ADHD Observer Questionnaire

ADHD Observer Questionnaire

(For a Family Member, Friend, or Partner)
Patient Name:*
Your Name:*
Your Relationship to the Individual:*
Example: spouse, sibling, friend, coworker, etc.
Date of Assessment:*

MonthDayYear
Date
This questionnaire is designed to assess ADHD-related symptoms in someone you know. Please answer based on your observations over the past few weeks. There are no right or wrong answers—just respond as accurately as possible.
Section 1: Attention & Organization
1. How often do they make careless mistakes in work, schoolwork, or daily tasks?*

NeverSometimesOftenVery Often
2. How often do they struggle to sustain attention in tasks or conversations?*

NeverSometimesOftenVery Often
3. How often do they appear distracted or inattentive when spoken to directly?*

NeverSometimesOftenVery Often
4. How often do they leave tasks unfinished or switch between tasks without completing them?*

NeverSometimesOftenVery Often
5. How often do they seem disorganized or forget important responsibilities?*

NeverSometimesOftenVery Often
6. How often do they avoid or procrastinate on tasks requiring mental effort?*

NeverSometimesOftenVery Often
7. How often do they misplace important items (e.g., keys, phone, documents)?*

NeverSometimesOftenVery Often
8. How often do they forget appointments, tasks, or commitments?*

NeverSometimesOftenVery Often
9. How often do they become easily distracted by things happening around them?*

NeverSometimesOftenVery Often
If known, at what age did these attention-related difficulties first become noticeable?
Section 2: Hyperactivity & Impulsivity
10. How often do they have trouble sitting still, frequently fidgeting or moving around?*

NeverSometimesOftenVery Often
11. How often do they leave their seat or have difficulty remaining seated when expected?*

NeverSometimesOftenVery Often
12. How often do they seem restless or excessively active?*

NeverSometimesOftenVery Often
13. How often do they talk excessively or interrupt conversations?*

NeverSometimesOftenVery Often
14. How often do they blurt out answers before a question is finished?*

NeverSometimesOftenVery Often
15. How often do they struggle with waiting their turn in conversations or activities?*

NeverSometimesOftenVery Often
16. How often do they intrude on others’ conversations or activities?*

NeverSometimesOftenVery Often
If known, at what age did these hyperactivity or impulsivity difficulties first become noticeable?
Section 3: Impact on Daily Life
In your own words, how do these symptoms affect:
Their daily activities and responsibilities?
Their work or school performance?
Their relationships with you and others?
Total Inattentive Score (9 Questions):
Total Hyperactive/Impulsivity Score (7 Questions):
Should be Empty:

ADHD Observer Questionnaire

Section 1: Attention & Organization

Section 2: Hyperactivity & Impulsivity

Section 3: Impact on Daily Life