ADHD WURS1 Intake Childhood Observer (logged out Adult and child)

Introduction

You have been nominated to provide collateral history information for a patient who is being assessed for ADHD. Please complete the below questions to the best of your knowledge in order that we can fully assess their childhood symptoms.

Your relationship to the patient

 

 

Wender Utah ADHD Rating Scale

In childhood they were or had / are or have:

Concentration problems, easily distracted
Anxious, worrying
Nervous, fidgety
Inattentive, daydreaming
Hot or short tempered, low boiling point
Temper outbursts, tantrums
Trouble with stick-to-it-tiveness, not following through, failing to finish things started
Stubborn, strong willed
Sad or blue, depressed, unhappy
Disobedient with parents, rebellious, sassy
Low opinion of themself
Irritable
Moody, ups and downs
Angry
Active without thinking, impulsive
Tendency to be immature
Gulity feelings, regretful
Losing control of themself
Tendency to be or act irrational
Unpopular with other children, didn’t/dont’t keep friends for long, didnt/dont’t get along with other children
Trouble seeing things from someone else’s point of view
Trouble with authorities, trouble with school, visits to principals office

In school they were or had / are or have:

Overall a poor student, slow learner
Trouble with mathematics or numbers
Not achieving up to their potential