SELF-REPORT CONNERS

Your Name

DOB

Today's Date

Gender

Male Female

INSTRUCTIONS: Here are some things that children and teenagers might say. Tell us, in YOUR opinion how true these things are about you. Think about yourself 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 me. It never (or seldom) happened.
1 = In the past month, this was JUST A LITTLE TRUE about me. It happened occasionally.
2 = In the past month, this was PRETTY MUCH TRUE about me. It happened often. (or quite a bit)
3 = In the past month, this was VERY MUCH TRUE about me. It happened very often. (very frequently)

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

1. I blurt out the first thing I think of

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. I struggle to complete hard tasks

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. It is hard for me to pay attention to details

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. It is hard for me to sit still.

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. I cant pay attention for long.

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. I am good at some things

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. I make 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

8. I do things to hurt people

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. I have trouble understanding what I read

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. I start fights with other people.

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. I like it when people say good things about me.

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. I tell the truth; I do 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

13. I have trouble with spelling.

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. I lose track of what I am supposed to do.

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. I have trouble playing or doing things quietly.

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. I get distracted by things that are going on around me.

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. I break things when I am angry or upset.

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. I have trouble finishing things.

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. Punishment in my house is not fair.

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. I am happy, even when I am 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

22. My parents expect too much from me.

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. I enjoy myself when I do my favorite 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

24. I act 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

25. I am happy or cheerful.

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. My parents are too harsh when they punish me.

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. I have 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

28. I am 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

29. I am restless.

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. When I get mad at someone, I get even with them.

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. I talk too much.

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. I destroy stuff that belongs to other people.

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. I have 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

34. My parents are too critical of me.

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. I can't 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

36. I learn more slowly that other kids my age.

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. My parents are too strict with me.

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. I have trouble with math.

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. I bully or threaten other people.

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. Do you have other problems?

41. What are your main strengths and skills?

Your information will be encrypted.

Loading...