The following checklist should be completed by parents and teachers and
shared with physician. The more checks in the "Fits Student" column, the
more likely the student my be an appropriate referral for a comprehensive
A.D.D. evaluation. NOTE: General medical problems, emotional disorders,
vision/hearing problems, family stress and intellectual impairment are
factors which may produce behaviors similar to A.D.D.
Fits Student Does Not Fit Student
1. Acts before thinking ______ ______
2. Fails to finish tasks ______ ______
3. Extremely poor listening habits ______ ______
4. Jumps from one activity to another ______ ______
5. Very easily distracted ______ ______
6. Difficulty taking turns ______ ______
7. Easily frustrated in situations ______ ______
8. Overactive/always on the go ______ ______
9. Disruptive in group situations ______ ______
10. Poor sustained concentration skills______ ______
11. Excessive talking ______ ______
12. Blurts our answers ______ ______
13. Does messy work ______ ______
14. Fidgets excessively ______ ______
15. Poorly organized ______ ______
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