day profile of adhd symptoms, parent version (dayas-p)

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180560/#CR9 Supplementary material Day Profile of ADHD Symptoms, Parent Version (DAYAS-P) Name of the child ________________________ Rater: mother, father, other: ________ Date: _________________ How problematic was the behaviour of the child throughout the daily routine at different times during the last week (school days only)? Problem intensity morning (wake up, getting dressed etc.) afternoon until 4 pm (lunch, homework) late afternoon until 7 pm evening and going to bed 1. Hyperactivity: Is restless, hyperactive, always on the go, can’t sit still 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 2. Inattention: Is inattentive, distracted, can’t concentrate, fails to sustain attention 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 3. Impulsivity: Is impulsive, can’t wait, interrupts others, acts without thinking 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 4. Defies rules or Not at all Just a little Pretty much Very much Not at all Just a little Pretty much Not at all Just a little Pretty much Not at all Just a little Pretty much Very much

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Day Profile of ADHD Symptoms, Parent Version (DAYAS-P) + Teacher Version (DAYAS-T)

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Page 1: Day Profile of ADHD Symptoms, Parent Version (DAYAS-P)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180560/#CR9

Supplementary material

Day Profile of ADHD Symptoms, Parent Version (DAYAS-P)

Name of the child ________________________ Rater: mother, father, other: ________

Date: _________________

How problematic was the behaviour of the child throughout the daily routine at different times during the last week (school days only)?

Problem intensitymorning

(wake up, getting dressed etc.)

afternoon until 4 pm

(lunch, homework)

late afternoon until 7 pm

evening and going to bed

1. Hyperactivity: Is restless, hyperactive, always on the go, can’t sit still 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

2. Inattention: Is inattentive, distracted, can’t concentrate, fails to sustain attention 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

3. Impulsivity: Is impulsive, can’t wait, interrupts others, acts without thinking 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

4. Defies rules or instructions, argues with adults 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

5. Is angry or resentful, shows aggressive behaviour or has temper tantrums 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

6. Overall behaviour problems 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

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Page 2: Day Profile of ADHD Symptoms, Parent Version (DAYAS-P)

Please rate the intensity of the following problem behaviour or symptoms in the last week

1. Worries, anxious 0 1 2 3 2. Tearful, sad, depressed 0 1 2 33. Dull, tired, listless 0 1 2 34. Socially withdrawn, decreased interaction with others 0 1 2 35. Crabby, irritable 0 1 2 36. Twitches, nervous movements, tics (i.e. eye blinking, facial twitching) 0 1 2 37. Picking at skin, nail-biting, lip chewing 0 1 2 38. Headaches 0 1 2 39. Stomach ache 0 1 2 310. Loss of appetite 0 1 2 311. Sleep problems 0 1 2 3

Thank you © M. Döpfner, Dept. of Psychiatry and Psychotherapy of Childhood and Adolescence at the University of Cologne,

Germany ([email protected])

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Page 3: Day Profile of ADHD Symptoms, Parent Version (DAYAS-P)

Day Profile of ADHD Symptoms, Teacher Version (DAYAS-T)

Name of the pupil________________________ Class: ______________________

School: _________________________________ Rater:_____________________

Date: _________________

How problematic was the behaviour of the pupil in the first and in the second half of the school morning during the last week?

Problem behaviour problem intensitymorning first half

morning second half

1. Hyperactivity: Is restless, hyperactive, always on the go, can’t sit still 0 1 2 3 0 1 2 3

2. Inattention: Is inattentive, distracted, can’t concentrate, fails to sustain attention 0 1 2 3 0 1 2 3

3. Impulsivity: Is impulsive, can’t wait, interrupts others, acts without thinking 0 1 2 3 0 1 2 3

4. Defies rules or instructions, argues with adults 0 1 2 3 0 1 2 3 5. Is angry or resentful, shows aggressive behaviour or has

temper tantrums 0 1 2 3 0 1 2 3 6. Overall behaviour problems 0 1 2 3 0 1 2 3

Please rate the intensity of the following problem behaviour or symptoms in the last week

1. Worries, anxious 0 1 2 3 2. Tearful, sad, depressed 0 1 2 33. Dull, tired, listless 0 1 2 34. Socially withdrawn, decreased interaction with others 0 1 2 35. Crabby, irritable 0 1 2 36. Twitches, nervous movements, tics (i.e. eye blinking, facial twitching) 0 1 2 37. Picking at skin, nail-biting, lip chewing 0 1 2 3

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Page 4: Day Profile of ADHD Symptoms, Parent Version (DAYAS-P)

8. Headaches 0 1 2 39. Stomach ache 0 1 2 3

Thank you © M. Döpfner, Dept. of Psychiatry and Psychotherapy of Childhood and Adolescence at the University of Cologne,

Germany ([email protected])