Sample Teacher Rating Form (preview only — can't be submitted here)
This is what your child's teacher fills out each week or month — 15 quick ratings plus two questions about schoolwork, about 2–3 minutes.
- ADHD symptoms (items 1–12) — hyperactivity/impulsivity and inattention: staying seated, waiting turns, staying on task, following directions.
- Behavior & social functioning (items 13–15) — class rules, getting along with classmates, mood.
- Schoolwork — how much assigned work gets done, and how well.
Each item is rated 0–3 (Never to Very Often); for items 13–15 higher is better, for the rest lower is better. The teacher can also add a brief note.
After each submission you get a plain-language results summary by email — a comprehensive overview of how your child is doing. The ratings build into a trend graph across the school year.
Prefer to fill it out yourself and see the results? Try the interactive demo →
1.Fidgets with hands or feet or squirms in seat.
2.Difficulty remaining seated.
3.Difficulty waiting turn.
4.Talks excessively.
5.Interrupts others.
6.Always "on the go".
7.Easily distracted.
8.Avoids or dislikes tasks that require sustained mental effort.
9.Trouble paying attention.
10.Careless/messy work.
11.Does not seem to listen when spoken to.
12.Difficulty following directions.
13.Follows class rules.
14.Gets along with peers.
15.Seems happy and in good mood.
Academic Performance
Completion of assigned work this week:
Quality of work completed this week:
If the quality of work varied significantly between academic subjects, please describe:
Please share any other information for this week that you think is important: