WEB Submission: Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Use this industry-standard screening tool to identify if your experiences align with common ADHD traits.
This assessment takes less than 5 minutes and provides an initial indication based on your feelings.

Once you submit your responses, you will receive your results immediately.
Ryan Williams, RMN, INP, will also receive a copy and can follow up with you to discuss your score and explore the next steps toward a formal diagnosis.
Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email
Date Completed

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

In the last 6 months, how often do you experience these symptoms?

Rows	Never	Rarely	Sometimes	Often	Very Often
1. How often do you have trouble wrapping up the final details of a project, once thechallenging parts have been done?
2. How often do you have difficulty getting things in order when you have to do a task thatrequires organization?
3. How often do you have problems remembering appointments or obligations?
4. When you have a task that requires a lot of thought, how often do you avoid or delay gettingstarted?
5. How often do you fidget or squirm with your hands or feet when you have to sit down for along time?
6. How often do you feel overly active and compelled to do things, like you were driven by amotor?
7. How often do you make careless mistakes when you have to work on a boring or difficultproject?
8. How often do you have difficulty keeping your attention when you are doing boring orrepetitive work?
9. How often do you have difficulty concentrating on what people say to you, even when theyare speaking to you directly?
10. How often do you misplace or have difficulty finding things at home or at work?
11. How often are you distracted by activity or noise around you?
12. How often do you leave your seat in meetings or in other situations in which you areexpected to stay seated?
13. How often do you feel restless or fidgety?
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
15. How often do you find yourself talking too much when you are in social situations?
16. When you’re in a conversation, how often do you find yourself finishing the sentences of thepeople you are talking to, before they can finish it themselves?
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
18. How often do you interrupt others when they are busy?

Calucation
Should be Empty: