Wender Utah Rating Scale, 45-item version
Patient Name
*
Birth Date
*
Please select a month
January
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Month
Please select a day
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31
Day
Please select a year
2025
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Year
Gender
*
Who is your Provider?
*
Please Select
Danielle Partin PA-C
Corilin Meggitt NP
Evanthia Garza PA-C
Francesca Carter PA-C
Amy Cairns PA-C
Chelsea Weedon Rhea PA-C
Sarah Gray PA-C
Brianna Dillon PA-C
Don't know-Not sure
For each of the 45 items, check the box that best describes your behavior:
As a child I was (or had)
*
Not At All or very slightly
Mildly
Moderately
Quite a bit
Very Much
1. Active, restless, always on the go
2. Afraid of things
3. Concentration problems, easily distracted
4. Anxious, worrying
5. Nervous, fidgety
6. Inattentive, daydreaming
7. Hot- or short-tempered, low boiling point
8. Shy, sensitive
9. Temper outbursts, tantrums
10. Trouble with stick-to-it-tiveness, not following
through. Failing to finish things started
11. Stubborn, strong-willed
12. Sad or blue, depressed, unhappy
13. Incautious, dare-devilish, involved in pranks
14. Disobedient with parents, rebellious, sassy
15. Low opinion of myself
16. Irritable
17. Outgoing, friendly, enjoy company of people
18.
Sloppy, disorganized
19. Moody, ups and downs
20. Angry
As a child I was (or had)
*
Not At All or very slightly
Mildly
Moderately
Quite a bit
Very Much
21. Acting without thinking, impulsive
22. Tendency to be immature
23. Guilty feelings, regretful
24. Losing control of myself
25. Tendency to be or act irrational
26. Unpopular with other children, didn't keep
friends for long, didn't get along with other
children
27. Poorly coordinated, did not participate in
sports
28. Afraid of losing control of self
29. Running away from home
30. Getting into fights
31. Teasing other children
32. Follower, led around too much
33. Trouble seeing things from someone else's point of view
34. Trouble with authorities, trouble with school, visits to principal's office
Medical Problems as a child
*
Not At All or very slightly
Mildly
Moderately
Quite a bit
Very Much
35. Headaches
36. Stomachaches
Academic problems as a child:
*
Not At All or very slightly
Mildly
Moderately
Quite a bit
Very Much
37. Overall a poor student, slow learner
38. Slow reader
39. Trouble reversing letters
40. Problems with spelling
41. Trouble with mathematics or numbers
42. Bad handwriting
43. Able to read pretty well but never really
enjoyed reading
44. Not achieving up to potential
Suspended or expelled?
*
Yes
No
If Suspended or expelled, which grades?
Interpretation:
Scores of 30 or higher best identify ADHD within a community setting.
Scores of 46 or higher best identify ADHD withing a clinical setting.
Part 1 Wender Utah rating scale score =
Part 2 Wender Utah rating scale score =
Part 3 Wender Utah rating scale score =
Wender Utah rating scale score =
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