ADHD

Child
Evaluation v.2

A diagnostic interview of ADHD in children

ACE v.2

English
Professor Susan Young

www.psychology-services.uk.com
Preface

I started working with young people with Attention Deficit/Hyperactivity Disorder (ADHD) around 30
years ago. The clinical picture has changed over these years due to research, which has considerably
advanced our scientific knowledge and understanding about the aetiology, presentation, treatment and
prognosis of ADHD. ADHD is now recognised to be a lifespan condition for many individuals yet, despite
international guidelines on the assessment, treatment and management of ADHD, too many young
people reach adulthood with undiagnosed ADHD. This means that the diagnosis is being missed or that
they are misdiagnosed in childhood. It also means that these young people will not receive the optimal
treatment for their symptoms and associated problems; many will not reach their potential and for
some the future is bleak. The good news is that there are large treatment effects for ADHD
interventions and one can intervene at any age, but if children with ADHD are to mature into confident
young adults who experience psychological wellbeing and have a good quality of life we need to
intervene as early as possible. I therefore developed the ADHD Child Evaluation (ACE) in the hope that
this semi-structured interview will support healthcare practitioners in their assessment and diagnosis of
ADHD in childhood.

Revision of ACE
The first edition of ACE has now been updated to reflect changes to the ICD-11 diagnostic criteria which
came into effect on 1st January 2022. This revised edition for the assessment of children is called
‘ACEv.2’. The revised version for the assessment of adults is ‘ACE+v.2’.

I hope you have discovered the background, self-report and informant-report pre-assessment
questionnaires; they are free to download from my website. I find it extremely helpful to obtain this
information in advance of the interview. The background questionnaire is the same as the one included
in the interview, but I have included this as a separate downloadable document for your convenience.
The self-report and informant-report questionnaires have been revised and re-named ‘ACE-SRv.2’ and
‘ACE-IRv.2’ for use with children, and ‘ACE+SRv.2’ and ‘ACE+IRv.2’ for use with young people and adults.

I thank all of my colleagues who have kindly given feedback on previous drafts of the ACE interviews, in
particular Cornelius Ani, David Coghill, Eric Taylor, Isaac Szpindel, Jade Smith, Nader Ali Perroud, Tami
Kramer, Tony Rostain and Paul Ramchandani. Special thanks go to Hannah Mullens for her support in
the creation and development of the project, the design of the ACE interviews and administrative
support for their translation into multiple languages.

Professor Susan Young,

London, 1st January 2024

© Psychology Services Limited: 2024. All Rights Reserved. https://www.psychology-services.uk.com

[1]
Contents

Page

Introduction to ADHD 3

ACEv.2 Administration and Training 5

INTERVIEW
Background 7

Symptom Ratings 11

Observations 30

Co-existing Problems and Disorders 31

Scoring 37

[2]
Introduction to ADHD

The World Health Organization1 describes Attention Deficit Hyperactivity Disorder (ADHD) to be a
neurodevelopmental disorder characterised by a persistent pattern of inattention and/or hyperactivity-
impulsivity that has a direct negative impact on academic, occupational or social functioning. Across
cultures, the symptoms of ADHD consistently fall into these two separate dimensions, however culture
can influence acceptability of symptoms as well as how caregivers respond to them.

Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level
of stimulation or frequent rewards, distractibility and problems with organisation. Hyperactivity refers
to excessive motor activity and difficulties with remaining still, most evident in structured situations
that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli,
without deliberation or consideration of the risks and consequences (e.g. engaging in behaviours with
potential for physical injury, impulsive decisions, reckless driving).

The relative balance and the specific manifestations of inattentive and hyperactive-impulsive
characteristics varies across individuals and may change over the course of development. Nearly half of
all children diagnosed with ADHD will continue to exhibit symptoms and associated difficulties into
adolescence and approximately one-third into adulthood. Early diagnosis will provide an opportunity
for early intervention, which in turn may improve an individual’s quality of life across the lifespan.

The prevalence of ADHD is suggested to be around 5% in children and 2.5% in adults. It is more
common in males, with a sex ratio of 2.3 to 1 for children, and 1.5 to 1 for adults. This may be because
young boys present with greater hyperactivity than girls, and thus they are more likely to be noticed
and referred for assessment.

Diagnostic criteria
There are two diagnostic criteria in common use, the Diagnostic and Statistical Manual of Mental
Disorders 5th Edition (DSM-52) and the International Statistical Classification of Diseases and Related
Health Problems 10th Revision (ICD-111).

The DSM-5 and ICD-11 criteria are very similar in defining three presentations of ADHD: (1)
predominantly inattentive, (2) predominantly hyperactive-impulsive, and (3) combined presentation
(with neither inattentive nor hyperactive-impulsive symptoms clearly predominating). There are 18
itemised symptoms in total; 9 inattentive and 9 hyperactive-impulsive.

