Conners form

For ADHD follow-up visits (after initial diagnosis) each ADHD f/u should have the following form filled out and brought at each visit. During the school year, the teacher fills out the form. When not in school, the parent fills out the form. We give them at each visit, but if we forget or you lose them, you may print them out below. We need to know how hour child is doing each morning and each afternoon on average.
Conners Abbreviated Teacher's Rating Scale
Dear Teacher,
Please evaluate your student ____________________________using the following criteria.
Teacher's name________________________________
Time of day patient is taught by you: ( )average am-noon                     ( )average noon - 3pm
Date______________
                                                        NOT AT                   JUST A                    PRETTY                          VERY
                                                           ALL                        LITTLE                    MUCH                              MUCH
OBSERVATIONS                            _______              _______                  _______                      _______
1.RESTLESS OR OVERACTIVE

2.EXCITABLE OR IMPULSIVE

3.DISTURBS OTHER CHILDREN

4.FAILS TO FINISH THINGS
HE STARTS. SHORT
ATTENTION SPAN

5.CONSTANTLY FIDGETING

6.INATTENTIVE, EASILY
DISTRACTED

7.DEMANDS MUST BE MET
IMMEDIATELY. EASILY
FRUSTRATED.
8.CRIES OFTEN AND EASILY.

9.MOOD CHANGES - QUICKLY
AND DRASTICALLY.

10.TEMPER OUTBURSTS,
EXPLOSIVE UNPREDICTABLE
BEHAVIOR
COMMENTS:

These forms can be printed out by going to www.pedscpac.com. Go to "Conners forms"