ADHD Screening Report

TEACHER FORM 01 / REPORT OVERVIEW ADHD Screening Report Teacher Form / Classroom observation STUDENT INFORMATION Name Age Grade Assessment date Completed by Observation period SCREENING RESULT Moderate Mainly Attention & Focus This level reflects the responses to this screening questionnaire. It is not a measure of ADHD severity or a diagnosis. CURRENT LEVEL None Mild Moderate High Behavioral profile The teacher reported frequent behaviors more often in Attention & Focus than in Hyperactivity & Impulsivity. In this report, 6 of 9 attention-related behaviors and 2 of 9 hyperactivity/impulsivity behaviors were reported frequently. Attention & Focus 6 of 9 behaviors Reported frequently Hyperactivity & Impulsivity 2 of 9 behaviors Reported frequently These counts show how many behaviors in each area were reported as occurring Often or Very Often. Overview Responses Support Next steps 01 / 04 Sample Sample Not shown SAMPLE Not shown Sample Not shown Not shown