Adult ADHD Self-Report Scale

ASRS-v1.1 Symptom Checklist

Instructions

The questions on the back page are designed to stimulate dialogue between you and your clinician and to help confirm if you might have symptoms consistent with adult ADHD.

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.

Response Scale:

  • Never = 0 points
  • Rarely = 1 point
  • Sometimes = 2 points
  • Often = 3 points
  • Very Often = 4 points
Part A: ADHD Screener Questions (Questions 1-6) SCREENER
1
How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
2
How often do you have difficulty getting things in order when you have to do a task that requires organization?
3
How often do you have problems remembering appointments or obligations?
4
When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
5
How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
6
How often do you feel overly active and compelled to do things, like you were driven by a motor?
Part B: Additional ADHD Symptoms (Questions 7-18)
7
How often do you make careless mistakes when you have to work on a boring or difficult project?
8
How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
9
How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
18
How often do you have difficulty waiting your turn in situations when turn taking is required?

Adult ADHD Self-Report Scale Results

0
Screener Score (Part A)
0
Total Score
Negative
Screen Result
ADHD Symptom Profile
Inattentive vs Hyperactive-Impulsive Symptoms
Important Disclaimer: This self-report scale is a screening tool and should not be used as a substitute for professional medical diagnosis. The results should be discussed with a qualified healthcare provider, psychiatrist, or psychologist who can conduct a comprehensive ADHD evaluation. A positive screen does not confirm ADHD diagnosis, and a negative screen does not rule out ADHD.