Client DIVA5 Areas of Functioning Client DIVA5 Areas of Functioning Criterion C Client Code Name: * Date: * (Your code name is the first three letters of your first and last name. For example, John Doe, would have the following code name: JOHDOE). Email: * Phone: * In which areas do you have/have you had problems with these symptoms? ADULTHOOD Work (paid, supported or voluntary)/education or college/day centre Did not complete education/training needed for work Work below level of education/level of intellectual abilities Tire quickly of a workplace Pattern of many short-lasting jobs Difficulty with administrative work/planning Not able to manage in work or college or day centre Disruptive in work or college or day centre Challenging behaviour at home, work, college or daycentre Not achieving promotions Under-performing at work Left work following arguments or dismissal Sickness benefits/disability benefit as a result of symptoms Limited impairment through compensation of external structure OtherOther Relationships and/or family Tire quickly of relationships Fall out with friends/relatives Not been able to manage in different care settings Impulsively commencing/ending relationships Unequal partner relationship owing to symptoms Relationship problems, lots of arguments, lack of intimacy Divorced owing to symptoms Problems with upbringing as a result of symptoms Difficulty with housekeeping and/or administration Financial problems or gambling OtherOther Social contacts Challenging behaviour/behavioural difficulties Tire quickly of social contacts Difficultly maintaining social contacts Conflicts as a result of communication problems Difficulty initiating social contacts Low self-assertiveness as a result of negative experiences Not being attentive (i.e. forget to send a card/empathizing/ phoning, etc) OtherOther Free time/hobbies Unable to relax properly during free time Having to play lots of sports in order to relax Injuries as a result of excessive sport Unable to finish a book or watch a film all the way through Being continually busy and therefore becoming overtired Tire quickly of hobbies Accidents/loss of driving licence as a result of reckless driving behaviour Sensation seeking and/or taking too many risks Contact with the police/the courts Binge eating OtherOther Self-confidence/self-image Frequently needing attention from others or engage in such behaviours Frequently seeking reassurance or engage in such behaviours Uncertainty through negative comments of others Negative self-image due to experiences of failure Fear of failure in terms of starting new things Excessive intense reaction to criticism Perfectionism Distressed by the symptoms of ADHD OtherOther If you are human, leave this field blank. Next Δ
