BAARS-IV OTHER-REPORT CURRENT ONLY

BAARS-IV CURRENT OTHER-REPORT

Current Symptoms
Date

Month Day Year
Date
Name of Person Being Rated (the client)

First Name Last Name
Name of Person Completing Form (your name)

First Name Last Name
Your relationship to the person being rated:

Mother Father Brother/Sister Spouse/Partner Friend Coworker Other

You are being asked to describe the behavior of someone whom you know well. How often does that person experience each of these problems? Please check the circle next to each item below that best describes the person’s behavior DURING THE PAST 6 MONTHS.

	Never or Rarely;	Sometimes;	Often;	Very Often;
Fails to give close attention to details or makes careless mistakes in work or other activities:
Difficulty sustaining attention in tasks or fun activities:
Doesn't listen when spoken to directly:
Doesn't follow through on instructions and fails to finish work or chores:
Has difficulty organizing tasks and activities:
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort:
Loses things necessary for tasks or activities:
Easily distracted by extraneous stimuli or irrelevant thoughts:
Forgetful in daily activities:
Fidgets with hands or feet or squirms in seat:
Leaves seat in classrooms or in other situations in which remaining seated is expected:
Shifts around excessively or feels restless or hemmed in:
Has difficulty engaging in leisure activities quietly (feels uncomfortable, or is loud or noisy):
Is “on the go” or act as if “driven by a motor” (or feels like they have to be busy or always doing something):
Talks excessively (in social situations):
Blurts out answers before questions have been completed, completes others’ sentences, or jumps the gun:
Has difficulty awaiting their turn:
Interrupts or intrudes on others (butts into conversations or activities without permission or takes over what others are doing):
Prone to daydreaming when should have been concentrating on something or working:
Has trouble staying alert or awake in boring situations:
Easily confused:
Easily bored:
Spacey or “in a fog”:
Lethargic, more tired than others:
Underactive or has less energy than others:
Slow moving:
Doesn't seem to process information as quickly or as accurately as others:

Did this person experience any of these 27 symptoms at least “Often” or more frequently?

Yes No
If so, how old was this person when these symptoms began? blank years old.
If so, in which of these settings did those symptoms impair their functioning? Place a check mark next to all of the areas that apply.

School Home Work Social Relationships
If you checked any of the domains indicating settings in which symptoms impair this person's functioning, please provide examples of their current difficulties in the appropriate spaces below.
School:
Home:
Work:
Social Relationships:
Inattention Score
Hyperactive Impulsivity Score
Should be Empty:

BAARS-IV CURRENT OTHER-REPORT