Name: Age:

Often fails to give close attention to details or makes careless mistakes Difficulty sustaining attention in tasks or activities Appears not to listen when spoken to directly Often does not follow through on instructions Difficulty organizing tasks and activities Avoids or dislikes tasks requiring sustained mental effort Often loses things necessary for tasks or activities Easily distracted by extraneous stimuli Forgetful in daily activities

Fidgets with hands or feet or squirms in seat Leaves seat when remaining seated is expected Runs or climbs excessively in inappropriate situations Unable to play or engage in leisure activities quietly Often "on the go" or acts as if "driven by a motor" Talks excessively Blurts out answers before questions have been completed Difficulty waiting turn Interrupts or intrudes on others