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Q.1
You ask your child to go upstairs, straighten his room, and bring his laundry down to the basement. He goes upstairs, gets distracted, and can’t remember what he was supposed to do next.
*
Frequently
Sometimes
Rarely
Q.2
You ask your child to wait while you finish a phone call before he tells you something important. By the time you finish, he’s forgotten what he wanted to say.
*
Frequently
Sometimes
Rarely
Q.3
Your child forgets to bring home the materials and books needed to complete a homework assignment.
*
Frequently
Sometimes
Rarely
Q.4
You ask your child who he played with at school. He remembers playing tag but not the names of the children he played with.
*
Frequently
Sometimes
Rarely
Q.5
Your child misplaces pencils, crayons, workbook, homework papers, books, and any other item that isn’t attached to her.
*
Frequently
Sometimes
Rarely
Q.6
During parent-teacher conferences, you are told that your child doesn’t listen or follow instructions.
*
Frequently
Sometimes
Rarely
Q.7
Your child has a hard time retelling the story that you just read to her and skips key details.
*
Frequently
Sometimes
Rarely
Q.8
Your child has difficulty staying on task. She is easily sidetracked moving from one activity to another, without finishing any of them.
*
Frequently
Sometimes
Rarely
Q.9
Your child has difficulty remembering all the steps required to solve a multi-step math or word problem.
*
Frequently
Sometimes
Rarely
Q.10
Your child has difficulty keeping in mind all the elements required to participate in a team sport.
*
Frequently
Sometimes
Rarely
Q.11
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