Penh ne eeu De Renee Letras cera Nombre del maestro (a)/Tercher's Name: Hora de clase/ Clas Times = : ‘Matera/Periodol Class Nome/Perod: ed Fecha actual Today's Date. A Nomibre del slumnno()/ iil’ Name: 7 Grado escola Grade Levee 7 Instruceiones: Al evaluar a su alumno, conteste baséndose en lo que considera apropiado para un nifio de esa edad. Las respuestas deben reflejar su conducta desde el inicio del afio escolar. Indique el nimero de ‘semanas o meses que ha podido observar su condu z Directions: Each rating should be considered In the context of what Is appropriate for the age ofthe child you are ‘rating and should reflect that child's behavior since the beginning of the school year. Please indicate the number of weeks or months you have been able to evaluate the behaviors: 7 7 Estz -valuacién se refiere a un periodo en el que e! nifio(a) Is this evaluation based on a time when the child Ci tomaba medicamentos no tomaba medicamentos 1 nolo sabe was on medication was not on medication not sure? Siolomaal WuncalAveces! Seguidal Muy seguidal Symptoms Never Occasionally Often __Very Often 1. No pone atencin a los detalles o comets e cecolares por descuido Fails 0 give attention 1 detail or makes care “Has dificult sustaining attention to task or activites Ee 3. Parece no estar esuchando cuando see habla drectamente o ees not sem 0 listen when spoken to directly nes hasta el finaly no coneluye sus acti (no porque se reise a seguirlas 0 porque no las comprenda) oes not folio trough on instructions and fais to fnsh schoolwork (not due wo oppositional behavior o alure wo woderstand) “Tine dfiultad al organiza sus tareas actividades o r 2 3 as ificuly ongoing tasks and activities i {Brita le disgusta 0 se niega a comencar actividades que requieren 7 T 2 tun contin esfuerza mental Avis disties, os rluctat to engage in task that require sustained mental effort, 7 ende cosas que son indspensables para cumplir con sus tareaso actividades (areas dea escuela, pices o libros) hing neesary for tasks or activities (school assignments pencils or boks) Se dista fciimente con estimulos externas 0 7 2 3 1s easily distracted by extrancous stat 9, Es olvidadizo(a) en sus actividades cotidianas a 7 T 2 3 4s fngefl in daily activities di (0. Mueveconstantements las manos o los pis, © no ve etd quietola) en su atento 0 7 2 a Fidges with hands or fot or squirm in seat aloes cotta nt oan oe dere nna bin Dresdner © 205 Adenia Amro de alr, nied de Nath Carina ‘vedo meio yom em psi fae ada remenda araionee ‘Cpe Hl ure Cato de jamie Candela nde Nor ‘arent gin econ conc inre enti le lenne Nealon Sls ile del Caled Sad nt Mop de as us de Claiiccn Vind ta po Ma. Woah MD, amas @® CAR) micuQ McNeil DDIcATED FO THE HEALTH OF ALL CHILDREN * aes ce rate OotyHora de easels prs 2 Materia Periadol Class Navme/Periodt i Fecha actual Todays Dare 7 Nombre del alumnno(a)/ Chis Name: Grado escolar Grade Levels “Sintomas (continuaciény Nunca! Avecsal Soguido/ Wy seguidal Symptoms (continued) ‘Never Occasionally Often _Very Ofton 1. Se pone de pie en el aula cuando debiera permanecer sentado| 0 1 2 3 ___Laaves ea in assroon on other situations in which emaining sated is expected Serer 12. Correo eamina por todos lcor cuando debiera permanssersentado ° T z coe ‘os about or cls excessively in situations in which remaining sated isespeced Te diculta jugar o empezar actividades rcretivas mis tranguas ° r ae 3 ifiulty playing or engaging in leisure activites quietly 7 a TH Esté en constante movimiento 0 acta como si“tuviera un motor por dentra™ 0 T z 1501 the go" or often acs asf “driven bya mtr” 7 TS, Habla