Calm / Fidgets

Self-esteem:
Good / Fair

Difficulty falling asleep:
Yes / No

Easy going / Aggressive

Intelligence:
Low / Average / High

Difficulty waking up:
Yes / No

High energy / Lethargic

Gets along with friends:
Yes / No

Restless:
Yes / No

Happy / Depressed

Inattentive:
Yes / No

Self-centered:
Yes / No

Pleasant / Irritable

Impulsive:
Yes / No

Accident prone:
Yes / No

Charming / Sullen

Disorganized:
Yes / No

Interrupts/butts in:
Yes / No

Class clown / Shy

Loses things:
Yes / No

Two parent family:
Yes / No

Relaxed / Anxious

Forgets things:
Yes / No

Step-parents:
Yes / No

Cautious / Daring

Complies with requests:
Yes / No

Family understands AD/HD (supportive):
Yes / No

Tenacious / Gives up easily

Will do chores:
Yes / /No

Reasonable discipline:
Yes / No

Compliant / Defiant

Truthful:
Yes / No

Open communication:
Yes / No

Copes well / Easily frustrated

Responds to medication:
Yes / No

Relatives understand AD/HD (supportive):
Yes / No

Angry outbursts / Calm

Family stresses (money, illness, divorce, remarriage):
Yes / No

Talks a lot / Quiet and low-key

Attending the same school:
Yes / No