Assess Your Child's Executive Function Skills
Take this survey to learn more about your child's executive function strengths and weaknesses. Read each item below and then rate that item based on the extent to which you agree or disagree with how well it describes you or your child. Use the rating scale below to choose the appropriate score. Then add the three scores in each section. Use the key at the end to determine strengths (2-3 highest scores) and weaknesses (2-3 lowest scores).

A copy of your results will be sent to you via email. You will also receive contact information if you would like to receive a free consultation to discuss interventions and strategies, in the home and in the school.

David P. Murphy, M.Ed., Ed.D.
www.effectiveeffortconsulting.com
www.linkedin.com/in/drdavidmurphy/
Office: (888) 389-8650

Questionnaire credit: Dawson, P. & Guare, R. (2012). Coaching students with executive skills deficits. New York: The
Guilford Press.

Email address *
Name
Your answer
1. I don’t jump to conclusions *
Strongly disagree
Strongly agree
2. I think before I speak. *
Strongly disagree
Strongly agree
3. I don’t take action without having all the facts. *
Strongly disagree
Strongly agree
Your total score (section 1): *
Your answer
4. I have a good memory for facts, dates, and details. *
Strongly disagree
Strongly agree
5. I am very good at remembering the things I have committed to do. *
Strongly disagree
Strongly agree
6. I seldom need reminders to complete tasks. *
Strongly disagree
Strongly agree
Your total score (section 2): *
Your answer
7. My emotions seldom get in the way when performing on the job. *
Strongly disagree
Strongly agree
8. Little things do not affect me emotionally or distract me from the task at hand. *
Strongly disagree
Strongly agree
9. I can defer my personal feelings until after a task has been completed. *
Strongly disagree
Strongly agree
Your total score (section 3): *
Your answer
10. No matter what the task, I believe in getting started as soon as possible. *
Strongly disagree
Strongly agree
11. Procrastination is usually not a problem for me. *
Strongly disagree
Strongly agree
12. I seldom leave tasks to the last minute. *
Strongly disagree
Strongly agree
Your total score (section 4): *
Your answer
13. I find it easy to stay focused on my work. *
Strongly disagree
Strongly agree
14. Once I start an assignment, I work diligently until it’s completed. *
Strongly disagree
Strongly agree
15. Even when interrupted, I find it easy to get back and complete the job at hand. *
Strongly disagree
Strongly agree
Your total score (section 5): *
Your answer
16. When I plan out my day, I identify priorities and stick to them *
Strongly disagree
Strongly agree
17. When I have a lot to do, I can easily focus on the most important things. *
Strongly disagree
Strongly agree
18. I typically break big tasks down into subtasks and timelines. *
Strongly disagree
Strongly agree
Your total score (section 6): *
Your answer
19. I am an organized person. *
Strongly disagree
Strongly agree
20. It is natural for me to keep my work area neat and organized. *
Strongly disagree
Strongly agree
21. I am good at maintaining systems for organizing my work. *
Strongly disagree
Strongly agree
Your total score (section 7): *
Your answer
22. At the end of the day, I’ve usually finished what I set out to do. *
Strongly disagree
Strongly agree
23. I am good at estimating how long it takes to do something. *
Strongly disagree
Strongly agree
24. I am usually on time for appointments and activities. *
Strongly disagree
Strongly agree
Your total score (section 8): *
Your answer
25. I take unexpected events in stride. *
Strongly disagree
Strongly agree
26. I easily adjust to changes in plans and priorities. *
Strongly disagree
Strongly agree
27. I consider myself to be flexible and adaptive to change. *
Strongly disagree
Strongly agree
Your total score (section 9): *
Your answer
28. I routinely evaluate my performance and devise methods for personal improvement. *
Strongly disagree
Strongly agree
29. I am able to step back from a situation in order to make objective decisions. *
Strongly disagree
Strongly agree
30. I “read” situations well and can adjust my behavior based on the reactions of others. *
Strongly disagree
Strongly agree
Your total score (section 10): *
Your answer
31. I think of myself as being driven to meet my goals. *
Strongly disagree
Strongly agree
32. I easily give up immediate pleasures to work on long-term goals. *
Strongly disagree
Strongly agree
33. I believe in setting and achieving high levels of performance. *
Strongly disagree
Strongly agree
Your total score (section 11): *
Your answer
34. I enjoy working in a highly demanding, fast-paced environment. *
Strongly disagree
Strongly agree
35. A certain amount of pressure helps me to perform at my best. *
Strongly disagree
Strongly agree
36. Jobs that include a fair degree of unpredictability appeal to me. *
Strongly disagree
Strongly agree
Your total score (section 12): *
Your answer
Look at the key below and list the 2 or 3 strengths and the 2 or 3 weaknesses.
Strongest skills *
Your answer
Weakest Skills *
Your answer
You made it to the end. You will receive a summary of the survey via email. Check your spam filter. If you want to discuss these results and executive function skill development options, then please let me know. All the best, Dr. Murphy
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