Barkley Other Report: Childhood Symptoms

Name of person to be rated

Your name

Instructions

You are being asked to describe the childhood behavior of someone whom you know well. How often did that person experience each of these problems? Please select the answer that best describes their behavior when they were a child BETWEEN 5 AND 12 YEARS OF AGE.

Section 1 (Inattention)

Section 2 (Hyperactivity - Impulsivity)

Section 3