Self Assessment – Dr John Flett

self-assessment adhd Test

Please ensure all relevant documentation and reports are present before completing the form.
If you have difficulty attaching and uploading reports please email these documents.

Self assessment ADHD

Please ensure all relevant documentation and reports are present before completing the form. If you have difficulty attaching and uploading reports please email these documents.

Self-Assessment for ADHD and the most important associate comorbidities Dr. John Flett. Hillcrest Private Hospital. www. drflett.com, 031-1000 474 email: assessment@courses.drflett.com
The form is a screening tool to highlight potential symptoms of ADHD and associated conditions such as anxiety, oppositional defiant disorder and learning disabilities. The information collected in this test is used in conjunction with a full professional interview and examination to make the diagnosis of ADHD
Completion Date
DD slash MM slash YYYY
Child's Name*
First Last
Date of Birth of Child*
DD slash MM slash YYYY
Email Parent*
Enter Email Confirm Email
1. Does not pay attention to details or makes careless mistakes with, for example, homework*
- Never
- Occasionally
- Often
- Very Often
2. Has difficulty keeping attention on what needs to be done*
- Never
- Occasionally
- Often
- Very Often
3. Does not seem to listen when spoken to directly*
- Never
- Occasionally
- Often
- Very Often
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand)*
- Never
- Occasionally
- Often
- Very Often
5. Has difficulty organizing tasks and activities*
- Never
- Occasionally
- Often
- Very Often
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort*
- Never
- Occasionally
- Often
- Very Often
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books)*
- Never
- Occasionally
- Often
- Very Often
8. Is easily distracted by noises or other stimuli*
- Never
- Occasionally
- Often
- Very Often
9. Is forgetful in daily activities*
- Never
- Occasionally
- Often
- Very Often
10. Fidgets with hands or feet or squirms in seat*
- Never
- Occasionally
- Often
- Very Often
11. Leaves seat when remaining seated is expected*
- Never
- Occasionally
- Often
- Very Often
12. Runs about or climbs too much when remaining seated is expected*
- Never
- Occasionally
- Often
- Very Often
13. Has difficulty playing or beginning quiet play activities*
- Never
- Occasionally
- Often
- Very Often
14. Is “on the go” or often acts as if “driven by a motor”*
- Never
- Occasionally
- Often
- Very Often
15. Talks too much*
- Never
- Occasionally
- Often
- Very Often
16. Blurts out answers before questions have been completed*
- Never
- Occasionally
- Often
- Very Often
17. Has difficulty waiting his or her turn*
- Never
- Occasionally
- Often
- Very Often
18. Interrupts or intrudes on others’ conversations and/or activities*
- Never
- Occasionally
- Often
- Very Often
19. Argues with adults*
- Never
- Occasionally
- Often
- Very Often
20. Loses temper*
- Never
- Occasionally
- Often
- Very Often
21. Actively defies or refuses to go along with adults’ requests or rules*
- Never
- Occasionally
- Often
- Very Often
22. Deliberately annoys people*
- Never
- Occasionally
- Often
- Very Often
23. Blames others for his or her mistakes or misbehaviors*
- Never
- Occasionally
- Often
- Very Often
24. Is touchy or easily annoyed by others*
- Never
- Occasionally
- Often
- Very Often
25. Is angry or resentful*
- Never
- Occasionally
- Often
- Very Often
26. Is spiteful and wants to get even*
- Never
- Occasionally
- Often
- Very Often
27. Bullies, threatens, or intimidates others*
- Never
- Occasionally
- Often
- Very Often
28. Starts physical fights*
- Never
- Occasionally
- Often
- Very Often
29. Lies to get out of trouble or to avoid obligations (ie,“cons” others)*
- Never
- Occasionally
- Often
- Very Often
30. Plays truant from school (skips school) without permission*
- Never
- Occasionally
- Often
- Very Often
31. Is physically cruel to people*
- Never
- Occasionally
- Often
- Very Often
32. Has stolen things that have value*
- Never
- Occasionally
- Often
- Very Often
33. Deliberately destroys others’ property*
- Never
- Occasionally
- Often
- Very Often
34. Has used a weapon that can cause serious harm (bat, knife, brick, gun)*
- Never
- Occasionally
- Often
- Very Often
35. Is physically cruel to animals*
- Never
- Occasionally
- Often
- Very Often
36. Has deliberately set fires to cause damage*
- Never
- Occasionally
- Often
- Very Often
37. Has broken into someone else’s home, business, or car*
- Never
- Occasionally
- Often
- Very Often
38. Has stayed out at night without permission*
- Never
- Occasionally
- Often
- Very Often
39. Has run away from home overnight*
- Never
- Occasionally
- Often
- Very Often
40. Has forced someone into sexual activity*
- Never
- Occasionally
- Often
- Very Often
41. Is fearful, anxious, or worried*
- Never
- Occasionally
- Often
- Very Often
42. Is afraid to try new things for fear of making mistakes*
- Never
- Occasionally
- Often
- Very Often
43. Feels worthless or inferior*
- Never
- Occasionally
- Often
- Very Often
44. Blames self for problems, feels guilty*
- Never
- Occasionally
- Often
- Very Often
45. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”*
- Never
- Occasionally
- Often
- Very Often
46. Is sad, unhappy, or depressed*
- Never
- Occasionally
- Often
- Very Often
47. Is self-conscious or easily embarrassed*
- Never
- Occasionally
- Often
- Very Often
48. Overall school performance*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
49. Reading*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
50. Writing*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
51. Mathematics*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
52. Relationship with parents*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
53. Relationship with siblings*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
54. Relationship with peers*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
55. Participation in organized activities (eg, teams)*
- Excellent
- Above average
- Average
- Somewhat a Problem
- Problematic
Email
This field is for validation purposes and should be left unchanged.

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Self assessment ADHD

Self-Assessment for ADHD and the most important associate comorbidities Dr. John Flett. Hillcrest Private Hospital. www. drflett.com, 031-1000 474 email: assessment@courses.drflett.com

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