very often
*3. I have blamed myself unnecessarily when things " No, not at all
went wrong
" Yes, most of the time *8. I have felt sad or miserable
" Yes, some of the time " Yes, most of the time
" Not very often " Yes, quite often
" No, never " Not very often
" No, not at all
4. I have been anxious or worried for no good reason
" No, not at all *9. I have been so unhappy that I have been crying
" Hardly ever " Yes, most of the time
" Yes, sometimes " Yes, quite often
" Yes, very often " Only occasionally
" No, never
*5. I have felt scared or panicky for no very good reason
" Yes, quite a lot *10. The thought of harming myself has occurred to me
" Yes, sometimes " Yes, quite often
" No, not much " Sometimes
" No, not at all " Hardly ever
" Never
Source: Reprinted, with permission, from Cox JL, Holden JM, Sagovsky R. 1987. Detection of postnatal depression:
Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782–786.

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 BRIGHT FUTURES
Stages of Substance Use and Suggested Interventions
Stages of Use
Abstinence
Child or adolescent does not use any
drugs or alcohol.
Experimental Use
Child or adolescent infrequently uses
tobacco, alcohol, or drugs.
Substances are usually obtained from,
and used with, friends.
Although associated drug-related
problems are uncommon, risks can
be serious.
Regular Use
Child or adolescent uses alcohol or
drugs on an occasional but regular basis.
“Social drinking” in adolescents often
involves significant binge drinking.
Problem Use
Child or adolescent has experienced ad-
verse consequences associated with use.
Child or adolescent may have had
problems with grades, detentions, or
suspensions; parents or peers; motor
vehicle crashes; injuries; or physical or
sexual assaults.
TOOL FOR PROFESSIONALS
Interventions
■ Be aware of children and adolescents at risk for substance abuse:
Family history of alcohol or drug abuse
Early onset of conduct disorder or aggressive behavior
History of attention deficit hyperactivity disorder, school difficulties, mood
and anxiety disorders
History of poor supervision, trauma, or abuse
■ Encourage and support continued abstinence.
■ Encourage activities that build on a child’s or adolescent’s strengths and self-
esteem (e.g., sports, community activities, art and music classes, participation
in faith-based organizations).
■ Discuss with the child or adolescent what she would do if she were pressured
to use drugs or alcohol.
■ Educate the child or adolescent about potential consequences and health-
related risks of tobacco, drug, or alcohol use, stressing the more immediate
consequences (e.g., “If you continue to smoke, I believe it will affect your
soccer performance”).
■ Stress the importance of not drinking or using drugs and driving, and of not
riding with a driver who has been drinking or using drugs.
■ Develop a “rescue plan” with the child or adolescent and parents. A rescue
plan should specify that the child or adolescent will receive a ride home if he
finds himself in an unsafe situation, including being intoxicated or high, and
the commitment that discussion about the behavior will take place at a time
when it can be rational.
■ See above interventions.
■ Ask the child or adolescent to consider the link between problems she is hav-
ing and alcohol or drug use. Remember that helping a child or adolescent
become motivated to address her alcohol or drug use is an ongoing process,
which begins with highlighting concerns about current behavior.
■ Discuss concerns and options for change. (See Tool for Health Professionals:
Discussing Substance Use, p. 63.)
■ Consider an “Abstinence Challenge”: “If you can agree to give up
drugs/alcohol for a while, this will give us important information about your
control over your use. If you can’t do it, it probably means that your use has
gotten to the point where you may need more professional help.”
(continued on next page)
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Stages of Substance Use and Suggested Interventions (continued)
Stages of Use
Problem Use, continued
Substance Abuse
Child or adolescent engages in
ongoing use of drugs or alcohol,
despite harm.
Loss of control over use.
Substance Dependency
Child or adolescent is preoccupied
with use.
Development of tolerance or with-
drawal symptoms.
Increase in risk-taking and dangerous
drug-related behaviors.
Secondary Abstinence
The goal of substance use treatment
is abstinence, as control over use is
almost impossible to reestablish
once lost.
Source: Adapted, with permission, from Knight JR. 1997. Adolescent substance use: Screening, assessment, and intervention.
Contemporary Pediatrics 14(4):45–72.
Interventions
■ If the child or adolescent refuses an abstinence challenge, continue to follow
up. For example, say, “You have heard what my concerns are. Will you at
least give some thought to what I said and come back again to talk more?”
■ Develop a “rescue plan” with the child or adolescent and parents. A rescue
plan should specify that the child or adolescent will receive a ride home if he
finds himself in an unsafe situation, including being intoxicated or high, and
the commitment that discussion about the behavior will take place at a time
when it can be rational.
■ Continue to work with the child or adolescent and family until the child or ado-
lescent is ready to engage in substance abuse treatment. See interventions above.
Refer for the appropriate level of services, when ready to engage in treatment:
Outpatient Treatment. Includes community and school resources, 12-step
groups, peer-support groups, and individual counseling. May be used for
children and adolescents who are motivated to change behaviors and are
not physiologically addicted to substances. May also be used as a transition
from more intensive treatment settings. (Sixty percent of teens who attended
weekly community support groups after discharge from inpatient or residential
substance abuse treatment programs remained drug-free for the first year.)
Partial or Day Hospital. May be considered for children and adolescents
who need more intensive structure and support in order to break the cycle
of substance use but are motivated for treatment and are not physiologi-
cally dependent. Also used as a transition from more intensive treatments.
Residential Treatment. Should be considered for children and adolescents who
are unlikely to be able to stop drug or alcohol use if they remain in their home
environment, including children or adolescents who may be at risk for with-
drawal or those with a history of treatment failures in less restrictive settings.
Inpatient Treatment. For children or adolescents who are at significant risk
for withdrawal symptoms, who have serious psychiatric disorders or symp-
toms (suicidal, homicidal, psychotic, or acutely dangerous behaviors), or
who have failed in other treatment settings.
■ Refer to formal treatment program (residential or inpatient).
■ Continue to follow the child or adolescent closely, and ensure that supports
and treatment programs are maintained.
■ Relapse is part of the early process of recovery. Avoid stigmatizing or aban-
doning the child or adolescent if it occurs.
■ Relapse can be viewed as a learning opportunity; the level of supports and
treatments can be reviewed and increased as indicated.
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 BRIGHT FUTURES TOOL FOR PROFESSIONALS

