1. Fails to give close attention to details or makes careless mistakes.
n/a
0
1
2
3
4
2. Trouble sustaining attention in routine situations (i.e., homework,
chores, paperwork).
n/a
0
1
2
3
4
3. Trouble listening.
n/a
0
1
2
3
4
4. Fails to finish things.
n/a
0
1
2
3
4
5. Poor organization for time or space (such as backpack, room, desk, paperwork).
n/a
0
1
2
3
4
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort.
n/a
0
1
2
3
4
7. Loses things.
n/a
0
1
2
3
4
8. Easily distracted.
n/a
0
1
2
3
4
9. Forgetful.
n/a
0
1
2
3
4
10. Poor planning skills.
n/a
0
1
2
3
4
11. Lack clear goals or forward thinking.
n/a
0
1
2
3
4
12. Difficulty expressing feelings.
n/a
0
1
2
3
4
13. Difficulty expressing empathy for others.
n/a
0
1
2
3
4
14. Excessive daydreaming.
n/a
0
1
2
3
4
15. Feeling bored.
n/a
0
1
2
3
4
16. Feeling apathetic or unmotivated.
n/a
0
1
2
3
4
17. Feeling tired, sluggish or slow moving.
n/a
0
1
2
3
4
18. Feeling spacey or "in a fog."
n/a
0
1
2
3
4
19. Fidgety, restless or trouble sitting still.
n/a
0
1
2
3
4
20. Difficulty remaining seated in situations where remaining seated is
expected.
n/a
0
1
2
3
4
21. Runs about or climbs excessively in situations in which it is inappropriate.
n/a
0
1
2
3
4
22. Difficulty playing quietly.
n/a
0
1
2
3
4
23. "On the go" or acts as if "driven by a motor."
n/a
0
1
2
3
4
24. Talks excessively.
n/a
0
1
2
3
4
25. Blurts out answers before questions have been completed.
n/a
0
1
2
3
4
26. Difficulty awaiting turn.
n/a
0
1
2
3
4
27. Interrupts or intrudes on others (e.g., butts into conversations or
games).
n/a
0
1
2
3
4
28. Impulsive (saying or doing things without thinking first).
n/a
0
1
2
3
4
29. Excessive or senseless worrying.
n/a
0
1
2
3
4
30. Upset when things do not go your way.
n/a
0
1
2
3
4
31. Upset when things are out of place.
n/a
0
1
2
3
4
32. Tendency to be oppositional or argumentative.
n/a
0
1
2
3
4
33. Tendency to have repetitive negative thoughts.
n/a
0
1
2
3
4
34. Tendency toward compulsive behaviors.
n/a
0
1
2
3
4
35. Intense dislike for change.
n/a
0
1
2
3
4
36. Tendency to hold grudges.
n/a
0
1
2
3
4
37. Trouble shifting attention from subject to subject.
n/a
0
1
2
3
4
38. Trouble shifting behavior from task to task.
n/a
0
1
2
3
4
39. Difficulties seeing options in situations.
n/a
0
1
2
3
4
40. Tendency to hold on to own opinion and not listen to others.
n/a
0
1
2
3
4
41. Tendency to get locked into a course of action, whether or not it is
good.
