Sunflower Mental Health and Wellbeing

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ADHD Rating Scale-IV: Home version ( ages between 5-18)

Sex: Male or Female

Grade:

Completed by:

Mother

Father

Guardian

Grandparent

How to do?

Circle the number that best describes your child’s home behaviour over the past 6 months.

Q1:
Fails to give close attention to details or makes careless
mistakes in schoolwork.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q2:
Fidgets with hands or feet or squirms in seat.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q3:
Has difficulty sustaining attention in tasks or play activities.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q4:
Leaves seat in classroom or in other situations in which
remaining seated is expected.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q5:
Does not seem to listen when spoken to directly.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q6:

Runs about or climbs excessively in situations in which
it is inappropriate.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q7:

Does not follow through on instructions and fails to
finish work.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q8:

Has difficulty playing or engaging in leisure activities quietly
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q9:
Has difficulty organizing tasks and activities
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q10:

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

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q11:

Avoids tasks (eg, schoolwork, homework) that require
sustained mental effort.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q12:
Talks excessively
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q13:
Loses things necessary for tasks or activities.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q14:

Blurts out answers before questions have been completed.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q15:

Is easily distracted.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q16:

Has difficulty awaiting turn.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q17:
Is forgetful in daily activities.
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

Q18:
Interrupts or intrudes on others
*

0 Never or Rarely

1 Sometimes

2 Often

3 Very often

Required

How to score

A diagnosis of ADHD depends on the type and number of symptoms your child is having and how
those symptoms are affecting him or her. This screening tool is scored by a healthcare provider and
is used in the process of making a diagnosis. The tables on the back of this screening tool are for use
by your child’s healthcare provider. If you feel that your child may be showing signs of ADHD, please complete
this questionnaire and share the results with your healthcare provider

Kind Reminder

Please go to your GP for further assessment and referral!

If you want to contact us for a further assessment or going through the assessment outcome, please email or call us to book a free initial 10 minutes tele-consultation.

Our email: admin@sunflowermentalhealth.com.au

Phone: 0426851396

We will try out best to contact you soon!

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