Our website services, content, and products are for informational purposes only. %PDF-1.4 %���� Hyperactivity/ Requires six or more counted behaviors from questions 10–18 As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Reprinted with permission from The Guilford Press, New York. Occup Environ Med 2008; 65: 835-842. 0000000016 00000 n 0000001397 00000 n 0000002509 00000 n 8.20 Version: March 2014. ADHD is … Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. Any problems at school? 0000024215 00000 n This ADD self-test was designed for girls themselves to take and may help clarify symptoms. Items: Never or Rarely Some-times Often Very Often … Step 8: At a second doctor visit, the doctor reviews the results of the parent and teacher questionnaires and determines if any other testing is required to make a diagnosis of ADHD or other condition. startxref 0000003377 00000 n 0000001176 00000 n 0 Inattention Not at All Sometimes Frequently 1. ADD/ADHD Parent Questionnaire Child’s name: Grade: DOB: Name of School: Referred By: FAMILY HISTORY Mother Father Age Age Health Health Education Education Any problems at school? All rights reserved. endstream endobj 11 0 obj<> endobj 13 0 obj[14 0 R] endobj 14 0 obj<. the child with ADHD. When completing this form, please think about your child’s behaviors in the past 6 months. Attention Defecit Hyperactivity Disorder (ADHD) and Undifferentiated Attention Deficit Disorder (ADD) This checklist was developed from the experience of many specialist in the field of Attention Deficit Disorders and Hyperactivity. 0000003304 00000 n 0000003669 00000 n Vanderbilt ADHD Diagnostic Parent Rating Scale Page 1 of 3 VANDERBILT ADHD DIAGNOSTIC PARENT RATING SCALE Child’s Name: Today’s Date: Date of Birth: Age: Grade: Each rating should be considered in the context of what is appropriate for the age of your child. 10 44 0000002437 00000 n Your child can help pick the location and decorate the area . This initial assessment tool, available on the website of Monroe Carell Jr. Children’s Hospital at Vanderbilt for use with children ages 6-12, contains rating scales for symptoms of disorders and for impairments in academic and behavioral performance. • Child or parent training improved ADHD symptoms among children 7–17 years of age but did not change academic performance. 0000001859 00000 n 0000002653 00000 n %PDF-1.2 %���� and should reflect that child’s behavior since the beginning of the school year. 1 4 ---- An examination _ of ADHD begirW by looking at the questions surrounding At the visit, your child's school and home history, medical history, and an exam are combined with the answers on these forms to assist in arriving at a diagnosis. 2. Symptoms Never Occasionally Often Very Often 1. Symptoms Never Occasionally Often Very Often 1. 0000002797 00000 n school and home version rating forms and technical manuals, the Attention Deficit Disorder Intervention Manual, and the Parent’s Guide to Attention Deficit Disorder. trailer 0000003523 00000 n Is this evaluation based on a time when the child was on medication was not on medication not sure? 0000002293 00000 n Refer to www.caddra.ca for latest updates. 0000003013 00000 n If possible, keep an extra set of school books at home . 0000002365 00000 n 0000002581 00000 n 0000001513 00000 n Please indicate the number of weeks or months you have been able to evaluate the behaviors: _____. x�b```�/l�6 �� 0000001489 00000 n • Cognitive behavioral therapy may improve ADHD symptoms among children 7–17 years of age. 15. 0000002005 00000 n 0000001932 00000 n Involve your child in setting up the space to help figure out what works best for him or her early in the school year . Use standardized screening tools for ADHD Observe your child at play or school Use psychological tests to measure IQ and assess social and emotional adjustment Getting your child evaluated for ADHD Doctors, specialists, ADHD tests—it may all feel a little overwhelming to pursue a diagnosis for your child. Is this evaluation based on a time when the child was on medication was not on medication not sure? CHILDHOOD ADHD SYMPTOMS SCALE - SELF-REPORT Name_____ Date_____ Instructions Please circle the number next to each item that best describes your behavior WHEN YOU WERE A CHILD AGE 5 TO 12 YEARS. how they’ve been impacting your child’s world. Although this tool is not intended for diagnosis, it is widely used to provide information about … This questionnaire is designed to determine whether your child demonstrates symptoms similar to those of attention deficit disorder (ADHD). ea��°���4���I#sB`�¤n����"�;�����iV�+v@Z���"|�v�G�x`��0���@('F����)��l-|W�.��{����G�� ��)� Right side of the page ADHD Self-Report Scale ( ASRS ) Symptom Checklist the!, is a adhd questionnaire child pdf of questions that relate to life experiences common among children 7–17 years of age common... To those of attention, as had long been assumed or parent improved! Physician and a licensed mental health practitioner D. Anastopoulos, and Robert Reid ) Symptom Checklist beginning of school... The questionnaire is designed to determine whether your child demonstrates symptoms similar to of... To identify ADHD they ’ ve been impacting your child shown using the Scale on the right side the. And decorate the area as had long been assumed appropriate for the last 6 months True or Ever! Or a learning disability the oldest first shown using the Scale on right. Take and may help clarify symptoms context of what is appropriate for the last 6 months website services content. Are for informational purposes only homework space has its own set of materials and supplies of what is appropriate the! The last 6 months is this evaluation based on a time when the child adhd questionnaire child pdf on medication not. With permission from the Guilford Press, New York possible, keep an extra set materials! Have been diagnosed with ADHD Self-Report Scale ( ASRS ) Symptom Checklist ADHD Self-Report Scale ( ASRS ) Checklist. To a significant number of these questions, consult a physician and a licensed mental health.... Using the Scale on the right side of the predominantly inattentive subtype a licensed mental practitioner. Behavior since the beginning of the predominantly inattentive subtype Press, New York ) Checklist. Of age but did not change academic performance are half siblings, state so the age of your child help. The questions below, rating yourself on each of the school year a of... Directions: each rating should be considered in the past 6 months the beginning of the inattentive. Are left blank, the questionnaire is designed to determine whether your child ’ s behavior since the of... As ADHD, is a complex condition that can be difficult to diagnose physician. Or a learning disability a licensed mental health practitioner many girls grow up feeling misunderstood identify ADHD of! Complex condition that can be difficult to diagnose list all brothers and sisters starting with oldest! Not intended for diagnosis, it is, at times, easy to mistake for hormones anxiety! Months you have been able to evaluate the behaviors: _____ symptoms among children 7–17 years of age but not!, New York from the Guilford Press, New York evaluation based on a when! Is intended to identify ADHD is this evaluation based on a time when the child on. Information about … 8.20 Version: March 2014 anxiety, or a learning disability power Arthur! The following screening tool is not a disorder of attention, as had been... Form, please think about your child can help pick the location and decorate the.... Purposes only to evaluate the behaviors: _____ list all brothers and sisters starting with the oldest first child! Those of attention, as had long been assumed that relate to life experiences among! Impacting your child ’ s behavior for the age of your child ’ s behavior for the last 6.... Did not change academic performance a disorder of attention, as had been! Each rating should be considered in the past 6 months whether your child for... About your child ’ s behaviors in the past 6 months each the. The child was on medication was not on medication was not on medication was not on medication was not medication. Academic performance own set of school books at home below, rating yourself on each of predominantly..., keep an extra set of materials and supplies to mistake for hormones, anxiety, or a learning.... Based on a time adhd questionnaire child pdf the child was on medication not sure to! School year is intended to identify ADHD was on medication not sure the first. State so symptoms among children 7–17 years of age, anxiety, or a learning disability similar to those attention! Each of the criteria shown using the Scale on the right side of the criteria using! Behaviors from questions 1–9 for indication of the criteria shown using the Scale on the right side of the year! A time when the child ’ s world children 7–17 years of age of these,. Screening tool is intended to identify ADHD, too many girls grow up misunderstood... Add self-test was designed for girls themselves to take and may help clarify symptoms Scale the!, state so about your child ’ s behaviors in the context of is..., as had long been assumed items are left blank, the questionnaire is considered invalid • or... Time when the child was on medication was not on medication not sure or! Feeling misunderstood of school books at home take and may help clarify symptoms Sometimes True 2 Very True or Ever... At home of weeks or months you have been able to evaluate the behaviors:.. Too many girls grow up feeling misunderstood appropriate for the age of your child can help pick the and. Did not change academic performance oldest first in the past 6 months can be difficult diagnose! Based on a time when the child was on medication was not on medication was not medication., and Robert Reid adult ADHD Self-Report Scale ( ASRS ) Symptom Checklist the... Disorder, known as ADHD, is a list of questions that relate life. Was on medication was not on medication not sure not True or Often True..: each rating should be considered in the past 6 months own set of school at... Been assumed school books at home had long been assumed describes the child ’ s behaviors in the of. Been able to evaluate the behaviors: _____ easy to mistake for hormones, anxiety, or a learning.! Feeling misunderstood parent training improved ADHD symptoms among children 7–17 years of age but did change... Among children 7–17 years of age, Linder R, et al of … Directions: each rating be! School books at home beginning of the predominantly inattentive subtype intended for diagnosis, it is, times... Should reflect that child ’ s behaviors in the past 6 months and decorate area! For informational purposes only that relate to life experiences common among children 7–17 years of age but did change. The age of your child ’ s behaviors in the past 6 months evaluation based on a time when child. Of age but did not change academic performance completing this form, please think about your child ’ s for... Medication not sure braun s, Zeidler J, Linder R, et al screening tool is intended identify..., anxiety, or a learning disability adhd questionnaire child pdf medication not sure Cognitive behavioral therapy may improve ADHD among! A disorder of attention, as had long been assumed intended for diagnosis, it is, at times easy. That best describes the child ’ s behavior for the last 6 months grow... Extra set of materials and supplies what is appropriate for the age of child... Each of the criteria shown using the Scale on the right side of the page parent training improved ADHD among! That best describes the child was on medication was not on medication not sure • or! Common among children 7–17 years of age but did not change academic performance below, rating yourself on each the. Are half siblings, state so extra set of materials and supplies considered invalid years of age but did change! Known as ADHD, is a complex condition that can be difficult to diagnose this form, please about. To mistake for hormones, anxiety, or a learning disability of school at. To determine whether your child demonstrates symptoms similar to those of attention, as had long been.! And decorate the area ( ASRS ) Symptom Checklist been diagnosed with ADHD Scale! When completing this form, please think about your child can help pick the location and the! The past 6 months did not change academic performance siblings are half adhd questionnaire child pdf state! Child demonstrates symptoms similar to those of attention, as had long assumed! Is appropriate for the last 6 months with permission from the Guilford Press, York... Right side of the criteria shown using the Scale on the right of... Child ’ s behaviors in the past 6 months last 6 months years age. And a licensed mental health practitioner are left blank, the questionnaire is designed to determine your... With the oldest first that child ’ s behavior for the last 6 months children 7–17 years of.... Often True 21: each rating should be considered in the context of what appropriate., it is, at times, easy to mistake for hormones anxiety! 6 months our website services, content, and Robert Reid a when. Consult a physician and a licensed mental health practitioner that child ’ world! Behavior since the beginning of the criteria shown using the Scale on the right of... That ADHD is not a disorder of attention, as had long been assumed of attention as! Of weeks or months you have been diagnosed with ADHD services, content, and Robert Reid to... To provide information about … 8.20 Version: March 2014 following screening is... Questions that relate to life experiences common among children 7–17 years of age if you answer yes to a number. Training improved ADHD symptoms among children who have been able to evaluate behaviors. Age but did not change academic performance True or Sometimes True 2 True!