Four-Leg Audit – ADHD Treatment Health CheckStep 1 of 7 – Welcome14% TREATMENT HEALTH CHECKThe Four-LegAuditYour ADHD Treatment Health CheckA structured questionnaire to identify strengths, gaps, and your next best step40%💊 MedicationUnderstanding how medication works, dose optimisation20%🏠 Home EnvironmentCommunication, routines20%🏫 School SupportWISC-5 interpretation, teacher partnership20%🌱 Your Child’s FoundationsSleep systems, exercise strategiesThis tool distils what I discuss with families in my consulting room into a structured self-assessment. It will identify where your child’s treatment is strong, where it is wobbling, and where to focus your energy next.— Dr John Flett, Specialist PaediatricianThe 30% Rule: Children with ADHD typically function at roughly 70% of their age for executive functions. A ten-year-old often operates like a seven-year-old for planning, organisation, and self-control.Tip: If you have a partner, do this separately first. Then compare. You may be surprised how differently you see each leg.IMPORTANT NOTICEThe Four-Leg Audit is an educational tool for information purposes only. It is not a diagnostic instrument and does not constitute medical advice or replace a clinical assessment. Results are intended to help parents reflect on and prioritise their child’s treatment. If you have specific concerns, please consult your treating clinician.Disclaimer Acceptance(Required) I understand that this audit is for educational and informational purposes only, and does not replace professional medical advice or clinical assessment.Your DetailsPlease provide basic details so we can personalise your results.Child's Name(Required) First Last Your Email Address(Required) Email Consent Yes, please store my email and send me my resultsStep 1 of 6Comorbidity ScreenBefore we assess the four legs, identify which conditions travel alongside your child’s ADHD. Approximately 80% of children with ADHD have at least one associated condition.Tick any that have been diagnosed or that you suspect. You can also skip this step.Associated Conditions (Comorbidities) Anxiety — Excessive worry, avoidance, physical complaints, difficulty separating, panic symptoms Depression — Persistent sadness, loss of interest, withdrawal, changes in sleep/appetite, hopelessness Learning Disabilities — Dyslexia, dyscalculia, dysgraphia, processing speed difficulties Oppositional Behaviour (ODD) — Persistent defiance, frequent arguments, deliberate provocation Sleep Disorders — Difficulty falling asleep, restless sleep, frequent waking, sleep apnoea Sensory Processing Difficulties — Over/under-sensitivity to noise, touch, textures, light Enuresis / Bedwetting — Ongoing wetting beyond expected age Autism Spectrum Traits — Social communication difficulties, rigid routines, intense interests💊Leg 1 · Weight: ~40%MedicationThe Brain Glasses. The Wi-Fi Booster. Medication is the strongest single intervention for moderate to severe ADHD. It addresses the neurochemical foundation — helping the brain’s signals arrive more clearly and consistently.If your child is not on medication, rate these questions based on whether medication has been properly considered and discussed with a specialist.Q1: Has your child's medication dose been properly optimised?(Required) 1 2 3 4 5 6 7 8 9 10Not just the starting dose — has it been titrated upward to find the therapeutic dose with regular follow-up? Many children remain on sub-therapeutic doses.Q2: Does the medication provide adequate coverage throughout the day and week?(Required) 1 2 3 4 5 6 7 8 9 10Does it last through school, homework, after-school activities, and weekends? Or does it wear off at 2pm, leaving the afternoon unprotected?Q3: Is your child free from significant side effects?(Required) 1 2 3 4 5 6 7 8 9 10No zombie effect, no major appetite loss they can’t manage, no sleep disruption, no emotional flatness. If side effects are present, are they being actively managed?Q4: Do you have regular follow-up appointments with your prescriber?(Required) 1 2 3 4 5 6 7 8 9 10At least every three to six months. Is your prescriber genuinely reviewing how things are going — not just writing repeat prescriptions?Q5: Do you understand what medication can and cannot do?(Required) 1 2 3 4 5 6 7 8 9 10Medication addresses focus, impulse control, and regulation — it does not teach skills, fix relationships, or build routines.★ Q6: Have your child's associated conditions been properly identified through appropriate assessment?(Required) 1 2 3 4 5 6 7 8 9 10Anxiety, learning disabilities, sleep disorders, oppositional behaviour — have they been assessed by the right professionals?🏠Leg 2 · Weight: ~20%Home EnvironmentStructure is love, not punishment. The home environment is the leg you control most directly. It includes how you communicate with your child, the routines and structure you create, how you respond to challenging behaviour, and the relationship you build.Q7: Do you have consistent daily routines your child can predict?(Required) 1 2 3 4 5 6 7 8 9 10Morning routine, after-school routine, homework time, bedtime routine — are they written, visible, and followed most days?Q8: Is your communication style effective for your child's ADHD brain?(Required) 1 2 3 4 5 6 7 8 9 10One instruction at a time, processing time given, understanding checked, follow-through consistent. Eye contact first, then instruction.Q9: Do you use structure and visual supports rather than relying on verbal reminders?(Required) 1 2 3 4 5 6 7 8 9 10Routine charts, visual timetables, timers, launchpad systems, When-Then language — external scaffolding that reduces nagging.Q10: Is your response to challenging behaviour calm, consistent, and connected?(Required) 1 2 3 4 5 6 7 8 9 10Connection before correction. Natural consequences. Repair after conflict. Can you distinguish between can’t and won’t?Q11: Is your relationship with your child mostly positive?(Required) 1 2 3 4 5 6 7 8 9 10More positive interactions than negative. Do you spend at least 10–15 minutes of daily one-on-one time that is not about homework, behaviour, or ADHD?★ Q12: Are your home strategies adapted to your child's full profile — not just ADHD?(Required) 1 2 3 4 5 6 7 8 9 10If your child has anxiety alongside ADHD, have you adjusted your approach? Standard ADHD strategies may backfire with an anxious child.🏫Leg 3 · Weight: ~20%School SupportAccommodations are not advantages — they are the removal of disadvantages. Your child spends six to eight hours a day at school. What happens in that environment matters enormously.Q13: Does your child's teacher genuinely understand ADHD?(Required) 1 2 3 4 5 6 7 8 9 10Not just the label — the neurology. Do they see the difference between can’t and won’t?Q14: Are specific, documented accommodations and active interventions in place?(Required) 1 2 3 4 5 6 7 8 9 10Not just passive accommodations (extra time, preferential seating) but active strategies: daily report cards, chunked instructions, movement breaks.Q15: Is there an Individual Support Plan (ISP) or equivalent that includes behavioural strategies?(Required) 1 2 3 4 5 6 7 8 9 10In South Africa, through the SIAS framework. Does it include specific behavioural strategies — not just accommodations like extra time?Q16: Do you have regular, constructive communication with the school?(Required) 1 2 3 4 5 6 7 8 9 10Collaborative meetings, not just crisis calls. Email follow-ups documenting agreements. The school sees you as a partner.Q17: Does the school environment support your child's physical and social needs?(Required) 1 2 3 4 5 6 7 8 9 10Structured physical outlet during school. Social inclusion — your child feels they belong, not that they’re the ‘problem child.’★ Q18: Have any learning disabilities been separately assessed, with specific accommodations for each?(Required) 1 2 3 4 5 6 7 8 9 10A child with ADHD and dyslexia needs ADHD accommodations and reading support — separately. Has the WISC-5 been done?🌱Leg 4 · Weight: ~20%Your Child’s FoundationsThe goal isn’t “Mum makes me go to bed on time.” The goal is “I know my brain works better when I sleep.” This leg matters more and more as your child grows.Q19: Is your child getting adequate sleep consistently?(Required) 1 2 3 4 5 6 7 8 9 109–11 hours for ages 6–12, 8–10 hours for teenagers. Consistent bedtime, screen-free wind-down, cool dark quiet room.Q20: Does your child get regular physical exercise?(Required) 1 2 3 4 5 6 7 8 9 10At least 30 minutes of moderate-to-vigorous activity most days. Ideally timed before school or homework. Exercise is a free dose of dopamine.Q21: Is your child's nutrition supporting their general brain health?(Required) 1 2 3 4 5 6 7 8 9 10Protein at breakfast. Regular meals. Adequate hydration. If on stimulant medication, is appetite suppression being managed?Q22: Does your child understand their own brain?(Required) 1 2 3 4 5 6 7 8 9 10Do they know what ADHD is, in age-appropriate language? Can they name their strengths alongside their challenges?Q23: Is your child's self-esteem intact and being actively protected?(Required) 1 2 3 4 5 6 7 8 9 10Do they believe they are capable, valued, and understood? Or have years of struggle eroded their confidence?★ Q24: If your child has associated conditions, are these being actively supported with their own interventions?(Required) 1 2 3 4 5 6 7 8 9 10Therapy for anxiety, OT for sensory processing, specific reading support for dyslexia — distinct from medication and school accommodations.This field is hidden when viewing the formMedication AverageThis field is hidden when viewing the formHome AverageThis field is hidden when viewing the formSchool AverageThis field is hidden when viewing the formFoundations AverageThis field is hidden when viewing the formOverall Weighted ScoreThis field is hidden when viewing the formMedication WeightedThis field is hidden when viewing the formHome WeightedThis field is hidden when viewing the formSchool WeightedThis field is hidden when viewing the formFoundations Weighted
