For each item, select 1 which best describes this child/adolescent:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork or tasks

2. Often has difficulty sustaining attention in tasks or play activities

3. Often does not seem to listen when spoken to directly

4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties

5. Often has difficulty organizing tasks and activities

6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort

7. Often loses things necessary for activities (e.g., toys, school assignments, pencils or books)

8. Often is distracted by extraneous stimuli

9. Often is forgetful in daily activities

10. Often fidgets with hands or feet or squirms in seat

11. Often leaves seat in classroom or in other situations in which remaining seated is expected

12. Often runs about or climbs excessively in situations in which it is inappropriate

13. Often has difficulty playing or engaging in leisure activities quietly

14. Often is “on the go” or often acts as if “driven by a motor”

15. Often talks excessively

16. Often blurts out answers before questions have been completed

17. Often has difficulty awaiting turn

18. Often interrupts or intrudes on others (e.g., butts into conversations/games)

19. Often loses temper

20. Often argues with adults

21. Often actively defies or refuses adult requests or rules

22. Often deliberately does things that annoy other people

23. Often blames others for his or her mistakes or misbehavior

24. Often is touchy or easily annoyed by others

25. Often is angry and resentful

26. Often is spiteful or vindictive

Assessment Result:

Inattention Subset:

Hyperactivity/Impulsivity Subset:

Opposition/Defiance Subset:

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