Children Mind Questionnaire 940 E. El Camino Real Sunnyvale, CA 94087 harminder@homeopathicvibes.com www.homeopathicvibes.com Office Phone (408)737-7100 Office Fax (408)737-7102 Name *FirstLastEmail *Phone At home and school I find my mind wandering from tasks that are uninteresting or difficultNot at allJust a littleSome whatModeratelyQuite a lotVery much I find it difficult to read written material unless it is very interesting or very easyNot at allJust a littleSome whatModeratelyQuite a lotVery much Especially in groups, I find it hard to stay focused on what is being said in conversationsNot at allJust a littleSome whatModeratelyQuite a lotVery much I have a quick temper... a short fuse.Not at allJust a littleSome whatModeratelyQuite a lotVery much I am irritable, and get upset by minor annoyances.Not at allJust a littleSome whatModeratelyQuite a lotVery much I say things without thinking and later regret having said them. Not at allJust a littleSome whatModeratelyQuite a lotVery much I make quick decisions without thinking enough about their possible bad results. Not at allJust a littleSome whatModeratelyQuite a lotVery much My relationships with people are made difficult by my tendency to talk first and think later. Not at allJust a littleSome whatModeratelyQuite a lotVery much My moods have highs and lowsNot at allJust a littleSome whatModeratelyQuite a lotVery much I have trouble planning in what order to do a series of tasks or activities.Not at allJust a littleSome whatModeratelyQuite a lotVery much I easily become upset. Not at allJust a littleSome whatModeratelyQuite a lotVery much I seem to be thin skinned and many things upset me. Not at allJust a littleSome whatModeratelyQuite a lotVery much I almost always am on the goNot at allJust a littleSome whatModeratelyQuite a lotVery much I am more comfortable when moving than when sitting still.Not at allJust a littleSome whatModeratelyQuite a lotVery much In conversations, I start to answer questions before the questions have been fully asked?Not at allJust a littleSome whatModeratelyQuite a lotVery much I usually work on more than one project at a time, and fail to finish many of them.Not at allJust a littleSome whatModeratelyQuite a lotVery much There is a lot of “static” or “chatter” in my headNot at allJust a littleSome whatModeratelyQuite a lotVery much Even when sitting quietly, I am usually moving my hands or feetNot at allJust a littleSome whatModeratelyQuite a lotVery much In group activities it is hard for me to wait my turn. Not at allJust a littleSome whatModeratelyQuite a lotVery much My mind gets so cluttered that it is hard for it to function. Not at allJust a littleSome whatModeratelyQuite a lotVery much My thoughts bounce around as if my mind is a pinball machine. Not at allJust a littleSome whatModeratelyQuite a lotVery much My brain feels as if it is a television set with all the channels going at once.Not at allJust a littleSome whatModeratelyQuite a lotVery much I am unable to stop daydreamingNot at allJust a littleSome whatModeratelyQuite a lotVery much I am distressed by the disorganized way my brain worksNot at allJust a littleSome whatModeratelyQuite a lotVery much CommentSubmit