Executive Functioning questionnaire (Parental Version)
Please note that all information submitted via this form is strictly confidential and stored securely.
Adapted from Smart but Scattered Teens (Guare, R. & Dawson, P. (2013). Smart but scattered teens. Guilford Press, NY)
Rate each item below based on how well it describes your teen, using this rating scale to choose the appropriate score:
  • 1 Strongly disagree
  • 2 Disagree
  • 3 Tend to disagree
  • 4 Neutral
  • 5 Tend to agree
  • 6 Agree
  • 7 Strongly agree
NB: Please total each subsection separately (i.e. each subsection should have a score out of 21)

Item

My teen...

Score

1
Acts on impulse.
2
Gets in trouble for talking too much in class.
3
Says things without thinking them through.

Sub-total

4
Says, “I’ll do it later”, then forgets about it.
5
Forgets homework assignments or forgets to bring home needed materials.
6
Loses or misplaces belongings such as jerseys, sports equipment, homework diaries, etc.

Sub-total

7
Gets annoyed or flustered when homework is too hard/confusing/takes too long to finish.
8
Has a short fuse or is easy frustrated.
9
Is easily upset when things don’t go as planned.

Sub-total

10
Has trouble thinking of a different solution to a problem if the first one doesn’t work.
11
Resists change in plans or routine.
12
Has problems with open-endeed homework assignments (i.e. doesn’t know what to write about when given a creative writing assignment).

Sub-total

13
Has difficulty paying attention – is easily distracted.
14
Runs out of steam before finishing homework or other tasks.
15
Has difficulty sticking with homework or chores until they are finished.

Sub-total

16
Puts off homework/chores/assignments until the last minute.
17
Has difficulty setting aside fun activities to start homework.
18
Needs many reminders to start chores/homework.

Sub-total

19
Has trouble planning how to approach big assignments (i.e., knowing what to do first, second, etc).
20
Has difficulty setting priorities when there is lots to do.
21
Becomes easily overwhelmed by big assignments or long-term projects.

Sub-total

22
Has disorganized schoolbag and notes.
23
Leaves desk messy.
24
Has difficulty keeping bedroom tidy.

Sub-total

25
Has a hard time estimating how long it takes to do something (i.e., homework, projects).
26
Often doesn’t finish homework at night, and rushes to get it done before school starts.
27
Is slow getting ready for things (i.e. appointments, sport, etc).

Sub-total

28
Has difficulty saving up money for a desired object (problem with delaying instant gratification).
29
Doesn’t see the value in earning good grades to achieve a long-term goal (i.e. university entrance/job).
30
Difficulty looking into the future (more concerned with present concerns).

Sub-total

31
Lacks effective study strategies.
32
Doesn’t check work for mistakes even when the stakes are high.
33
Doesn’t evaluate performance and change tactics to increase success.

Sub-total