Wants good things to happen to them. (R)

It’s impossible for them to pay attention to things.

Has no control over their behavior.

Says it’s impossible to think unless they’re moving around.

There is nothing they can pay attention to for a long time.

Finds it impossible to get work done because they can’t remember how to do it.

Is hard to motivate, even with highly desirable rewards.

Makes impulsive decisions.

Is Impulsive.

Needs to be moving around.

Has trouble sitting still.

Creates stress for the family.

Creates a chaotic family life.

Actively refuses to follow the rules.

Actively refuses to do what adults tell them to do.

Forgets to turn in completed work.

Hands things in late.

Interrupts other people’s conversations, games,
or activities.

Talks out of turn.

People don’t want to be friends with them.

Has trouble making or keeping friends.

It’s hard for me to pay attention for a long time.

I have trouble focusing for a long time.

I get tired because I worry so much.

I worry too much about a lot of things.

I have too much energy to stay still.

It’s hard for me to sit still.

I feel sad, gloomy, or irritable for many days at
a time.

I feel like things are not going well in my life, and I can’t do anything about it.

I get really angry all of a sudden.

It’s hard for me to control how angry I get.

I have trouble concentrating.

I get so distracted that I can’t get things done.

I have trouble sleeping because I worry about things.

I have trouble controlling my worries.

My family gets frustrated with me.

I cause problems for my family.

Steals while confronting a person (for example, mugging, purse snatching, or armed robbery).

I steal from people by robbing them.

Has intentionally set fires for the purpose of causing damage.

I set things on fire to cause damage.

Has broken into someone else’s house, building, or car.

I’ve broken into houses, buildings, or cars.

Is cruel to animals.

I do things to hurt animals.

Uses a weapon to scare or hurt people.

I use a weapon to scare or hurt people.

Has forced someone into sexual activity.

I made someone do something sexual against their will.

Has hurt themself on purpose.

I have hurt myself on purpose.

Has talked about, planned, or attempted suicide.

I have thought about hurting myself.

n/a

I have planned or tried to hurt myself.

Is forgetful in daily activities.

I forget to do things.

Avoids or dislikes things that take a lot of effort and are not fun.

I don’t like doing things that make me think hard for a long time.

Has trouble getting started on tasks or projects.

I have trouble getting started on things I’m supposed to do.

Is easily distracted.

I am easily distracted.

Doesn’t seem to listen to what people are saying to them.

People don’t think I’m listening to them.

Doesn’t finish schoolwork, work, or other tasks.

I don’t finish things I start, like schoolwork, work, or other tasks.

Has trouble getting back on task after being interrupted.

It’s hard for me to get back to work after I’ve been interrupted.

Fails to follow through on instructions.

I have trouble following instructions.

Has difficulty managing their time.

It’s hard for me to manage my time.

Has trouble concentrating.

I have trouble concentrating.

Has trouble organizing tasks or activities.

I have trouble keeping my things organized.

Fails to pay close attention to details.

It’s hard for me to pay attention to details.

Makes careless mistakes in schoolwork or other activities.

I make careless mistakes.

Has trouble planning ahead.

I have trouble planning ahead.

Loses or misplaces things that they need.

I lose things that I need.

n/a

I avoid doing things that make me think hard for a long time.

Gets so focused on something that they lose track of what is going on around them.

n/a

Has a hard time prioritizing tasks.

It’s hard for me to figure out what to do first.

Has a short attention span.

It’s hard for me to pay attention for a long time.

Has trouble changing from one task to another.

I have trouble changing from one task to another.

Has trouble staying focused on work or play for a long time.

I have trouble focusing for a long time.

Leaves their seat when they should stay seated.

I get out of my seat when I am not supposed to.

n/a

I have too much energy to stay still.

Needs to be moving around.

I feel like I need to be moving around.

Isn’t aware that they are being loud.

I don’t know that I’m being loud until someone tells me.

Talks too much.

I talk too much.

Runs or climbs when they are not supposed to.

I run or climb even when I am not supposed to.

Is unable to be quiet when playing or using free time.

I can’t play or do things quietly.

Gets overly excited.

n/a

Has trouble sitting still.

It’s hard for me to sit still.

Acts as if driven by a motor.

I feel like I am driven by a motor.

Fidgets or squirms in their seat.

I fidget or squirm in my seat.

