ADHD Teacher Input Observation Checklist

Attention/Concentration
Observation Item Often Sometimes Rarely Not Observed Comments
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Is easily distracted by external stimuli
Has trouble organizing tasks and activities
Impulsivity
Observation Item Often Sometimes Rarely Not Observed Comments
Has difficulty awaiting turn
Blurts out answers before questions are completed
Interrupts or intrudes on others
Hyperactivity
Observation Item Often Sometimes Rarely Not Observed Comments
Fidgets with hands or feet or squirms in seat
Leaves seat in classroom or in other situations when expected to remain seated
Talks excessively
Runs about or climbs excessively
Additional Comments
Teacher Signature
Date