Symptoms vary according to chronological age and disorder severity. Although symptoms of
hyperactivity become less overt during adolescence and adulthood, individuals may still experience
difficulties with inattention, impulsivity and restlessness. ‘Several’ symptoms are required to be present
for a diagnosis. When assessing children, ‘several’ is usually considered to be at least six symptoms
within the domain of either the inattentive or hyperactive-impulsive domains. When assessing young
people and adults (age 17 and older) ‘several’ symptoms in childhood are typically operationalised to be
three or more in either of these domains and in their adulthood, ‘several’ is usually considered to be at
least five symptoms. In order for a diagnosis to be made additional criteria must be met as follows:

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• There must be evidence of several symptoms prior to age 12, although some individuals may first
come to clinical attention later in adolescence or as adults, often when demands exceed the
individual’s capacity to compensate for limitations.

• Symptoms must have presented as a persistent pattern (for at least six months) and the degree of
inattention and hyperactivity-impulsivity must fall outside the limits of normal variation expected
for age and level of intellectual functioning.

• Symptoms must be evident across multiple situations or settings (e.g. home, school, work, with
friends or relatives) and are likely to vary according to the structure and demands of the setting.

• Symptoms must reduce the quality of social, academic or occupational functioning (e.g. poor
academic performance, interpersonal relationship problems, employment problems).

• Symptoms must not be better accounted for by another mental, behavioural or

neurodevelopmental disorder and are not due to the effect of a substance or medication.

Whilst ADHD can be diagnosed in children under the age of five (there is no minimum age proposed by
the diagnostic systems), symptoms can be hard to distinguish from the variation seen in normative
behaviours during pre-school years. Thus, it is recommended that assessors exercise caution when
conducting an assessment of ADHD in children younger than five.

Co-existing problems and disorders

For a diagnosis of ADHD, symptoms must not be better explained by another mental disorder (e.g.
substance use, anxiety, depression). This requires the assessor to conduct a mental state examination
to consider whether another condition may better account for presenting symptoms (i.e. a differential
diagnoses). However, up to two-thirds of children and adults with ADHD will present with one or more
co-existing conditions; these include oppositional defiant and conduct disorder, anxiety and mood
disorders, tic disorders, substance use disorder and autistic spectrum disorders. Hence the assessor
must distinguish between primary (i.e. differential) and secondary (i.e. co-existing) conditions.

Who can diagnose ADHD?

The National Institute for Health and Care Excellence (NICE 3) advises that a ‘diagnosis of ADHD should
only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare
professional with training and expertise in the diagnosis of ADHD.’ In other words, this must be a
clinician trained to distinguish ADHD from other conditions in order to determine differential diagnosis.

References
1World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.). Geneva: World Health
Organization https://icd.who.int/
2
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.
3National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management NG87. (2019).

https://www.nice.org.uk/guidance/ng87

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ACEv.2 Administration and Training
The ADHD Child Evaluation (ACEv.2) is a tool designed to support healthcare practitioners to assess for
ADHD in children aged 5-16 years. The ACEv.2 interview leads the assessor through the diagnostic
process by assessing the core symptoms of ADHD and the extent to which they impair functioning.
ACEv.2 sets out a series of questions that correspond with the core symptoms of inattention,
hyperactivity and impulsivity, and typical examples of the manifestation of these symptoms are
provided which can be used to prompt the assessor and guide clinical judgement. In order to assess
whether the core symptoms are having a negative impact in two or more settings, ACEv.2 prompts the
investigation of each symptom in both home and school situations. Examples are given for each setting.
Out of school activities should be noted as an example from home.

Training in the ACEv.2 and ACE+v.2

This can be accessed at https://professor-susan-young-psychology-services.teachable.com.

Interviewee
ACEv.2 is a clinical interview that should be administered by a healthcare practitioner to individuals who
are close to the child and have known him/her for a considerable time. They must be familiar with the
child’s functioning in different settings. Typically, parents/carers or other family members who are
familiar with the home setting are interviewed. Usually, the child is also invited to contribute to the
interview as this provides the opportunity to obtain the child’s perspective, as well as the opportunity
to observe their behaviour in the assessment setting. Whenever possible, independent evidence should
be obtained from school (i.e. a teacher interview and/or examination of school reports). For older
children in their mid-teens, ACEv.2 can be administered directly to the child; nevertheless, it is advisable
to gain corroborative information from appropriate informants and to obtain school reports if possible.

