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Select all behaviors that would have described your daughter (or you) at age 7.
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First Name
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Age when daughter (or you) were diagnosed?
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Inattentiveness
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Makes careless mistakes in schoolwork
Frequently overlooks or misses details
Takes excess time to complete tasks
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Difficulty Maintaining Attention
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Easily distracted, especially in unstructured enviroments
Has trouble staying focused during tasks or conversations
Is easily bored unless subject interests her
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Poor Listening Skills
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Seems to be elsewhere, even without distractions
Appears dreamy or preoccupied
Requires frequent repetition of instructions
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Organization and Forgetfulness
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Loses items necessary for tasks
Poor sense of time and deadlines
Often forgets instructions or assignments
Need frequent reminders
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Restlessness and Impulsivity
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Fidgets or squirms excessively
Leaves seat when expected to remain seated
Interrupts or butts in on others
Quickly becomes impatient
Is often asked to quiet down
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Social Awkwardness
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Difficulty making and keeping friends
Shy and introverted
Prefer solitary activities
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Emotional Dyregulation
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Often cries or has meltdowns
Screams
Easily upset
Seems immature for age
Loses self-control
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Would this questionnaire aid earlier diagnosis?
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__Yes
__No
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If you (or your parents) completed this questionnaire when your daughter (or you were 7), do you believe it would have led to an earlier diagnosis of ADHD?
What additional behaviors should we include?
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Comments
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