Adult ADHD Diagnosis Quick-Check

Adult ADHD Diagnosis Quick-Check
Name *

First Name Last Name
Date *

Month Day Year
Date
Current ADHD Symptoms
For each question, please check "yes" if this behavior has occurred often (frequently or more often than in other people of your age group) during the last six months.

Do you: *

	Yes	No
Often make decisions impulsively?
Often have difficulty stopping activities or behavior when you should do so?
Often start projects or tasks without reading or listening to directions carefully?
Often have poor follow-through on promises?
Often have trouble doing things in proper order?
Often drive with excessive speed?
Often become easily distracted by extraneous stimuli?
Often have difficulty sustaining attention in tasks or leisure activities?
Often have difficulty organizing tasks and activities?

Now, add up your "yes" answers and enter the total of Current ADHD Symptoms here: *
Areas of Impairment
If you answered yes to any of the questions above, did these problems interfere significantly with your ability to function as well as others in the following areas? Please check all that apply:
In your:

Occupation or job Social life Educational activities
Please enter the number of checked Areas of Impairment here: *
Recall of Childhood Behavior
Think back to when you were between the ages of 5 and 12 years old. Please answer yes or no to whether the following difficulties occurred often for you when you were a child.

When you were a child, did you: *

	Yes	No
Often fail to give close attention to details or make careless mistakes in your work?
Often have difficulty sustaining attention in tasks or fun activities?
Often feel restless?
Often avoid, dislike, or were reluctant to engage in work that required sustained mental effort?
Often forget things in your daily activities?
Often interrupt or intrude on others?

Now, add up your "yes" answers and enter the total number of Childhood Behaviors here: *
For office use only

Scoring:

Does the patient have 6 or more current symptoms of ADHD?

AND Does the patient have 4 or more childhood symptoms of ADHD?

AND Does the patient have 2 or more areas of life impairment?

If yes to all above, they have an 87% chance of having ADHD, a 0% chance of being classified as normal without any disorder, and a 13% chance of having a psychiatric disorder other than ADHD.
Should be Empty:

Current ADHD Symptoms