ADHD Behavioral Checklist

A schoolboy looking directly at the camera, a girl in his class looking at him questioningly.

Use this ADHD Behavioral Checklist to keep track of a child’s ADHD symptoms.

Book Excerpt from the ADHD e-BOOK

© Martin L Kutscher, MD.
May copy for patient use.

Child’s Name:
Date:
Please rate the severity of each problem listed.
(0)none (1)slight (2)moderate (3)major
Your Name:
Subject (if teacher):
Please add comments below!
Symptom DescriptionDay 1Day 2Day 3Day 4Day 5Day 6Day 7
Trouble attending to work that child understands well
Trouble attending to work that child understands poorly
Impulsive (trouble waiting turn, blurts out answers)
Hyperactive (fidgity, trouble staying seated)
Disorganized
Homework not handed in
Inconsistent work and effort
Poor sense of time
Does not seem to talk through problems
Over-reacts
Easily overwhelmed
Blows up easily
Trouble switching activities
Hyper-focused at times
Poor handwriting
Certain academic tasks seem difficult (specifiy)
Seems deliberately spiteful, cruel or annoying
Anxious, edgy, stressed or painfully worried
Obsessive thoughts or fears; perseverative rituals
Irritated for hours or days on end (not just frequent, brief blow-ups)
Depressed, sad, or unhappy
Extensive mood swings
Tics: repetitive movements or noises
Poor eye contact
Does not catch on to social cues
Limited range of interests and interactions
Unusual sensitivity to sounds, touch, textures, movement or taste
Coordination difficulties
Other (specify)

If the child is on medication, please answer the following questions:

  1. Can you tell when the child is on medication or not?
  2. Does the medication work consistently throughout the day?
  3. Does the child appear to be on too much or too little medication?

Excerpts from Chapter 9: For Kids to Read
(“Hey, What Happened to My Brakes?”)

Imagine this: A kid is on a bicycle speeding downhill. The world is whizzing by. He needs to avoid holes in the pavement. The road is curving. The wind buzzes in his ear, and makes his eyes tear.

Suddenly, there are rocks in the road. He goes to put on the brakes—but they don’t work!! As the bike speeds downhill, just staying on it seems overwhelming. Too many obstacles call for the rider’s attention. So much seems out of control. Who has time to pay attention to the huge truck coming up?

That’s the life of someone with attention deficit hyperactivity disorder (ADHD). It all comes from difficulty “Putting on the Brakes,” to borrow the title of a book by Patricia Quinn and Judith Stern.

Here’s what’s happening. Your brain’s “boss” is located just behind your forehead. These frontal lobes figure out where you want to go, and the individual steps of how to get there. Like any boss, a large part of their job is saying “no.” For example, parents are supposed to be the boss in the house. Think how often their job is to say “no.” They’re always saying things like, “Susan, do not have a fifth scoop of ice-cream,” or “Bob, stop playing Nintendo so that you can do your homework,” or “Jill, don’t stay out past 10PM.” Unless something puts brakes on our actions, we would spin out of control.

Well, at least that is how it is supposed to work. Dr. Russell Barkley explains that for ADHD people, the front part of their brains—the boss—doesn’t do a good job of putting on the brakes. This means that these people may:

  • Have trouble putting brakes on distractions. Their minds are pulled off the main topic by any competing action. This leads to the “Attention Deficit” of ADHD.
  • Have trouble sitting still rather than checking out those distractions. This leads to the “Hyperactivity” of ADHD.
  • Have trouble putting brakes on any thought that comes into their minds. There is trouble putting brakes on frustrations and over-reactions. This leads to “impulsivity.” Note: in current terminology, there is no such classification as “ADD.” If you are inattentive but not hyperactive, then the correct “label” is “ADHD of the Primarily Inattentive Type.”

No wonder things go out of control so often!

Download Dr. Kutscher’s entire ADHD e-BOOK here!

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