ADHD Diagnostic Assessment (NICHQ)-Teacher Informant

Assessment 1 of 46

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. Fails to give attention to details or makes careless mistakes in schoolwork
2. Has difficulty sustaining attention to tasks or activities
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)
5. Has difficulty organizing tasks and activities
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7. Loses things necessary for tasks or activities (school assignments, pencils, books)
8. Is easily distracted by extraneous stimuli
9. Is forgetful in daily activities
10. He or she Is on the go or often acts as if driven by a motor
11. Fidgets with hands or feet or squirms in seat
12. Leaves seat in classroom or in other situations in which remaining seated is expected
13. Runs about or climbs excessively in situations in which remaining seated is expected
14. Has difficulty playing or engaging in leisure activities quietly
15. Talks excessively
16. Blurts out answers before questions have been completed
17. Has difficulty waiting in line
18. Interrupts or intrudes in on others (eg. butts into conversations/games)
19. Activity defies or refuses to comply with adults requests or rules
20. He or she lies to obtain goods for favors or to avoid obligations
21. Deliberately destroys others property
22. Loses temper
23. Is angry or resentful
24. Is spiteful and vindictive
25. Bullies, threatens, or intimidates others
26. Initiates physical fights
27. Is physically cruel to people
28. Has stolen items of nontrivial value
29. Feels lonely, unwanted, or unloved: complains that no one loves him or her
30. Is fearful, anxious, or worried
31. Is self-conscious or easily embarrassed
32. Is afraid to try new things for fear of making mistakes
33. Feels worthless or inferior
34. Blames self for problems: feels guilty
35. Is sad, unhappy, or depressed
36. Reading
37. Mathematics
38. Written expression
39. Relationship with peers
40. Following directions
41. Disrupting class
42. Assignment completion
43. Organizational skills