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Diagnostic Criteria* for
Attention-Deficit/Hyperactivity
Disorder (ADHD)
Patient Name__________________________
Date________________Patient Age________
Evaluated by___________________________
Relationship to Patient__________________
Check the applicable symptoms in each section.
INATTENTION

_____ Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities
_____ Often has difficulty sustaining attention in tasks or play activities
_____ Often does not seem to listen when spoken to directly
_____ Often does not follow through on instruction and fails to finish schoolwork, chores, or duties (not due to oppositional behavior or failure to understand instructions)
_____ Often has difficulty organizing tasks and activities
_____ Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
_____ Often loses things necessary for tasks or activities, such as toys, assignments, books, or tools
_____ Is often easily distracted by extraneous stimuli
_____ Is often forgetful in daily activities

HYPERACTIVITY

_____ Often fidgets with hands or feet or squirms in seat
_____ Often leaves seat in classroom or in other situations in which remaining seated is expected
_____ Often runs about or climbs excessively in situations in which it is inappropriate (adolescents or adults may have feelings of restlessness)
_____ Is often "on the go" or often acts as if "driven by a motor"
_____ Often talks excessively

IMPULSIVITY

_____ Often blurts out answers before questions are completed
_____ Often has difficulty waiting
_____ Often interrupts or intrudes on others, such as butting into conversations or games


______ Total number of inattention items checked _______ Total number of hyperactivity & impulsivity items checked