ADHD Informant Questionnaire

ADHD Informant Questionnaire
Complete this form to provide observations about the individual's attention, hyperactivity, and impulsivity behaviors.
Informant's Full Name
First NameLast Name
Relationship to the Individual
Informant's Email Address
example@example.com
Informant's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Individual's Full Name
First NameLast Name
Individual's Age
Individual's Gender
Other
Context of Observation (select all that apply)
Other
Assessment Period (e.g., past 6 months)

Rate the following behaviors based on your observations of the individual over the assessment period.

Rows	Never	Rarely	Sometimes	Often	Very Often
Fails to give close attention to details or makes careless mistakes
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish tasks
Has difficulty organizing tasks and activities
Avoids or dislikes tasks that require sustained mental effort
Loses things necessary for tasks or activities
Easily distracted by extraneous stimuli
Forgetful in daily activities
Fidgets with hands or feet or squirms in seat
Leaves seat in situations when remaining seated is expected
Runs about or climbs in inappropriate situations
Unable to play or engage in activities quietly
Is "on the go" or acts as if "driven by a motor"
Talks excessively
Blurts out answers before questions have been completed
Has difficulty waiting turn
Interrupts or intrudes on others

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