Introduction to the ACEv.2 interview

Prior to administering the interview, the assessor should establish rapport with the interviewee in order
to make them feel comfortable, settled and at ease. It is recommended that the assessor begins by
finding out about the child and the family using general open-ended questions, for example “I’m here to
learn as much as I can about your child and their behaviours. Could you tell me a little bit about your
child and the concerns that you have?”. It is useful to establish what daily life is like for the child and
those around them, and to understand what is expected of the child at home (i.e. behaviours, chores)
and how the child is progressing at school. When beginning administration of the ACEv.2 interview, it is
important to ‘set the scene’ by explaining that you will ask questions that relate to ADHD symptoms and
they will be invited to consider whether these symptoms have been present over the past six months.
Ask the interviewee to provide examples (as many as possible) of how the symptoms manifest at home,
school or other activities. You should also ask the interviewee to consider whether the symptoms seem
to occur with greater frequency compared with other children their age (e.g. with siblings or peers).

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Administering the ACEv.2 interview
Begin the interview by completing the background information section. In addition to demographic
information, this section enquires about the presence of early risk factors in the child’s life, their
medical history, educational history, peer relationships and family background. It is important to take
time over these questions as these details are necessary for understanding the context of the child’s
behaviour and may provide insight regarding the child’s difficulties.

There follow items relating to the symptom criteria of inattention (nine items), hyperactivity (five items)
and impulsivity (four items). First read out the question and prompt the interviewee to consider the
presence of this symptom at home and at school. The assessor is guided by a brief description that
summarises the common presentation of children with ADHD in these respective settings. This written
guidance serves as a prompt to the assessor and it should not be read aloud to the interviewee. Prompt
the interviewee to describe specific situations and/or to give specific examples of when the symptom or
problem is present, the onset of the symptom or problem, its contextual presentation, its frequency,
severity and mediating factors. It is particularly important to consider the difficulties experienced by the
child due to this symptom/problem and whether it occurs more frequently than would be expected for
a child of a similar age and developmental level. Make notes in the corresponding home/school boxes;
the notes should be written in sufficient depth to guide and support the assessor’s decision about
whether the symptom is present or absent.

From this in-depth exploration of each symptom, the assessor will judge whether a symptom is present
and if it is impairing. If there are uncertainties that prevent a clear decision being made, it may be
helpful to refer to documents for collateral information (such as school reports) and/or to seek the
perspective of others involved in the child’s care and/or extra-curricular activities.

An observation section is provided after the symptom evaluation section where the assessor can make
notes regarding their observations of the child if they are present during the interview (and/or for
observations made in another setting).

Co-existing problems and disorders

Following the observation section, the assessor is steered to consider the issue of differential or co-
occurring presentations by referring to a list of alternative and/or common co-existing problems. These
include neurodevelopmental/cognitive, behavioural, emotional, physical and medical disorders, and
each include a brief description that aims to prompt the assessor to consider the presentation of the
child from a different perspective. When conducting the assessment it is not recommended that the
problems are disclosed (as labelled) to the individual. The assessor should lead with general questions
that relate to the condition before focusing on specific symptoms. A space is provided to make notes
and classify whether the condition has been previously diagnosed or whether further investigation is
required. This section is not intended to make a diagnosis; rather it aims to identify behaviours that
should be considered as potential differential or co-existing conditions requiring further investigation.

Scoring the interview

Instructions for scoring the ACEv.2 interview are provided at the end of the interview section.

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INTERVIEW - Background

Name of child:

Date of birth: ___ /___ /___

Gender: Male Female Other – please specify

Informant's name(s):

Relationship to child:

Date of interview: ___ /___ /___

Name of assessor:

Family structure (number of siblings, who lives at home, any family difficulties):

At what age did you or anyone else first become concerned about the presentation of the child (please
detail)? Was the child slow to meet developmental milestones (walking, talking etc)?
:

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Early Risk Factors Present (tick those that apply and make notes below):
Premature birth* Head injury involving loss of consciousness*

Low birth weight* Parental mental health issues*

Early trauma (e.g. physical, sexual Maternal smoking and/or substance use during
emotional abuse)* pregnancy (including alcohol)*

*Please detail:

Has the child had their cognitive ability assessed? Yes* No

*Please detail:

Medical History
Does the child have any medical diagnoses/problems?
Yes* No
(e.g. heart problems, history of seizures)

*Please detail:

Is the child currently taking any medication or illicit substance? Yes* No

*Please detail:

Has the child received any non-medical interventions?

(e.g. cognitive or educational psychology assessment, Yes* No
counselling, psychological therapy, speech and language therapy)

*Please detail:

[8]
Education
What is the child’s current educational level?
(i.e. year of schooling)

Does/did the child attend a mainstream school? Yes No*

*Please detail:

Does the child have special educational needs? Yes* No

*Please detail:

Does/did the child receive extra support or help at school? Yes* No

*Please detail:

Has the child ever been excluded from school? Yes* No

*How many times? Once Twice More than

twice
*Please detail:

Has the child ever failed a grade or repeated a subject/class?

