Adult Dyslexia Checklist

1
Name* This field is required.
First Name
Last Name
2
Age Range* This field is required.
18- 25
26-39
40-55
56-64
over 65
3
Gender* This field is required.
Male
Male
Female
N/A
4
E-mail* This field is required.
example@example.com
5
1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
6
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
7
3. How often do you have problems remembering appointments or obligations?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
Other
8
4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
9
5. How often do you fidget or squirm with your hands or feet when sitting for a long time?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
10
6. How often do you feel overly active and compelled to do things, like you were driven by a motor?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
11
7. How often do you make careless mistakes when you have to work on a boring or difficult project?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
12
8. How often do you have difficulty keeping your attention when doing boring or repetitive work?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
13
9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
14
10. How often do you misplace or have difficulty finding things at home or at work?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
15
11. How often are you distracted by activity or noise around you* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
16
12. How often do you leave your seat in meetings or other situations where you are expected to stay seated?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
17
13. How often do you feel restless or fidgety?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
18
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
19
15. How often do you find yourself talking too much when you are in social situations?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
20
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 it themselves?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
21
17. How often do you have difficulty waiting your turn in situations when turn-taking is required?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
22
18. How often do you interrupt others when they are busy?* This field is required.
NEVER
RARELY
SOMETIMES
OFTEN
VERY OFTEN
23
YOUR SCORE
24
If your results show that you may be ADHD, would like to be contacted to receive further support with ADHD?* This field is required.
YES
NO
25
It is important to remember that this test does not constitute an assessment of one’s difficulties. It is just an indication of some of the areas in which you or the person you are assessing may have difficulties.

However, this questionnaire may provide a better awareness of the nature of an individual’s difficulties and may indicate that further professional help may be needed.

YOUR RESULTS WILL BE EMAILED TO YOU IMMEDIATELY.

PLEASE CHECK YOUR JUNK EMAIL, IF THE EMAIL WITH YOUR RESULTS FAILS TO ARRIVE IN YOUR INBOX
26
I understand that the result of the checklist only indicates a moderate or high probability of ADHD and is not an assessment.* This field is required.
Yes, I understand the is not an assessment but a checklist screening.
Should be Empty: