Directions: Each rating should be considered in the context of what is appropriate for the age of your child. When completing this form, please think about your child's behaviors in the past 6 months.
Symptoms
Does not pay attention to detais or makes careless mistakes with, for example, homework:
- Never Occasionally Often Very Often
Has difficulty keeping attention to what needs to be done:
- Never Occasionally Often Very Often
Does not seem to listen when spoken to directly:
- Never Occasionally Often Very Often
Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand):
- Never Occasionally Often Very Often
Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand):
- Never Occasionally Often Very Often
Has difficulty organizing tasks and activities:
- Never Occasionally Often Very Often
Avoids, dislikes, or does not want to start tasks that require ongoing mental effort:
- Never Occasionally Often Very Often
Loses things necessary for tasks or activities (toys, assignments, pencils, or books):
- Never Occasionally Often Very Often
Is easily distracted by noises or other stimuli:
- Never Occasionally Often Very Often
Is forgetful in daily activities:
- Never Occasionally Often Very Often
Fidgets with hands or feet or squirms in seat:
- Never Occasionally Often Very Often
Leaves seat when remaining seated is expected:
- Never Occasionally Often Very Often
Runs about or climbs too much when remaining seated is expected:
- Never Occasionally Often Very Often
Has difficulty playing or beginning quiet play activities :
- Never Occasionally Often Very Often
Is “on the go” or often acts as if “driven by a motor”:
- Never Occasionally Often Very Often
Talks too much:
- Never Occasionally Often Very Often
Blurts out answers before questions have been completed:
- Never Occasionally Often Very Often
Has difficulty waiting his or her turn:
- Never Occasionally Often Very Often
Interrupts or intrudes in on others’ conversations and/or activities:
- Never Occasionally Often Very Often
Argues with adults:
- Never Occasionally Often Very Often
Loses temper:
- Never Occasionally Often Very Often
Actively defies or refuses to go along with adults’ requests or rules:
- Never Occasionally Often Very Often
Deliberately annoys people:
- Never Occasionally Often Very Often
Blames others for his or her mistakes or misbehaviors:
- Never Occasionally Often Very Often
Is touchy or easily annoyed by others:
- Never Occasionally Often Very Often
Is angry or resentful:
- Never Occasionally Often Very Often
Is spiteful and wants to get even:
- Never Occasionally Often Very Often
Bullies, threatens, or intimidates others:
- Never Occasionally Often Very Often
Starts physical fights:
- Never Occasionally Often Very Often
Lies to get out of trouble or to avoid obligations (ie,“cons” others):
- Never Occasionally Often Very Often
Is truant from school (skips school) without permission:
- Never Occasionally Often Very Often
Is physically cruel to people:
- Never Occasionally Often Very Often
Has stolen things that have value:
- Never Occasionally Often Very Often
Deliberately destroys others’ property:
- Never Occasionally Often Very Often
Has used a weapon that can cause serious harm (bat, knife, brick, gun):
- Never Occasionally Often Very Often
Is physically cruel to animals:
- Never Occasionally Often Very Often
Has deliberately set fires to cause damage:
- Never Occasionally Often Very Often
Has broken into someone else’s home, business, or car:
- Never Occasionally Often Very Often
Has stayed out at night without permission:
- Never Occasionally Often Very Often
Has run away from home overnight:
- Never Occasionally Often Very Often
Has forced someone into sexual activity:
- Never Occasionally Often Very Often
Is fearful, anxious, or worried:
- Never Occasionally Often Very Often
Is afraid to try new things for fear of making mistakes:
- Never Occasionally Often Very Often
Feels worthless or inferior:
- Never Occasionally Often Very Often
Blames self for problems, feels guilty:
- Never Occasionally Often Very Often
Feels lonely, unwanted, or unloved; complains that “no one loves him or her”:
- Never Occasionally Often Very Often
Is sad, unhappy, or depressed:
- Never Occasionally Often Very Often
Is self-conscious or easily embarrassed:
- Never Occasionally Often Very Often