Is restless.

I feel restless.

Blurts out the first thing that comes to mind.

I say the first thing that I think of.

Uses other people’s things without asking permission.

I forget to ask before using other people’s things.

n/a

I decide quickly without really thinking things through.

Has difficulty waiting for their turn.

I have trouble waiting for my turn.

Interrupts other people’s conversations, games, or activities.

I interrupt people when they are talking or playing games.

Intrudes on or takes over what others are doing.

n/a

Acts before thinking.

I do things before thinking about them.

Talks out of turn.

I talk when it’s not my turn.

Blurts out answers before the question has been completed.

I blurt out the answer before the question is finished.

Is impulsive.

I’m impulsive.

Loses temper.

I lose my temper.

Has trouble controlling their emotions.

It’s hard for me to control my feelings.

Has trouble calming down when upset.

I have trouble calming down when I get upset.

Says or does things they don’t mean to because they are angry.

I say or do things I don’t mean because I’m angry.

Gets really angry all of a sudden.

I get really angry all of a sudden.

Overreacts when they get upset.

I overreact when I get upset.

Mood changes quickly and drastically.

My mood changes quickly.

Has trouble controlling their anger.

It’s hard for me to control how angry I get.

Is sad, gloomy, or irritable.

I feel sad, gloomy, or irritable for many days at a time.

Seems hopeless about the future.

The future seems hopeless to me.

Feels worthless.

I feel worthless.

Seems tired.

I am tired.

Doesn’t enjoy things like they used to.

I don’t feel like doing things that I used to enjoy.

Feels helpless.

I feel like things are not going well in my life, and I can’t do anything about it.

n/a

I have trouble sleeping because I worry about things.

Has trouble controlling their worries.

I have trouble controlling my worries.

Gets tired or worn out from worrying.

I get tired because I worry so much.

Worries too much about many different things.

I worry too much about a lot of things.

Appears tense, nervous, or jumpy.

I feel nervous or jumpy.

Fears they will act in a way that could lead to embarrassment or rejection.

I’m scared that people won’t like me if they see how nervous I am.

n/a

I have trouble knowing what to do even when it was just explained to me.

Doesn’t know what their homework is or where they put it.

I don’t know what my homework is or where I’ve put it.

Forgets to turn in completed work.

I forget to turn in completed work.

Has trouble completing schoolwork or work because of distractions.

I get so distracted that I can’t get things done.

Hands things in late.

I hand things in late.

Hands in incomplete work or tests.

I accidentally skip questions in work or tests.

Checks their work for mistakes. (R)

I check my work for mistakes. (R)

Gets invited to play or go out with others. (R)

I get invited to play or go out with others. (R)

Is annoying to peers.

Other kids say I’m annoying.

Peers complain about their behavior.

Other kids complain about the way I act.

Interacts well with peers. (R)

n/a

People don’t want to be friends with them.

People don’t want to be friends with me.

Has trouble making or keeping friends.

Making friends is hard for me.

n/a

I feel like I don’t fit in.

n/a

I feel rejected by my family.

Disrupts family activities.

n/a

n/a

My family gets frustrated with me.

Creates stress for the family.

I cause problems for my family.

Makes it hard for the family to have fun together.

n/a

Causes the family to be late for appointments or activities.

I make my family late for things.

Argues with family members.

I argue with family members.

Doesn’t get along well with family members.

I get along well with my family. (R)

Creates a chaotic family life.

n/a

Is forgetful in daily activities.

I forget to do things.

Avoids or dislikes things that take a lot of effort and are not fun.

I don’t like doing things that make me think hard for a long time.

Is easily distracted.

I am easily distracted.

Doesn’t seem to listen to what people are saying to them.

People don’t think I’m listening to them.

Doesn’t finish schoolwork, work, or other tasks.

I don’t finish things I start, like schoolwork, work, or other tasks.

Fails to follow through on instructions.

I have trouble following instructions.

Has trouble organizing tasks or activities.

I have trouble keeping my things organized.

Fails to pay close attention to details.

It’s hard for me to pay attention to details.

Makes careless mistakes in schoolwork or other activities.

I make careless mistakes.

Loses or misplaces things that they need.

I lose things that I need.

n/a

I avoid doing things that make me think hard for a long time.

Has trouble staying focused on work or play for a long time.

I have trouble focusing for a long time.

