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Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
Name
*
Email Address
*
Age (Years)
*
Part A
Please answer the following questions regarding how you have felt and conducted yourself over the past 6 months.
1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
3. How often do you have problems remembering appointments or obligations?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
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?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
Part B - Additional cues on ADHD symptoms
7. How often do you make careless mistakes when you have to work on a boring or difficult project?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
10. How often do you misplace or have difficulty finding things at home or at work?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
11. How often are you distracted by activity or noise around you?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
13. How often do you feel restless or fidgety?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
15. How often do you find yourself talking too much when you are in social situations?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
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?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
18. How often do you interrupt others when they are busy?
*
A
Never
B
Rarely
C
Sometimes
D
Often
E
Very Often
Submit
