Meghan Searl, Ph.D., ABPP-CN
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Behavior Checklist (childhood)
Please rate the following as they applied to you
when you were a child
(i.e. during elementary school)
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
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Just a little
Pretty much
Very much
comment (optional)
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2. Often has difficulties sustaining attention in tasks or play activities
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Not at all
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Very much
comment (optional)
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3. Often does not seem to listen when spoken to
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Just a little
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comment (optional)
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4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
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Not at all
Just a little
Pretty much
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comment (optional)
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5. Often has difficulty organizing tasks or activities
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Not at all
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Very much
comment (optional)
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6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
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Not at all
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comment (optional)
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7. Often loses things necessary for tasks or activities (e.g. school assignments, pencils, books, tools)
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Not at all
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comment (optional)
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8. Is often easily distracted by extraneous stimuli
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comment (optional)
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9. Is often forgetful in daily activities
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Not at all
Just a little
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comment (optional)
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10. Often fidgets with hands or feet or squirms in seat
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Not at all
Just a little
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comment (optional)
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11. Often leaves seat in classroom or other situations in which remaining in seat is expected
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Not at all
Just a little
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comment (optional)
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12. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to feelings of restlessness)
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Not at all
Just a little
Pretty much
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comment (optional)
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13. Often has difficulty engaging in leisure activities quietly
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Not at all
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comment (optional)
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14. Is often “on the go” or often acts as if “driven by a motor”
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comment (optional)
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15. Often talks excessively
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comment (optional)
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16. Often blurts out answers before questions have been completed
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Not at all
Just a little
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comment (optional)
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17. Often has difficulty awaiting turn
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Not at all
Just a little
Pretty much
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comment (optional)
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18. Often interrupts or intrudes on others (i.e. bursts into conversations)
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Not at all
Just a little
Pretty much
Very much
comment (optional)
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