ADHD Adult Screening Report

ADHD Adult Screening Report
Kia ora, welcome to the Executive Function and ADHD Tools Survey!
We aim to better understand the challenges you may face, and if any areas of your executive functioning may need support. Your responses will help us identify effective tools and strategies that can provide meaningful support in improving time management, organisation, and self-discipline.

All responses will be kept confidential, and the survey should take approximately 20-45 minutes to complete.

If you have any questions or concerns whilst completing the survey, please do not hesitate to reach out to your clinician for further assistance.

Thank you for your time and participating!

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Executive Function Screener + Personalised ReportGet access to our online screener designed to identify executive functioning challenges and ADHD traits in adults. Includes a personalised PDF report with your scores, comparison to population averages, and tailored next steps. This tool supports self-understanding and referral conversations, but is not a diagnostic assessment.

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Ko wai koe? | Who are you?
What is your name?*

First NameLast Name
What is your preferred email?*
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What is your preferred contact number?*
Please enter a valid phone number.
Of the below areas, what ones are you interested in receiving support for?*

Work/EducationRelationships and/or FamilyFree time/HobbiesSelf-confidence/Self-imageSocial Connections
Is there something specific that you are wanting to learn?
Any other comments at this stage?

Tell us a bit more...
This next section is focused on how ADHD shows up in your life. The more details you give, the more we can help.
Self-awareness

Self-awareness is the ability to focus on your own thoughts, actions, and feelings in the moment. Reflect on how aware you are of your behaviours and reactions in different situations.
Do you often find yourself wondering why you reacted in a certain way, or are you usually conscious of your responses?*
Self-restraint

Self-restraint involves controlling impulses and taking a moment to think before acting. Consider how well you manage to pause and think before reacting.
Are there times when you struggle to stop yourself from acting impulsively, or do you generally find it easy to hold back?*
Non-verbal working memory

Non-verbal working memory refers to holding mental images or information in your mind to guide what you do. Think about how easily you can recall details and ideas without external prompts.
Do you often struggle to keep track of things in your head, or do you usually manage to remember what’s important?*
Verbal working memory

Verbal working memory involves talking yourself through tasks or problems in your mind. Reflect on how often you use self-talk to organise your actions and thoughts.
Do you find it helpful to have an internal dialogue, or do you find it challenging to guide yourself without external help?*
Emotional self-regulation

Emotional self-regulation is the ability to manage your emotions in challenging situations. Consider how well you handle your emotions when things don’t go as planned.
Are you able to stay calm, or do you find yourself reacting more strongly than you would like?*
Self-motivation

Self-motivation is about maintaining the drive to work toward long-term goals, even without immediate rewards. Reflect on how motivated you feel when working on tasks that don’t have immediate outcomes.
Do you struggle to keep going without external deadlines, or are you generally able to stay on track?*
Planning and problem-solving

Planning and problem-solving involve breaking down tasks into smaller steps and adjusting your approach as needed. Think about how easily you create a plan and adapt when faced with challenges.
Do you find it hard to plan effectively, or are you able to come up with solutions and manage your tasks well?*
Thank you for taking the time to share your experiences!

	Never or Rarely	Sometimes	Often	Always	Not applicable to me
Procrastinate or put off doing things until the last minute
Poor sense of time
Waste or mismanage my time
Not prepared on time for work or assigned tasks
Fail to meet deadlines for assignments
Have trouble planning ahead or preparing for upcoming events
Forget to do things I am supposed to do
Can’t seem to accomplish the goals I set for myself
Late for work or scheduled appointments
Can’t seem to hold in mind things I need to remember to do
Can’t seem to get things done unless there is an immediate deadline
Have difficulty judging how much time it will take to do something or get somewhere
Have trouble motivating myself to start work
Have difficulty motivating myself to stick with my work and get it done
Not motivated to prepare in advance for things I know I am supposed to do
Have trouble completing one activity before starting into a new one
Have trouble doing what I tell myself to do
Difficulties following through on promises or commitments I may make to others
Lack self-discipline
Have difficulty arranging or doing my work by its priority or importance; can’t “prioritize” well
Find it hard to get started or get going on things I need to get done

