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Psychological Testing and Assessment
 

ADHD Tracking Scale: Self Report Form 

Your Name: ______________________________ 

Form completed by: ______________________  Date: ____________  (Note: To permit tracking of 
                                                                                            behavior, please be sure to enter today’s date).

 Circle the number that best describes your behavior today.

 

Never or Rarely

Sometimes

Often

Very Often

1.   Failed to give close attention to details or makes careless
      mistakes (e.g., in schoolwork).

1

2

3

4

2.   Fidgeted with hands or feet or squirms in seat

1

2

3

4

3.   Had difficulty sustaining attention in tasks or other
      activities

1

2

3

4

4.   Left seat in situations in which remaining seated is
      expected

1

2

3

4

5.   Did not seem to listen when spoken to directly.

1

2

3

4

6.   Moved about excessively in situations in which it was
      inappropriate, or seems very restless.

1

2

3

4

7.   Did not follow through on instructions and failed to finish
      homework (not due to oppositional behavior or failure to
      understand instructions).

1

2

3

4

8.   Had difficulty engaging in leisure activities quietly

1

2

3

4

9.   Had difficulty organizing tasks and activities

1

2

3

4

10. Is “on the go” or acts as if “driven by a motor.”

1

2

3

4

11. Avoided or was reluctant to engage in tasks(e.g.,
      schoolwork, homework) that required sustained mental
      effort.

1

2

3

4

12. Talked excessively.

1

2

3

4

13. Loset things necessary for tasks or activities (e.g., school
      assignments, pencils, books)

1

2

3

4

14. Blurted out answers before questions had been
      completed.

1

2

3

4

15. Was easily distracted by extraneous stimuli.

1

2

3

4

16. Had difficulty awaiting turn.

1

2

3

4

17. Was forgetful in daily activities.

1

2

3

4

18. Interrupted or intruded on others (e.g., butts into
      conversations

1

2

3

4

19. Daydreamed; seemed “in a fog”

1

2

3

4

20. Other (specify)

1

2

3

4

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