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Mountains
Private Practice CenterOF NEW YORK

ADHD Questionnaire

Scoring key
Answer how well each statement describes you when you don't use
special aids or tricks you have developed to get around or
compensate for difficulties you might have. 

Score each answer as follows:

 

0 - doesn't describe me at all

 

1 - describes me somewhat

 

2 - describes me pretty well

 

3 - describes me very well

 

INITIATION

 

I have trouble getting started doing things

 

I procrastinate

 

COMPLETION

 

I have trouble completing things

 

EXECUTION

 

I don't do tasks efficiently (good job in short time)

 

It is hard for me to do two or three tasks in a row.

 

I don't always do what needs to be done.

 

DISTRACTION

 

I am easily distracted by things I hear or see even when I am trying to concentrate

 

PERSEVERANCE AND FOCUS

 

I don't stick to tasks that are optional

 

I can't stick to a task even if I have to

 

I often switch from doing one thing to another

 

INATTENTIVENESS

 

I don't pay attention when I should

 

I have trouble listening while others speak to me

 

I am absent minded

 

MEMORY

 

I have trouble remembering things I want to do

 

I get so deeply into one thing that I forget others

 

I have trouble with my short term memory

 

I lose or misplace things

 

TIME

 

I confuse appointment times

 

I forget appointments

 

I am often late for appointments

 

FUTURE AWARENESS AND PLANNING

 

I have trouble making plans long in advance

 

I let my gas tank needle get close to empty

 

I rarely get to trains at least 10 minutes early

 

ORGANIZATION

 

I get disorganized

 

My personal work area is messy

 

I put on my seat belt after the car has started moving

 

I don't prioritize or plan my day

 

I can't work well without structure or direction

 

I have difficulty taking command of my time.

 

I waste a lot of time doing nothing.

 

PHYSICAL ACTIVITY (HYPERACTIVITY)

 

I need to keep walking, moving around

 

I have trouble sitting still, I fidget

 

FRUSTRATION/IMPULSIVENESS

 

I get angry easily

 

I am easily frustrated

 

I get impatient easily

 

I interrupt when other people are talking

 

I am impulsive, do things without thinking

 

ANXIETY

 

I focus and concentrate better if I am somewhat anxious.

 

MULTI-TASKING (parallel)

 

I have trouble doing more than one thing at a time well

 

I often try to do more than one task at a time

 

I tend to make things more complicated than they need to be

 

MULTI-TASKING (serial)

 

I dislike tasks that require a long series of steps

 

SLEEP

 

I have trouble getting to sleep because my mind is going

 

UNCATEGORIZED

 

I get so deeply into one thing that I forget other things I have to do

 

I believe that there is usually a quick solutions to problems

 

 

 

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