• ADD / ADHD Questionnaire

    Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
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  • Please answer the questions below, rating yourself on each of the criteria shown using the scale. Select the best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your healthcare professional to discuss during today’s appointment.

  • 1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
  • 2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
  • 3. How often do you have problems remembering appointments or obligations?
  • 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
  • 5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
  • 6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
  • 7. How often do you make careless mistakes when you have to work on a boring or difficult project?
  • 8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
  • 9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
  • 10. How often do you misplace or have difficulty finding things at home or at work?
  • 11. How often are you distracted by activity or noise around you?
  • 12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
  • 13. How often do you feel restless or fidgety?
  • 14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
  • 15. How often do you find yourself talking too much when you are in social situations?
  • 16. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?
  • 17. How often do you have difficulty waiting your turn in situations when turn taking is required?
  • 18. How often do you interrupt others when they are busy?
  • Should be Empty: