BrainWare Cognitive Rating Scale (13-Adult)

Brain Ware Cognitive Rating Scale (13-Adult)

The purpose of this rating scale is to enable a parent or teacher to evaluate on behaviors that typically relate to cognitive development in key areas. It can also be used by adults to evaluate themselves. Please read each of the statements and rate the individual according to the following scale. After you have rated the individual on all statements, we will calculate a score for this individual in each area. After you complete the form and click “SUBMIT,” you will get an email with a summary of your ratings and results by cognitive area.

Person Performing the Evaluation
Name*
First Name Last Name
Email*
Person Being Evaluated
Name*
First Name Last Name
Age*
Please enter a number from 12 to 101.
Gender*
Date of Evaluation*
MM slash DD slash YYYY

Attention*

	Never/almost never	Seldom	At times	Often	Always/almost always
1. Can sustain attention for appropriate periods of time in routine home, school, work situations
2. Can maintain proper attention even when distractions are present
3. Pays attention to details
4. Listens carefully and makes eye contact when being spoken to
5. Finishes tasks he or she starts
6. Can shift attention easily when moving from one activity to another

Memory*

	Never/almost never	Seldom	At times	Often	Always/almost always
7. Remembers things he/she is asked to do
8. Once he/she learns to do a task, remembers how to do it days or weeks later
9. Remembers the details of a story that he/she hears from someone else
10. When he/she reads a book or sees a movie, can remember the order in which significant events happened
11. Remembers information when he/she makes an effort to learn it (as for a test)
12. Can repeat information he/she just received

Perceptual Processing*

	Never/almost never	Seldom	At times	Often	Always/almost always
13. Does not make a lot of careless errors
14. Can follow a map
15. Can visualize how a room would look if the furniture were moved into different places
16. Can organize visual information into categories
17. Understands and does not get confused when instructions are given
18. Accurately repeats someone’s name when introduced to them

Core Executive Functions*

	Never/almost never	Seldom	At times	Often	Always/almost always
19. Can remember a set of instructions and perform them accurately
20. Can handle tasks that are complex and require significant mental effort without getting frustrated
21. Is able to see a situation from multiple perspectives
22. Does not react impulsively
23. Is able to shift his/her thinking when he/she learns new information
24. Has confidence in his/her learning ability

Higher-Order Executive Functions*

	Never/almost never	Seldom	At times	Often	Always/almost always
25. Uses imagination and creativity
26. Plans ahead and uses forethought
27. Is good at finding solutions to problems
28. Before acting on a situation, takes the potential circumstances of his/her actions into consideration
29. Enjoys taking on challenging tasks
30. Bounces back from failures or setbacks quickly

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