	Never or Rarely	Sometimes	Often	Always	Not applicable to me
I do not seem to anticipate the future as much or as well as others
Can’t seem to remember what I previously heard or read about
I have trouble organizing my thoughts
When I am shown something complicated to do, I cannot keep the information in mind so as to imitate or do it correctly
I have trouble considering various options for doing things and weighing their consequences
Have difficulties saying what I want to say
Unable to come up with or invent as many solutions to problems as others seem to do
Find myself at a loss for words when I want to explain something to others
Have trouble putting my thoughts down in writing as well or as quickly as others
Feel I am not as creative or inventive as others of my level of intelligence
In trying to accomplish goals or assignments, I find I am not able to think of as many ways of doing things as others
Have trouble learning new or complex activities as well as others
Have difficulty explaining things in their proper order or sequence
Can’t seem to get to the point of my explanations as quickly as others
Have trouble doing things in their proper order or sequence
Unable to “think on my feet” or respond as effectively as others to unexpected events
I am slower than others at solving problems I encounter in my daily life
Easily distracted by irrelevant events or thoughts when I must concentrate on something
Not able to comprehend what I read as well as I should be able to do; have to reread material to get its meaning
Cannot focus my attention on tasks or work as well as others
Easily confused
Can’t seem to sustain my concentration on reading, paperwork, lectures, or work
Find it hard to focus on what is important from what is not important when I do things
I don’t seem to process information as quickly or as accurately as others

	Never or Rarely	Sometimes	Often	Always	Not applicable to me
Find it difficult to tolerate waiting; impatient
Make decisions impulsively
Unable to inhibit my reactions or responses to events or others
Have difficulty stopping my activities or behavior when I should do so
Have difficulty changing my behavior when I am given feedback about my mistakes
Make impulsive comments to others
Likely to do things without considering the consequences for doing them
Change my plans at the last minute on a whim or last minute impulse
Fail to consider past relevant events or past personal experiences before responding to situations (I act without thinking)
Not aware of things I say or do
Have difficulty being objective about things that affect me
Find it hard to take other people’s perspectives about a problem or situation
Don’t think about or talk things over with myself before doing something
Trouble following the rules in a situation
More likely to drive a motor vehicle much faster than others (Excessive speeding)
Have a low tolerance for frustrating situations
Cannot inhibit my emotions as well as others
I don’t look ahead and think about what the future outcomes will be before I do something (I don’t use my foresight)
I engage in risk taking activities more than others are likely to do

	Never or Rarely	Sometimes	Often	Always	Not applicable to me
Likely to take short cuts in my work and not do all that I am supposed to do
Likely to skip out on work early if my work is boring to do
Do not put as much effort into my work as I should or than others are able to do
Others tell me I am lazy or unmotivated
Have to depend on others to help me get my work done
Things must have an immediate payoff for me or I do not seem to get them done
Have difficulty resisting the urge to do something fun or more interesting when I am supposed to be working
Inconsistent in the quality or quantity of my work performance
Unable to work as well as others without supervision or frequent instruction
I do not have the willpower or determination that others seem to have
I am not able to work toward longer term or delayed rewards as well as others
I cannot resist doing things that produce immediate rewards even if they are not good for me in the long run

	Never or Rarely	Sometimes	Often	Always	Not applicable to me
Quick to get angry or become upset
Overreact emotionally
Easily excitable
Unable to inhibit showing strong negative or positive emotions
Have trouble calming myself down once I am emotionally upset
Cannot seem to regain emotional control and become more reasonable once I am emotional
Cannot seem to distract myself away from whatever is upsetting me emotionally to help calm me down. I can’t refocus my mind to a more positive framework.
Unable to manage my emotions in order to accomplish my goals successfully or get along well with others
I remain emotional or upset longer than others
I find it difficult to walk away from emotionally upsetting encounters with others or leave situations in which I have become very emotional
I cannot rechannel or redirect my emotions into more positive ways or outlets when I get upset
I am not able to evaluate an emotionally upsetting event more objectively
I cannot redefine negative events into more positive viewpoints when I feel strong emotions

ADHD Adult Screening Report

Kia ora, welcome to the Executive Function and ADHD Tools Survey!

Ko wai koe? | Who are you?

Tell us a bit more...

Self-awareness

Self-restraint

Non-verbal working memory

Verbal working memory

Emotional self-regulation

Self-motivation

Planning and problem-solving

Screening Questions 1

Screening Questions 2

Screening Questions 3

Screening Questions 4

Screening Questions 5

Looking Forward