Partner report

CURRENT BEHAVIOUR SCALE – PARTNER REPORT

Instructions
Please circle the number next to each item that best describes your partner’s behaviour
DURING THE PAST 6 MONTHS

Items: Never or
Rarely Sometimes Often Very Often

1. Fails to give close attention to details or 0 1 2 3

make careless mistakes in work

2. Fidgets with hands or feet or squirm in seat 0 1 2 3

3. Has difficulty sustaining attention in tasks or 0 1 2 3

fun activities

4. Leaves seat in situations in which sitting is 0 1 2 3

expected

5. Appears not to listen when spoken to 0 1 2 3

directly

6. Appears restless 0 1 2 3

7. Does not follow through on instructions and 0 1 2 3

fails to finish work

8. Has difficulty engaging in leisure activities 0 1 2 3

or doing fun things quietly

9. Has difficulty organising tasks and activities 0 1 2 3

10. Appears to be “on the go all the time ” or as 0 1 2 3

if “driven by a motor”

11. Avoids, dislikes, or is reluctant to engage in 0 1 2 3

work that requires sustained mental effort

12. Talk excessively 0 1 2 3

13. Loses things necessary for tasks or activities 0 1 2 3

14. Blurts out answers before questions have 0 1 2 3

been completed

15. Easily distracted 0 1 2 3

16. Has difficulty awaiting turn 0 1 2 3

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17. Forgetful in daily activities 0 1 2 3

18. Interrupts or intrude on others 0 1 2 3

To what extent do the problems you may have circled on the previous page interfere with
your partner’s ability to function in each of these areas of life activities?

Areas: Never or Sometime Often Very

Rarely s Often

In his/her home life with immediate family 0 1 2 3

In his/her work or occupation 0 1 2 3

In his/her social interactions with others 0 1 2 3

In his/her activities or dealings in the community 0 1 2 3

In any educational activities 0 1 2 3

In your dating or marital relationship 0 1 2 3

In his/her management of money 0 1 2 3

In his/her ability to drive a motor vehicle 0 1 2 3

In his/her leisure or recreational activities 0 1 2 3

In his/her management of daily responsibilities 0 1 2 3

Partner report