 |
| 1. | Does not pay attention or makes careless mistakes |
0 | 1 | 2 | 3 |
|
| 2. | Has difficulty keeping attention to what needs to be done |
0 | 1 | 2 | 3 |
|
| 3. | Does not seem to listen when spoken to directly |
0 | 1 | 2 | 3 |
|
| 4. | Does not follow through when given directions and fails to finish activities |
0 | 1 | 2 | 3 |
|
| 5. | Has difficulty organizing tasks and activities |
0 | 1 | 2 | 3 |
|
| 6. | Avoids or does not want to start tasks that require ongoing mental effort |
0 | 1 | 2 | 3 |
|
| 7. | Loses things necessary for tasks or activities (toys, pencils or books) |
0 | 1 | 2 | 3 |
|
| 8. | Is easily distracted by noises or other stimuli |
0 | 1 | 2 | 3 |
|
| 9. | Is forgetful in daily activities |
0 | 1 | 2 | 3 |
|
| 10. | Fidgets with hands or feet or squirms in seat |
0 | 1 | 2 | 3 |
|
| 11. | Leaves seat when remaining seated is expected |
0 | 1 | 2 | 3 |
|
| 12. | Runs about or climbs too much when remaining seated is expected |
0 | 1 | 2 | 3 |
|
| 13. | Has difficulty playing or beginning quiet play activities |
0 | 1 | 2 | 3 |
|
| 14. | Is "on the go" or often acts as if "driven by a motor" |
0 | 1 | 2 | 3 |
|
| 15. | Talks too much |
0 | 1 | 2 | 3 |
|
| 16. | Blurts out answers before questions have been completed |
0 | 1 | 2 | 3 |
|
| 17. | Has difficulty waiting his or her turn |
0 | 1 | 2 | 3 |
|
| 18. | Interrupts or intrudes on others' conversations and/or activities |
0 | 1 | 2 | 3 |
|
 |
|
| |
Behaviour / performance |
Excellent |
Above average |
Average |
Problematic |
|
| 19. | Overall school performance |
0 | 1 | 2 | 3 |
|
| 20. | Reading |
0 | 1 | 2 | 3 |
|
| 21. | Writing |
0 | 1 | 2 | 3 |
|
| 22. | Mathematics |
0 | 1 | 2 | 3 |
|
| 23. | Relationship with parents |
0 | 1 | 2 | 3 |
|
| 24. | Relationship with siblings |
0 | 1 | 2 | 3 |
|
| 25. | Relationship with peers |
0 | 1 | 2 | 3 |
|
