Abbreviated Adhd Symptom Checklist Template
ADVERTISEMENT
1Abbreviated ADHD Symptom Checklist 4
Name:
Date:
Person Completing Form:
Relationship:
Directions: Indicate the degree to which each item below is a problem. Please respond to all
items.
Never Sometimes Often
Very Often
1.
0
1
2
3
2. Difficulty paying attention
0
1
2
3
3. Does not seem to listen
0
1
2
3
4. Difficulty following instructions; does not finish things
0
1
2
3
5. Difficulty getting organized
0
1
2
3
6. Avoids doing things that require a lot of effort
0
1
2
3
7. Loses things
0
1
2
3
8. Easily distracted
0
1
2
3
9. Forgetful
0
1
2
3
10. Fidgets with hands or feet; squirms in seat
0
1
2
3
11. Difficulty remaining seated
0
1
2
3
12. Runs about or climbs on things
0
1
2
3
13. Difficulty playing quietly
0
1
2
3
14. On the go; acts as if driven by a motor
0
1
2
3
15. Talks excessively
0
1
2
3
16. Blurts out answers to questions
0
1
2
3
17. Difficulty waiting turn
0
1
2
3
18. Interrupts others or butts into their activities
0
1
2
3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Life