ADHD-ODD-CDName of the child *Contact Number *Email AddressDate of Birth *Background details *1. Often interrupts or intrudes on others (e.g., butts into conversations or games) *Not At AllJust a LittlePretty MuchVery Much2. Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) *Not At AllJust a LittlePretty MuchVery Much3. Often argues with adults *Not At AllJust a LittlePretty MuchVery Much4. Often lies to obtain goods or favours or to avoid obligations (i.e., "cons" others) *Not At AllJust a LittlePretty MuchVery Much5. Often initiates physical fights with other members of his or her household *Not At AllJust a LittlePretty MuchVery Much6. Has been physically cruel to people *Not At AllJust a LittlePretty MuchVery Much7. Often talks excessively *Not At AllJust a LittlePretty MuchVery Much8. . Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) *Not At AllJust a LittlePretty MuchVery Much9. . Is often easily distracted by extraneous stimuli *Not At AllJust a LittlePretty MuchVery Much10. Often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking *Not At AllJust a LittlePretty MuchVery Much11. Often truant from school, beginning before age 13 years *Not At AllJust a LittlePretty MuchVery Much12. Often fidgets with hands or feet or squirms in seat *Not At AllJust a LittlePretty MuchVery Much13. Is often spiteful or vindictive *Not At AllJust a LittlePretty MuchVery Much14. Often swears or uses obscene language *Not At AllJust a LittlePretty MuchVery Much15. Often blames others for his or her mistakes or misbehaviour *Not At AllJust a LittlePretty MuchVery Much16. Has deliberately destroyed others' property (other than by fire setting) *Not At AllJust a LittlePretty MuchVery Much17. Often actively defies or refuses to comply with adults' requests or rules *Not At AllJust a LittlePretty MuchVery Much18. Often does not seem to listen when spoken to directly *Not At AllJust a LittlePretty MuchVery Much19. Often blurts out answers before questions have been completed *Not At AllJust a LittlePretty MuchVery Much20. Often initiates physical fights with others who do not live in his or her household (e.g., peers at school or in the neighbourhood) *Not At AllJust a LittlePretty MuchVery Much21. Often shifts from one uncompleted activity to another *Not At AllJust a LittlePretty MuchVery Much22. Often has difficulty playing or engaging in leisure activities quietly *Not At AllJust a LittlePretty MuchVery Much23. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities *Not At AllJust a LittlePretty MuchVery Much24. Is often angry and resentful *Not At AllJust a LittlePretty MuchVery Much25. Often leaves seat in classroom or in other situations in which remaining seated is expected *Not At AllJust a LittlePretty MuchVery Much26. Is often touchy or easily annoyed by others *Not At AllJust a LittlePretty MuchVery Much27. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions) *Not At AllJust a LittlePretty MuchVery Much28. Often loses temper *Not At AllJust a LittlePretty MuchVery Much29. Often has difficulty sustaining attention in tasks or play activities *Not At AllJust a LittlePretty MuchVery Much30. Often has difficulty awaiting turn *Not At AllJust a LittlePretty MuchVery Much31. Has forced someone into sexual activity *Not At AllJust a LittlePretty MuchVery Much32. Often bullies, threatens, or intimidates others *Not At AllJust a LittlePretty MuchVery Much33. Is often "on the go" or often acts as if "driven by a motor" *Not At AllJust a LittlePretty MuchVery Much34. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) *Not At AllJust a LittlePretty MuchVery Much35. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) *Not At AllJust a LittlePretty MuchVery Much36. Has been physically cruel to animals *Not At AllJust a LittlePretty MuchVery Much37. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) *Not At AllJust a LittlePretty MuchVery Much38. Often stays out at night despite parental prohibitions, beginning before age 13 years *Not At AllJust a LittlePretty MuchVery Much39. Often deliberately annoys people *Not At AllJust a LittlePretty MuchVery Much40. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) *Not At AllJust a LittlePretty MuchVery Much41. Has deliberately engaged in fire setting with the intention of causing serious damage *Not At AllJust a LittlePretty MuchVery Much42. Often has difficulty organizing tasks and activities *Not At AllJust a LittlePretty MuchVery Much43. Has broken into someone else's house, building, or car *Not At AllJust a LittlePretty MuchVery Much44. Is often forgetful in daily activities *Not At AllJust a LittlePretty MuchVery Much45. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) *Not At AllJust a LittlePretty MuchVery MuchAttention Deficit & Hyperactivity Disorder - INATTENTION SYMPTOMS (6 More Items to be endorsed 'Pretty Much' & 'Very Much")Attention Deficit & Hyperactivity Disorder - HYPERACTIVITY SYMPTOMS (6 More Items to be endorsed 'Pretty Much' & 'Very Much")Oppositional Defiant Disorder (4 More Items to be endorsed 'Pretty Much' & 'Very Much")Conduct Disorder - Aggression to People and Animals (3 More Items to be endorsed 'Pretty Much' & 'Very Much" in any category / Combination)Conduct Disorder - Destruction of Property (3 More Items to be endorsed 'Pretty Much' & 'Very Much" in any category / Combination)Conduct Disorder - Deceitfulness or Theft (3 More Items to be endorsed 'Pretty Much' & 'Very Much" in any category / Combination)Conduct Disorder - Serious Violation of Rules (3 More Items to be endorsed 'Pretty Much' & 'Very Much" in any category / Combination)SubmitPlease do not fill in this field.
