Transcription of CHILDHOOD ADHD SYMPTOMS SCALE - SELF-REPORT
1 CHILDHOOD adhd SYMPTOMS SCALE - self -REPORTName_____ Date_____InstructionsPlease circle the number next to each item that best describes your behavior WHEN YOUWERE A CHILD AGE 5 TO 12 :Never orRarelySome-timesOftenVeryOften1. Failed to give close attention to details or makecareless mistakes in my work01232. Fidgeted with hands or feet or squirm in seat01233. Difficulty sustaining my attention in tasks or funactivities01234. Left my seat in classroom or in other situations inwhich seating was expected01235. Didn t listen when spoken to directly01236. Felt restless01237. Didn t follow through on instructions and failed tofinish work01238. Had difficulty engaging in leisure activities or doingfun things quietly01239. Had difficulty organizing tasks and activities012310. Felt on the go or driven by a motor 012311. Avoided, disliked, or was reluctant to engage inwork that requires sustained mental effort012312.
2 Talked excessively012313. Lost things necessary for tasks or activities012314. Blurted out answers before questions had beencompleted012315. Easily distracted012316. Had difficulty awaiting turn012317. Forgetful in daily activities012318. Interrupted or intruded on others0123 CURRENT adhd SYMPTOMS SCALE - self -REPORTName_____ Date_____InstructionsPlease circle the number next to each item that best describes your behaviorDURING THE PAST 6 :Never orRarelySome-timesOftenVeryOften1. Fail to give close attention to details or makecareless mistakes in my work01232. Fidget with hands or feet or squirm in seat01233. Difficulty sustaining my attention in tasks or funactivities01234. Leave my seat in classroom or in other situations inwhich seating is expected01235. Don t listen when spoken to directly01236. Feel restless01237. Don t follow through on instructions and fail tofinish work01238.
3 Have difficulty engaging in leisure activities ordoing fun things quietly01239. Having difficulty organizing tasks and activities012310. Feel on the go or driven by a motor 012311 Avoid, dislike, or am reluctant to engage in workthat requires sustained mental effort012312. Talk excessively012313. Lose things necessary for tasks or activities012314. Blurt out answers before questions have beencompleted012315. Easily distracted012316. Have difficulty awaiting turn012317. Forgetful in daily activities012318. Interrupt or intrude on others0123
