ASRS v1.1

1
Name of Form
2
INSTRUCTIONS

Approximate time: 7-10 minutes to respond to 18 questions.

Please answer the questions according to what is true for you. Questions are broken up into 2 parts: Part A and Part B.

All responses are confidential.
3
A-1. How often do you have trouble wrapping up final details of a project, once the challenging parts have been done?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
4
A-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
5
A-3. How often do you have problems remembering appointments or obligations?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
6
A-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
7
A-5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
8
A-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
9
B-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
10
B-8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
11
B-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
12
B-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
13
B-11. How often are you distracted by activity or noise around you?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
14
B-12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
15
B-13. How often do you feel restless or fidgety?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
16
B-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
17
B-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
18
B-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?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
19
B-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
20
B-18. How often do you interrupt others when they are busy?* This field is required.
Never
Rarely
Sometimes
Often
Very Often
21
Your Score Is:
22
PART A: Understanding Your High Score (4-6)

Your score is {totalScore143}, which indicates that your symptoms are highly consistent with ADHD in adults (4-6).

Score Breakdown

0–3: Symptoms are not consistent with ADHD in adults

4-6: Symptoms are highly consistent with ADHD in adults

Your Score Suggests:

A high number of ADHD-related traits that may impact focus, social skills, task completion, and/or impulse control.

Frequently losing focus during conversations, meetings, or while reading.

Struggling to prioritize tasks, leading to procrastination or feeling overwhelmed.

Regularly misplacing important items (keys, phone, documents, etc.).

Feeling a strong need for instant gratification, making long-term planning difficult.

Struggling to relax or unwind, always feeling like something needs to be done.

PART B:

The questions in Part B are not scored. Instead, the section is designed to help you reflect on how your symptoms may be affecting different areas of your life. These insights are most valuable when reviewed with a clinician who can provide personalized guidance and support.

While this isn’t a diagnosis or treatment plan, it’s an important starting point! If you’d like to explore this further, we’re here for you.

When to Explore ADHD Clinically

Scores in the high range may suggest the need for further exploration of how ADHD traits influence daily life and well-being.

ADHD traits may require support when they are accompanied by:

Persistent struggles with focus, leading to difficulty completing work or personal tasks.

Impulsivity that results in difficulties with decision-making or social interactions.

Significant procrastination, disorganization, or difficulty following through on plans.

Next Steps

If these resonate, seeking support from an ADHD-informed professional can provide clarity, self-understanding, and helpful strategies for navigating challenges.

Our team of specialists is ready to help you take the first step toward self-discovery and support!
23
PART A: Understanding Your Low Score (0-3)

Your score is {totalScore143}, which indicates that your symptoms are not likely consistent with ADHD in adults (0-3).

Score Breakdown

0–3: Symptoms are not consistent with ADHD in adults

4-6: Symptoms are highly consistent with ADHD in adults

Your Score Suggests:

Minimal to moderate traits of ADHD, indicating a general ability to maintain focus, organization, and impulse control within typical ranges.

Few to occasional difficulties with attention, task completion, or hyperactivity.

A general ability to manage responsibilities and daily life without significant need for accommodations or support.

When Low to Mild Traits Are a Strength

Low scores highlight abilities that can support personal and professional success. These strengths include:

Consistent attention and focus on tasks without frequent distractions.

Effective time management and organizational skills.

An ability to complete projects and maintain productivity without significant struggles.

PART B:

The questions in Part B are not scored. Instead, the section is designed to help you reflect on how your symptoms may be affecting different areas of your life. These insights are most valuable when reviewed with a clinician who can provide personalized guidance and support.

While this isn’t a diagnosis or treatment plan, it’s an important starting point! If you’d like to explore this further, we’re here for you.

Next Steps

If you experience challenges with focus, organization, or motivation in specific situations, exploring these with a mental health professional could be beneficial.

Our team of specialists is here to support you in understanding your cognitive strengths while addressing any areas of concern. Take the next step toward self-discovery today!
24
What are you interested in?* This field is required.
Neuro-informed Couples Counseling.
Neuro-informed Individual Counseling
An Assessment and Diagnosis (only available for residents of California)
Nothing, just send my scores please
I'm not sure. I'd like to talk to a care coordinator.
25
The type of assessment that I am interested in (note only available in California):* This field is required.
Autism Assessment - $1,500
ADHD Assessment - $900
Dual Assessment (ASD and ADHD) - $1,800
Sensory Assessment - $300 (as an add on to Autism or ADHD assessment)
Alexithymia Assessment - $300 (as an add on to Autism or ADHD assessment)
PDA Assessment (Pathological Demand Avoidance) - $300 (as an add on to the Autism or ADHD assessment)
26
Where do you live? (This helps match you with a therapist or coach).* This field is required.
California
Not in California
27
Session fees vary by experience and qualifications. Share what you can pay, and we’ll match you with the right professional.* This field is required.
$300 and up
$250 to $300
$200 to $250
$150 to $200
$100 to $150 - considered "Sliding Scale". Appointments at this price are limited and may not be available.
28
My name is:* This field is required.
First Name
Last Name
29
Email* This field is required.
example@example.com
30
Phone Number
Please enter a valid phone number.
31
Please share any additional background:
Huge
Large
Normal
Small
Ok
Ok
32
What's Next?

You will be sent a copy of your scores if you've provided your email address.

If you marked that you are interested in counseling services, our Client Care Coordinator will be in touch within 24 hours to connect you with one of our experts.

Please feel free to reach out to our Client Care Coordinator, Cassie Clayton, if you have any questions in the meantime!

Email : clientcare@newpathfamily.com

Text or Call: (408) 475-2746
Should be Empty: