Assessment of Executive Functioning (BDEFS-CA) Date MM slash DD slash YYYY Name of Person Completing Form(Required) First Last Relationship to the Student Email(Required) Enter Email Confirm Email Student's Name(Required) First Last Birth Date MM slash DD slash YYYY Birth Gender (This is a relevant marker for scoring this assessment) Instructions: How often does your child experience each of these problems? Please check the best answer to each item that best describes his/her behavior DURING THE PAST 6 MONTHS. If your child is currently taking medications for any psychiatric or psychological disorder, please rate his/her behavior based on how he/she acts while OFF THE MEDICATION. From Barkley Deficits in Executive Functioning Scale – Children and Adolescents (BDEFS-CA) by Russell A. Barkley. Section OneEF1. Procrastinates or puts off doing things until the last minute Never or Rarely Sometimes Often Very Often EF2. Has a poor sense of time Never or Rarely Sometimes Often Very Often EF3. Wastes or doesn’t manage his/her time well Never or Rarely Sometimes Often Very Often EF4. Not prepared/on time for schoolwork or assigned tasks given at home Never or Rarely Sometimes Often Very Often EF5. Has trouble planning ahead or preparing for upcoming events Never or Rarely Sometimes Often Very Often EF6. Can’t seem to accomplish the goals he/she sets for him/herself Never or Rarely Sometimes Often Very Often EF7. Not able to get things done unless there is an immediate deadline or consequence(s) Never or Rarely Sometimes Often Very Often EF8. Has difficulty judging how much time it will take to do something or get somewhere Never or Rarely Sometimes Often Very Often EF9. Has trouble starting the work he/she is asked to do Never or Rarely Sometimes Often Very Often EF10. Has difficulty sticking with his/her work and getting it done Never or Rarely Sometimes Often Very Often EF11. Not able to prepare in advance for things he/she knows he/she is supposed to do Never or Rarely Sometimes Often Very Often EF12. Has trouble following through on what he/she agrees to do Never or Rarely Sometimes Often Very Often EF13. Has difficulty doing the work he/she is asked to do in the order of its priority or importance; can’t “prioritize” well Never or Rarely Sometimes Often Very Often Section TwoEF14. When shown something complicated to do, he/she cannot keep it in mind so as to do it correctly Never or Rarely Sometimes Often Very Often EF15. Has trouble considering various ways of doing things Never or Rarely Sometimes Often Very Often EF16. Has difficulty saying what he/she wants to say Never or Rarely Sometimes Often Very Often EF17. Unable to come up with or invent as many solutions to problems as others Never or Rarely Sometimes Often Very Often EF18. At a loss for words when he/she wants to explain something Never or Rarely Sometimes Often Very Often EF19. Has trouble explaining his/her ideas as well or as quickly as others Never or Rarely Sometimes Often Very Often EF20. Not as creative or inventive as others of his/her age Never or Rarely Sometimes Often Very Often EF21. Has trouble learning new or complex activities Never or Rarely Sometimes Often Very Often EF22. Has difficulty explaining things in their proper order or sequence Never or Rarely Sometimes Often Very Often EF23. Can’t seem to get to the point of his/her explanations Never or Rarely Sometimes Often Very Often EF24. Has trouble doing things in his/her proper order or sequence Never or Rarely Sometimes Often Very Often EF25. Unable to “think on his/her feet,” problem-solve, or respond effectively to unexpected events Never or Rarely Sometimes Often Very Often EF26. Slow at solving problems he/she encounters in his/her daily life Never or Rarely Sometimes Often Very Often EF27. Doesn’t seem to process information quickly or accurately Never or Rarely Sometimes Often Very Often Section ThreeEF28. Has difficulty waiting for things; has to have things or do things he/she wants right away Never or Rarely Sometimes Often Very Often EF29. Makes decisions impulsively Never or Rarely Sometimes Often Very Often EF30. Unable to inhibit his/her reactions to events or to what others say or do to him/her; reacts on impulse Never or Rarely Sometimes Often Very Often EF31. Has difficulty stopping what he/she is doing when it is time to do so Never or Rarely Sometimes Often Very Often EF32. Has difficulty correcting his/her behavior when he/she is given feedback about his/her mistakes Never or Rarely Sometimes Often Very Often EF33. Makes impulsive comments Never or