Your relationship to the patient:

    Please describe how he/she is within your relationship generally; include positives and negatives and any recurring issues





    1. he/she is able to complete projects that he/she starts (whether for work, hobbies, or home life)

    If you answer sometimes or often, please give some examples of the kinds of projects YOU HAVE completed

    2. When assigned a task that requires organization, he/she is able to organize and order things accordingly.

    3. he/she is able to keep appointments reliably.

    4. he/she is able to start tasks on time, including those that require some thought.

    5. he/she fidgets and squirms with his/her hands or feet.

    6. he/she feels overly active and compelled to do things.

    7. he/she makes careless mistakes.

    8. he/she finds it difficult to keep attention on anything he/she is doing.

    9. he/she finds it difficult to concentrate on what people are saying to him/her.

    10. he/she misplaces things or has difficulty finding them.

    11. he/she becomes easily distracted by noise or activity around him/her.

    12. he/she leaves his/her seat during meetings or other situations where remaining seated is expected.

    13. he/she has difficulty relaxing or unwinding when he/she has time to himself/herself.

    14. he/she finds himself/herself talking too much in social occasions.

    15. he/she finds himself/herself finishing the sentences of other people while talking to them.

    16. he/she has difficulty waiting his/her turn in situations where taking turns is required.

    17. he/she interrupts other people when they are busy.