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El Camino Pediatrics:  ADHD Rating Scale-IV -- Home Version

Child's Name _________________________

Child's Age ________      Sex:  M      F      Grade________      Child's Race________

Completed by:  Mother    Father    Guardian    Grandparent
Circle the number that best describes your child's home behavior over the last 6 months
never or rarely sometimes often very often
1. Fails to give close attention to details or makes careless mistakes in schoolwork. 0 1 2 3
2. Fidgets with hands or feet or squirms in seat. 0 1 2 3
3. Has difficulty sustaining attention in tasks or play activities. 0 1 2 3
4. Leaves seat in classroom or in other situations in which remaining seated is expected. 0 1 2 3
5. Does not seem to listen when spoken to directly. 0 1 2 3
6. Runs about or climbs excessively in situations in which it is inappropriate. 0 1 2 3
7. Does not follow through on instructions and fails to finish work. 0 1 2 3
8. Has difficulty playing or engaging in leisure activities quietly. 0 1 2 3
9. Has difficulty organizing tasks and activities. 0 1 2 3
10. Is "on the go" or acts as if "driven by a motor." 0 1 2 3
11. Avoids tasks (e.g., schoolwork, homework) that require sustained mental effort. 0 1 2 3
12. Talks excessively 0 1 2 3
13. Loses things necessary for tasks or activities. 0 1 2 3
14. Blurts out answers before questions have been completed. 0 1 2 3
15. Is easily distracted. 0 1 2 3
16. Has difficulty awaiting turn. 0 1 2 3
17. Is forgetful in daily activities. 0 1 2 3
18. Interrupts or intrudes on others. 0 1 2 3