Yes* No
(i.e. not achieved an expected target)

*Please detail:

Does/did the child attend any extra-curricular activities? Yes* No

*Please detail:

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Peer Relationships
Describe the quality of the child’s friendships (both inside and outside of school):

Family Background
Mother’s highest level of education and current occupation:

Father’s highest level of education and current occupation:

Do any family members have neurodevelopmental conditions (e.g. ADHD, Autism Spectrum Disorder,
Intellectual impairment)?

Yes* No

*Please detail:

Do any family members have a specific learning difficulty?

Yes* No

*Please detail:

Do any family members have a history of a psychiatric disorder?

Yes* No

*Please detail:

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Symptom Ratings

Questions 1-9 enquire about the child’s ability to pay attention.

Questions 10-14 enquire about the child’s restlessness and hyperactivity.
Questions 15-18 enquire about the child’s impulsive behaviours.

Instructions
Read out the question and prompt the interviewee to consider the presence of the symptom at home
and at school and the extent to which it reduces the quality of the child’s social, academic or
occupational functioning. Try to get examples and note responses in the corresponding boxes. The
written guidance above the boxes serves as a prompt for the assessor and this should not be read out
to the interviewee. Record in the top right-hand corner of each page your decision about whether the
symptom criterion has been met.

When conducting the interview bear in mind and note the following points:

 Onset: When did this symptom first appear? (Symptoms must be present prior to age 12)

 Duration: Has this symptom been present for six months or more?

 Pervasiveness: Does this symptom appear in more than one context (e.g. at school, home
and/or other activities outside of school (e.g. sports and social clubs)?

 Persistence: Is this symptom occurring more frequently than that typically expected for the
child’s age and level of intellectual development? This requires the symptom to be present
‘often’, i.e. it is the usual style of the child, occurring much or most of the time. However, this will
depend on the situation and is not invariant.

 Difficulties: To what extent does this symptom reduce the quality of the child’s academic,
occupational or social functioning?

When interviews are conducted with parents/carers or other family members who are familiar with the
home setting, it is recommended that independent evidence is obtained for the school section (i.e. with
a teacher interview and/or by examination of school reports). Usually, the child is also invited to
contribute to the interview as this provides the opportunity to obtain the child’s perspective, as well as
the opportunity to observe their behaviour in the assessment setting. For older children in their mid-
teens, ACEv.2 can be administered directly to the child; nevertheless, it is advisable to gain corroborative
information from appropriate informants and to obtain school reports if possible.

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 Criterion Met:
Does the child often fail to give close attention to details
1. or make careless errors?
At Home
At School

Home
The child may complete tasks inefficiently, e.g. by missing out steps in chores or other activities which
then need repeating, not paying attention to instructions, or breaking items due to rushing (not paying
attention to what they are doing). The child may make lots of mistakes in their homework even when
they understand what to do, and homework may be presented as messy with lots of corrections. The
child may not notice important information in the environment, such as road crossings or signs of
danger.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may hand in incomplete work and/or poorly presented work that looks rushed and contains
many errors. On test papers, children may skip questions and/or not think to check whether there are
more questions on the other side of the paper (leading the child to achieve a lower mark/grade).
Children may find tasks that require a lot of detail particularly stressful and time consuming.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[12]
 Criterion Met:
Does the child often fail to sustain attention in tasks
2. or play activities?
At Home
At School

Home
At home or clubs this symptom can be observed by the child frequently changing the toy they are
playing with or the activity they are doing. They may only stay on task for a few minutes. This may be
because they have become bored or because something more engaging has caught their eye. Children
may struggle to complete activities and tasks, even with adult support. They may avoid reading books or
sitting through a movie, for example. They may also lose their train of thought when engaged in
conversation.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may find tasks that are repetitive and/or require sustained mental effort notably difficult
compared to their peers, for example the child may complain and/or struggle with essay based tasks.
Teachers may comment that the child needs frequent reminders and redirection to return to the task.
The child may state the task is boring and seem to lack the motivation to reach the end, becoming
irritable, frustrated and/or disruptive. By contrast, they may struggle less (or not at all) with tasks they
enjoy. The child may not appear to settle during break or lunch times; they may frequently change who
they play with and the toys they play with.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[13]
 Criterion Met:
Does the child often appear to not listen when being
3. spoken to directly?
At Home
At School

