• Form 2: Child and Adolescent ADHD Symptom Questionnaire

    Designed for use by young people aged 5-17 years.

  • Part 1: Symptoms of attention-deficit (DSM-5 criterion A1)

  • For each question, please tick all boxes that apply. 

  • A1 - Do you often fail to give close attention to details, or do you make careless mistakes in your work or during other activities?

  • Examples:*

  • A2 - Do you often have difficulty sustaining your attention in tasks?

  • Examples:*

  • A3 - Does it often seem as though you are not listening when you are spoken to directly?

  • Examples:*

  • A4 - Do you often not follow through on instructions and often fail to finish chores or duties?

  • Examples:*

  • A5 - Do you often find it difficult to organise tasks and activities?

  • Examples:*

  • A6 - Do you often avoid (or do you dislike, or are you reluctant to engage in) tasks that require sustained mental effort?

  • Examples:*

  • A7 - Do you often lose things that are necessary for tasks or activities?

  • Examples:*

  • A8 - Are you often easily distracted by extraneous stimuli?

  • Examples:*

  • A9 - Are you often forgetful in daily activities?

  • Examples:*

  • Part 2: Symptoms of hyperactivity-impulsivity (DSM-5 Criterion A2)

  • H/I 1 - Do you often fidget with or tap hands or feet, or do you often squirm in your seat?

  • Examples:*

  • H/I 2 - Do you often leave your seat in situations where it is expected that you remain seated?

  • Examples:*

  • H/I 3 - Do you often feel restless?

  • Examples:*

  • H/I 4 - Do you often find it difficult to engage in leisure activities quietly?

  • Examples:*

  • H/I 5 - Are you often 'on the go' or do you often act as if 'driven by a motor'?

  • Examples:*

  • H/I 6 - Do you often talk excessively?

  • Examples:*

  • H/I 7 - Do you often blurt out an answer before questions have been completed?

  • Examples:*

  • H/I 8 - Do you often find it difficult to await your turn?

  • Examples:*

  • H/I 9 - Do you often interrupt or intrude on others?

  • Examples:*

  • Criterion B

  • Have you always had these symptoms of attention deficit / hyperactivity / impulsivity?*

  • Criterion C

    In which areas do you have / have you had problems with these symptoms?
  • Work / Education*
  • Relationships / Family*
  • Social Contacts*
  • Free time / Hobbies*
  • Self-confidence / self-image*

  • Criterion D:

    In this section we ask that you explain in more detail (using personal examples) how your experience of ADHD symptoms has interfered in the quality of your social / academic / occupational life.

  • Thank you for completing the Child and Adolescent ADHD Symptom Questionnaire!

    You may now click 'submit'!

  • We would like to express our sincere gratitude for completing this form in preparation for your upcoming ADHD Direct appointment. We value your contribution immensely and eagerly anticipate reviewing the details you have provided to ensure a thorough evaluation.

    If you have any additional concerns or questions prior to your appointment, please do not hesitate to contact us. We look forward to meeting you soon!

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