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#2 NEW PATIENT- ADHD assessment

Instructions: Please read examples provided for each section, and rate how accurate the examples describe your actions in your daily life. You do not need to answer each question individually.

1. Carelessness

Do you make a lot of mistakes (in school or work)? Is this because you?re careless?

Do you rush through work or activities?

Do you rush through work or activities?

Do you have trouble with detailed work?

Do you not check your work?

Do people complain that you are careless?

Are you messy or sloppy?

Is your desk or work space so messy that you have difficulty finding things?

2. Difficulty sustaining attention in activities

Do you have trouble paying attention when watching movies, reading, or attending lectures?

Is it hard for you to keep your mind on school or work?

Do you have unusual trouble staying focused on boring or repetitive tasks?

Does it take a lot longer than it should to complete tasks because you can?t keep your mind on the task? Is it even harder for you than some others you know?

Do you have trouble remembering what you read and do you need to re-read the same passage several times?

3. Doesn't listen

Do people (spouse, boss, colleagues, friends) complain that you don?t seem to listen or respond (or daydream) when spoken to or when asked to do tasks? A lot?

Do people have to repeat directions?

Do you find that you miss the key parts of conversations because of drifting off in your own thoughts? Does it cause problems?

4. No follow through

Do you have trouble finishing things (such as work or chores)?

Do you often leave things half done and start another project?

Do you need consequences (such as deadlines) to finish?

5. Can't organize

Do you have trouble following instructions (especially complex, multistep instructions that have to be done in a certain order with different steps)?

Do you need to write down instructions, otherwise you will forget them?

Do you have trouble organizing tasks into ordered steps?

Is it hard prioritizing work and chores?

Do you need others to plan for you?

Do you have trouble with time management? Does it cause problems?

Does difficulty in planning lead to procrastination and putting off tasks until the last moment possible?

6. Avoids/dislikes tasks requiring sustained mental effort

Do you avoid tasks (work, chores, reading, board games) that are challenging or lengthy because it?s hard to stay focused on these things for a long time?

Do you have to force yourself to do these tasks? How hard is it?

7. Loses important items

Do you lose things (eg, important work papers, keys, wallet, coats, etc)? A lot? More than others?

Are you constantly looking for important items?

Do you get into trouble for this (at work or at home)?

Do you need to put items (eg, glasses, wallet, keys) in the same place each time, otherwise you will lose them?

8. Easily distractable

Are you ever very easily distracted by events around you such as noise (conversation, TV, radio), movement, or clutter?

Do you need relative isolation to get work done?

Can almost anything get your mind off of what you are ding, such as work, chores, or if you're talking to someone?

Is it hard to get back to task once you stop?

9. Forgetful in daily activities

Do you forget a lot of things in your daily routine? Like what? Chores? Work? Appointments or obligations?

Do you forget to bring your things to work, such as work materials or assignments due that day?

Do you need to write regular reminders to yourself to do most activities or tasks, otherwise you will forget?

10. Squirms and fidgets

Can you sit still or are you always moving your hands or feet, or fidgeting in your chair?

Do you tap your pencil or your feet a lot? Do people notice?

Do you regularly play with your hair or clothing?

Do you consciously resist fidgeting or squirming?

11. Can't stay seated

Do you have trouble staying in your seat? At work? In class? At home while watching TV or eating dinner? In church or temple?

Do you chose to walk rather than sit?

Do you have to force yourself to stay seated?

Is it difficult for you to sit through a meeting or lecture?

Do you avoid going to functions that require you to sit for long periods of time?

12. Runs/climbs excessively

Are you physically restless?

Do you frequently feel restless inside?

Do yu feel agitated when you cannot exercise on an almost daily basis?

13. Can't play or work quietly

Do you have a hard time playing/working quietly?

During leisure activity (nonstructured times or on your own such as reading a book, listening to music, playing a board game), are you agitated or dysphoric?

Do you always need to be busy after work or while on vacation?

14. "On the go" or "driven by a motor"

Do you feel like you have a lot of energy and always have to be moving and are always "on the go"?

Is it hard for you to slow down?

Do you feel like you are driven by a motor?

Do you feel unable to relax?

15. Talks excessively

Do you talk a lot? All the time? More than other people?

Do people complain about your talking? Is it a problem?

Are you often louder than the other people you are talking to?

16. Blurts out answers

Do you give answers to questions before someone finishes asking?

Do you say things before its your turn?

Do you say things that don't fit into the conversation?

Do you say or do things without thinking? A lot?

17. Can't wait for turn

Is it hard for you to wait your turn (in conversation, lines, while driving?)

Are you frequently frustrated with delays? Does it cause problems?

Do you put a great deal of effort into planning to not be in situations where you might have to wait?

18. Rude/interrupts others

Do you talk when others are asking, without waiting until you are acknowledged?

Do you butt into others conversations before being invited?

Do you interrupt others activities?

Is it hard for you to wait to get your point across in conversations or at meetings?

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