BC Sparrow Clinic - FREE ADHD Questionnaire

Sparrow ADHD & Wellness Clinic - FREE ADHD Questionnaire

ADULT ADHD SELF-REPORT SCALE (ASRS-V1.1) SYMPTOM CHECKLIST
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Please answer the questions below, rating yourself on each of the criteria by checking the appropriate box. As you answer each question, place a checkmark in the box that best describes how you have felt and conducted yourself over the past 6 months. If you find you are answering the majority questions as "Often, or Very Often", you may benefit from an ADHD assessment with a professional.
Part A
How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

NeverRarelySometimesOftenVery Often
Number
How often do you have difficulty getting things in order when you have to do a task that requires organization?

NeverRarelySometimesOftenVery Often
Number
How often do you have problems remembering appointments or obligations?

NeverRarelySometimesOftenVery Often
Number
When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

NeverRarelySometimesOftenVery Often
Number
How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?

NeverRarelySometimesOftenVery Often
Number
How often do you feel overly active and compelled to do things, like you were driven by a motor?

NeverRarelySometimesOftenVery Often
Number
Calculation
Part B
How often do you make careless mistakes when you have to work on a boring or difficult project?

NeverRarelySometimesOftenVery Often
How often do you have difficulty keeping your attention when you are doing boring or repetitive work?

NeverRarelySometimesOftenVery Often
How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?

NeverRarelySometimesOftenVery Often
How often do you misplace or have difficulty finding things at home or at work?

NeverRarelySometimesOftenVery Often
How often are you distracted by activity or noise around you?

NeverRarelySometimesOftenVery Often
How often do you leave your seat in meetings or in other situations in which you are expected to stay seated?

NeverRarelySometimesOftenVery Often
How often do you feel restless or fidgety?

NeverRarelySometimesOftenVery Often
How often do you have difficulty unwinding and relaxing when you have time to yourself?

NeverRarelySometimesOftenVery Often
How often do you find yourself talking too much when you are in social situations?

NeverRarelySometimesOftenVery Often
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?

NeverRarelySometimesOftenVery Often
How often do you have difficulty waiting your turn in situations when turn taking is required?

NeverRarelySometimesOftenVery Often
How often do you interrupt others when they are busy?

NeverRarelySometimesOftenVery Often
Do you agree to receive the results of your quiz via email from Sparrow ADHD & Wellness?

YesNo
Would you like to receive seasonal emails about promotions and ADHD services and resources?

YesNo
© World Health Organization 2003 All rights reserved. Based on the Composite International Diagnostic Interview © 2001 World Health Organization. All rights reserved. Used with permission.
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Part A

Part B