Child and adolescent ADHD Screening This screening questionnaire is adapted from the Vanderbilt Assessment Scale. Each question should be considered in the context of what is appropriate for the age of your child. Please think about your child’s behaviour over the last 6 months. Step 1 of 2 50% Client ID(Required) Name & date of birth or client ID/reference numberDo you have any immediate concerns around the safety of yourself or the person you are completing this form on behalf of?(Required) Yes No If you have answered ‘Yes’ to this question, please note that Onebright does not provide a crisis response service. If you have urgent wellbeing concerns please contact your GP, GP out of hours service, NHS 111, 999, or the Samaritans on 116 123 (UK & ROI).Is your child currently taking any medication?(Required) Yes No Not sure Does not pay close attention to details or makes careless mistakes with, for example, homework(Required) Never Occassionally Often Very often Has difficulty keeping attention to what needs to be done(Required) Never Occassionally Often Very often Does not seem to listen when spoken to directly(Required) Never Occassionally Often Very often Does not follow through on instructions and fails to finish schoolwork, chores, or duties(Required) Never Occassionally Often Very often Has difficulty organising tasks and activities(Required) Never Occassionally Often Very often Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework)(Required) Never Occassionally Often Very often Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)(Required) Never Occassionally Often Very often Is distracted by extraneous stimuli/unrelated things happening around(Required) Never Occassionally Often Very often Is forgetful in daily activities happening around(Required) Never Occassionally Often Very often Fidgets with hands or feet or squirms in seat(Required) Never Occassionally Often Very often Leaves seat in classroom or in other situations in which remaining seated is expected(Required) Never Occassionally Often Very often Runs about or climbs excessively in situations in which remaining seated is expected(Required) Never Occassionally Often Very often Has difficulty playing or engaging in leisure activities quietly(Required) Never Occassionally Often Very often Is "on the go" or often acts as if "driven by a motor"(Required) Never Occassionally Often Very often Talks excessively(Required) Never Occassionally Often Very often Blurts out answers before questions have been completed(Required) Never Occassionally Often Very often Has difficulty waiting in line(Required) Never Occassionally Often Very often Interrupts or intrudes on others (eg, butts into conversations/games)(Required) Never Occassionally Often Very often Academic PerformanceReading(Required) Excellent Above average Average Somewhat of a problem Problematic Mathematics(Required) Excellent Above average Average Somewhat of a problem Problematic Written expression(Required) Excellent Above average Average Somewhat of a problem Problematic Behaviour in the ClassroomRelationships with peers(Required) Excellent Above average Average Somewhat of a problem Problematic Following directions(Required) Excellent Above average Average Somewhat of a problem Problematic Disrupting class(Required) Excellent Above average Average Somewhat of a problem Problematic Assignment completion(Required) Excellent Above average Average Somewhat of a problem Problematic Organisational skills(Required) Excellent Above average Average Somewhat of a problem Problematic