Leaves their seat when they should stay seated.

I get out of my seat when I am not supposed to.

Needs to be moving around.

I feel like I need to be moving around.

Talks too much.

I talk too much.

Has difficulty waiting for their turn.

I have trouble waiting for my turn.

Runs or climbs when they are not supposed to.

I run or climb even when I am not supposed to.

Interrupts other people’s conversations, games, or activities.

I interrupt people when they are talking or playing games.

Is unable to be quiet when playing or using free time.

I can’t play or do things quietly.

Intrudes on or takes over what others are doing.

n/a

Has trouble sitting still.

It’s hard for me to sit still.

Acts as if driven by a motor.

I feel like I am driven by a motor.

Blurts out answers before the question has been completed.

I blurt out the answer before the question is finished.

Fidgets or squirms in their seat.

I fidget or squirm in my seat.

Is restless.

I feel restless.

Loses temper.

I lose my temper.

Actively refuses to follow the rules.

I refuse to follow the rules.

Is angry and resentful.

People make me angry.

Tries to get even with people.

When I get mad at someone, I get even with them.

Is irritable or easily annoyed by others.

I am easily annoyed.

Annoys other people on purpose.

I annoy people on purpose.

Upsets or offends others on purpose.

I upset or offend others on purpose.

Actively refuses to do what adults tell them to do.

I refuse to do what adults ask me to do.

Blames their mistakes or misbehavior on others.

I blame others for my mistakes or bad behavior.

Argues with adults.

I argue with adults.

Physically hurts people.

I hurt people by doing things like punching, kicking, or scratching.

Steals while confronting a person (for example, mugging, purse snatching, or armed robbery).

I steal from people by robbing them.

Starts fights with people.

I start fights with other people.

Steals valuable things secretly (for example, through shoplifting or forgery).

I steal valuable things when no one is watching.

Has intentionally set fires for the purpose of causing damage.

I set things on fire to cause damage.

Bullies, threatens, or scares others.

I bully, threaten, or scare others.

Has broken into someone else’s house, building, or car.

I’ve broken into houses, buildings, or cars.

Stays out at night, even though it breaks the rules.

I stay out at night, even though it breaks the rules.

Lies to avoid having to do something or to get things.

I tell lies to get out of doing things or to get stuff.

Is cruel to animals.

I do things to hurt animals.

Intentionally damages or destroys things that belong to others.

I destroy things on purpose that belong to others.

Uses a weapon to scare or hurt people.

I use a weapon to scare or hurt people.

Skips classes.

I skip classes.

Has forced someone into sexual activity.

I made someone do something sexual against their will.

Has run away from home for at least one night.

I have run away from home for at least one night.

Is easily distracted.

Has trouble getting back on task after being interrupted.

Fails to follow through on instructions.

Has trouble concentrating.

Has trouble organizing tasks or activities.

Has a hard time prioritizing tasks.

Has a short attention span.

Has trouble changing from one task to another.

Has trouble staying focused on work or play
for a long time.

Is impulsive.

Is restless.

Checks their work for mistakes. (R)

Describe how these behaviors cause serious problems for your child at home, in school, at work, or with their friends.

Describe how these behaviors cause serious problems for this student in school, at work, or with their friends.

Describe how these behaviors cause serious problems for you at home, in school, at work, or with your friends.

Do you have any other concerns about your child?

Do you have any other concerns about this student?

Do you have any other problems?

What strengths or skills does your child have?

What strengths or skills does this student have?

What are your main strengths or skills?

Wants good things to happen to them. (R)

It’s impossible for them to pay attention to things.

Says it’s impossible to think unless they’re moving around.

Has no control over their behavior.

There is nothing they can pay attention to for a long time.

Finds it impossible to get work done because they can’t remember how to do it.

Is hard to motivate, even with highly desirable rewards.

Leaves their seat when they should stay seated.

Has trouble sitting still.

It’s hard for me to sit still.

Is restless.

Is restless.

I feel restless.

Isn’t aware that they are being loud.

n/a

n/a

Needs to be moving around.

n/a

I feel like I need to be moving around.

Fidgets or squirms in their seat.

Fidgets or squirms in their seat.

n/a

n/a

Talks too much.

I talk too much.

n/a

Is unable to be quiet when playing or using free time.

n/a

n/a

n/a

I have too much energy to stay still.