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Home
About
Specialties
ADD/ADHD Counseling, Therapy or Coaching
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Physical Health Links
Blog
GET STARTED NOW
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Home
About
Specialties
ADD/ADHD Counseling, Therapy or Coaching
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Physical Health Links
Blog
roger@doctorlavine.com
|
(954) 716-6702
BAARS IV Other Report Online Test
Step
1
of
10
0%
General Information
Your full name
First
Last
Full name of person being rated
First
Last
Email
*
Phone
*
Your relationship to person being rated?
*
Mother
Father
Brother/sister
Spouse/Partner
Friend
PART 1
CURRENT SYMPTOMS
You are being asked to describe the behavior of someone whom you know well. How often does that person experience each of these problems?
For the next 18 items, please select the option that best describes the person’s behavior
DURING THE PAST 6 MONTHS.
Section 1 - Inattention
1. Fails to give close attention to details or makes careless mistakes in his/her work or other activities
*
Never or Rarely
Sometimes
Often
Very Often
Question one
Q1 is symptom
2. Has difficulty sustaining his/her attention in tasks or fun activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is symptom
3. Doesn’t listen when spoken to directly
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is symptom
4. Doesn’t follow through on instructions and fails to finish work or chores
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is symptom
5. Has difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 5
Q5 is symptom
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
*
Never or Rarely
Sometimes
Often
Very Often
Question 6
Q6 is symptom
7. Loses things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 7
Q7 is symptom
8. Is easily distracted by extraneous stimuli or irrelevant thoughts
*
Never or Rarely
Sometimes
Often
Very Often
Question 8
Q8 is symptom
9. Is forgetful in daily activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 9
Q9 is symptom
Hidden
Total Section 1
Hidden
Section 1 Symptom Count
Great job! You've completed section 1.
Please click the next button to continue with section 2
Section 2 - Hyperactivity
10. Fidgets with hands or feet or squirms in seat
*
Never or Rarely
Sometimes
Often
Very Often
Question 10
Q10 is symptom
11. Leaves his/her seat in classrooms or in other situations in which remaining seated is expected
*
Never or Rarely
Sometimes
Often
Very Often
Question 11
Q11 is symptom
12. Shifts around excessively or feels restless or hemmed in
*
Never or Rarely
Sometimes
Often
Very Often
Question 12
Q12 is symptom
13. Has difficulty engaging in leisure activities quietly (feels uncomfortable, or is loud or noisy)
*
Never or Rarely
Sometimes
Often
Very Often
Question 13
Q13 is symptom
14. Is “on the go” or act as if “driven by a motor” (or he/she feels like he/she has to be busy or always doing something)
*
Never or Rarely
Sometimes
Often
Very Often
Question 14
Q14 is symptom
Hidden
Total Section 2
Hidden
Total symptoms section 2
Awesome! You've completed section 2.
Please click the next button to continue with section 3
Section 3 - Impulsivity
15. Talks excessively (in social situations)
*
Never or Rarely
Sometimes
Often
Very Often
Question 15
Q15 is symptom
16. Blurts out answers before questions have been completed, completes others’ sentences, or jumps the gun
*
Never or Rarely
Sometimes
Often
Very Often
Question 16
Q16 is symptom
17. Has difficulty awaiting his/her turn
*
Never or Rarely
Sometimes
Often
Very Often
Question 17
Q17 is symptom
18. Interrupts or intrudes on others (butts into conversations or activities without permission or takes over what others are doing)
*
Never or Rarely
Sometimes
Often
Very Often
Question 18
Q18 is symptom
Hidden
Total Section 3
Hidden
Total Symptoms section 3
Way to go! You've completed section 3.
Please click the next button to continue with section 4
19. Did this person experience any of these 18 symptoms at least “Often” or more frequently (Did you circle a 3 or a 4 above)?
*
Yes
No
How old was the person when those symptoms began?
Did this person experience any of these 18 symptoms at least “Often” or more frequently (Did you circle a 3 or a 4 above)?
