Adult ADHD Self-Report Scale

Please only complete this form if you have been asked to by a Clinician at Newton Drive Health Centre.

You can access more information about the ADHD Self-Report Scale here: ADHD UK – Homepage – ADHD UK

Adult ADHD Self-Report Scale (ASRS) Symptom Checker

Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right hand side of the page. As you answer each question, pick the option that best describes how you have felt and conducted yourself over the past 6 months. Once you have completed the form, click submit at the bottom and this will be sent to the GP involved in your care.

Name
Date of Birth
Date Completed

1. How often do you have trouble wrapping up the final details of a project, once the challening parts have been done?
2. How often do you have difficulty getting things in order when you have to do a task that required organisation?
3. How often do you have problems remembering appointments or obligations?
4. When you have a task that requires a lot of thought, hoe 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 A

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 dofficulty keeping your attention when you are doing boring or repetative work?
9. How often do you have difficulty concentrating on what people say to you, even when the yare speaking to you directlyu?
10. How often do you misplace or have difficulty finsding things at home or at work?
11. How often are you distracted by activity or noise around you?
12. How often do you leave your seat in meetings or other wituations in which you are expected to remain seated?
13. How often do you feel restless or fidgety?
14. How often do you have difficulty unwiding and relaxing when you have time to yourself?
15. How often do you find yourself talking too much when you are in social situations?
16. When you're in a conversation, how often do you find yourself finishing the sentences of other people you are talking to, before they can finish them themselves?
17. How often do you have difficulty waiting your turn in situations when tsaking turns is required?
18. How often do you interrupt others when they are busy?

Part B

This field is for validation purposes and should be left unchanged.