Attention Deficit Hyperactivity Disorder Tracking Sheet



Student: ______________________________________ Date: ________________


Please indicate by tally mark the number of incidents of each behavior observed for each 5-minute
time interval. Begin documenting once behaviors are observed and continue for five minutes. Please
attempt to document behaviors during the a.m. and p.m.


5- Minute randomly timed intervals (ex. from 8:10 to 8:15)


Inattentiveness:


Makes careless mistakes in schoolwork

a.m.:

a.m.:

a.m.:

Lunch:

p.m.:

p.m.:

p.m.:















Difficulty maintaining  attention w/ tasks/ activities








Does not follow instructions/fails to finish work








Loses things needed for task or activities








Dislikes/avoids task requiring sustained attention








Forgetful in daily activities








Easily distracted by extraneous stimuli








Does not seem to listen








Other








Impulsivity:


Blurts our answers before questions are completed






















Difficult waiting for turn








Interrupts or intrudes on others








Easily angered or upset (lacks coping skills)








Other








Hyperactivity:


Fidgets with hands, feet, squirms in seat






















Leaves seat when expected to remain seated








Runs/climbs excessively in inappropriate places








Difficulty engaging in leisure activities








Is often on the go or acts as if “driven by a motor”








Talks excessively








Makes excessive noises /mouth/hands/feet...








Other