Behavior Rating Scale for ADHD


    Child's name:     

    Today's Date:     

    Rater's name:     

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    Criteria for ADHD
    Inattention
    Severity
                None                                                                                     Severe
    Often fails to give close attention to details or makes careless mistakes in school, work, or other activities
    		0 1 2 3 4 5 6 7 8 9 10
    Often has difficulty sustaining attention in tasks or play activities
    		0 1 2 3 4 5 6 7 8 9 10
    Often does not seem to listen when spoken to directly
    		0 1 2 3 4 5 6 7 8 9 10
    Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
    		0 1 2 3 4 5 6 7 8 9 10
    Often has difficulty organizing tasks and activities
    		0 1 2 3 4 5 6 7 8 9 10
    Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
    		0 1 2 3 4 5 6 7 8 9 10
    Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)
    		0 1 2 3 4 5 6 7 8 9 10
    Is often easily distracted by extraneous stimuli
    		0 1 2 3 4 5 6 7 8 9 10
    Is often forgetful in daily activities
    		0 1 2 3 4 5 6 7 8 9 10

    Hyperactivity
    Severity
                None                                                                                     Severe
    Often fidgets with hands or feet or squirms in seat
    		0 1 2 3 4 5 6 7 8 9 10
    Often leaves seat in classroom or in other situations in which remaining seated is expected
    		0 1 2 3 4 5 6 7 8 9 10
    Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
    		0 1 2 3 4 5 6 7 8 9 10
    Often has difficulty playing or engaging in leisure activities quietly
    		0 1 2 3 4 5 6 7 8 9 10
    Is often "on the go" or often acts as if "driven by a motor"
    		0 1 2 3 4 5 6 7 8 9 10
    Often talks excessively
    		0 1 2 3 4 5 6 7 8 9 10

    Impulsivity
    Severity
                None                                                                                     Severe
    Often blurts out answers before questions have been completed
    		0 1 2 3 4 5 6 7 8 9 10
    Often has difficulty awaiting turn
    		0 1 2 3 4 5 6 7 8 9 10
    Often interrupts or intrudes on others (e.g., butts into conversations or games)
    		0 1 2 3 4 5 6 7 8 9 10




    OVERALL SEVERITY SCORE:
    Inattention Severity
    Hyperactivity Severity
    Impulsivity Severity
    Total Severity Score
    Questions? Send them to larry.burd@med.und.edu.