Adult ADHD Observation Form
Name of Client
First Name
Last Name
Name of Observer
First Name
Last Name
Relationship
Relationship to client?
How long have you known them?
Date
-
Month
-
Day
Year
Date
Please answer the questions below, rating this person based on your observations over the past 6 months.
Part A
1. How often does this person have trouble wrapping up the final details of a project, once the challenging parts have been done?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
2. How often does this person have difficulty getting things inorder when they have to do a task that requires organization?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
3. How often does this person have problems remembering appointments or obligations?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
4. When this person has a task that requires a lot of thought,how often do they avoid or delay getting started?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
5. How often does this person fidget or squirm with their hands or feet when they have to sit down for a long time?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
6. How often does this person seem overly active and compelled to do things, as if they were driven by a motor?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
Part B
7. How often does this person make careless mistakes whenthey have to work on a boring or difficult project?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
8. How often does this person have difficulty keeping their attention when you are doing boring or repetitive work?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
9. How often does this person have difficulty concentrating on what people are saying, even when they are speaking to the person directly?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
10. How often does this person misplace or have difficulty finding things at home or at work?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
11. How often is this person distracted by activity or noise around them?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
12. How often does this person leave their seat in meetings or other situations in which they are expected to remain seated?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
13. How often does this person appear restless or fidgety?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
14. How often does this person have difficulty unwinding and relaxing when they have time to themselves?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
15. How often does this person talk too much when in social situations?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
16. When this person is in a conversation, how often do they finish the sentences of the people they are talking to, before they can finish them themselves?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
17. How often does this person have difficulty waiting their turn in situations when turn taking is required?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
18. How often does this person interrupt others?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very often
Is there any additional information that is relevant to the above situations? If so, please describe:
Submit
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