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Adult Attention Deficit Hyperactivity Disorder (ADHD) Self-Report Scale
Jan 4, 2014
•
Mark Morgan
categories:
Psychiatry & Psychology
Adult ADHD Self-Report Scale
Please answer the questions below. As you answer each question, choose the answer 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.
Patient Name
Today’s Date
Section A (SCREEN)
never
rarely
sometimes
often
very often
<-- 1. How often do you have trouble wrapping up the final details of a project,
once the challenging parts have been done?
never
rarely
sometimes
often
very often
<-- 2. How often do you have difficulty getting things in order when you have to do
a task that requires organization?
never
rarely
sometimes
often
very often
<-- 3. How often do you have problems remembering appointments or obligations?
never
rarely
sometimes
often
very often
<-- 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
never
rarely
sometimes
often
very often
<-- 5. How often do you fidget or squirm with your hands or feet when you have
to sit down for a long time?
never
rarely
sometimes
often
very often
<-- 6. How often do you feel overly active and compelled to do things, like you
were driven by a motor?
To complete and score Section B (SEVERITY) questions, click above
Section B (SEVERITY)
never
rarely
sometimes
often
very often
<-- 7. How often do you make careless mistakes when you have to work on a boring or
difficult project?
never
rarely
sometimes
often
very often
<-- 8. How often do you have difficulty keeping your attention when you are doing boring
or repetitive work?
never
rarely
sometimes
often
very often
<-- 9. How often do you have difficulty concentrating on what people say to you,
even when they are speaking to you directly?
never
rarely
sometimes
often
very often
<-- 10. How often do you misplace or have difficulty finding things at home or at work?
never
rarely
sometimes
often
very often
<-- 11. How often are you distracted by activity or noise around you?
never
rarely
sometimes
often
very often
<-- 12. How often do you leave your seat in meetings or other situations in which
you are expected to remain seated?
never
rarely
sometimes
often
very often
<-- 13. How often do you feel restless or fidgety?
never
rarely
sometimes
often
very often
<-- 14. How often do you have difficulty unwinding and relaxing when you have time
to yourself?
never
rarely
sometimes
often
very often
<-- 15. How often do you find yourself talking too much when you are in social situations?
never
rarely
sometimes
often
very often
<-- 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?
never
rarely
sometimes
often
very often
<-- 17. How often do you have difficulty waiting your turn in situations when
turn taking is required?
never
rarely
sometimes
often
very often
<-- 18. How often do you interrupt others when they are busy?
Section A (SCREEN) Result –->
interpretation
score1=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6);score1>3?'Section A - Symptoms highly consistent with ADHD in adults, further investigation is warranted':'Section A - Negative screen for ADHD, consider other diagnoses'
Section B (SEVERITY) Result -->
interpretation
score2=+(Q7)+(Q8)+(Q9)+(Q10)+(Q11)+(Q12)+(Q13)+(Q14)+(Q15)+(Q16)+(Q17)+(Q18);score2>47?'Section B - Average frequency of symptoms = VERY OFTEN':score2>35?'Section B - Average frequency of symptoms = OFTEN':score2>23?'Section B - Average frequency of symptoms = SOMETIMES':score2>11?'Section B - Average frequency of symptoms = RARELY':'Section B - Average frequency of symptoms = NEVER'
display/hide references
reference:
#1
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005 Feb;35(2):245-56.
Post RE, Kurlansik SL. Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults. Am Fam Phys. 2012 May 1;85(9):890-896.
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