| Weekly ADHD Monitoring Form # 6178
David Rabiner, Ph.D.
Child's name: _____________________________ Teacher: _______________________ Date:______________
Teacher: Please answer the items below on your observations of this child during the past week. Note that for
|Weekly ADHD Monitoring Form||Not at all||Just a little||Often||Very Often|
|1.||fidgets with hands or feet and squirms in seat|
|2.||difficulty remaining seated|
|3.||difficulty awaiting turn|
|4.||always "up and on the go" or acts as if "driven by a motor"|
|6.||interrupts or intrudes on others|
|8.||fails to finish assigned tasks|
|9.||difficulty sustaining attention|
|10.||careless or messy work
|11.||does not seem to listen when spoken to|
|12.||difficulty following directions|
|13.||follows class rules|
|14.||gets along with peers|
|15.||seems happy and in a good mood|
|16.||Indicate how the behaviors rated on the other side compared during the morning and afternoon times during the prior week by checking one of the choices below. (Note: If you only have this child in class during morning or afternoon this does not apply) __morning better than afternoon ___no clear difference ___afternoon better than morning|
|17.|| Indicate the approximate percentage of assigned class work that this child completed during the past week:
0% 20% 40% 60% 80% 100%
|18.|| The general quality of work completed by this child this week was:
___ very poor ___poor ___satisfactory ___good ___very good
|19.||If the quality of this child's work varied significantly between subjects, please indicate this below.
|20.|| Did this child turn in all assigned homework? If not, please indicate the assignments that were missing.
|21.||Please include any other comments or observations that you believe are important.
|From: David Rabiner. The ADHD Monitoring System. Copyright 1999 by David Rabiner. This form may be reproduced by myADHD.com active members for their personal use.|