Adult ADHD Self-Report Scale

First Name

Last Name

Phone *

Email *

Todays Date

Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your healthcare professional to discuss during today’s appointment.

1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

Choose here...

Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

2. How often do you have difficulty getting things in order when you have to do a task that requires organization?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

3. How often do you have problems remembering appointments or obligations?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

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

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

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

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

6. How often do you feel overly active and compelled to do things, like you were driven by a motor?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

7. How often do you make careless mistakes when you have to work on a boring or difficult project?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

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

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

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

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

10. How often do you misplace or have difficulty finding things at home or at work?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

11. How often are you distracted by activity or noise around you?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

13. How often do you feel restless or fidgety?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

14. How often do you have difficulty unwinding and relaxing when you have time to yourself?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

15. How often do you find yourself talking too much when you are in social situations?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

16. 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 them themselves?

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

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

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Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.

18. How often do you interrupt others when they are busy?

Choose here...

Never
Rarely
Sometimes
Often
Very Often
No elements found. Consider changing the search query.
List is empty.