PANDA - Adult ADHD Self-Report Scale

Adult ADHD Self-Report Scale

(ASRS-v1.1) Symptom Checklist
Name:*

FirstLast
Date of Birth:*

MonthDayYear
Date
DIRECTIONS: Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months.
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
NeverRarelySometimesOftenVery Often
Should be Empty: