Wender Utah Rating Scale for ADHD (Aviva) The original Wender Utah Rating Scale is 61 questions. This version represents the 25 questions most associated with ADHD. Step 1 of 3 33% 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).As a Child I was (or had):concentration problems, easily distracted(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyanxious, worrying(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlynervous, fidgety(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyinattentive, daydreaming(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyhot- or short-tempered, low boiling point(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytemper outbursts, tantrums(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytrouble with stick-to-it-tiveness, not following through, failing to finish things started(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlystubborn, strong-willed(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlysad or blue, depressed, unhappy(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlydisobedient with parents, rebellious, sassy(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question only As a Child I was (or had):low opinion of myself(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyirritable(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlymoody, ups and downs(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyangry(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyacting without thinking, impulsive(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytendency to be immature(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyguilty feelings, regretful(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlylosing control of myself(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytendency to be or act irrational(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlyunpopular with other children, didn't keep friends for long, didn't get along with other children(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytrouble seeing things from someone else's point of view(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytrouble with authorities, trouble with school, visits to principal's office(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question only As a child in school I was (or had):overall a poor student, slow learner(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlytrouble with mathematics or numbers(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question onlynot achieving up to potential(Required) Not at all or very slightly Mildly Moderately Quite a bit Very much Please tick one option per question only