Home
It may seem that the child is daydreaming or their mind is elsewhere. Family and visitors to the home
may comment on this. This means they miss information; they don’t know what to do or get things
wrong. Alternatively, the child may appear to listen, but subsequently forget or be unable to repeat
instructions. In sports, for example, the child may appear to listen to the coach but fail to follow
through on instructions.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
Teachers may comment that the child is not listening in class. They may comment that the child
requires multiple prompts. Instructions have to be repeated many times and/or broken down into
small steps in order to successfully complete a task. Teachers may move the child to sit at the front of
the class or next to an assistant. Some teachers may misperceive the child’s presentation to be defiant
behaviour.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[14]
 Criterion Met:
Does the child often fail to follow through on instructions
4. or to finish tasks?
At Home
At School

Home
When given chores to do at home, the child may miss out some tasks and/or not finish everything they
set out to do. Common examples are not completing their self-care routine, including dressing;
forgetting items when going to shops and/or returning with random items; leaving taps running; and
needing many reminders to complete an activity. Even when following written instructions, the child
may miss out steps, for example when putting together a toy, resulting in errors and toys being
incorrectly assembled.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may have difficulty following and remembering instructions, leading to incomplete tasks and
unmet goals. For example, the child may be observed to start a practical activity but forget or miss out
steps or go off-task and leave it prematurely. They require structure and direction to complete tasks.
Children may receive warnings or detentions for oppositional behaviour due to incomplete classwork
and homework.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[15]
 Criterion Met:
Does the child often have difficulty organising tasks and
5. activities?
At Home
At School

Home
The child may seem to always be in a rush or running late to clubs or activities. The child may undertake
tasks in an order that seems illogical to others due to poor planning and organising skills. Children may
be untidy and have difficulty finding their toys or clothes. Older children may find it hard to balance
homework and leisure activities, not due to a disregard for their homework but due to poor time
management and organisational skills. They may have relationship problems due to missing events or
letting down friends.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may miss deadlines as they have not organised or planned their work efficiently. They may
appear to be generally messy and untidy (in their appearance and with their belongings). They may
make notes during lessons that lack structure. When the timetable becomes more complicated during
the transition to secondary school, children may frequently turn up late for lessons and become
stressed by the higher expectation of autonomy. They may leave things behind at home, such as their
bus pass, locker key, snack box, sports kit and homework.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[16]
 Criterion Met:
Does the child often avoid or strongly dislike tasks that
6. require sustained mental effort?
At Home
At School

Home
The child may avoid or delay tasks requiring sustained mental effort. They may not persevere on tasks
they find hard and/or repetitive. The child may procrastinate and put off homework tasks. When asked
to do a chore, the child may complete smaller tasks first and put off more intensive tasks, and/or
protest a lot about having to complete the task. The child may join clubs but disengage from activities
that lack physical stimulation or activity. The child may avoid games they perceive to be long, repetitive
and/or educational, becoming oppositional at these times as they find the task aversive.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may try to avoid specific lessons that they find particularly intensive and require mental effort,
such as maths, writing, essays and long project work. During lessons, the child may protest or lack effort
and become frustrated and irritable. They may become restless and/or oppositional. The child may
make excuses to leave the classroom, including feigning illness. In extreme cases the child may feign
illness to stay at home and avoid attending some classes, and/or truant from school.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[17]
 Criterion Met:
Does the child often lose things necessary for certain
7. tasks or activities?
At Home
At School

Home
The child may be untidy. They may regularly lose or misplace items such as their bus pass, keys,
clothing, schoolwork and toys, and have no inclination of where or when they last had the item. This
means that they may turn up for activities unprepared and/or without the equipment or materials that
they need, for example without their coat, scarf, football, tennis racket, USB stick and/or paperwork.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may lose or misplace their school bag, books, school uniform, bus pass and sports kit. The
child or parents/carers may often be checking lost property at school to search for lost clothing, pencil
cases and school books. Teachers report the child often attends lessons without the equipment or
materials required for lessons.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[18]
 Criterion Met:
Does the child often appear easily distracted by external
8. stimuli or thoughts that are not related to the task at hand?
At Home
At School

Home
The child may appear to frequently be daydreaming and/or observed to quickly shift focus to another
(more stimulating) task. The child may be easily distracted by their surroundings, including activities
and/or background noise (such as the television) that others seem to be able to block out or ignore.
Multitasking may be particularly challenging. The child may apply coping strategies that mask this
symptom, such as preferring to do homework in a quiet room.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may appear to be distracted by their surroundings to a greater extent than their peers. They
may be distracted by noise and activity in the classroom, as well as noise and activity from outside such
as children in the playground or any outside sports. Teachers may report that they go off-task because
they chatter to peers, or are seen to be daydreaming and require prompting to return to the task. It
may be reported that they work better one-to-one or in small groups.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[19]
 Criterion Met:
Is the child often forgetful in the course of daily
9. activities?
At Home
At School

