AD/HD Diagnostic Rating Scale

 

Name:________________________

Date of Birth:___________________

Each rating should be considered in the context of what is appropriate for the age of the children you are rating.

Frequency Code: 0=never 1=occasionally 2=often 3=very often
  1. Fails to give attention to details or makes careless mistakes in schoolwork.
  2. Has difficulty sustaining attention to tasks or activities.
  3. Does not seem to listen when spoken to directly.
  4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand).
  5. Has difficulty organizing tasks and activities.
  6. Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort.
  7. Loses things necessary for tasks or activities (school assignments, pencils or books).
  8. Is easily distracted by extraneous stimuli.
  9. Is forgetful in daily activities.
  10. Fidgets with hands and feet or squirms in seat.
  11. Leaves seat in classroom or in other situations in which remaining seated is expected.
  12. Runs about or climbs excessively in situations in which remaining seated is expected.
  13. Has difficulty playing or engaging in leisure activities quietly.
  14. Is "on the go" or often acts as if "driven by a motor".
  15. Talks excessively.
  16. Blurts out answer before questions have been completed.
  17. Has difficulty waiting in line.
  18. Interupts or intrudes on others (e.g., butts into conversations or games).
0

0
0
0


0
0

0

0
0
0
0

0

0
0
0
0
0
0
1

1
1
1


1
1

1

1
1
1
1

1

1
1
1
1
1
1
2

2
2
2


2
2

2

2
2
2
2

2

2
2
2
2
2
2
3

3
3
3


3
3

3

3
3
3
3

3

3
3
3
3
3
3
Do you feel that your child's behavior was improved today?
__yes
__no
Do you believe your child was on medication today?
__yes
__no
Any Side Effects:
__decreased appetite
__headache
__stomachache
__change in personality other______________

Courtesy of Mark Wolraich, MD Vanderbilt University

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