DIVA (Child)

General Information
QuestionYour notes
Client's Name
Client's Age
Informant
Pronouns
Symptoms of attention-deficit (DSM-5 criterion A1)
QuestionYour notes
A1. Difficulties giving close attention to details and making careless mistakes?
Meets Criteria:
A2. Difficulty sustaining attention during tasks?
Meets Criteria:
A3. Not listening when spoken to directly?
Meets Criteria:
A4. Difficulties following through on instructions?
Meets Criteria:
A5. Difficulties with organising and planning?
Meets Criteria:
A6. Avoid or delay the completion of tasks that require sustained mental effort?
Meets Criteria:
A7. Often losing items necessary for tasks or activities?
Meets Criteria:
A8. Easily distracted by extraneous stimuli?
Meets Criteria:
A9. Often forgetful in daily activities?
Meets Criteria:
Symptoms of Hyperactivity - Impulsivity (DSM-5 criterion A2)
QuestionYour notes
H/I 1. Increased fidgeting?
Meets Criteria:
H/I 2. Difficulties staying seated for long periods of time?
Meets Criteria:
H/I.3 Feeling restless?
Meets Criteria:
H/I 4. Difficulties engaging in leisure activities quietly?
Meets Criteria:
H/I 5. Appearing "on the go" or acting as if "driven by a motor"?
Meets Criteria:
H/A 6. Talking excessively?
Meets Criteria:
H/I 7. Blurting out an answer before questions have been completed?
Meets Criteria:
H/I 8. Difficulties waiting?
Meets Criteria:
H/I 9. Often interrupting or intruding on others?
Meets Criteria:
Domains of Functioning
QuestionYour notes
Work or Education?
Family / Relationships?
Free Time / Hobbies?
Social Contacts?
Self-confidence / Self-image?
Differential Diagnosis
QuestionYour notes
Differential Diagnosis