Home
The child may frequently forget where they left something, and spend a lot of time searching for
objects, toys, clothes etc. The child may forget to attend appointments, meetings or clubs. They may
forget to communicate important information and/or letters from school to parents/carers (which
remain at the bottom of their school bag). When visiting friends or relatives, the child may not collect all
of their property, even items or toys that are important to them. They may need reminders to do
routine tasks, such as brushing their teeth.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may regularly forget their timetable and/or leave items at home that they need for class. They
may forget to collect all of their belongings as they move from classroom to classroom. The child may
forget when their homework is due and fail to hand it in on time, even if it has been completed. They
may forget to attend meetings and appointments, or even detentions, despite knowing the
consequence. They are perceived to be unreliable.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[20]
 Criterion Met:
Does the child often fidget with their hands or feet or
10. squirm on their seat?
At Home
At School

Home
The child may be observed to be fidgety and restless, even when watching television, at the dinner
table and/or in the car. The child may fidget even when engaged on a task or activity they find
interesting, or when feeling tired. They are frequently being told to stop rocking back on their chair,
kicking their legs and/or fiddling with objects. These behaviours may cause problems in the cinema, in
places of worship and/or in restaurants.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
Teachers may comment that the child is fidgety and restless in class, irrespective of the topic or activity,
and that their fidgeting disturbs other children. The child may shuffle about in their seat, kick their legs,
rock back on their chair, fiddle with items on the table, and/or doodle on their books. The child may be
perceived as clumsy because they often fall over or knock over items.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[21]
 Criterion Met:
Does the child often leave their seat in situations in which
11. remaining seated is expected?
At Home
At School

Home
The child may have difficulty settling down. In particular, the child may struggle to stay seated even
when this is compulsory or important, getting up multiple times. This may be observed by the child
wandering around the room when watching television and/or leaving their seat at the dinner table. The
child may need constant engagement to help them remain seated on public transport and they may
struggle to cope with long journeys.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
Despite frequent reminders and redirection, the child may struggle to stay seated. The child may swing
back on their chair or leave their seat and sit on the floor. When engaged in floor work, the child may
roll about on the floor and disrupt peers. The child may find excuses to get up and move around, such
as to go to the toilet, to go and talk to someone, or to look at something. The child may be unable to
modify their behaviour, even when redirected or reprimanded.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[22]
 Criterion Met:
Does the child often run about or climb excessively in
12. situations in which it is inappropriate?
At Home
At School

Home
The child may run around and climb on objects despite attempts by parents/carers to manage this
behaviour. The child may have damaged furniture through these activities, or hurt themselves. They
may run or climb in areas where this is not permitted and/or engage in behaviours that are risky or
dangerous, such as climbing up on roofs, cars, trees, and running across the street or track lines. Older
children may channel the urge to run and climb into sporting activities.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may appear restless and eager for break time and physical activities when they can engage in
boisterous play and climbing activities. They may need time to calm down when returning to the
classroom. The child may be reprimanded for running in corridors. On class trips they may need
additional supervision to ensure they stay with the group or walk safely. Older children may appear
more restless and fidgety than overtly active.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[23]
 Criterion Met:
Does the child often have difficulty playing or engaging
13. quietly in leisure activities?
At Home
At School

Home
The child may be rarely observed to engage in quiet play activities, instead being described as loud, on
the go and overly active. When asked to play quietly, the child may go off-task because they get up, run
around, and/or make a lot of noise. The child may struggle to adhere to social norms and control
behaviour in settings such as museums, galleries or church. The child may disturb others by talking
throughout television programmes or at the cinema.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may talk or shout when it’s quiet time or during activities that require concentration. They
may ask lots of questions, talk over others, and distract their peers. Reminders to be quiet and/or
reprimands don’t seem to help. Given the choice, the child may avoid quiet activities, preferring to
choose physically active or noisy ones. Older children may be reprimanded for chatting and disturbing
their peers during individual work and/or have difficulty settling down during tests.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[24]
 Criterion Met:
Does the child often present with excessive motor
14. activity?
At Home
At School

Home
The child may be described as being constantly on the go from morning to night and unable to switch
off. They struggle to settle at bedtime. Young children may seem like a whirlwind, moving from task to
task, running around, and not engaging with activities. On public transport the child may require
additional supervision to ensure that they stay seated and safe. Parents/carers may report feeling worn
out by the child. Older children may present as less chaotic but still struggle to settle and fully engage.
The child may report a desire to relax but feel unable to ‘switch off’, even when they go to bed.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may be seen as a whirlwind, running, climbing, and moving aimlessly between activities. The
child may appear to be chaotic and always on the go. At the end of the day the child may not seem to
be tired but instead presents as irritable or overwhelmed. The child may favour anticipated break times
and physical activities rather than class work. Given the choice, extra-curricular activities involve
physical activities rather than less active pursuits.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[25]
 Criterion Met:
Does the child often blurt out answers before questions
15. have been completed?
At Home
At School

