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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 AGE
  • Name
  • 1. Failed to give close attention to details or made careless mistakes in my work * Required
  • 2. Fidgeted with hands or feet or squirmed in seat * Required
  • 3. Had difficulty my sustaining attention in tasks or fun activities * Required
  • 4. Left my seat in classroom or other situations in which sitting was expected * Required
  • 5. Didn’t listen when spoken to directly * Required
  • 6. Restless in the “squirmy” sense * Required
  • 7. Didn’t follow through on instructions and failed to finish work * Required
  • 8. Had difficulty engaging in leisure activities or doing fun things quietly * Required
  • 9. Had difficulty organising tasks and activities * Required
  • 10. Felt “on the go all the time” or acted as if “driven by a motor” * Required
  • 11. Avoided, disliked, or was reluctant to engage in work that required sustained mental effort * Required
  • 12. Talked excessively * Required
  • 13. Lost things necessary for tasks or activities * Required
  • 14. Blurted out answers before questions had been completed * Required
  • 15. Easily distracted * Required
  • 16. Had difficulty awaiting turn * Required
  • 17. Forgetful in daily activities * Required
  • 18. Interrupted or intruded on others * Required

  • Areas of life activities

    To 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 * Required
  • 20. In your social interactions with other children * Required
  • 21. In your activities or dealings in the community * Required
  • 22. In school * Required
  • 23. In sports, clubs, or other organisations * Required
  • 24. In learning to take care of themselves * Required
  • 25. In your play, leisure or recreational activities * Required
  • 25. In your handling of daily chores or other responsibilities * Required

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