Weekly ADHD Monitoring Form # 6178 David Rabiner, Ph.D. |
Child's name: _____________________________ Teacher: _______________________ Date:______________ Teacher: Please answer the items below on your observations of this child during the past week. Note that for |
Weekly ADHD Monitoring Form | Not at all | Just a little | Often | Very Often | |
1. | fidgets with hands or feet and squirms in seat | ||||
2. | difficulty remaining seated | ||||
3. | difficulty awaiting turn | ||||
4. | always "up and on the go" or acts as if "driven by a motor" | ||||
5. | talks excessively | ||||
6. | interrupts or intrudes on others | ||||
7. | easily distracted | ||||
8. | fails to finish assigned tasks | ||||
9. | difficulty sustaining attention | ||||
10. | careless or messy work |
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11. | does not seem to listen when spoken to | ||||
12. | difficulty following directions | ||||
13. | follows class rules | ||||
14. | gets along with peers | ||||
15. | seems happy and in a good mood |
16. | Indicate how the behaviors rated on the other side compared during the morning and afternoon times during the prior week by checking one of the choices below. (Note: If you only have this child in class during morning or afternoon this does not apply) __morning better than afternoon ___no clear difference ___afternoon better than morning |
17. | Indicate the approximate percentage of assigned class work that this child completed during the past week: ___________________________________________________________________________________ 0% 20% 40% 60% 80% 100% |
18. | The general quality of work completed by this child this week was: ___ very poor ___poor ___satisfactory ___good ___very good |
19. | If the quality of this child's work varied significantly between subjects, please indicate this below. |
20. | Did this child turn in all assigned homework? If not, please indicate the assignments that were missing. |
21. | Please include any other comments or observations that you believe are important. |
From: David Rabiner. The ADHD Monitoring System. Copyright 1999 by David Rabiner. This form may be reproduced by myADHD.com active members for their personal use. |