Rarely Sometimes Often Very Often EF34. Likely to do things without considering the consequences for doing them Never or Rarely Sometimes Often Very Often EF35. Acts without thinking things over Never or Rarely Sometimes Often Very Often EF36. Finds it hard to take another person’s perspective about a problem or situation Never or Rarely Sometimes Often Very Often EF37. Doesn’t stop and talk things over with him/herself before deciding to do something Never or Rarely Sometimes Often Very Often EF38. Has trouble following the rules in a situation Never or Rarely Sometimes Often Very Often EF39. Engages in risky behavior or risk taking Never or Rarely Sometimes Often Very Often EF40. Has trouble with self-discipline (self-control) Never or Rarely Sometimes Often Very Often Section FourEF41. Takes short cuts in his/her chores, schoolwork, or other assignments and does not do all that he/she is supposed to do Never or Rarely Sometimes Often Very Often EF42. Quits working if his/her chores, schoolwork, or other assignments are boring for him/her to do Never or Rarely Sometimes Often Very Often EF43. Does not put much effort into his/her chores, schoolwork or other assignments Never or Rarely Sometimes Often Very Often EF44. Seems lazy or unmotivated Never or Rarely Sometimes Often Very Often EF45. Has to depend on other people to help get his/her chores, schoolwork or other assignments done Never or Rarely Sometimes Often Very Often EF46. Things must have an immediate pay off for him/her or he/she is not able to get them done Never or Rarely Sometimes Often Very Often EF47. Has difficulty resisting the urge to do something fun or more interesting when he/she is supposed to be working Never or Rarely Sometimes Often Very Often EF48. Inconsistent in the quality or quantity of his/her work performance Never or Rarely Sometimes Often Very Often EF49. Unable to work without supervision or frequent instruction Never or Rarely Sometimes Often Very Often EF50. Lacks willpower or self-determination Never or Rarely Sometimes Often Very Often EF51. Not able to work toward longer-term or delayed rewards Never or Rarely Sometimes Often Very Often EF52. Not able to resist doing things that produce immediate rewards even if they are not good for him/her in the long run Never or Rarely Sometimes Often Very Often EF53. Gives up too easily if something requires much effort Never or Rarely Sometimes Often Very Often EF54. Not able to get started in his/her chores, school projects or work without a lot of prodding or encouragement from others Never or Rarely Sometimes Often Very Often Section FiveEF55. Has a low tolerance for frustrating situations Never or Rarely Sometimes Often Very Often EF56. Cannot inhibit his/her emotions Never or Rarely Sometimes Often Very Often EF57. Quick to get angry or become upset Never or Rarely Sometimes Often Very Often EF58. Overreact emotionally Never or Rarely Sometimes Often Very Often EF59. Easily excitable Never or Rarely Sometimes Often Very Often EF60. Not able to inhibit showing strong negative or positive emotions Never or Rarely Sometimes Often Very Often EF61. Has trouble calming him/herself down once he/she is emotionally upset Never or Rarely Sometimes Often Very Often EF62. Not able to be reasonable once he/she is emotional Never or Rarely Sometimes Often Very Often EF63. Cannot seem to distract him/herself away from whatever is upsetting him/her emotionally to help calm down. Can’t refocus his/her mind to a more positive framework Never or Rarely Sometimes Often Very Often EF64. Not able to manage his/her emotions in order to accomplish his/her goals successfully or get along well with others Never or Rarely Sometimes Often Very Often EF65. Remains emotional or upset longer than other children Never or Rarely Sometimes Often Very Often EF66. Finds it difficult to walk away from emotionally upsetting encounters with others or leave situations in which he/she has become emotional Never or Rarely Sometimes Often Very Often EF67. Not able to rechannel or redirect his/her emotions into more positive ways or outlets when he/she gets upset Never or Rarely Sometimes Often Very Often EF68. Not able to evaluate an emotionally upsetting even more objectively or reasonably Never or Rarely Sometimes Often Very Often EF69. Not able to reevaluate or redefine negative events into a more positive viewpoint when he/she feels strong emotions Never or Rarely Sometimes Often Very Often EF70. Emotionally impulsive or quick to show or express his/her feelings Never or Rarely Sometimes Often Very Often