PARENT SHORT CONNERS

Student Name

Student DOB

Gender

Male Female

Grade

PARENT NAME

Today's Date

INSTRUCTIONS: Here are some things that parents might say about their children. Please tell us about YOUR child and what he/she has been like in the PAST MONTH. Read each item carefully, then mark how well it describes your child or how frequently it has happened in the PAST MONTH.

0 = In the past month, this was NOT TRUE AT ALL about my child. It never (or seldom) happened.
1 = In the past month, this was JUST ALITTLE TRUE about my child. It happened occasionally.
2 = In the past month, this was PRETTY MUCH TRUE about tmy child. It happened often. (or quite a bit)
3 = In the past month, this was VERY MUCH TRUE about my child. It happened very often. (very frequently)

please respond to each item. If you are unsure about an item please give your best guess

1. Forgets to turn in completed work

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

2. Is perfect in every way

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

3. Fidgets or squirms in seat

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

4. Is one of the last to be picked for teams

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

5.Restless or overactive

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

6. Does not know how to make friends

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

7. Runs or climbs when he/she is not supposed to.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

8. Cannot grasp arithmetic

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

9. Is difficult to please or amuse

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

10. Needs extra explanation of instructions

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

11. Is hard to motivate (even with rewards like candy or money)

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

12. Makes mistakes

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

13. Acts as if driven by a motor

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

14. Starts fights with others on purpose.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

15. Has trouble getting started on tasks and projects.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

16. Is happy, cheerful, and has a positive attitude.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

17. Doesn't pay attention to details; makes careless mistakes.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

18. Has trouble keeping friends

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

19. Bullies, threatens or scares others

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

20. Loses things (for example, schoolwork, pencils, books, or toys).

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

22. I cannot figure out what makes him/her happy.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

23. Threatens to hurt others.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

24. Is constantly moving.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

25. Has trouble with reading.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

26. Is angry or resentful.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

27. Has a short attention span.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

28. Excitable, impulsive.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

29. Cannot do things right

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

30. Has trouble concentrating.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

31. Tells the truth; does not even tell 'little white lies.'

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

32. Has trouble organizing tasks or activities

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

33. Is fun to be around.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

34. Inattentive, easily distracted.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

35. Is messy or disorganized.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

36. Spelling is poor

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

37. Is patient and content, even when waiting in a long line.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

38. Has no friends

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

39. Does not understand what he/she needs.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

40. Behaves like an angel.

Not true at all (Never, Seldom) Just a little true (Occasionally)

1

Pretty much true (Often, Quite a bit)

2

Very Much True (Very often, Very Frequently)

3

41. Has trouble keeping his/her mind on work/play for long

Not true at all (Never, Seldom) Just a little true (Occasionally) Pretty much true (Often, Quite a bit) Very Much True (Very often, Very Frequently)

42. Has to struggle to complete hard tasks

Not true at all (Never, Seldom) Just a little true (Occasionally) Pretty much true (Often, Quite a bit) Very Much True (Very often, Very Frequently)

43. Does not get invited to play or go out with others.

Not true at all (Never, Seldom) Just a little true (Occasionally) Pretty much true (Often, Quite a bit) Very Much True (Very often, Very Frequently)

44. Do you have any other concerns about your child?

45. What strengths or skills does your child have?

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