KindPilot — 4-Week ADHD Medication Tracking Sheet

Child's First Name (optional)

Age

Medication

Dose

Start Date

How to use this sheet

Fill in one row each evening — it takes under 2 minutes. Rate focus and mood on a 1-5 scale. Circle appetite level. Record sleep hours. Count meltdowns. Note if medication was taken. Add any relevant observations.

Focus/Mood scale: 1 = Very poor 2 = Below average 3 = Average 4 = Good 5 = Excellent

Week 1

Date	Focus (1-5)	Mood (1-5)	Appetite (W/S/B)	Sleep (hours)	Meltdowns (count)	Meds (Y/N/L)	Notes
Mon ___
Tue ___
Wed ___
Thu ___
Fri ___
Sat ___
Sun ___

Week 2

Date	Focus (1-5)	Mood (1-5)	Appetite (W/S/B)	Sleep (hours)	Meltdowns (count)	Meds (Y/N/L)	Notes
Mon ___
Tue ___
Wed ___
Thu ___
Fri ___
Sat ___
Sun ___

Week 3

Date	Focus (1-5)	Mood (1-5)	Appetite (W/S/B)	Sleep (hours)	Meltdowns (count)	Meds (Y/N/L)	Notes
Mon ___
Tue ___
Wed ___
Thu ___
Fri ___
Sat ___
Sun ___

Week 4

Date	Focus (1-5)	Mood (1-5)	Appetite (W/S/B)	Sleep (hours)	Meltdowns (count)	Meds (Y/N/L)	Notes
Mon ___
Tue ___
Wed ___
Thu ___
Fri ___
Sat ___
Sun ___

4-Week Summary (fill before your appointment)

Average Focus (1-5)

Average Mood (1-5)

Total Meltdowns (4 weeks)

Medication Adherence (%)

Average Sleep (hours)

Appetite Trend (better/same/worse)

Key observations / concerns for doctor

Questions for doctor