ADHD RATING SCALE IV
Parent: Please have your CHILD complete this rating scale if old enough to do so.
Your Name ______Your Age ______Today’s Date ______
Circle the number that best describes your behavior over the past six months.
NeverVery
HOW OFTEN DO YOU…or rarelySometimesOftenOften
1.Fail to give close attention to details or0123
make careless mistakes doing work.
2.Fidget with hands or feet or squirm in seat.0123
3.Have difficulty sustaining attention in tasks0123
or fun activities.
4.Leave seat in classroom, work or other0123
situations in which sitting is expected.
5.Not listen when spoken to directly.0123
6.Feel restless.0123
7.Not follow through on instructions and0123
fail to finish work.
8.Have difficulty engaging in leisure activities0123
or doing fun things quietly.
9.Have difficulty organizing tasks and activities.0123
10.Feel ‘on the go’ or as if ‘driven by a motor’.0123
11.Avoid, dislike, or is reluctant to engage in work0123
that requires sustained mental effort.
12.Talk excessively.0123
13.Lose things necessary for tasks and activities.0123
14.Blurt out answers before questions have been0123
completed.
15.Become easily distracted.0123
16.Have difficulty awaiting turn.0123
17.Become forgetful in daily activities.0123
18.Interrupt or intrude on others.0123
(Used with permission of Dr. Russell Barkley of the University of Massachusetts Medical Center.)
ADHD RATING SCALE IV
Parent: Please complete this rating scale about your child.
Parent completing form ______Your child’s name ______Today’s Date ______
Circle the number that best describes your child’s behavior over the past six months.
NeverVery
HOW OFTEN DOES YOUR CHILD…or rarelySometimesOftenOften
1.Fail to give close attention to details or0123
make careless mistakes doing work.
2.Fidget with hands or feet or squirm in seat.0123
3.Have difficulty sustaining attention in tasks0123
or fun activities.
4.Leave seat in classroom, work or other0123
situations in which sitting is expected.
5.Not listen when spoken to directly.0123
6.Feel restless.0123
7.Not follow through on instructions and0123
fail to finish work.
8.Have difficulty engaging in leisure activities0123
or doing fun things quietly.
9.Have difficulty organizing tasks and activities.0123
10.Feel ‘on the go’ or as if ‘driven by a motor’.0123
11.Avoid, dislike, or is reluctant to engage in work0123
that requires sustained mental effort.
12.Talk excessively.0123
13.Lose things necessary for tasks and activities.0123
14.Blurt out answers before questions have been0123
completed.
15.Become easily distracted.0123
16.Have difficulty awaiting turn.0123
17.Become forgetful in daily activities.0123
18.Interrupt or intrude on others.0123
(Used with permission of Dr. Russell Barkley of the University of Massachusetts Medical Center.)