Home
The child may have difficulty waiting for their turn to speak and instead blurt things out or interrupt
others. They may struggle to follow the ‘turn-taking’ rules of conversation but instead seem motivated
to say immediately what is on their mind (even if this is unrelated to the topic of conversation). The
child may seem to be impatient for others to finish speaking. Older children may finish other people’s
sentences for them.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may be frequently reminded or reprimanded for talking in lessons. The child may seem to
dominate the class by frequently calling out or talking over others. The child may have difficulty waiting
for their turn to speak and/or answer questions. Older children may have some awareness of this
difficulty but struggle to inhibit their behaviour. These behaviours may irritate peers and lead the child
to be unpopular.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[26]
 Criterion Met:
Does the child often have difficulty inhibiting
16. behaviour and/or waiting turn?
At Home
At School

Home
The child may act immediately and without consideration of risks and/or consequences, leading to
negative outcomes (e.g. injury, sanctions). They may be very impatient and become overly emotional
when something they want is not available. They avoid queues as they struggle to wait in line. They may
attempt to do this but, unless occupied, they become unmanageable, disruptive, or embarrassing.
Parents/carers may report having to leave situations, for example when shopping in the supermarket.
This may even be the case when queuing for something the child desires, such as a ride at a theme park.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may be reprimanded pushing, shoving or fighting. Teachers may raise concerns about them
handling equipment (e.g. in sports or science lessons). They are told off for queue jumping and/or not
taking turns in class activities or when playing with friends. The child may appear to be oppositional
and/or become distressed or agitated, even for activities that require a short wait and/or waiting for a
desired activity. Teachers may comment that the child has good intentions but becomes overly
enthusiastic and/or has peer relationship problems due to perceived self-centred behaviour.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[27]
 Criterion Met:
17. Does the child often interrupt or intrude on others? At Home
At School

Home
The child may intrude on the conversations, private space, or activities, of others. The child may
understand the social boundaries, but lack the patience to manage them. They might interrupt private
conversations and their behaviour may be perceived as attention seeking. The child may not seem to
respect the privacy of parents/carers or siblings, using the possessions of others without asking. They
may act without thinking through the consequences of their behaviour. Reprimands may have had
limited effect.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
Teachers may notice that the child tends to interrupt others, speak out in assembly, use things that do
not belong to them, and/or appear to monopolise and take over the personal space and time of others
(both children and staff). They may act without thinking through the consequences of their behaviour.
The child may have little appreciation of how their behaviour is perceived by others and this may lead
to interpersonal conflict with peers.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[28]
 Criterion Met:
Does the child often talk excessively without appropriate
18. response to social constraints?
At Home
At School

Home
The child may be persistently chattering, even when they know the situation calls for quiet. The child
may jump from topic to topic, having an endless narrative, and dominate conversations as they struggle
to stop talking. They may interrupt the conversations of others, even when they are on the phone.
Parents/carers may report having to frequently remind the child to be quiet or settle down.
Is this symptom present? If yes, give examples and probe about how it causes difficulties at home

School
The child may chatter to peers in class, even when they have been asked to work quietly or during tests.
They may not respond to reminders or reprimands. They may dominate conversations, talk over others
(even teachers) and give tangential responses to questions.

Is this symptom present? If yes, give examples and probe about how it causes difficulties at school

[29]
Observations

Please use this space to detail any observations of the child’s behaviour and interactions. Make sure to
note the observed levels of inattention, hyperactivity and impulsivity displayed across the timespan.
Typical behaviours may present as: prematurely breaking off from activities before they are finished
and not returning to them; going off-task completely; disorganisation of activities, such as starting to
draw without gathering all of the crayons needed beforehand; fidgeting, as well as motoric activity; and
acting without thinking.

Date of observation: ___ /___ /___

Time of observation: ___ : ___

Observation setting:

Duration of observation: ___ hours ___ minutes

[30]
Co-existing Problems and Disorders

Common differential and co-existing conditions are presented below. The assessor should conduct a
mental state examination and consider whether any of these conditions are present. If so, the assessor
must decide whether a condition is primary (i.e. differential diagnosis) or secondary (i.e. co-existing
condition). It is important to establish whether the presenting problem is chronic or whether it has a
recent onset. It is recommended that the assessor DOES NOT disclose (as labelled) the disorder being
discussed. Preferably, the assessor should lead with general questions that relate to the condition
before focusing on specific symptoms.

