Read each item below and then rate that item based on the extent to which the behavior occurs for the child.  Use the rating scale below to choose the appropriate score. 

Question Title

* 1. Info

Question Title

* 2. Response Inhibition

  Never Rarely Sometimes Frequently Almost Always
1. Doesn't interrupt
2. Thinks before he/she speaks
3. Shows self restraint when provoked

Question Title

* 3. Working Memory

  Never Rarely Sometimes Frequently Almost Always
4. Remembers to bring materials to and from school
5. Remembers things he/she has committed to do
6. Completes tasks without reminders

Question Title

* 4. Emotional Control

  Never Rarely Sometimes Frequently Almost Always
7. Emotions don't get in the way of doing assigned tasks
8. Little things don't affect him/her emotionally or distract him/her from work
9. Recovers quickly from disappointment or change in plans

Question Title

* 5. Task Initiation

  Never Rarely Sometimes Frequently Almost Always
10. Gets started on tasks independently
13. Procrastination is not a problem
14. Tasks are not left to the last minute

Question Title

* 6. Sustained Attention

  Never Rarely Sometimes Frequently Almost Always
13. Stays focused on work
14. Sustains attention until tasks are completed
15. If interrupted, returns to work without reminders

Question Title

* 7. Planning/ Prioritization

  Never Rarely Sometimes Frequently Almost Always
16. Identifies priorities for a task or time period and sticks to them
17. Stays focused on the most important tasks
18. Can make and follow plans for multi-step tasks with developmental-appropriate support

Question Title

* 8. Organization

  Never Rarely Sometimes Frequently Almost Always
19. Keeps notebook/ backpacks organized
20. Desk/ work area is neat and organized
21. Keeps track of homework, permission slips, lunch money, etc.

Question Title

* 9. Time Management

  Never Rarely Sometimes Frequently Almost Always
22. Finishes tasks within allotted time
23. Good at estimating how long it takes to do something
24. Does not dawdle over work or daily routines

Question Title

* 10. Flexibility

  Never Rarely Sometimes Frequently Almost Always
25. Doesn't "get stuck" on things
26. "Shifts gears" easily when plan have to change
27. Handles "open-ended" tasks easily

Question Title

* 11. Metacognition

  Never Rarely Sometimes Frequently Almost Always
28. Can monitor and evaluate performance when engaged in challenging tasks
29. Can think of more than one solution to a problem
30. Reads situations well and adjusts behavior based on the reactions of others

Question Title

* 12. Goal Directed Persistence

  Never Rarely Sometimes Frequently Almost Always
31 Sets a goal and sticks with it until it is achieved
32. Gives up immediate pleasures to work on longer term goals
33. Able to persists with effortful work when the outcome is the one the child desires

Question Title

* 13. Please List His/ Her Strengths

Question Title

* 14. Please List His/ Her Weaknesses

Question Title

* 15. Additional Comments

T