Childhood Adhd Symptoms Scale Chart - Self-Report Page 2
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1
2CURRENT ADHD SYMPTOMS SCALE
SELF-REPORT
-
Name____________________________________
Date_________
Instructions
Please circle the number next to each item that best describes your behavior
DURING THE PAST 6 MONTHS.
Very
Never or
Some-
Often
Items:
Often
Rarely
times
0
3
1. Fail to give close attention to details or make
1
2
careless mistakes in my work
0
3
2. Fidget with hands or feet or squirm in seat
1
2
0
3
3. Difficulty sustaining my attention in tasks or fun
1
2
activities
0
3
4. Leave my seat in classroom or in other situations in
1
2
which seating is expected
0
3
5. Don’t listen when spoken to directly
1
2
0
3
6. Feel restless
1
2
0
3
7. Don’t follow through on instructions and fail to
1
2
finish work
0
3
8. Have difficulty engaging in leisure activities or
1
2
doing fun things quietly
0
3
9. Having difficulty organizing tasks and activities
1
2
0
3
10. Feel “on the go” or “driven by a motor”
1
2
0
3
11 Avoid, dislike, or am reluctant to engage in work
1
2
that requires sustained mental effort
0
3
12. Talk excessively
1
2
0
1
3
13. Lose things necessary for tasks or activities
2
0
3
14. Blurt out answers before questions have been
1
2
completed
3
15. Easily distracted
0
1
2
0
1
3
16. Have difficulty awaiting turn
2
0
1
3
17. Forgetful in daily activities
2
1
3
18. Interrupt or intrude on others
0
2
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