JAAS Psych Adult ADD Screening Examination

Adult ADD Screening Examination

Jasper / Goldberg Adult ADD Screening Examination
The items below refer to how you have behaved and felt during most of your adult life.
If you have usually been one way and recently have changed, your responses should reflect how you have usually been.

Select one of the numbers that follows each item using the following scale:

0 = Not at all
1 = Just a little
2 = Somewhat
3 = Moderately
4 = Quite a lot
5 = Very much
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Mobile
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Email*
example@example.com
At home, work, or school, I find my mind wandering from tasks that are uninteresting or difficult.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
I find it difficult to read written material unless it is very interesting or very easy.*

0

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2

3

4

5

0 is Not at all, 5 is Very much
Especially in groups, I find it hard to stay focused on what is being said in conversations.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
I have a quick temper...a short fuse.*

0

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2

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4

5

0 is Not at all, 5 is Very much
I am irritable, and get upset by minor annoyances.*

0

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2

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4

5

0 is Not at all, 5 is Very much
I say things without thinking, and later regret having said them.*

0

1

2

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5

0 is Not at all, 5 is Very much
I make quick decisions without thinking enough about their possible bad results.*

0

1

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4

5

0 is Not at all, 5 is Very much
My relationships with people are made difficult by my tendency to talk first and think later.*

0

1

2

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4

5

0 is Not at all, 5 is Very much
My moods have highs and lows.*

0

1

2

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5

0 is Not at all, 5 is Very much
I have trouble planning in what order to do a series of tasks or activities.*

0

1

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5

0 is Not at all, 5 is Very much
I easily become upset.*

0

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5

0 is Not at all, 5 is Very much
I seem to be thin skinned and many things upset me.*

0

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5

0 is Not at all, 5 is Very much
I almost always am on the go.*

0

1

2

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4

5

0 is Not at all, 5 is Very much
I am more comfortable when moving than when sitting still.*

0

1

2

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4

5

0 is Not at all, 5 is Very much
In conversations, I start to answer questions before the questions have been fully asked.*

0

1

2

3

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5

0 is Not at all, 5 is Very much
I usually work on more than one project at a time, and fail to finish many of them.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
There is a lot of "static" or "chatter" in my head.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
Even when sitting quietly, I am usually moving my hands or feet.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
In group activities it is hard for me to wait my turn.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
My mind gets so cluttered that it is hard for it to function.*

0

1

2

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4

5

0 is Not at all, 5 is Very much
My thoughts bounce around as if my mind is a pinball machine.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
My brain feels as if it is a television set with all the channels going at once.*

0

1

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5

0 is Not at all, 5 is Very much
I am unable to stop daydreaming.*

0

1

2

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4

5

0 is Not at all, 5 is Very much
I am distressed by disorganisation.*

0

1

2

3

4

5

0 is Not at all, 5 is Very much
Total:
Signature*

Clear
Positive results may result from anxiety, depression or mania. These conditions must be ruled out before a diagnosis of Adult ADD can be made.
Should be Empty: