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ADHD Screener for Children
From ADDitude and b
ased on the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
This questionnaire is designed to determine whether your child demonstrates symptoms similar to those of attention deficit disorder (ADHD). This is NOT a diagnosis. If you are interested in an Adult Screener for ADHD, please click here for our Adult ADHD Screener:
TxCet ADHD Screener for Adults
DIRECTIONS:
Please answer the questions below, rating your child on each of the criteria shown using the multiple choice format under each question. As you answer each question, chose the descriptor that best describes how your child has conducted him or herself over the past 6 months. Texas Center for Educational Testing will then contact you with the level of impairment associated with the results. You can also contact us at 940-209-0010 or
www.txcet.com
for more information.
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* Indicates required question
Email
*
Your email
Name of client
*
Your answer
Name of Adult completing screener AND relationship to client (i.e., mom, dad, guardian, grandparent, etc.)
*
Your answer
Age of client:
*
Your answer
Grade level of the client
*
Your answer
Today's date
*
MM
/
DD
/
YYYY
Phone number:
Your answer
City and State where you live:
Your answer
Have the child been diagnosed with ADHD or a learning disability previously? If yes, please explain
*
Your answer
How long has the child experienced these symptoms?
*
since early childhood
recently
Other:
Where/when does the child experience these symptoms?
*
in multiple environments (i.e., home, sports, school, with family, friends, strangers, extra-curricular activities) )
only at school
only when tired
only when has to sit and listen for long periods of time
Other:
Required
Does the client have trouble going to sleep at night, even when tired?
*
Never
Rarely
Sometimes
Often
Very Often
My child interrupts other peoples' activities and conversations.
*
Never
Rarely
Sometimes
Often
Very Often
Even the smallest distractions can throw my child off task.
*
Never
Rarely
Sometimes
Often
Very Often
My child has difficulty waiting patiently to take turns, and butts ahead in lines or grabs toys from playmates.
*
Never
Rarely
Sometimes
Often
Very Often
My child talks a lot, even when she/he has nothing much to say.
*
Never
Rarely
Sometimes
Often
Very Often
My child fails to complete an activity before moving to the next activity.
*
Never
Rarely
Sometimes
Often
Very Often
My child interferes in the classroom because she/he has difficulty engaging in quiet activities without disturbing others.
*
Never
Rarely
Sometimes
Often
Very Often
My child constantly seems to be fidgeting.
*
Never
Rarely
Sometimes
Often
Very Often
Even when spoken to directly, my child seems to not be paying attention.
*
Never
Rarely
Sometimes
Often
Very Often
In class or at home, my child blurts out answers to questions before they are fully asked.
*
Never
Rarely
Sometimes
Often
Very Often
My child tries to avoid activities that require sustained concentration and a lot of mental effort
*
Never
Rarely
Sometimes
Often
Very Often
My child has problems remaining seated even when she/he is supposed to.
*
Never
Rarely
Sometimes
Often
Very Often
My child forgets to do things, even when constantly reminded.
*
Never
Rarely
Sometimes
Often
Very Often
My child acts as if she/he is driven by a motor.
*
Never
Rarely
Sometimes
Often
Very Often
My child is disorganized and, even with my help, can't seem to learn how to become organized.
*
Never
Rarely
Sometimes
Often
Very Often
My child loses things like homework and personal belongings.
*
Never
Rarely
Sometimes
Often
Very Often
Are you interested in information about evaluations/reevaluations or information in any of the following? Select all that apply:
Dyslexia
Dscalculia (math)
Dsygraphia (writing)
Learning Disabilities
ADHD
College Major Assessment
Career Assessment
Other:
Anything you would like to ask or tell us?
Your answer
Thank you for taking the ADHD screener. We will contact you soon with your results!
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