ADHD Questionnaire

ADHD Questionnaire*

If you suspect that your child or teenager might struggle with ADD or ADHD, complete the following form. It will then be available to Dr. Forrest if you wish a consultation.

One of the most common situations facing parents today is when their childs mental focus, behavior and restlessness falls outside the accepted norms. These children are often labeled as having attention deficit hyperactivity disorder. It is recommended that these kids should have further testing or evaluation.

These evaluations often begin with parenting and teacher checklists to see if the child has enough symptoms of inattention, and/or hyperactivity and impulsivity to meet the criteria for having ADHD. While this form cannot diagnose your child it may give some guidelines to help you decide whether to have a more complete evaluation.

When filling out this form consider your child's general behavior over the last three to six months.

0 = Never
1 = Occasional
2 = Often
3= Very Often

Attention Deficit Signs

0
1
2
3
Fails to give close attention to details.

Often has trouble keeping attention on tasks or play activities.

Does not seem to listen when spoken to directly

Often does not follow instructions and fails to finish schoolwork.

Has difficulty organizing tasks and activities
Avoids, dislikes, or is reluctant to engage sustained mental effort.
Often looses things
Is easily distracted
Frequently forgets or misplaces things.

Hyperactivity Signs

0
1
2
3
Fidgets with hands or feet or squirms in seat
Leaves seat in classroom or in other inappropriately
Runs around or climbs too much inappropriately
Has difficulty playing quietly
Is often restless, moving or fidgeting.
Often talks excessively.

Impulsiveness Signs

0
1
2
3
Acts impulsively or without considering the consequence.
Blurts out answerers before questions are completed.
Has difficulty waiting their turn
Does not remain seated during class.
Lacks tact, saying the first thing that comes to mind.
*Adapted from the DSM-IV diagnostic criteria for ADHD.
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Not Certain What To Do Next?
If you are uncertain as to which products or programs to use or which tests to take; or, if you would like additional help: