Adult ADHD Collateral Assessment Form

  • Adult ADHD Collateral Assessment Form

    Please answer based on your current observations of the patient. Leave items blank if unsure. Include full names, contact info, relationship, and date. Refer to school-based wording as work or daily responsibilities. Complete the rating scales accordingly.

  • Respondent and Patient Information

  • These fields must match across all ADHD forms to support cross-form comparison and reporting.
  • Patient Date of Birth*
     - -
  • Flagging guidance: Within Normal Range, Borderline, Elevated, or Severe. Base the final interpretation on symptom frequency and functional impairment.
  • Answer based on your own current observations of the patient, not the patient’s answers. If you are unsure about any item, leave it blank. School-based wording should be interpreted for adult functioning as work, home responsibilities, deadlines, meetings, appointments, organization, and current daily functioning.
  • Today’s date*
     - -

  • WFIRS-P Current Adult Observer Impairment Scale

  • Family
  • Has the adult’s behavior caused tension or conflict within the family?*
  • Does the adult’s behavior make family routines harder to manage?*
  • Does the adult’s behavior affect family relationships or closeness?*
  • School/Work equivalent
  • Does the adult’s functioning interfere with work performance or job responsibilities?*
  • Does the adult have difficulty meeting deadlines, staying organized, or completing tasks at work?*
  • Does the adult’s behavior cause problems with supervisors, coworkers, or workplace expectations?*
  • Life Skills
  • Does the adult have difficulty managing daily responsibilities such as finances, appointments, or household tasks?*
  • Does the adult have trouble keeping track of belongings, bills, or important items?*
  • Does the adult need more help than expected to stay on top of everyday life skills?*
  • Self-Concept
  • Does the adult seem frustrated, discouraged, or negatively affected by their functioning?*
  • Does the adult’s current functioning appear to affect their confidence or self-esteem?*
  • Does the adult seem embarrassed or ashamed about their difficulties?*
  • Social Activities
  • Does the adult have difficulty keeping up with social plans or commitments?*
  • Does the adult’s behavior interfere with friendships or social relationships?*
  • Does the adult avoid social activities because of their current difficulties?*
  • Risky Activities
  • Does the adult act impulsively in ways that could lead to harm or problems?*
  • Does the adult take unnecessary risks in daily life, driving, work, or relationships?*
  • Does the adult’s current behavior create safety concerns for themselves or others?*

  • BAARS-IV Collateral Report

  • Fails to give close attention to details or makes careless mistakes in work or other activities*
  • Has difficulty sustaining attention in tasks or activities*
  • Does not seem to listen when spoken to directly*
  • Does not follow through on instructions or fails to finish tasks*
  • Has difficulty organizing tasks and activities*
  • Avoids or is reluctant to engage in tasks that require sustained mental effort*
  • Loses things necessary for tasks or activities*
  • Is easily distracted by extraneous stimuli*
  • Is forgetful in daily activities*
  • Fidgets with hands or feet or squirms in seat*
  • Leaves seat in situations when remaining seated is expected*
  • Feels restless or has difficulty remaining still*
  • Has difficulty engaging in leisure activities quietly*
  • Is often "on the go" or acts as if driven by a motor*
  • Talks excessively*
  • Blurts out answers before questions have been completed*
  • Has difficulty waiting for his or her turn*
  • Interrupts or intrudes on others*
  • Should be Empty: