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Childs Name:_______________________
Completed by:
Sex: M
F Age:________ Grade:________
Never or
Rarely
Sometimes
Often
Very Often
From ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. 1998, George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid. Reprinted with
permission from The Guilford Press, New York.
How to score
A diagnosis of ADHD depends on the type and
number of symptoms your child is having and how
those symptoms are affecting him or her. This
screening tool is scored by a healthcare provider and
is used in the process of making a diagnosis. The
tables on the back of this screening tool are for use
by your childs healthcare provider. If you feel that your
child may be showing signs of ADHD, please complete
this questionnaire and share the results with your
healthcare provider.
HI
5-7
24
23
20
17
14
14
13
13
12
11
11
10
9
9
9
9
9
8
7
4
2
0
0
HI
8-10
20
19
15
13
12
11
11
9
9
8
8
8
7
7
7
7
6
6
5
2
1
0
0
HI
11-13
18
17
12
11
11
10
9
9
8
8
8
7
7
6
6
6
6
5
4
2
0
0
0
HI
14-18
19
18
16
15
13
11
10
10
9
9
8
8
7
7
6
6
6
5
5
2
0
0
0
IA
5-7
23
22
18
16
15
14
13
12
11
11
10
10
9
9
9
8
8
7
6
3
1
0
0
IA
8-10
21
20
16
15
14
13
12
12
11
11
10
9
9
8
8
8
8
7
6
3
1
0
0
IA
11-13
26
25
21
19
17
16
15
13
12
11
11
11
10
10
10
10
9
8
7
3
1
0
0
IA
14-18
21
20
16
16
15
14
13
12
12
11
11
10
10
9
9
9
8
7
6
3
1
0
0
Total
5-7
38
37
30
29
29
28
27
24
23
21
20
19
19
19
19
18
17
15
13
7
4
1
0
Total
8-10
39
38
30
26
24
22
21
20
18
17
16
16
15
15
14
14
14
12
11
6
2
0
0
Total
11-13
43
42
28
24
23
22
21
20
19
19
18
18
17
17
16
16
15
13
11
5
2
0
0
Total
14-18
35
34
32
28
28
24
23
22
21
20
19
19
18
16
14
14
13
12
10
5
2
0
0
%ile
99+
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
80
75
50
25
10
1
IA
5-7
24
23
20
20
18
16
15
15
14
13
13
12
12
12
12
11
11
9
8
5
2
0
0
IA
8-10
26
25
22
19
18
17
16
15
15
14
14
14
13
13
12
12
12
11
9
6
3
0
0
IA
11-13
27
26
24
22
21
20
19
18
18
18
18
17
17
16
16
14
14
10
9
5
2
1
0
IA
14-18
25
24
23
19
18
17
16
15
14
14
14
13
12
12
11
11
10
9
8
4
1
0
0
Total
5-7
43
42
40
37
36
34
33
30
30
29
29
28
27
25
22
22
21
19
18
10
6
2
0
Total
8-10
49
48
42
37
34
31
29
27
26
26
25
24
24
23
23
22
21
20
17
10
5
1
0
Total
11-13
51
50
47
38
37
35
34
34
33
32
31
30
30
28
26
23
22
19
14
7
4
1
0
Total
14-18
41
40
36
32
30
28
27
27
26
25
23
21
21
20
20
19
18
16
13
7
3
0
0
%ile
99+
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
80
75
50
25
10
1
HI
5-7
26
25
22
21
19
17
17
17
16
16
15
14
14
13
13
12
12
11
9
5
3
1
0
HI
8-10
25
24
21
18
17
17
15
15
14
14
13
13
12
11
11
10
10
9
8
4
2
0
0
HI
11-13
25
24
21
18
18
18
18
16
16
15
14
13
12
11
10
10
9
8
7
3
1
0
0
HI
14-18
19
18
16
16
15
13
12
11
11
11
10
10
10
9
9
8
8
7
6
2
0
0
0