Working! Screen:
Adult ADHD Questionnaire — 18 Items
1.
Carelessness
Do you make silly mistakes?
Rush through your work?
Are you messy? Unable to find things?
None
Mild
Moderate
Severe
2.
Sustaining Attention
Do you have trouble remembering what was said or what you have read?
Does it take you longer to do things because you cannot keep your mind on the task?
None
Mild
Moderate
Severe
3.
Trouble Listening
Do you have to ask people to repeat directions to get something done?
Do people complain that you seem to daydream instead of listen?
When trying to remember, do you realize you've missed key parts of what was said?
None
Mild
Moderate
Severe
4.
Completing Tasks
Do you to forget to finish what you were doing?
Do you need a deadline to be able to finish your work?
Do you return to a room you've been in and realize you've left things out or opened?
None
Mild
Moderate
Severe
5.
Trouble Organizing
Do you have trouble breaking down tasks into orderded steps?
Do you have trouble with time management?
None
Mild
Moderate
Severe
6.
Avoids Lengthy Tasks
Do you have trouble with particularly long tasks or board games?
Do you tend to avoid them or feel better about shorter tasks?
None
Mild
Moderate
Severe
7.
Loses Items
Do you often misplace your keys, wallet or papers?
Are you constantly looking for things? Does this cause you trouble?
None
Mild
Moderate
Severe
8.
Easily Distractable
Do you get pulled away from things you are doing?
Do you start new tasks before several others are complete?
None
Mild
Moderate
Severe
9.
Forgetful in Daily Activities
Do you find it difficult to stick to a daily routine?
Do you forget to bring important work materials or assignments with you?
None
Mild
Moderate
Severe
10.
Fidgety
Can you sit still or do you need to be shaking your foot or otherwise moving? Are you always playing with your hair, clothing or items?
None
Mild
Moderate
Severe
11.
Trouble sitting
When seated, do you often pop up to look at things or brouse? Would you rather be walking than sitting?
If you must stay seated do you need to constantly remind yourself as such?
None
Mild
Moderate
Severe
12.
Runs and Climbs
Are you physically restless? Do you feel agitated if you cannot excercise?
None
Mild
Moderate
Severe
13.
Cannot Work Quietly
Do you have a hard time working quietly? Would you rather be talking or reading to yourself?
Do you work better with background noise such as music or the TV?
None
Mild
Moderate
Severe
14.
Always on the Go
Do you feel unable to relax and do nothing? Is it hard for you to adjust to a slower pace?
Are you always up and on the go, looking for the next thing that will interest you?
None
Mild
Moderate
Severe
15.
Talks Excessively
Do you talk a lot? All the time? Do people complain about your excessive talking?
None
Mild
Moderate
Severe
16.
Blurts Out Answers
Do you give answers to quesstions before the person is finished asking?
Do you say things without thinking? Do you speak before it is your turn?
None
Mild
Moderate
Severe
17.
Can't Wait for Turn
Is it hard for you to wait for your turn while driving or have a discussion?
Are you severely frustrated with delays? Does it cause problems?
None
Mild
Moderate
Severe
18.
Interrupts Others
Do you talk while others are talking? Do you but into other people's conversations?
Is it hard for you to wait to get your point across in conversations or a meeting?
None
Mild
Moderate
Severe
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