excesivamente 0 ' e “Talks excessively B HEE ee 16. Responde precipitadamente incluso antes de escuchar la pregunta completa 0 3 _Blurs out answers before questions have been completed a : 17. Tlene dificaltad lnaciendo fils o cola 0 T 2 3 Has ified waiting in Line 7 PEE TB. Se entrometeo interrumpe« otros (en conversaciones 0 juegos) 7 T 3 ts nto conversations/gamcs) Loses temper BO, Desai aberaenie oe nega a cmplirlas dene os vgls de ov adios 0 7 i 3 ‘Actly defies or ees to copy with du requests ode eae TBI, Sele ve enojado(a oresentido( 3 T 3 Teangy er resent 7 oe ee 2, Es encorwaa)yvengavoa) 0 7 3 3 Is spite and vind Ee ae a eH 23. Reta, amenaza o intimida a otros ° 1 2 Bulg, hrentens or inate hers i Comiena pleat de contacto feo peer eee Initiates pyc fghs : FE 25. Mient para conseguir ines ofvoreso par air us oDigacones ° 7 3 3 Lis ban gods fr evar orn aol obligations (“cn others) Snaansaen 6s seamen erel con Ios dems ° T z 3 Is plier people i zt eee 27. Ha obadoobjetos de cierto valor ° 1 3 Has soe ts of vont ve - _ 2B. Destruye delberadamente la propisad aja ° 7 z 3 Deliberate dsp other’ propery 7 7D. Sent edo ansiedad o etd preocupadote) 7 7 z 3 Aspe asin orverried Hae tt 7 3 té pendent de sus actos oe avergicnzaficimente ° z 3 1s sl-canscious or easly embarassed American Academy 2 of Pediatrics y NICHQ: McNeil)[Nombre del maestro (a) Teachers Name SEEPS Eee Co RE CUeE Eee Hora de cse/Cas Time H Materia Periodo/ Cla Name/Perods 8 Fecha actual Today’ Date: a Nombre del lumno(a)iChil’s Nome, Grado escolar Grade Level Sintomas (continuaclay Nunca A vessal —— Seguldal Muy segaldal Symptoms (continued) Never Occasionally Often Very Often 31, Teme cer nuevas cos por emora comer eres ° Hi 2 3 Is af ory nee hing for fr of making mises ae 32. Se desprecia a si mismo se siente inferior o 1 2 i? = Fes wert or inferior + = 3F “emte que los problemas son esponsibiidad saya ys sens calpable a 7 nee fr probles fd guty ere 54, Se sont soo(a), rechazado() 0 sin amon se qusa de que nadielo quiere =O 2 2 3 5 Feats ey uwted or loved complains that noone loves him or er” 435. Selle ve triste, infeliz 0 deprimido(a) 0 oH 2 3 Ls sad, unhappy, or depressed Sobre Ciena Con enainientrPertomance xcetent) lonormay Normal’ alicia _aeuitad! Comportamiento Academicol Academie Performance Zrcofent "Above Average Somewhat Problematic Average ofa Problem 36. tecture 7 2 3 4 3 Renting i : +37. Matemiticas od Mathematics 38. Expresion escrta 1 zi 7 7 s Wren expresion Sobre cieta con Conaits escolar Excelent lonormal Norma iced! duty Giaseroom Behavioral Performance ‘icolort "Above. Average Somewhat Problematic Average ofa Problem P Rlicion con sus compateoe 7 > 3 4 3 Relationship wth pee TW Sigs inaruciones 2 5 7 5 Following directions 4. Conducta en clase 7 2 3 3 Disrupting class —_ asnee = “. Conclaye las treat aignadae T z 7 3 Assignment completion “49. Habilidad para orgenizarse 7 z 3 7 Organizational tls Cemeosatne(sommant: American Academy (23% of Pediatrics y NICHQ: McNeibr CUO RCL ere renee het) NICH@Q Vanderbilt Assessment Scale—TEACHER Informant, continued Por favor devuelva esta forma a/Please return this form tor. 4 Direccion/Mailing address: Fax/Fax number; a —— _ For Office Use Only ‘Total number of questions scored 2 or 3 in questions 1-9: ‘Total number of questions scored 2 or 3 in questions 10-18: ‘Tot mptom Score for questions 1-18: ‘Total number of questions scored 2 or 3 in questions 19-28; ‘Total number of questions scored 2 or 3 in questions 29-35: __ ‘Total number of questions scored 4 or 5 in questions 3643: ‘Average Performance Score: ” American Academy ee, ; Teer oe ae