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Attention Controls Survey

You will read some statements about attention. Decide if your ability to control it is high or low.
Name: 


Four Concentration Controls are listed below. Order them from the one you have the most control over to the one you have the least control over. Only use a number once.
    1 2 3 4
Mood Control  
Motor Control (control over muscles, body, and movement)  
Behavior Control  
Daydreaming Control (your ability to control when you daydream)  


Rate your fine motor control. This is your ability to control your body. Think of being able to write neatly.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your ability to control your moods. This is your control over being too sad or too happy.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your tempo control. This is your ability to do a task at the right pace and not work too quickly.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your ability to control your five senses. This means being able to tune out unimportant sights and sounds.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your behavior control. Thinking before acting.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your daydreaming control. Do you daydream often in school.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your motivation contol. This is your ability to do something that you have to do but don't find exciting like studying for a test in your least favorite class.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your desires control. Your ability to control impulsive wants regarding food, things, objects, and gadgets.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your social control in school. The ability to tune out other kids when you need to concentrate in class.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Four Concentration Controls are listed below. Order them from the one you have the most control over to the one you have the least control over. Only use a number once.
    1 2 3 4
Motivation Control (ability to do things that aren't exciting)  
Tempo Control (doing things at the right rate of speed, not rushing)  
Consistency Control (doing quality work everyday or being up and down)  
Alertness Control (ability to stay awake and not get drowsy)  


Rate your gross motor control. Think of being a good athlete and coordination. Not clumsy.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your consistency control. This is your ability to perform or do a good job time after time. Its lower if you do good one day and poor the next.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your memory control. How good is your memory for remembering important things like what you read, when assignments are do, or when you have a test.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Rate your alertness control in school. This is your ability to stay awake in classes and not feel drowsy.
 
  1 2 3 4 5 6 7 8 9 10  
Low  High


Four Concentration Controls are listed below. Order them from the one you have the most control over to the one you have the least control over. Only use a number once.
    1 2 3 4
Control over the 5 Senses (not paying attention to unimportant things)  
Desires Control (ability to control thoughts about things you want)  
Memory Control (ability to remember important things)  
Social Control (ability to tune out unimportant sights and sounds)  





Mr. Burns
Worthington Middle School
Worthington, MN