Wender Utah Rating Scale for ADHD

Client ID(Required)

Name & date of birth or ENQ number

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 only

anxious, worrying(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

nervous, fidgety(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

inattentive, daydreaming(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

hot- 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 only

temper outbursts, tantrums(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

trouble 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 only

stubborn, strong-willed(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

sad or blue, depressed, unhappy(Required)

Not at all or very slightly

Mildly

Moderately

Quite a bit

Very much

Please tick one option per question only

disobedient 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