Instructions: Place a check mark next to the symptoms that occur Frequently or Very Frequently for your child or teen.

Important Note: This is not a tool for diagnosis. Its purpose is simply to help you determine whether ADHD may be a factor in your child’s behavior. An actual diagnosis can be made only by an experienced professional.

___ Always on the go

___ Can’t sit still

___ Doesn’t seem to listen

___ Often fails to finish things

___ Has poor concentration and attention when it comes to school work

___ Often fidgets with hands/feet or squirms in seat or physically restless

___ Easily distracted

___ Has a hard time playing quietly

___ Talks excessively

___ Often interrupts or “butts in” to other’s games or conversations

___ Seems disorganized, loses things they need for school, binder is a mess

___ Takes risks without considering the danger involved (e.g. running into the street without looking)

___ Blurts out answers to questions before they have been completed