• 0141-429-0943
  • 36 Admiral Street, Kinning Park, G41 1HU
  • ggc.gp52260@nhs.scot

Mull Medical Practice

ADHD (Child)

"*" indicates required fields

Name*
DD slash MM slash YYYY
For each item, select the box that best describes this child. Put only one check per item and add any comments/examples below.

Part A

1: Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities*
2. Often has difficulty sustaining attention in tasks or play activities*
3. Often does not seem to listen when spoken to directly*
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties*
5. Often has difficulty organizing tasks and activities*
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework)*
7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)*
8. Often is distracted by extraneous stimuli*
9. Often is forgetful in daily activities*
10. Often fidgets with hands or feet or squirms in seat*
11. Often leaves seat in classroom or in other situations in which remaining seated is expected*
12. Often runs about or climbs excessively in situations in which it is inappropriate*
13. Often has difficulty playing or engaging in leisure activities quietly*
14. Often is "on the go" or often acts as if "driven by a motor"*
15. Often talks excessively*
16. Often blurts out answers before questions have been completed*
18. Often interrupts or intrudes on others (e.g., butts into conversations/games)*
19. Often loses temper*
20. Often argues with adults*
21. Often actively defies or refuses adult requests or rules*
22. Often deliberately does things that annoy other people*
23. Often blames others for his or her mistakes or misbehaviour*
24. Often is touchy or easily annoyed by others*
25. Often is angry and resentful*
26. Often is spiteful or vindictive*

What is the main concern for your child / young person - what gets in the way the most?

Please give examples below if your child / young person:*

Please list 3 goals for your child / young person from an ADHD assessment:

Please state your child’s school year:

Is your child working at age related expectations?
Is your child on the SEN register?
Have they experienced exclusions because of their current profile?
Are they struggling to reach potential because of current profile?
Does your child / young person have any of the following?

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  • 0141-429-0943
  • 36 Admiral Street, Kinning Park, G41 1HU
  • ggc.gp52260@nhs.scot

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