Children Attention Problems Checklist
Bright Start Bright Future Counselling Center
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Choose the attention issue that you observe in your child.
None/ Very Mild
Mild
Moderate
Severe
Very Severe
Misses important information
Has trouble listening
Makes careless errors
Short attention span
Disorganized/can’t prioritize
Procrastinates
Easily distracted
Difficulty staying on task
Avoids initiating a mental effort
Lacks interest in activities
Loses things
Is easily bored
Daydreams/spaces-out
Low energy/sleepy during the day
Apathetic/unmotivated
Dislikes sustained mental effort
Underachiever
Trouble following directions
Difficulty remembering
Easily frustrated
Acts before thinking/impulsive
Trouble changing focus
Inflexible/avoids change
Doesn’t anticipate consequences of behavior
Frequently repeats thoughts and words
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