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CLICK ON THE APPROPRIATE RATING: |
Never |
Mild |
Often |
Severe |
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1. Poor attention to details |
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2. Careless mistakes in academic or other activities |
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3. Short attention span to tasks or play activities |
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4. Seems not to listen when spoken to |
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5. Difficulties following through and finishing tasks |
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6. Poor organization skills, procrastinates, takes a long time to start work |
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7. Avoids tasks requiring attention (homework, reading) |
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8. Loses and forgets things (school assignments, pencils, books) |
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9. Easily distracted (by external stimuli) |
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10. Forgetful in daily activities |
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11. Fidgets hands or squirms in seat |
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12. Gets up from chair inappropriately (can't stay seated for a long time) |
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13. Runs, climbs excessively, notably overactive |
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14. Difficulties playing quietly |
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15. Up and on the go (as if driven by a motor) |
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16. Talks excessively |
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17. Answers before question completed |
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18. Difficulties waiting turn |
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19. Interrupts or intrudes into conversation or activity |
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20. Eating difficulties |
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21. Sleeping difficulties |
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22. Headaches |
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23. Bed wetting |
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24. Speech delay (current or history of speech delay) |
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25. Abdominal pain or diarrhea |
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26. Anxiety (excessive fear) afraid of new situations |
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27. Depressed mood (unhappy child, cries easily, irritable) |
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28. Compulsive behavior (rituals, arranging objects, etc.) |
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29. Oppositional and defiant (refuses to cooperate, answers back, disobedient) |
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30. Cruel |
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31. Social difficulties (mocked by other kids), likes to be on his own |
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32. Very "difficult" child |
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33. Mood swings |
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34. Feels easily hurt or cheated |
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35. Risk taking behaviors, hitting, throwing, runs to street, plays with fire |
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36. Tics, eye blinking, facial twitches |
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37. Spacing out, blank stare, in his own world |
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38. Destroys toys or property |
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39. Lies frequently |
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40. Picks on things (nails, clothing) |
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41. Wants to run things |
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