BEHAVIOR EVALUATION SCALE

NAME: ________________________________
Frequency Code: 0 = Never = Occ!"#on!$$y % = O&'en ( = Very O&'en
1. Fails to give attention to details or makes careless mistakes in schoolwork 0 1 2 3
2. Has difficulty sustaining attention to tasks or activities 0 1 2 3
3. Does not seem to listen when spoken to directly 0 1 2 3
4. Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or
failure to understand) 0 1 2 3
. Has difficulty organi!ing tasks and activities 0 1 2 3
". #voids$ dislikes$ or is reluctant to engage in tasks that re%uire sustained mental effort 0 1 2 3
&. 'oses things necessary for tasks or activities (school assignments$ pencils$ or )ooks* 0 1 2 3
+. ,s easily distracted )y e-traneous stimuli 0 1 2 3
.. ,s forgetful in daily activities 0 1 2 3
10. Fidgets with hands or feet or s%uirms in seat 0 1 2 3
11. 'eaves seat in classroom or in other situations in which remaining seated is e-pected 0 1 2 3
12. /uns a)out or clim)s e-cessively in situations in which remaining seated is e-pected 0 1 2 3
13. Has difficulty playing or engaging in leisure activities %uietly 0 1 2 3
14. ,s 0on the go1 or often acts as if 0driven )y a motor1 0 1 2 3
1. 2alks e-cessively 0 1 2 3
1". 3lurts out answers )efore %uestions have )een completed 0 1 2 3
1&. Has difficulty waiting in line 0 1 2 3
1+. ,nterrupts or intrudes on others (e.g.$ )utts into conversations or games* 0 1 2 3
1.. 'oses temper 0 1 2 3
20. #ctively defies or refuses to comply with adults4 re%uests or rules 0 1 2 3
21. ,s angry or resentful 0 1 2 3
22. ,s spiteful and vindictive 0 1 2 3
23. 3ullies$ threatens$ or intimidates others 0 1 2 3
24. ,nitiates physical fights 0 1 2 3
2. 'ies to o)tain goods for favors or to avoid o)ligations (i.e.$ 0cons1 others* 0 1 2 3
2". ,s physically cruel to people 0 1 2 3
2&. Has stolen items of nontrivial value 0 1 2 3
2+. Deli)erately destroys others4 property 0 1 2 3
2.. ,s fearful$ an-ious$ or worried 0 1 2 3
30. ,s self5conscious or easily em)arrassed 0 1 2 3
31. ,s afraid to try new things for fear of making mistakes 0 1 2 3
32. Feels worthless or inferior 0 1 2 3
33. 3lames self for pro)lems$ feels guilty 0 1 2 3
34. Feels lonely$ unwanted$ or unloved6 complains that 0no one loves him7her1 0 1 2 3
3. ,s sad$ unhappy$ or depressed 0 1 2 3
CLASSROOM BEHAVIOR
8ro)lematic #verage #)ove #verage
/elationship with peers 1 2 3 4
Following directions7rules 1 2 3 4
Disrupting class 1 2 3 4
#ssignment completion 1 2 3 4
9rgani!ational skills 1 2 3 4