ADD Parent Questionnaire by adj51771


									                                               THE ADD-Q
                                        Thompson Ph. D. & Sears M. D.

                                                                              Never    Some     A      Almost
NAME:_______________________________DATE:____________                           or       -     great   Always
GRADE;_________DATE OF BIRTH:______AGE:_____________                           very    times   deal
                         QUESTIONS:                                           rarely
    (Place Check ‘ ‘ in the appropriate column for each item.)
                        •       ATTENTIONS SPAN
1.    When my child is deeply interested in an activity I have difficulty
      dragging her away.
2.    My child does pay attention to things he wants to do.
3.    My child has difficulty paying attentions to things I want her to do.
4.    My child has difficulty paying attention to things others (e.g.
      teachers) want him to do (e.g. instructions).
5.    My child day-dreams, drifts into her own little world, oblivious to
      what’s going on.
6.    My child notes unimportant details that interest him, he misses the
      main idea.
7.    My child doesn’t pay attention to important details and often makes
      careless mistakes in school work. (E.g. + and - signs in math)
8.    My child’s school grades do not reflect her true ability - she
9.    My child is inconsistent n his work and behaviour, He is fine one
      day but not the next.
10.   It is hard for my child to follow routines, such as getting ready for
      school or getting ready for bead.
11.   My child gets easily sidetracked from a task someone else asks her
      to do. (For example, she stops to examine a bug on the wall and
      forgets she was on her way to brush her teeth.)
12.   My child honestly “forgets” to bring her assignments home.
      (“Forgetting” is NOT done in an angry or oppositional manner most
      of the time.)
13.   My child needs a lot of supervision to compete assignments (school
      work, chores) which require sustained attention.
14.   My child’s attention span is getting worse relative to other children
      the same age.
                            •    SPONTANEITY
15. My child fails to think through what he is about to do or say; that is
    leaps without looking.
16. My child has difficulty waiting turns, (for example, interrupts
    others, bursts out answers before a question is completed.)
17. My child has difficulty waiting in line, sharing or cooperating.
18. My child often gets into potentially dangerous situations.
19. My child has difficulty waiting for rewards, delaying gratification.
    (She wants the toy, to go biking and son, NOW!)
20. My child’s ability to control impulses is not improving with age.
                            •    ORGANIZATION
21. My child’s school work, belongings, time-management, personal
    functioning seen very disorganized.
22. When my child is working on his own hobbies or creating his own
    projects he is extremely organized.
                             •    EMOTIONAL
23.   My child overreacts to minor disturbances.
24.   My child is easily bored.
25.   My child shows rapid mood swings.
26.   My child has difficulty adjusting to sudden changes in routine.
                         •       ACTIVITY LEVEL
27. My child’s activity level is inappropriate for the situation, for
    example, she has difficulty sitting still in class, church, during
28. My child is restless, fidgets, squirms.
29. My child seems always on the go as if driven by a motor.
30. My child seems sluggish, lethargic and unmotivated.
                    CHECKS FOR EACH COLUMN
SCORE: (The total Number of CHECKS for each column multiplied              X 0=     x1       x2       x3
by 0, 1, 2, and 3 respectively.                                             0        =        =        =
                                                                              TOTAL = ______________

Why are there more items under the first two topics?
Attention Span and Spontaneity cover the major symptoms of ADD. It becomes increasingly difficult to separate
other behaviour disorders from ADD when we ask questions about Organization and Emotions. Activity level can
be confusing. Children with ADD can be hyperactive or lethargic.

The questionnaire is just to help you organize your thinking about your child. If you only have checks in the “a
great deal and almost always” columns for positive items such as numbers 1, 2, and 22 then ADD is a probably a

On the other hand, if you have a great many other items marked in the “a great deal and most always” columns then
it may be advisable for you to take this questionnaire and discuss your observations with a professional. (Note:
Hyperactive children will have higher scores than children who don’t have hyperactivity.)

Remember too that your child’s age may have an effect. Younger children may have higher scores.

1.    My child’s symptoms are accompanied by anger and a defiant and
      oppositional attitude.

Why One Last Question Which is Not Added Into The Score? ADD and Conduct Disorder and Oppositional
Disorder are very different problems. In the ADD-Q we want to help you to emphasize ADD but to recognize that
your child’s scores can be a great deal higher if your child is angry and has other behavioural difficulties.

For further information contact the ADD Centre at 204-897-4493. Visit our head office Web site
"" and in Winnipeg "," or read "The A.D.D. Book" by Dr. William
Sears and Dr. Lynda Thompson.

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