Life Domain/My Value  A B C

Importance Rating ac- ST = short term goals

of this cording to LT = long term goals
value my actual
1-10 behavior
1-10

Health/Well-Being ST:

LT:

Intimate Relationship ST:

LT:

Parenting ST:

LT:

Family Relationships ST:

LT:

Friendship/Social ST:

LT:

Career/Work ST:

LT:
 Life Domain/My Value  A B C
Importance Rating ac- ST = short term goals
of this cording to LT = long term goals
value my actual
1-10 behavior
1-10

Education/Personal ST:
Growth

LT:

Recreation/Leisure ST:

LT:

Spirituality ST:

LT:

Citizenship ST:

LT:

This table accompanies the book The Mindfulness Prescription for Adult ADHD by
Lidia Zylowska, MD, copyright © 2012. Published by Trumpeter Books, an imprint of
Shambhala Publications. Please use this material for your own personal use only.