Autism Spectrum Disorder

Is there evidence of speech delay, problems with forming and maintaining social relationships, social
communication, rigidity, repetitive behaviours and sensory hypersensitivity?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Cognitive Impairments
Is there evidence of generalised or specific learning difficulties such as reading, writing or arithmetic
difficulties?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

[31]
Speech and Language Impairments
Is there evidence of specific expressive and receptive language delay?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Tics Disorder (Including Tourette’s)

Is there evidence of motor and/or vocal tics?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Other Developmental Disorders

Is there evidence of gross motor or fine motor developmental difficulties?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

[32]
Traumatic Brain Injury
Is there evidence of a history of severe head trauma or recurrent head injuries (e.g. falls, sport
accidents, motor vehicle related injuries)? Note any loss of consciousness.
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Oppositional Defiance Disorder or Conduct Disorder

Is there evidence of oppositional behaviour and refusal to comply with authority, or more serious
antisocial behaviours?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Interpersonal Problems
Is there evidence of peer relationship problems (e.g. history/sensitivity to rejection, mixing with much
younger/older children, disrupted relationships with teachers and/or other adults)?
Notes:

Previously Further investigation

Yes No Yes No
Noted: required:

[33]
Post-Traumatic Stress Disorder
Has the child experienced any significant physical, sexual or emotional trauma?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Anxiety Disorders
Is there evidence of phobia, panic, separation and/or generalised anxiety?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Obsessive Compulsive Disorder

Is there evidence of obsessions, compulsions or other ritualistic or stereotyped behaviour?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

[34]
Depression
Is there evidence of low mood, negative thinking, low self-esteem, fluctuating mood, and irritability?
Note if there has ever been suicidal ideation or behaviour.
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Disruptive Mood Dysregulation Disorder

Is there evidence of excessive irritability and/or anger, either in intensity, frequency, and/or ease of
provocation?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Substance Misuse
Is there evidence of the child using or misusing substances including alcohol, cigarettes, prescription
medication and/or illicit drugs?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

[35]
Eating Disorders
Does the child have any abnormal eating habits that negatively affect physical or mental health (e.g.
avoidant/restrictive eating, binge eating, anorexia nervosa or bulimia nervosa)?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

Other Medical and Mental Health Conditions

Does the child have any other diagnoses or suspected inherited or acquired conditions (e.g. hearing
impairment, sleep-wake disorder, sleep apnea, nutritional deficiency, obesity, foetal alcohol syndrome,
and/or genetic, metabolic or endocrine disorders)?
Notes:

Previously Further investigation

Yes No Yes No
Diagnosed: required:

[36]
Scoring Sheet

Both DSM-5 and ICD-11 require several symptoms of inattention and/or hyperactivity-impulsivity to be
present for a diagnosis of ADHD. For children, this is usually considered to be six or more within each
domain. Onset of symptoms must be prior to the age of 12. Symptoms must be present for at least six
months across settings (e.g. at home and school) and reduce the quality of the child's social, academic
or occupational functioning. Transfer the data (recorded in the top right-hand corner of each symptom
item) by placing a ✓ in the boxes for each symptom present at home and/or school.
Inattention Domain Hyperactive-impulsive Domain
Symptom present Symptom present
Question at home and/or Question at home and/or
school school
1 10
2 11
3 12
4 13
5 14
6 15
7 16
8 17
9 18

Total number of Total number of

symptoms met: symptoms met:
Hyperactive-impulsive
Inattention Domain
Yes / No Domain Yes / No
6 or more symptoms met
6 or more symptoms met
at home and/or school
at home and/or school

1. Are these symptoms found in more than one setting? Yes No

2. Were these symptoms present before the age of 12? Yes No

3. Have these symptoms been present for six or more months? Yes No

4. Are these symptoms reducing the quality of the child’s social, academic or Yes No
occupational functioning?

5. Are these symptoms better explained by another condition? Yes No

For a diagnosis of ADHD, either the inattention domain and/or hyperactive-impulsive domain must have
a ‘yes’ response in the blue box above. Questions 1-4 must have a ‘yes’ response and question 5 must
have a ‘no’ response.
[37]
ADHD Diagnostic Category

Predominantly Inattentive Classification (DSM 314.00 and ICD-11 6A05.0)

Inattention criterion met but hyperactive-impulsive criterion not met
(i.e. Yes for the inattention domain only. Yes for questions 1-4 and No for question 5)

Predominantly Hyperactive-impulsive Classification (DSM 314.01 and ICD-11 6A05.1)

Hyperactive-impulsive criterion met but inattention criterion not met
(i.e. Yes for the hyperactive-impulsive domain only. Yes for questions 1-4 and No for question 5)

Combined Classification (DSM 314.01 and ICD-11 6A052)

Both the inattention and hyperactive-impulsive criterion met
(i.e. Yes for both the inattention and hyperactive-impulsive domains. Yes for questions 1-4
and No for question 5)

[38]
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