The Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) is a 43-item teacher-report measure designed to assess symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and common comorbid conditions in children aged 5-12 years (Wolraich et al., 1998). It is the teacher rated version which can be used in parallel with the parent version: Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS).
The VADTRS evaluates five distinct clinical dimensions plus functional impairment:
Example VADTRS Item
Additionally, the scale assesses functional impairment across two performance domains: academic performance (reading, mathematics, and written expression) and classroom behaviour Performance (peer relationships, following directions, class disruption, assignment completion, and organisational skills). This functional impairment assessment is used to determine whether a child meets the clinical cutoff criteria for each of the behavioural dimensions assessed.
For clinicians, the VADTRS offers several distinct advantages, particularly in comprehensive ADHD assessment. The scale provides critical information from the educational setting, where many ADHD symptoms are most readily observable and functionally impairing. This teacher perspective is essential given that DSM diagnostic criteria for ADHD require symptoms to be present across multiple settings. The VADTRS aids in assessment, treatment planning, and intervention evaluation within the school environment, where children spend a significant portion of their day and where academic and social functioning can be directly observed.
There is also a complementary parent-rated version, the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). The combined use of VADTRS and VADPRS helps clinicians ensure that symptoms are observed across multiple settings, which is a key diagnostic requirement for ADHD according to DSM criteria. This multi-informant approach helps clinicians identify whether functional impairment is present across settings, distinguish between situational versus pervasive difficulties, and develop more targeted intervention strategies that address setting-specific needs whilst ensuring consistency in approach between home and school environments.
The VADTRS has demonstrated value in both referred clinical samples and community populations, with the original validation study conducted in a large population of over 8,000 elementary school children across 16 schools (Wolraich et al., 1998). In treatment planning, scores on the VADTRS may indicate the need for targeted classroom interventions addressing particular aspects of functioning. For example, high scores on the Oppositional Defiant/Conduct subscale might suggest the need for classroom behaviour management strategies, while elevated Anxiety/Depression scores could indicate the need for additional emotional support within the educational setting.
The Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) scores consist of subscale scores across multiple clinical domains. Higher scores represent higher levels of symptoms within each of the domains measured. Raw scores (sum of Likert response options), symptom scores, clinical cutoff descriptors (whether meeting the diagnostic criteria or not), and percentiles (based upon the symptom counts) are provided for the following subscales of the VADTRS:
Items 36-43 assess functional impairment in academic (reading, mathematics, and written expression) and classroom (peer relationships, following directions, class disruption, assignment completion, and organisational skills) domains. These functional impairment questions are used to determine whether a child meets the clinical cutoff criteria for each of the behavioural dimensions assessed.
The VADTRS employs both dimensional (raw score) and symptom count scoring approaches. The raw score uses the dimensional scoring technique where sum scores for each subscale provide continuous measures of symptom severity, where higher scores equate to higher symptom severity. However, the percentiles are based upon symptom counts (the number of items rated as “often” or “very often” for each subscale) and are derived from the original normative sample of over 8,000 elementary school children from the Wolraich et al. (1998) validation study. Percentiles are calculated separately for male and female students, with combined norms used when gender information is not available. Percentiles indicate the child’s position relative to same-gender peers in the normative sample based on their symptom count. A percentile of 50 indicates that the symptom count for the child is at average and expected levels for a child of that gender, and a percentile of 90 indicates that the child has relatively high symptom counts compared to their peers (i.e., higher than 90 percent of their peers).
The clinical cutoffs use the symptom count approach where behaviours rated as “often” or “very often” are flagged as significant symptoms, with clinical cutoffs based upon meeting both threshold numbers AND functional impairment (Items 36-43). ADHD presentations require six or more qualifying symptoms plus functional impairment in at least one domain. Oppositional Defiant/Conduct problems require three or more symptoms plus impairment, and Anxiety/Depression requires three or more symptoms plus functional impairment. The functional impairment questions (Items 36-43) evaluate eight domains: three academic performance areas (reading, mathematics, written expression) and five classroom behavioural performance areas (peer relationships, following directions, class disruption, assignment completion, and organisational skills), where scores of 1 or 2 (problematic or somewhat of a problem) indicate significant impairment.
Note, research has consistently demonstrated gender differences in the presentation and recognition of ADHD, with females often being underdiagnosed due to less disruptive symptom presentations and different behavioural expressions (Hinshaw et al., 2022; Martin, 2024). To address this potential bias, the VADTRS interpretive system includes gender-equivalence flagging that identifies cases where female students may warrant further clinical evaluation despite not meeting traditional diagnostic thresholds. Specifically, when a female student’s symptom count falls below the diagnostic threshold but her percentile rank matches or exceeds that of males who do meet diagnostic criteria (90th percentile for inattentive symptoms, 95th percentile for hyperactive/impulsive symptoms), the interpretive text will include a clinical note highlighting this discrepancy. This flagging system recognises that percentile ranks may represent clinical significance across genders, and ensures that clinicians are alerted to potentially significant symptoms that might otherwise be overlooked in female students, thereby supporting more equitable diagnostic practices.
On first administration of the VADTRS a plot shows the normative percentiles for all subscales with a coloured background at the 90th percentile and above, indicating potentially elevated scores. A line is presented on this plot at the 50th percentile which indicates an average symptom level for each of the subscales. Subsequent administrations of the VADTRS show longitudinal plots showing the ADHD subtype raw scores and comorbid percentiles over time. Note the coloured shading in the background of both plots represents symptom severity, not necessarily whether a client meets diagnostic criteria or not (given this is dependent upon functional impairment too).
When VADTRS scores are available from multiple timepoints, changes in scores can provide valuable information about the effectiveness of interventions or developmental changes in symptoms. For comparative interpretation, changes in symptom counts are flagged. If applicable, this interpretive text outlining change in scores is displayed first within the interpretive text section.
The VADTRS was initially validated in a large population comprising elementary school children during two consecutive academic years (Wolraich et al., 1998). The full sample included 16 schools, 398 teachers, and 8,257 children in the 1993-1994 year, and 10 schools, 214 teachers, and 4,323 students during the 1994-1995 year. The sample was predominantly white, with African-American representing the only significant minority at 6.9% of the population. Approximately 17.2% of the sample were below the poverty level, and the sample comprised a range of settings including a medium-size city with varied ethnic and socioeconomic population, an upper-middle-class suburban section, and a rural section.
The internal consistency of the VADTRS has been consistently demonstrated across the validation samples. In the original study, coefficient alpha values were good for the inattention dimension (.92), hyperactive/impulsive dimension (.90), and oppositional-defiant/conduct dimension (.87), and the anxiety/depression dimension (.80) (Wolraich et al., 1998). The performance dimensions also demonstrated excellent internal consistency, with the classroom behaviour performance dimension achieving .94 and the academic performance dimension achieving .95.
Factor analysis identified a strong four-factor structure for the behavioural items, comprising inattention, hyperactivity/impulsivity, oppositional-defiant/conduct problems, and anxiety/depression dimensions. Principal component extraction followed by both orthogonal and oblique rotations supported this dimensional structure. The cumulative proportion of covariance accounted for by the latent dimensions was 52.8%, distributed as 33.5%, 8.2%, 7.2%, and 3.8% among the four respective prerotated dimensions. The performance section yielded two distinct dimensions (classroom behaviour and academic performance), accounting for 87.5% of the cumulative proportion of covariance (72.5% and 15.0% respectively). Confirmatory factor analysis provided strong support for the theoretical structure underlying the VADTRS. The latent variable structure identified in the Year 1 data set was confirmed in the Year 2 data set, with no item migrating from its hypothesised dimension. Coefficients of factor structure similarity between the two data sets averaged .99 and ranged from .99 to 1.0 for the four individual behavioural dimensions, demonstrating excellent stability of the factor structure across time.
Construct validity of the VADTRS is supported through theoretically consistent relationships between dimensions and known clinical conditions. Correlations between the behavioural dimensions ranged from .24 to .61, with the strongest associations being evidenced between the two ADHD dimensions (.61). The scale demonstrated meaningful relationships with teacher reports of diagnosed ADHD (r = .32 for both inattentive and hyperactive/impulsive dimensions), academic problems, and behavioural problems. Notably, the inattentive dimension showed a stronger association with academic problems (r² = 25%) compared to the hyperactive/impulsive dimension (r² = 7%), which aligns with theoretical expectations and clinical research findings. The academic and behavioural performance dimensions were appropriately associated with each other and with teacher reports of academic and behavioural problems, supporting their validity as measures of functional impairment.
Percentile rankings for the VADTRS are derived from symptom counts (the number of items rated as “often” or “very often” for each subscale) based on the original normative sample of over 8,000 elementary school children from the Wolraich et al. (1998) validation study. Gender-specific norms are essential because multivariate analysis revealed statistically significant gender differences (p < .001) across all behavioural dimensions, with males consistently demonstrating higher average symptom scores than females on inattentive, hyperactive/impulsive, and oppositional-defiant/conduct subscales, while females showed superior performance on academic and classroom behavioural measures. Percentiles are calculated separately for male and female students using standard normal distribution methods, where each possible symptom count is converted to a z-score using gender-specific means and standard deviations, then transformed to percentile ranks. When gender is not specified or is identified as non-binary, combined male and female percentiles are calculated using pooled statistics; however, these should be interpreted with caution as they may not fully represent the individual’s normative reference group. The normative statistics from the Wolraich et al. (1998) 1994-1995 sample are:
Males (n = 2,014):
Females (n = 1,972):
Combined (n = 3,986) (all values calculated from the male/female M and SDs):
This symptom count approach differs from dimensional raw score percentiles (as used in the VADPRS), providing direct correspondence with DSM diagnostic criteria while enabling meaningful comparison to the reference population’s symptom frequency distributions.
Wolraich, M. L., Feurer, I. D., Hannah, J. N., Baumgaertel, A., & Pinnock, T. Y. (1998). Obtaining systematic teacher reports of disruptive behaviour disorders utilizing DSM-IV. Journal of Abnormal Child Psychology, 26(2), 141–152. https://doi.org/10.1023/a:1022673906401
Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484-496. https://doi.org/10.1111/jcpp.13480
Martin, J. (2024). Why are females less likely to be diagnosed with ADHD in childhood than males? The Lancet. Psychiatry, 11(4), 303–310. https://doi.org/10.1016/S2215-0366(24)00010-5