Discussing Substance Use

Addressing substance use is often an extended process requiring ongoing communication. One key is
to target the discussion to the needs of the child or adolescent and his or her readiness to change. The
following approaches have proven useful in communicating with children and adolescents about sub-
stance use.
The FRAMES mnemonic describes six principles of effective brief interventions (Miller and Sanchez,
1994).

F Feedback on risk/impairment Use child’s or adolescent’s own description of

current problem. E.g., “You’ve told me your
grades have dropped this year, and you were in
an accident after drinking at a party.”

R Emphasis on personal responsibility E.g., “I’d like to work with you, but it’s up to
for change you to take responsibility for changing things.”

A Clear advice to change E.g., “I believe the best thing for you would be
to stop using drugs and alcohol.”

M Menu of options for behavior E.g., “You could try stopping completely, or
change and treatment cutting down, or I could refer you to a specialist.”

E Empathetic counseling style E.g., “I know that these things may be difficult
to hear, but I’m worried about you. I care about
your health and your future.”

S Faith in child’s or adolescent’s E.g., “Even though this may be difficult to do, I
self-efficacy to change believe in you and I know that you can do this
if you try.”

Interventions and communications addressing substance use can be more effective if health professionals
take into account a child’s or adolescent’s readiness for change at a moment in time. Recognizing that a
child or adolescent moves through stages of change (see table 1 on page 64) can help health professionals
tailor their message and feel less frustrated when immediate change does not occur.

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 BRIGHT FUTURES TOOL FOR PROFESSIONALS

Table 1. Stages of Change and

Goals of Intervention
Stages of Change Goal of Intervention Discussion
(Prochaska and
DiClemente, 1982; 1983)
Precontemplation
The individual has not yet Raise doubts and increase awareness of risks E.g., “Have you ever considered that you
begun to consider change as and problems. might not have been suspended from school if
an option. you hadn’t been smoking pot?”
No personal “ownership” of E.g., “Did you know that car accidents, particu-
problem behavior. larly those caused by drinking, are the number
one cause of death for people your age?”

Contemplation
Initial recognition of problem.
Ambivalence about change.
Acknowledgment of ambivalence, evoking
reasons for change, and tipping the balance
in favor of change.
E.g., “It sounds like part of you wants to stop
and part of you wants to keep on drinking,”
followed by discussion as presented in precon-
templation above, building on the child’s or
adolescent’s own reasons to desire change.

Determination
Mind is made up to change,
but individual does not yet
actually do it.
Recommendation of treatment options and
arranging follow-up visits or referral.
Recommend a nicotine replacement and make
a referral to a smoking-cessation support group
for tobacco smokers; recommend substance
abuse counseling and a 12-step support pro-
gram for alcohol and drug users.

Action
Behavior is actually changed,
but individual does not yet feel
comfortable.
Ongoing support. Praise progress; express confidence in the child’s
or adolescent’s ability to maintain change.
Problem solve to develop strategies to address
challenging situations.

Maintenance
New behavior requires less
conscious effort.
Relapse is an ongoing possibility.
Positive reinforcement and strategies to pre- Praise progress; express confidence in child’s or
vent relapse. adolescent’s ability to maintain change.
Ask about experiences in social or challenging
situations.

REFERENCES
Miller WR, Sanchez VC. 1994. Motivating young adults for treatment and lifestyle change. In Howard GS, Nathan PE, eds., Issues in Alcohol
Use and Misuse by Young Adults (pp. 55–81). Notre Dame, IN: University of Notre Dame Press.
Prochaska JO, DiClemente CC. 1983. Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of
Consulting and Clinical Psychology 51(3):390–395.
Prochaska JO, DiClemente CC. 1982. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy 19(3):276–288.

Source: Adapted, with permission, from Knight JR. 1997. Adolescent substance use: Screening, assessment, and intervention. Contemporary
Pediatrics 14(4):45–72.

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