Appendix B: ADHD Daily Behavior Rating Report Card

Person Completing Daily Behavior Rating Report Card: ____________________________________________________________________________

Student Name: ________________________________________   Date: __________________

(Circle)

During the day, this student:                        Seldom | Never | Sometimes | Most | All of Time

  1. Focused attention on school work during 0 1          2          3          4

academic periods.

  1. Finished assigned class work 0 1          2          3          4
  2. Remained in seat during academic periods 0 1          2          3          4
  3. Avoided calling out or inappropriate 0 1          2          3          4

verbalizations (e.g. nonsense noises).

  1. Avoided repetitive motor behaviors 0 1          2          3          4

(e.g. table-tapping) or playing with objects.

  1. Complied with reasonable adult requests 0 1          2          3          4

Comments: ___________________________________________________________________

_____________________________________________________________________________

Signature of Parent/Guardian: _________________________________ Date: ______________

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