ADHD Questionaire

Answer the questions to this list. If you think your child might have ADHD, take the list to the pediatrician for a referral to a child psychiatrist. That doctor will probably have their own list. Boys are scored differently than girls. Get each parent, teacher, scout leader and caregiver this questionaire. Please think about the past 6 months, not the past week or yesterday.

Be aware that ADHD-like behavior is NORMAL for toddlers. It's when the elementary school aged child hasn't grown out of this stage and it starts interfering with learning, that ADHD is suspected.


Symptoms of Inattention - Please answer as Never, Sometimes, Often, or Very Often

1. Fails to see details or read instructions
2. Makes careless mistakes in schoolwork, work, or other activities
3. Has difficulty paying attention in tasks or play activities
4. Does not seem to listen when spoken to directly (in one ear, out the other)
5. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
6. Has difficulty organizing tasks and activities, seems overwhelmed
7. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as homework)
8. Loses things (toys, school assignments, pencils, books, or tools)
9. Is easily distracted by outside stimuli (items on table, desk, a pet walks by, a noise in another room)
10. Is forgetful in daily activities such as getting ready in the morning or at bedtime
11. Unable to follow 2 or 3 item verbal list of instructions (brush your teeth and put on PJ's)
12. Doesn't pay attention to own body - doesn't wipe nose, doesn't care about potty accidents (this is different than being embarrassed and not wanting anyone to know)

Symptoms of Hyperactivity - Please answer with Never, Sometimes, Often or Very Often

1. Fidgets with hands or feet, must be doing something with them
2. Squirms in carseat or seat at school, church, meetings or during a meal. Just can't relax and sit still.
3. Leaves seat in classroom when remaining seated is required
4. Runs about or climbs in situations in which it is inappropriate
5. Has difficulty playing quietly, must be noisy
6. Is 'on the go' or acts as if 'driven by a motor'
7. Talks too much

Symptoms of Impulsivity - Please answer with Never, Sometimes, Often, or Very Often

1. Shouts out answers before questions have been completed or when told to raise hand
2. Has difficulty waiting his or her turn in lines or during games
3. Interrupts conversations
4. Doesn't think before acting - runs into street or parking lot, grabs things they want at the store

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