Complete the questionnaire below to assess whether your child suffers from ADHD or ADHD related difficulties.

Not at all = Symptom is not present
Very much = Symptom is prevalent most of the time

The results you receive are not a definite diagnosis. If the results show that ADHD might be a concern for your child then please contact us on (011) 917-1230 to book your child in for a concentration test.

INATTENTION/DISTRACTIBILITY

• 
  Not at all
• 
  Just a little
• 
  Pretty Much
• 
  Very Much

1 Has a short attention span, especially for low interest activities

2 Has trouble completing tasks

3 Daydreaming

4 Easily distracted

5 Nicknames such as "spacey" or "dreamer"

6 Forgetful

7 Starts many things - finishes few

IMPULSIVITY

• 
  Not at all
• 
  Just a little
• 
  Pretty Much
• 
  Very Much

1 Easily excited

2 Becomes frustrated easily

3 Does not think before acting

4 Does not plan well

5 Constantly moves from one activity to another

6 Dislikes group activities that require patience and taking turns

7 Is disorganised

8 Constantly in trouble for doing things wrong or for forgetting to do things

9 Requires supervision

10 Interrupts and talks out of turn

ACTIVITY LEVEL PROBLEMS (Overactivity/Hyperactivity)

• 
  Not at all
• 
  Just a little
• 
  Pretty Much
• 
  Very Much

1 Restless-either fidgets or is constantly on the go

2 Reduced need for sleep

3 Talks too much

4 Constantly running, jumping and climbing

5 Difficulty staying seated in class

ACTIVITY LEVEL PROBLEMS (Underactivity)

• 
  Not at all
• 
  Just a little
• 
  Pretty Much
• 
  Very Much

1 Sluggish-low energy level

2 Daydreaming, spacieness

3 Inattention due to low energy level rather than being distractable

4 Poor leadership ability

5 Has trouble getting started

Non-compliance

• 
  Not at all
• 
  Just a little
• 
  Pretty Much
• 
  Very Much

1 Repeatedly disobeys

2 Argues a lot

3 Ignores socially accepted standard of behaviour

4 Does not do what is asked on him/her

5 Deliberately annoys others

Your name*

Child's name*

Contact number*

Email address*

Terms & Conditions:*

Province*

-- Please Select -- The Eastern Cape The Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga The Northern Cape North West The Western Cape

Region*

-- Please Select --

Captcha

Newsletter Subscription