Residual Functional Capacity Childhood Mental Disorders Page 3

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Please identify the clinical findings and objective signs supporting the diagnoses.
Please list your patient’s symptoms.
For an Attention Deficit Hyperactivity Disorder Diagnosis:
How is the Attention Deficit Hyperactivity Disorder diagnosis manifested in developmentally
inappropriate degrees of inattention, impulsiveness, and hyperactivity.
Please be specific regarding qualitative deficits in the development of reciprocal social
interaction including but not limited to:
1. Marked inattention; and
2. Marked impulsiveness; and
3. Marked hyperactivity;
4. Other
Please be specific regarding qualitative deficits in verbal and nonverbal communication and in
imaginative activity including but not limited to:
1. Marked inattention; and
2. Marked impulsiveness; and
3. Marked hyperactivity;
4. Other
Mental Functional Assessment – Page Number 3

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