ADHD_ Tool
ST
INCLEN Diagnostic Tool for Attention Deficit Hyperactive Disorder
(INDT-ADHD)
INSTRUCTIONS FOR ADMINISTRATION
Primary caregiver must be present during the assessment for history
U
The informant should have been staying with the child for at least 6 months
The behavior in question
TR
- Should be present currently and a usual feature
- Should have been present for the last 6 months
Explain to the parents that the behaviors should be compared with children of same age and
similar background
Ask the questions verbatim.
Question can be repeated if the respondent cannot understand. Still, if the respondent
cannot understand, examples for the particular behaviour may be provided which are
No further elaboration is allowed
E N
appropriate to the child’s background (rural/urban, school going/ not school going)
PERSONAL INFORMATION OF THE CHILD
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Name of the ChildcPps dk uke:_____________________
Sex: (Male-1; Female-2 )fyax (yMdk-1; yMdh -2):
Date of Birth tUe frfFk: DD/MM/YYYY
Age (In months) mezz (eghuksa esa):
IN
Complete Address iwjk irk:
Phone number Qksu uEcj:
E
Date of Assessment ewY;kadu dh frfFk: DD/MM/YYYY
Name of the Assessor ewY;kadudrkZ dk uke:
TH
Respondent mRRkjnkrk dk uke:
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ADHD_ Tool
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SECTION A
A 1 Inattention Encircle the
appropriate
response
a Does your child often fail to give close attention to details (e.g., makes careless Yes No
mistakes in school/homework or is careless/ messy in other activities)? gka ugha
U
D;k ---------(vkidk cPpk) vDlj fdlh dke dh ckjhfd;ksa ij /;ku ugha ns ikrk gSS \ tSls&
Ldwy esa ;k ?kj ds dkeksa esa ykijokgh dh otg ls xyfr;k¡ djuk] nwljs dk;kZsa esa vO;ofLFkr
jgukA
b Does your child often have difficulty in concentrating while playing or doing his/ her Yes No
TR
homework? gka ugha
D;k ---------(vkids cPps) dks vDlj [ksyus esa ;k ?kj ds dkeksa dks /;ku yxkdj djus esa
eqf'dy gksrh gS\
c Does your child often have trouble in paying attention when somebody is talking to Yes No
him/her? gka ugha
tc dksbZ ------(vkids cPps) ls ckr djrk gSa rc D;k vDlj mls /;ku nsus esa ijs'kkuh gksrh gS \
d Does your child often does not follow instructions despite understanding them and Yes No
not due to disobedience? gka ugha
D;k ---------(vkidk cPpk)?kj esa ;k Ldwy esa fn, gq, funsZ'kksa dks le>us ds ckotwn vkSj pkgrs
gq, Hkh vDlj mudk ikyu ugha djrk gS\
N
If Yes, due to this is he/she often unable to complete his/her works in time?
vxj gk¡, rks D;k bl otg ls og viuk dke fu/kkZfjr le; ij ugha dj ikrk@ikrh gS \
E
(If response to BOTH the questions is “YES”, then mark it as “YES”
If response to first part is “YES” and second part is “NO”, then mark it as “NO”)
e Does your child often have difficulty in doing his/her home work, getting ready for Yes No
CL
school, putting toys back to their place on his own? gka ugha
D;k ---------(vkids cPps) dks viuk gkseodZ djus esa, Ldwy ds fy, rS;kj gksus esa ;k [ksyus ds
ckn vius f[kykSuksa dks O;ofLFkr djds j[kus esa vDlj ijs'kkuh gksrh gS \
f Does your child often avoid activities that require sustained mental efforts? (e.g., Yes No
homework/class work, looking at picture book, listening to story). gka ugha
D;k ---------(vkidk cPpk) vDlj ,sls dk;kZas ls drjkrk gSS ftuesa T;knk /;ku yxkuk iM+rk gS
tSls& gkseodZ, LdwyodZ, fp=ksa okyh dgkuh dh fdrkc ns[kuk vkSj dgkuh lquuk bR;kfnA
IN
g Does your child often loses things e.g. books, pencils, toys etc Yes No
D;k ---------(vkidk cPpk) vDlj phtsas [kks nsrk gS\ tSls& f[kykSus] fdrkcsa] isafly bR;kfnA gka ugha
h Does your child often lose concentration due to little distractions (e.g., traffic, road Yes No
vendors, animal sounds) and lose track of what he/she was doing at that time? gka ugha
D;k ---------(vkids cPps) dk /;ku vDlj NksVh&NksVh ckrksa ;k vkoktksa dh otg ls HkVdrk gS
vkSj bl dkj.k ls og fcYdqy Hkwy tkrk gS fd og D;k dj jgk Fkk\ tSls& Bsys okys dh vkokt]
E
xkfM;ksa dh vkokt] fpfM;ksa vkSj tkuojksa dh vkokt bR;kfnA
i Is your child more forgetful in daily activities compared to other children of his/her Yes No
age? (e.g., bathing, dressing, brushing teeth) gka ugha
D;k ---------(vkidk cPpk) nwljs cPpks dh rqyuk esa jkstejkZa ds dk;kZs dks vDlj Hkwy tkrk gS \
TH
tSls& nk¡r lkQ djuk] ugkuk] rS;kj gksukA
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ADHD_ Tool
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A 2 Hyperactivity-Impulsivity
