Does my child have ADHD?

The following questionnaire is based on 36 questions which will be analysed by a qualified Child Psychotherapist. The evaluation will include the severity of any difficulty, if any, and advice on how to proceed with regard to your child's difficulty. In all questions where there is a scale of 1-10, 1 indicates very little problem and 10 indicates a pronounced difficulty.


1. Age of child







Please make a selection.


2. How long have you had concerns about your child's behaviour?






Please make a selection.


3. Have there been any significant family changes, bereavements, traumas in the child's lifetime?

A value is required.


4. Was your child very colicky and fretful as a baby? A value is required.


5. Did your child have difficulty sleeping as a baby or cry more than usual? A value is required.


6. Did your child reach developmental milestones (such as crawling, walking and talking)




Please make a selection.


7. How frequently is your child's behaviour a difficulty?





Please make a selection.


8. Please give a 1-10 rating for you child in the following areas?


9. On a scale of 1-10 how would you rate your the severity of your child's difficulty in the following situations?


10. Would you describe your child as clumsy? A value is required.


11. Does your child often have serious accidents or injure him/herself? A value is required.


12. How is your child's academic performance in school?






Please make a selection.


13. On a scale of 1-10 how difficult does your child find it to concentrate on details in school work?


14. On a scale of 1-10 how difficult does your child find it to concentrate on homework?


15. On a scale of 1-10 how difficult does your child find it to concentrate on tasks or play activities?


16. Does your child often appear not to listen when being spoken to?


17. On a scale of 1-10 how difficult does your child find it difficult to concentrate on tasks?


18. On a scale of 1-10 how often does your child fail to complete tasks that they have happily undertaken to start?


19. On a scale of 1-10 how organised do you think your child is?


20. Does your child avoid undertaking tasks that require sustained mental effort?


21. Does your child often loose things such as clothes, school equipment or toys?


22. Is your child easily distracted by things going on around them?


23. Would you describe your child as forgetful?


24. Does your child often squirm or fidget in his/her seat?


25. Does your child often inappropriately leave his/her seat?


26. On a scale of 1-10 how often does your child inappropriately run around or climb?


27. Would you describe your child as restless, driven or always on the go?


28. On a scale of 1-10 how talkative would you say your child is?


29. How often is your child able to sit and play quietly?

A value is required.

A value is required.


30. Does your child often answer questions before they have been completely asked?

A value is required.

 

31. Does your child struggle to wait their turn?

A value is required.

 

32. Does your child often interrupt or intrude on others?

A value is required.

 

33. How would you rate the frustration levels of the parents with your child on a scale of 1-10?


34. Does your child regularly (once a week or more) have any kind of nightmares?

A value is required.


35. How do you feel about your child's behaviour? (please tick all that apply)









36. Please give a brief statement (up to 100 words) of any other information you feel is relevant to your child's difficulties



A value is required.

A value is required.


After submitting your Assessment you will be asked to make your payment of £50 to Ask A Child Therapist through Paypal.


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