*
School
Home
Work
Social Relationships
School
Please provide examples
Home
Please provide examples
Work
Please provide examples
Social Relationships
Please provide examples
Hidden
Part 1 - Total score for entire scale
Hidden
Sum of Sections Raw Scores 1 – 3
Hidden
Sum of Sections 1 - 3 Symptom Counts
PART 1 FINISHED
Please click the next button to start part 2
PART 2
CHILDHOOD SYMPTOMS
You are being asked to describe the behavior of someone whom you know well. How often did that person experience each of these problems?
For the next 18 items, please select the option that best describes their behavior when they were a child
BETWEEN 5 AND 12 YEARS OF AGE.
Section 1 - Inattention
1. Failed to give close attention to details or made careless mistakes in his/her work or other activities
*
Never or Rarely
Sometimes
Often
Very Often
Question one
Q1 is symptom
2. Had difficulty sustaining his/her attention in tasks or fun activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is symptom
3. Didn’t listen when spoken to directly
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is symptom
4. Didn’t follow through on instructions and failed to finish work or chores.
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is symptom
5. Had difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 5
Q5 is symptom
6. Avoided, disliked, or was reluctant to engage in tasks that required sustained mental effort
*
Never or Rarely
Sometimes
Often
Very Often
Question 6
Q6 is symptom
7. Lost things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 7
Q7 is symptom
8. Was easily distracted by extraneous stimuli or irrelevant thoughts.
*
Never or Rarely
Sometimes
Often
Very Often
Question 8
Q8 is symptom
9. Was forgetful in daily activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 9
Q9 is symptom
Hidden
Total Part 2 Section 1
Hidden
Total symptoms Part 2 Section 1
Great job! You've completed section 1.
Please click the next button to continue with section 2
Section 2 - Hyperactivity-Impulsivity
10. Fidgeted with his/her hands or feet or squirmed in his/her seat
*
Never or Rarely
Sometimes
Often
Very Often
Question 10
Q10 is symptom
11. Left his/her seat in classrooms or in other situations in which remaining seated was expected
*
Never or Rarely
Sometimes
Often
Very Often
Question 11
Q11 is symptom
12. Shifted around excessively or felt restless or hemmed in
*
Never or Rarely
Sometimes
Often
Very Often
Question 12
Q12 is symptom
13. Had difficulty engaging in leisure activities quietly (felt uncomfortable, or was loud or noisy)
*
Never or Rarely
Sometimes
Often
Very Often
Question 13
Q13 is symptom
14. Was “on the go” or acted as if “driven by a motor”
*
Never or Rarely
Sometimes
Often
Very Often
Question 14
Q14 is symptom
15. Talked excessively
*
Never or Rarely
Sometimes
Often
Very Often
Question 15
Q15 is symptom
16. Blurted out answers before questions had been completed, completed others’ sentences, or jumped the gun
*
Never or Rarely
Sometimes
Often
Very Often
Question 16
Q16 is symptom
17. Had difficulty awaiting his/her turn
*
Never or Rarely
Sometimes
Often
Very Often
Question 17
Q17 is symptom
18. Interrupted or intruded on others (butted into conversations or activities without permission or took over what others were doing)
*
Never or Rarely
Sometimes
Often
Very Often
Question 18
Q18 is symptom
Hidden
Part 2 Total Section 2
Hidden
Part 2 Total symptoms section 2
Awesome! Only one more step to go
Please click the next button to answer the last questions
19. Did the person experience any of these 18 symptoms at least “Often” or more frequently (Did you circle a 3 or a 4 above)?
*
Yes
No
In which of these settings did those symptoms impair the person’s functioning? Place a check mark (ü) next to all of the areas that apply to the person.
*
School
Home
Social Relationships
School
Please provide examples
Home
Please provide examples
Social Relationships
Please provide examples
Hidden
Part 2 - Total score for entire scale
Hidden
Sum of Sections 1 – 2 for Total Scores
Hidden
Sum of Sections 1 – 2 for Symptom Counts
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BAARS IV Self Report Online Test
DASS 42 ONLINE TEST
2881 East Oakland Park Blvd.
Fort Lauderdale, FL 33306
roger@doctorlavine.com
(954) 716-6702
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