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ADHD Daily Progress Monitoring Chart

A Tool for Tracking ADHD Symptoms and Treatment Response

Psychiatry

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date Started: ___________________

Daily Symptom Rating Scale

Rate each item from 0-3 (0 = Not present, 1 = Mild, 2 = Moderate, 3 = Severe)

Attention/Focus

  • Difficulty staying focused on tasks: ___
  • Easily distracted: ___
  • Problems completing assignments/work: ___
  • Forgetfulness in daily activities: ___

Hyperactivity/Impulsivity

  • Fidgeting/restlessness: ___
  • Difficulty staying seated: ___
  • Interrupting others: ___
  • Acting before thinking: ___

Medication Tracking

  • Medication name: ___________________
  • Dose: ___________________
  • Time taken: ___________________

Daily Activities

Sleep Quality (circle one)

Poor | Fair | Good | Excellent

Exercise/Physical Activity

Minutes of activity: ___ Type of activity: ___________________

Mood Rating (1-10): ___

Weekly Goals

Notes

Side effects or concerns: ________________________________ Positive changes observed: ______________________________

Bring this chart to your next appointment with your healthcare provider

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