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Dr. Q's ADHD Rating Scale

Student:                                                                                              Age:     

Rated by:                                                                                            Date:

 

not at all

just a little

pretty much

Very much

Inattention Questions:

        

1) is often disorganized

1

2

3

4

2) does not complete homework

1

2

3

4

3) makes careless errors in schoolwork

1

2

3

4

4) has trouble staying with tasks requiring effort

1

2

3

4

5) often seems “spaced out” and not listening

1

2

3

4

6) is often reluctant to start projects or homework

1

2

3

4

7) loses things frequently

1

2

3

4

8) is often forgetful

1

2

3

4

9) is easily distracted by outside events

1

2

3

4

10) works slowly & needs reminders to stay on-task

1

2

3

4
         
Hyperactive/Impulsive Questions:        
1) talks too much

1

2

3

4
2) squirms or fidgets when seated

1

2

3

4
3) gets up from seat when not supposed to

1

2

3

4
4) often blurts out or butts into conversations

1

2

3

4
5) interrupts/intrudes into other's space

1

2

3

4
6) has trouble waiting in line

1

2

3

4
7) is constantly moving around, rarely stays still

1

2

3

4
8) acts without thinking of the consequences

1

2

3

4
9) is restless and impatient

1

2

3

4
10) impulse control is often weak

1

2

3

4
 
Key: Any question in which a 2 or 3 is circled indicates a problem and is scored as one point.  The maximum is 20 points with 10 possible on the Inattentive Type and 10 possible on the Hyperactive/Impulsive Type items.

6/10 Items

Inattentive Type

Mild

7/10 or 8/10 Items

Inattentive Type

Moderate

9/10 or 10/10 Items

Inattentive Type

Severe
     

6/10 Items

Hyperactive/Impulsive Type

Mild

7/10 or 8/10 Items

Hyperactive/Impulsive Type

Moderate

9/10 or 10/10 Items

Hyperactive/Impulsive Type

Severe
This scale represents Dr. Quackenbush's opinion.  It is not psychometrically normed.  Consultation with a professional who is well-versed in ADHD is essential.

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