WEB Submission: ADHD Symptom Checklist Child

Supporting Your Child's Journey to Clarity
Welcome. We understand that taking this first step can feel significant, and we are here to support you.
This screening tool is designed to help us understand your child’s unique strengths and challenges.

How it Works:
- It's Brief: This should take approximately 5-10 minutes to complete.
- It's Confidential: All information shared here is handled with strict clinical privacy.
- Personal Review: Once submitted, Ryan Williams will personally review these results to provide you with meaningful feedback on the best next steps for your child.
Please note: This is a preliminary screening tool based on clinical observations. It is intended to identify ADHD-related traits and is not a formal medical diagnosis.
Parent/Guardian Name:*

First NameLast Name
Email:*
example@example.com
Date Completed:

MonthDayYear
Date
Child's First Name or Initials:
Child's Age:
School Year:
Section 1: Inattention

Please indicate how often each statement applies.
Failed to give close attention to details or made careless mistakes in work.

NeverSometimesMost of the timeAll of the time
Has difficulty sustaining attention in tasks or play activities (e.g., difficulty remaining focused during lectures, conversations, or reading).*

NeverSometimesMost of the timeAll of the time
Does not seem to listen when spoken to directly, even when there is no obvious distraction.*

NeverSometimesMost of the timeAll of the time
Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus).*

NeverSometimesMost of the timeAll of the time
Has difficulty organising tasks and activities (e.g., difficulty managing sequential tasks, poor time management).*

NeverSometimesMost of the timeAll of the time
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork, homework, lengthy reading).*

NeverSometimesMost of the timeAll of the time
Loses items necessary for tasks or activities (e.g., school materials, books, toys, tools).*

NeverSometimesMost of the timeAll of the time
Is easily distracted by extraneous stimuli, including unrelated thoughts.*

NeverSometimesMost of the timeAll of the time
Is often forgetful in daily activities, such as chores, running errands, or appointments.*

NeverSometimesMost of the timeAll of the time
Section 2: Hyperactivity

Please indicate how often each statement applies.
Fidgeted with hands or feet or squirmed in seat

NeverSometimesMost of the timeAll of the time
Leaves seat in situations when remaining seated is expected (e.g., leaves their desk at school or the dinner table at home).*

NeverSometimesMost of the timeAll of the time
Runs about or climbs in situations where it is inappropriate (Note: in adolescents or adults, this may be limited to feeling restless).*

NeverSometimesMost of the timeAll of the time
Unable to play or engage in activities quietly; makes excessive noise during activities.*

NeverSometimesMost of the timeAll of the time
Is often “on the go”, acting as if “driven by a motor” (e.g., finds it difficult to remain still for extended periods).*

NeverSometimesMost of the timeAll of the time
Often talks excessively or monopolises conversations without regard for others’ interest.*

NeverSometimesMost of the timeAll of the time
Section 3: Impulsivity

Please indicate how often each statement applies.
Blurts out an answer before a question has been completed (e.g., interrupts a teacher mid-sentence).*

NeverSometimesMost of the timeAll of the time
Interrupts or intrudes on others (e.g., butts into conversations, games, or activities without invitation).*

NeverSometimesMost of the timeAll of the time
Has difficulty waiting their turn (e.g., in line or during group activities).*

NeverSometimesMost of the timeAll of the time
Calculation
Should be Empty:

Supporting Your Child's Journey to Clarity

Section 1: Inattention

Section 2: Hyperactivity

Section 3: Impulsivity