Concentration Assessment

To what extent does the following statement apply to you?

I get bored easily.(Required)

A lot like me

Somewhat like me

Not like me

To what extent does the following statement apply to you?

It is hard for me to resume working on a task after I am interrupted.(Required)

A lot like me

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To what extent does the following statement apply to you?

My accuracy decreases as I work on a task.(Required)

A lot like me

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To what extent does the following statement apply to you?

I avoid activities that require a lot of effort.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I avoid activities that require sitting still.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I find myself doing the same thing over and over <br>because I have lost track of what of I have done.(Required)

A lot like me

Somewhat like me

Not like me

To what extent does the following statement apply to you?

I give up quickly when I have difficulty with an assignment.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I go from one assignment to another without completing them.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I lose things that I need for school.(Required)

A lot like me

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To what extent does the following statement apply to you?

My study place is disorganized.(Required)

A lot like me

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To what extent does the following statement apply to you?

I have difficulty planning ahead.(Required)

A lot like me

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To what extent does the following statement apply to you?

I need to borrow a pencil or paper from other students.(Required)

A lot like me

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To what extent does the following statement apply to you?

I blurt out answers to questions in class before I think them through.(Required)

A lot like me

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To what extent does the following statement apply to you?

I find myself surfing the Internet when doing an assignment online.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I have difficulty focusing on what the teacher is <br>saying when other students are talking.(Required)

A lot like me

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To what extent does the following statement apply to you?

I make careless mistakes when I take a test.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I pick up and drop hobbies and interests.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I don't follow the directions for an assignment.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I am fidgety when I don't have something specific to do.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

My performance in school is inconsistent from one day to the next.(Required)

A lot like me

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To what extent does the following statement apply to you?

I jump from topic to topic in a conversation.(Required)

A lot like me

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To what extent does the following statement apply to you?

I find myself doodling when taking class notes.(Required)

A lot like me

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To what extent does the following statement apply to you?

I look at other things in the classroom when my teacher <br>writes something on the chalkboard.(Required)

A lot like me

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To what extent does the following statement apply to you?

I have difficulty tuning out my environment when I have to really focus.(Required)

A lot like me

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To what extent does the following statement apply to you?

I misplace personal objects.(Required)

A lot like me

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To what extent does the following statement apply to you?

I interrupt others when they are speaking.(Required)

A lot like me

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To what extent does the following statement apply to you?

I overlook details when working on an assignment.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

It is hard for me to listen for long periods of time in class.(Required)

A lot like me

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To what extent does the following statement apply to you?

I leave my homework or assignments at home.(Required)

A lot like me

Somewhat like me

Not like me

To what extent does the following statement apply to you?

I am easily distracted by irrelevant sights and sounds in the classroom.(Required)

A lot like me

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To what extent does the following statement apply to you?

I forget things I must do.(Required)

A lot like me

Somewhat like me

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To what extent does the following statement apply to you?

I stop working on an assignment because I start thinking about other things.(Required)

A lot like me

Somewhat like me

Not like me

Name

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