CHILDHOOD BEHAVIOUR SCALE – SELF REPORT Please select the appropriate description that best describes your behaviour when you were a child.PLEASE RATE YOUR BEHAVIOUR BETWEEN 7 and 12 YEARS OF AGEName First Last 1. Failed to give close attention to details or made careless mistakes in my work* Never/Rarely Sometimes Often Very often 2. Fidgeted with hands or feet or squirmed in seat* Never/Rarely Sometimes Often Very often 3. Had difficulty my sustaining attention in tasks or fun activities* Never/Rarely Sometimes Often Very often 4. Left my seat in classroom or other situations in which sitting was expected* Never/Rarely Sometimes Often Very often 5. Didn’t listen when spoken to directly* Never/Rarely Sometimes Often Very often 6. Restless in the “squirmy” sense* Never/Rarely Sometimes Often Very often 7. Didn’t follow through on instructions and failed to finish work* Never/Rarely Sometimes Often Very often 8. Had difficulty engaging in leisure activities or doing fun things quietly* Never/Rarely Sometimes Often Very often 9. Had difficulty organising tasks and activities* Never/Rarely Sometimes Often Very often 10. Felt “on the go all the time” or acted as if “driven by a motor”* Never/Rarely Sometimes Often Very often 11. Avoided, disliked, or was reluctant to engage in work that required sustained mental effort* Never/Rarely Sometimes Often Very often 12. Talked excessively* Never/Rarely Sometimes Often Very often 13. Lost things necessary for tasks or activities* Never/Rarely Sometimes Often Very often 14. Blurted out answers before questions had been completed* Never/Rarely Sometimes Often Very often 15. Easily distracted* Never/Rarely Sometimes Often Very often 16. Had difficulty awaiting turn* Never/Rarely Sometimes Often Very often 17. Forgetful in daily activities* Never/Rarely Sometimes Often Very often 18. Interrupted or intruded on others* Never/Rarely Sometimes Often Very often Areas of life activitiesTo what extent did the problems you may have circled on the previous page interfere with your ability to function in each of these areas of life activities when you were a child between 7 and 12 years of age?19. In your home life with immediate family* Never/Rarely Sometimes Often Very often 20. In your social interactions with other children* Never/Rarely Sometimes Often Very often 21. In your activities or dealings in the community* Never/Rarely Sometimes Often Very often 22. In school* Never/Rarely Sometimes Often Very often 23. In sports, clubs, or other organisations* Never/Rarely Sometimes Often Very often 24. In learning to take care of themselves* Never/Rarely Sometimes Often Very often 25. In your play, leisure or recreational activities* Never/Rarely Sometimes Often Very often 25. In your handling of daily chores or other responsibilities* Never/Rarely Sometimes Often Very often Δ