The Vignette of Marcus: Marcus is a 10-year-old boy who has been struggling at school. During the past year he has frequently been distracted in class, and fidgety while in his seat. He often gets into trouble for not paying attention to the teacher, and has difficulty engaging in solitary activities such as reading or taking tests. He gets into trouble in school for talking too much, and for talking out of turn. While at recess, he continues to have difficulties standing still and taking turns. During class time, Marcus has difficulty following instructions and completing his work. He is easily distracted, does not pay attention to details, and frequently leaves his seat to interrupt the work of other students.

Marcus continues to have difficulty at home. He spends the weekdays with his mother and two younger brothers whose ages are 5 and 7. He tries to help with many of the household chores his mother cannot tend to while she is at work full-time, but has difficulty following through. He seems to want to be helpful. He has some difficulty getting along with his brothers, and often will take their toys without asking. On the weekends, Marcus lives with his father, stepmother, his 11-year-old stepsister, and his 3-year-old half-sister. He describes his father and stepmother as being very strict, which causes some difficulty for Marcus. He has difficulties sitting still, which causes significant difficulty when he goes out to dinner or to other events with his father and stepmother.

Marcus' teacher has met with his parents on several occasions to discuss his poor academic progress. She has expressed concern with the level of his academic skills in writing and math, as well as with his ability to control his energy and to 'fit in' with the others in his class. Both the teacher and school principal have recommended counseling for Marcus, and the parents' insurance plan will pay for 10 visits. Marcus' pediatrician has also suggested the possibility of medication.

What score would you document for Marcus, if Marcus' family completed the parent- or guardian-rated Level 1 crosscutting symptom measure? Include the specific information you included when coming up with this score.