AD/HD Self-Assessment

Please check the boxes where you have areas of concern. Then enter your email address and click on [Send Results] to have your score and recommendations emailed to you.

Attention Giving close attention to details
Make careless mistakes
Sustaining attention
Completing tasks/homework
Giving close attention to details
Organization
Sustaining mental effort
Distractibility
Forgetfulness
Oppositional Controlling temper
Deliberately annoying
Angry/resentful
Argumentative
Blames others
Spiteful/vindictive
Defiant
Easily annoyed
Swears
Impulsivity & Hyperactivity Fidgety/”squirmy”
Playing quietly
Interrupting
Remaining seated
Talk excessively
Restlessness
Taking turns

Mood Control Depressed/Irritable on daily basis
Joylessness
Increase or Decrease in Weight
Sleep difficulty (too much/little)
Restless
Feels “slow”
Lacks energy
Low self-esteem
Feels worthless/guilty
Difficulty concentrating
Feels hopeless

Conduct Bullying
Physical cruelty
Deliberately destroys property
Fighting
Steals
Lying
Uses weapons
Set fires
Truant

Anxiety Excessive anxiety/worry
Fears separation from parent
Inability to relax
Panic attacks
Fear of being alone
Worry of future
Self-conscious
Needs frequent reassurance
Fear of sleeping alone
Frequent nightmares
Over sensitivity to certain
     foods/fabrics


Learning Academic Skills Recognizing words
Learning math skills
Spelling
Skip lines when reading
Math word problems
Poor Handwriting
Reading comprehension
Forming letters/words
Expressing ideas in writing

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Age of individual assessed: