The following is a brief rating scale
derived from the ADD/ADHD Questionnaire For Parents. In essence, it
represents the most significant items on that scale designed to identify
those children who present with ADD/ADHD. It is reproduced here as a
"checklist" for some of the most significant or prominent
aspects of ADD/ADHD. This rating scale is not meant to be a diagnostic
indicator or to take the place of a full evaluation. Please fill it out
before coming into the center.
INSTRUCTIONS
Dear Parent/teacher: Please rate the severity of the
following problems for your child. If the child does not exhibit the
problem behavior or if you have not observed it, select 0. If the
behavior is shown or has been reported to you by others, indicate how
significant it is by selecting 1 for mild, 2 for moderate, 3 for severe
or 4 for profound. If any item varies in frequency instead of severity,
rate 1(low) to 4(high) to indicate frequency of occurrence for that
item.
No Problem
Mild
Moderate
Severe
Profound
1.
Changes from one activity to another very quickly.
0
1
2
3
4
2.
Gets more restless when his/her movement is restricted
0
1
2
3
4
3.
Has trouble keeping on the topic when talking.
0
1
2
3
4
4.
Goes from one question to another without waiting for
answers.
0
1
2
3
4
5.
Has trouble concentrating on what he/she is doing.
0
1
2
3
4
6.
Fails to learn from his/her mistakes.
0
1
2
3
4
7.
Has much difficulty waiting for things
0
1
2
3
4
8.
Seems to be unable to engage in "quiet play".
0
1
2
3
4
9.
Cannot carry out a task without being
"sidetracked".
0
1
2
3
4
10.
Seems to act or talk out before thinking.
0
1
2
3
4
11.
Loses many things such as toys, articles of clothing,
books, papers, etc.
0
1
2
3
4
12.
Needs a great deal of guidance to finish assignments.