n/a
0
1
2
3
4
42. Needing to have things done a certain way or you become very upset.
n/a
0
1
2
3
4
43. Others complain that you worry too much.
n/a
0
1
2
3
4
44. Tend to say no without first thinking about question.
n/a
0
1
2
3
4
45. Tendency to predict fear.
n/a
0
1
2
3
4
46. Frequent feelings of sadness.
n/a
0
1
2
3
4
47. Moodiness.
n/a
0
1
2
3
4
48. Negativity.
n/a
0
1
2
3
4
49. Low energy.
n/a
0
1
2
3
4
50. Irritability.
n/a
0
1
2
3
4
51. Decreased interest in others.
n/a
0
1
2
3
4
52. Decreased interest in things that are usually fun or pleasurable.
n/a
0
1
2
3
4
53. Feelings of hopelessness about the future.
n/a
0
1
2
3
4
54. Feelings of helplessness or powerlessness.
n/a
0
1
2
3
4
55. Feeling dissatisfied or bored.
n/a
0
1
2
3
4
56. Excessive guilt.
n/a
0
1
2
3
4
57. Suicidal feelings.
n/a
0
1
2
3
4
58. Crying spells.
n/a
0
1
2
3
4
59. Lowered interest in things usually considered fun.
n/a
0
1
2
3
4
60. Sleep changes (too much or too little).
n/a
0
1
2
3
4
61. Appetite changes (too much or too little).
n/a
0
1
2
3
4
62. Chronic low self-esteem.
n/a
0
1
2
3
4
63. Negative sensitivity to smells/odors.
n/a
0
1
2
3
4
64. Frequent feelings of nervousness or anxiety.
n/a
0
1
2
3
4
65. Panic attacks.
n/a
0
1
2
3
4
66. Symptoms of heightened muscle tension (headaches, sore muscles, hand
tremor).
n/a
0
1
2
3
4
67. Periods of heart pounding, rapid heart rate or chest pain.
n/a
0
1
2
3
4
68. Periods of trouble breathing or feeling smothered.
n/a
0
1
2
3
4
69. Periods of feeling dizzy, faint or unsteady on your feet.
n/a
0
1
2
3
4
70. Periods of nausea or abdominal upset.
n/a
0
1
2
3
4
71. Periods of sweating, hot or cold flashes.
n/a
0
1
2
3
4
72. Tendency to predict the worst.
n/a
0
1
2
3
4
73. Fear of dying or doing something crazy.
n/a
0
1
2
3
4
74. Avoid places for fear of having an anxiety attack.
n/a
0
1
2
3
4
75. Conflict avoidance.
n/a
0
1
2
3
4
76. Excessive fear of being judged or scrutinized by others.
n/a
0
1
2
3
4
77. Persistent phobias.
n/a
0
1
2
3
4
78. Low motivation.
n/a
0
1
2
3
4
79. Excessive motivation.
n/a
0
1
2
3
4
80. Tics (motor or vocal).
n/a
0
1
2
3
4
81. Poor handwriting.
n/a
0
1
2
3
4
82. Quick startle.
n/a
0
1
2
3
4
83. Tendency to freeze in anxiety provoking situations.
n/a
0
1
2
3
4
84. Lacks confidence in their abilities.
n/a
0
1
2
3
4
85. Seems shy or timid.
n/a
0
1
2
3
4
86. Easily embarrassed.
n/a
0
1
2
3
4
87. Sensitive to criticism.
n/a
0
1
2
3
4
88. Bites fingernails or picks skin.
n/a
0
1
2
3
4
89. Short fuse or periods of extreme irritability.
n/a
0
1
2
3
4
90. Periods of rage with little provocation.
n/a
0
1
2
3
4
91. Often misinterprets comments as negative when they are not.
n/a
0
1
2
3
4
92. Irritability tends to build, then explodes, then recedes, often tired
after a rage.
n/a
0
1
2
3
4
93. Periods of spaciness or confusion.
n/a
0
1
2
3
4
94. Periods of panic and/or fear for no specific reason.
n/a
0
1
2
3
4
95. Visual or auditory changes, such as seeing shadows or hearing muffled
sounds.
n/a
0
1
2
3
4
96. Frequent periods of deja vu (feelings of being somewhere you have never
been).
n/a
0
1
2
3
4
97. Sensitivity or mild paranoia.
n/a
0
1
2
3
4
98. Headaches or abdominal pain of uncertain origin.
n/a
0
1
2
3
4
99. History of a head injury or family history of violence or explosiveness.
n/a
0
1
2
3
4
100. Dark thoughts, may involve suicidal or homicidal thoughts.
n/a
0
1
2
3
4
101. Periods of forgetfulness or memory problems.
n/a
0
1
2
3
4