Adult Questionnaire

The test consist of six simple questions. Please respond by check the box “N” for never; “R” for rarely; “S” for sometimes; “O” for often; or “V” for very often.

Name

First Name

Last Name

Number

Question 1

How often do you have trouble wrapping up the final details of a task/assignment, once you complete the challenging parts? Give a breif discription below.

Question 2

How often do you have difficulty getting things in order when asked to perform a task that requires organization? Select option below.

Question 3

How often do you have problems remembering simple instructions or turning in work? Select option below.

Question 4

When you have a task that requires a lot of thought, how often do you avoid or delay getting started? Select option below.

Question 5

How often do you fidget or squirm with their hands and feet when you have to sit down for an extended period? Select the option below.

Question 6

How often are you overly active, hyper and cannot stop moving, as if you were driven by a motor? Select option below.

If you answered “S,” “O,” or “V” for questions 1,2, or 3, give yourself one piont for each. If you answered “O”, or “V” for questions 4,5, or 6, give yourself one piont for each. Now add up your pionts. A score of 4 or higher is a positive score. That means you ought to consult with your healthcare provider and go on to the next step in the diagnostic process. Please be advised, this is not a diagnostic test. It’s just a brief screening tool.

Download ADD Facts Sheet

Adult Questionnaire

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