ADHD Child NDQ Family

ADHD Child Assessment – Developmental History Questionnaire

To be completed by someone who has known the young person for most or all of their life. This questionnaire asks about the child’s development from birth to the present to assist with the ADHD assessment process. It includes a standardised SNAP-IV screening tool.

General Information

Child's Name:(Required)

Date of Birth:(Required)

Name(s) of Parent(s) / Main Carer(s):(Required)

Name of Person Completing This Questionnaire:(Required)

Parent / Family History

Names and ages of biological parents:(Required)

Occupations of biological parents:(Required)

Is the mother currently employed?(Required)

Is the father currently employed?(Required)

Medical history for yourself and your extended family (physical and psychological health, e.g., heart problems, blood pressure issues, thyroid problems, liver/kidney disease, tics/Tourette syndrome, epilepsy, glaucoma, substance misuse, depression, or other mental health conditions):(Required)

Did you or your partner experience any learning, behavioural, attention, social, or emotional difficulties at school?(Required)

Education or training after age 16 (college, apprenticeships, university):(Required)

Have any blood relatives experienced problems at school?(Required)

List details of the child’s brothers and sisters, including half-siblings:(Required)

Concerns about any of the above children (educational, social, medical, safeguarding):(Required)

Are you responsible for caring for anyone else not listed above?(Required)

Have there been any upsetting or traumatic events for you or your children (e.g., bereavement, illness, domestic violence, separation)?(Required)

Have there been any child protection concerns or social services involvement?(Required)

Are there any concerns about your housing?(Required)

Child’s Medical and Developmental History

Has your child had illnesses requiring frequent GP or hospital visits?(Required)

History of asthma or eczema:(Required)

Ear infections or hearing difficulties:(Required)

Vision problems (including glaucoma):(Required)

Skin markings, rashes, or bumps:(Required)

Heart or chest problems (including fainting or blackouts):(Required)

Blood pressure concerns:(Required)

Thyroid problems:(Required)

Liver or kidney problems:(Required)

Epilepsy:(Required)

Blood disorders:(Required)

Tics or Tourette syndrome:(Required)

Any visits to Accident and Emergency (reason and age):(Required)

Prescribed medicines (past and present, with reasons):(Required)

Over-the-counter medicines used:(Required)

Complementary medicines (herbal, vitamins, fish oils, etc.):(Required)

History of illicit substance or alcohol use:(Required)

Allergic reactions to medicines or foods:(Required)

Current overall health status:(Required)

Pregnancy and Birth

Medicines, drugs, or alcohol consumed during pregnancy:(Required)

Number of cigarettes smoked per day during pregnancy:(Required)

Complications during pregnancy or after delivery (e.g., special care admission):(Required)

Was the pregnancy full term? If not, how many weeks early?(Required)

Birth weight:(Required)

Postnatal depression or low mood after birth:(Required)

Early Development and Behaviour

Was your child an easy, affectionate baby?(Required)

Did they make good eye contact?(Required)

When did they first smile?(Required)

Did your child establish a good sleep and feeding routine?(Required)

Any early sleep, feeding, or crying difficulties?(Required)

Were they happy to separate from you as a baby?(Required)

Did you bond easily with your child?(Required)

Any developmental concerns?(Required)

Delays in speech or language?(Required)

Use of gestures, signs, pointing, facial expressions to communicate:(Required)

Difficulty with potty training:(Required)

Regression of skills:(Required)

Motor skills difficulties (shoelaces, handwriting, bike riding, cutlery use):(Required)

Age when child held out hands to be picked up:(Required)

Did your child copy your activities as a toddler?(Required)

Did they point to objects of interest?(Required)

Play preferences (alone or with others):(Required)

Games/toys/activities enjoyed:(Required)

Pretend play examples:(Required)

Attendance at playgroup/nursery (age started):(Required)

Ease of separation from carers at nursery:(Required)

Nursery staff comments on behaviour:(Required)

Concerns about language development:(Required)

When did you first notice differences in behaviour compared to peers?(Required)

Specific behaviours or patterns that raised concerns:(Required)

Current Behaviour and Concerns

Main current concerns (including triggers and patterns):(Required)

Inattention:(Required)

Hyperactivity:(Required)

Impulsivity:(Required)

Emotional regulation:(Required)

Mood patterns:(Required)

Factors that improve the situation:(Required)

Factors that make the situation worse:(Required)

Relationship between behaviour and mood/anxiety(Required)

Behaviour management strategies tried:(Required)

Dietary preferences and dislikes:(Required)

Ability to eat with others:(Required)

Independence in dressing:(Required)

Current sleep patterns and difficulties:(Required)

Bedtime and wake time:(Required)

Night waking, nightmares, or bedwetting:(Required)

Strengths, hobbies, interests:(Required)

Least enjoyed activities:(Required)

Special interests or intense hobbies:(Required)

Relationship with siblings:(Required)

Friendships and social skills:(Required)

Friend group patterns and stability:(Required)

Peer age differences and reasons:(Required)

Invitations to social activities:(Required)

Relationships with adults:(Required)

Aggressive behaviours and triggers:(Required)

Explosive temper outbursts and triggers:(Required)

Sadness or tearfulness compared to peers:(Required)

Difficulty with change or compromise:(Required)

Awareness of others’ emotions/health:(Required)

Ability to sit still when required:(Required)

Ability to follow multi-step instructions:(Required)

School Concerns

Name of child’s school:(Required)

School contact telephone number:(Required)

School contact email address:(Required)

Asked to collect child before end of school due to behaviour:(Required)

Official exclusions (details if yes):(Required)

School concerns – learning:(Required)

School concerns – behaviour:(Required)

School concerns – relationships with peers:(Required)

Support strategies in place at school:(Required)

Suggestions for further support:(Required)

Parent concern rating (1–10):(Required)

Child’s self-rating of trouble at home (1–10):(Required)

Child’s self-rating of trouble at school (1–10):(Required)

Other concerns not yet mentioned:(Required)

SNAP-IV: Inattention

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities(Required)

Often has difficulty sustaining attention in tasks or play activities(Required)

Often does not seem to listen when spoken to directly(Required)

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties(Required)

Often has difficulty organizing tasks and activities(Required)

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework)(Required)

Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)(Required)

Often is distracted by extraneous stimuli(Required)

Often is forgetful in daily activities(Required)

SNAP-IV: Hyperactivity / Impulsivity

Often fidgets with hands or feet or squirms in seat(Required)

Often leaves seat in classroom or in other situations in which remaining seated is expected(Required)

Often runs about or climbs excessively in situations in which remaining seated is expected(Required)

Often has difficulty playing or engaging in leisure activities quietly(Required)

Often is 'on the go' or often acts as if 'driven by a motor'(Required)

Often talks excessively(Required)

Often blurts out answers before questions have been completed(Required)

Often has difficulty awaiting turns(Required)

Often interrupts or intrudes on others (e.g., butts into conversations/games)(Required)

SNAP-IV: Opposition / Defiance

Often loses temper(Required)

Often argues with adults(Required)

Often actively defies or refuses adult requests or rules(Required)

Often deliberately does things that annoy other people(Required)

Often blames others for his or her mistakes or misbehaviour(Required)

Often is touchy or easily annoyed by others(Required)

Often is angry or resentful(Required)

Often is spiteful or vindictive(Required)

Clinician Name(Required)

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