Copeland

Copeland Checklist

Copeland Checklist
This checklist was developed from the experience of many specialists in the field of Attention Disorders and Hyperactivity. It is designed to help determine whether you or someone you are rating, has ADD/ADHD, to what agree, and if so, in which area(s) difficulties are experienced. Please mark all statements. Please be honest. The purpose of this questionnaire is to give you an indication but it is not a final diagnosis.
Name & Surname of the person who is to be checked
Name & Surname of the person who is completing this checklist
Email of the person completing this checklist
Inattention / Distractibility
Add your answers form this section and input the total here
Impulsivity
Add your answers form this section and input the total here
Hyperactivity
Add your answers form this section and input the total here
Underactivity
Add your answers form this section and input the total here
Non Compliance
Add your answers form this section and input the total here
Underachievement
Add your answers form this section and input the total here
Emotional Difficulties
Add your answers form this section and input the total here
Poor Peer Relations
Add your answers form this section and input the total here
Impaired Family Relationships
Add your answers form this section and input the total here


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