a Does your child often appear restless (e.g., tapping finger, moving hands and feet, Yes No
twisting the body when seated, squirming) ugha
gka
D;k ---------(vkidk cPpk) vDlj cspSu fn[krk gS tSls &mxfy;¡k FkiFkikrs jguk] gkFk&ik¡o
fgykrs jguk] cSBs gq, 'kjhj fgykrs jguk] NViVkrs jgukA
b Does your child often leave his/her seat in the middle of a class or meal? Yes No
U
D;k ---------(vkidk cPpk) vDlj d{kk eas ;k Hkkstu ds chp esa viuh txg ls mB tkrk gS \ ugha
gka
c Does your child often run about/ climb excessively in places where it is Yes No
TR
inappropriate? e.g., Excessive running/jumping/climbing in the class room or at ugha
gka
home, running about during prayers
D;k ---------(vkidk cPpk) vDlj vuqfpr txgksa ij vf/kdrj nkSM+rk gS ;k p<+rk gS
tSls&d{kk ;k ?kj esa vR;f/kd nkSM+uk] dwnuk] est ds Åij p<+uk\
d Does it seem that often he/she is unable to engage in play quietly? (e.g., playing Yes No
board games, building mud houses, playing with dolls [add group activity relevant to ugha
gka
culture])
D;k vkidks ,slk yxrk gS fd ---------(vkidk cPpk) vDlj 'kkfUriwoZd rjhds ls ugha [ksyrk gS
tSls& feV~Vh dk ?kj cukuk] xqfM;ksa ls [ksyuk] yqMks ;k dSje [ksyukA
e
market (as if driven by a motor) N
Is your child running around most of the time, even while inside the house or in the
D;k ---------(vkidk cPpk) vf/kdrj nkSM+rk jgrk gS pkgs og ?kj esa gks ;k cktkj esa tSls
mlds vUnj eksVj yxh gks\
E Yes
gka
No
ugha
f Does your child often talk excessively? Yes No
D;k ---------(vkidk cPpk) vDlj t#jr ls T;knk cksyrk gSA gka ugha
CL
g During conversations, does your child often start answering questions even before Yes No
the question has been completed? gka ugha
ckrphr ds nkSjku] D;k ---------(vkidk cPpk) vDlj loky iwjk gksus ls igys gh tokc nsuk
'kq: dj nsrk gS\
h While participating in group activities, is it often difficult for your child to wait for Yes No
his/her turn? gka ugha
D;k ---------(vkidk cPpk) vDlj nwljksa dh ckrksa ds chp esa cksy iM+rk gSS ;k nwljs cPpksa ds
IN
[ksy esa ?kql tkrk gS vkSj [ksy dks fcxkM+ nsrk gSS \
i Does your child frequently interrupt others conversation? (OR) Yes No
Does your child frequently interrupt the games being played by other children? gka ugha
D;k --------(vkids cPps) dks [ksy ds nkSjku vDlj viuh ckjh dk bUrtkj djus esa rdyhQ
gksrh gS\
E
TH
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ADHD_ Tool
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SECTION B: Complete this section based on the responses from section A (1-2) and
further history taking (3 -7)
1. Number of YES responses in A1 of section A (Inattention)
0: Less than six
1: Six or more
U
2. Number of YES responses in A2 of section A (Hyperactivity-Impulsivity)
0: Less than six
1: Six or more
3. Did these symptoms start before the age of seven years in your child?
TR
D;k vkidk cPps ;s y{k.k lkr lky dh mez ls igys 'kq: gq, Fks \
0: No
1: Yes
4. Does your child have / had any of these problems?
D;k vkids cPps dks buesa ls dksbZ ijs'kkuh gS@Fkh ?
(Tick () the problems present in the child)
- Frequent fights with other children vU; cPpksa ls vDlj yMkbZ djuk
- No/few friends nksLr cgqr de ;k fcYdqy ugha
- Very frequent injuries
N
- Frequent scolding by parents vDlj vkils MkaV [kkuk
- Frequent complaints from teachers vDlj Ldwy ls f'kdk;r
- Poor school performance i<kbZ esa cgqr detksj jguk
E
0: No (None of the above problems)
1: Yes (One or more of the above problems is present)
vkuk
5. Can these symptoms be explained by “Autism” and/or “Intellectual Disability”?
0: No
CL
1: Yes
6. Brief comments about the child’s condition cPps dh orZeku fLFkfr ds ckjs esa dFku :
(Additional notes & observation during the interview)
7. Diagnosis
IN
0: No ADHD (Response to both 1 to 4 is “0” and/or 5 is “0” or “1”)
1: ADHD (Response to 1 and or 2 is “1”, 3& 4 is “1” and 5 is “0”)
8: Other NDD (Response to both 1 to 4 is “0” and 5 is “1”)
9: Indeterminate (Response to 1, 2 and 3 is “0” But 4 is 1 OR Response to 1 & 2
is 0 & 3, 4 is 1 OR Response to 1 & 2 is 1 & 3 is 0 & 4 is 1 OR Response to 1-
4 is “1” and 5 is “1”)
8. If Q No. 7 is 0 or 9 , then enquire
E
Is the child on any medication or any non medical intervention for ADHD
0: No
1: Yes
Name of the Assessor Signature of the Assessor Date of assessment
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IN
CL
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5
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