Behavior Checklist for Kids

Parent's Name

Child's Name

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

1.) Is Easily Distracted.

2.) Does not plan ahead: Is impulsive.

3.) Makes careless mistakes or has trouble paying close attention to details.

4.) Fidgets (with his/her hands or feet) or squirms in his/her seat.

5.) Has trouble keeping his/her attention focused at school or during fun activities.

6.) Has a hard time sitting still for long: tends to leave his/her seat when he/she is not supposed to.

7.) Doesn't listen when people speak directly to him/her.

8.) Feels restless.

9.) Has trouble following through on instructions and fails to finish things he/she started.

10.) Is noisy and has difficulty doing things quietly.

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

11.) Has difficulty organizing tasks and activities.

12.) Is always on the go, as if driven by a motor.

13.) Avoids, dislikes, or is reluctant to engage in work that requires sustained mental effort.

14.) Talks too much.

15.) Loses things necessary for tasks or activities (lists, pencils, cell phone, keys, books, tools, etc).

16.) Blurts out answers before questions have been completed.

17.) Has trouble awaiting his/her turn.

18.) Is forgetful in his/her daily activities.

19.) Interrupts or intrudes on others accidentally.

20.) Is moody with a lot of ups and downs.

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

21.) Says things without thinking.

22.) Is not achieving up to his/her potential.

23.) Has a tendency to be immature for his/her age.

0=Not at All 2=Somewhat 4=Very Much

24.) Is unpopular, doesn’t keep friends long, or doesn’t get along with other children.

25.) Is easily frustrated.

26.) Has trouble with mathematics or numbers.