Testing of Child and Adult ADHD, Dyslexia and other Learning Disorders

19 Johnson Street
Newburyport, MA 01950
978-465-2999

35 Bedford Street
Suite 7
Lexington, MA 02420
781-860-7733

118 Maplewood Ave.
Portsmouth, NH 03801
603-433-8954

Child ADHD Testing Teen Teenager Attention Deficit Hyperactivity Disorder Massachusetts New Hampshire ADD Treatment Symptoms Signs Help Assessment

Symptoms of Attention Deficit Disorder, ADD, ADHD and Attention Problems in Children

Instructions: Please answer all questions. Click on the appropriate boxes to add a check mark. Submit this form for a printable version and bring it to your evaluation.

Child's name:

Age:

	Not at all	Just a little	Pretty much	Very much
1. Restless in the "squirmy" sense.
2. Makes inappropriate noises when he/she shouldn't.
3. Demands must be met immediately.
4. Acts "smart" (impudent or sassy).
5. Temper outbursts and unpredictable behavior.
6. Overly sensitive to criticism.
7. Distractibility or attention span problem.
8. Disturbs other children.
9. Daydreams.
10. Pouts and sulks.
11. Mood changes quickly and drastically.
12. Quarrelsome.
13. Submissive attitude toward authority.
14. Restless, always "up and on the go."
15. Excitable, impulsive.
16. Excessive demands for teacher's attention.
17. Appears to be unaccepted by group.
18. Appears to be easily led by other children.
19. No sense of fair play.
20. Appears to lack leadership.
21. Fails to finish things he/she starts.
22. Childish and immature.
23. Denies mistakes or blames others.
24. Does not get along well with other children.
25. Uncooperative with teacher.
26. Easily frustrated in efforts.
27. Uncooperative with teacher.
28. Difficulty in learning.
Please add any additional comments/concerns:

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