ADHD Rating Scale IV - Self Report Version (Past) Name First Last AgeDate MM slash DD slash YYYY Check the response that BEST DESCRIBES your behavior between the ages of 5 and 12. 1. Fails to give close attention to details or makes careless mistakes in work or other tasks. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 2. Fidgets with hands or feet. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 3. Has difficulty sustaining attention to tasks or play activities. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 4. Leaves seat in situations in which remaining seated is expected. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 5. Does not seem to listen when spoken to directly. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 6. Runs about or shows excessive energy in situations in which it is inappropriate. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 7. Does not follow through on instructions and fails to finish work. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 8. Has difficulty playing or engaging in leisure activities quietly. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 9. Has difficulty organizing tasks and activities. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 10. Is "on the go" or acts as if "driven by a motor." 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 11. Avoids tasks (e.g., reading, writing) that require mental effort. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 12. Talks excessively. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 13. Loses things necessary for tasks or activities. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 14. Blurts out answers before questions have been completed. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 15. Is easily distracted. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 16. Has difficulty awaiting turn. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 17. Is forgetful in daily activities. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often 18. Interrupts or intrudes on others. 0 Never or Rarely 1 Sometimes 2 Often 3 Very Often CAPTCHA
