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ADD/ADHD Screening

      Access Center 1.800.777.5722                                                                                                                                                24 hrs day/7 days

 

 

Adult ADHD/ADD Screening

This educational material is made available courtesy of Dr. Daniel Amen and ADDult Support of Washington for Adults with ADD, a non-profit organization based in Tacoma , whose purpose if to educate adults and the professionals who treat them about Attention Deficit Disorder. Our address is PO Box 7804 , Tacoma , WA , 98407 . Telephone 253-759-5085, E-mail: adult@addult.org and website: www.ADDult.org . We suggest you print this page to complete and score the checklist.

Read this list of behaviors and rate yourself (or the person who has asked you to rate him or her) on each behavior listed. Use the following scale and place the appropriate number next to the item. For purposes of this questionnaire, both ADD and ADHD are lumped into the single term ADD.

0 = Never    1 = Rarely    2 = Occasionally     3 = Frequently     4 = Very Frequently

Past History

*History of ADD symptoms in childhood, such as distractibility, short attention span, impulsivity or restlessness. ADD doesn't start at age 30.

History of not living up to potential in school or work (report cards with comments such as "not living up to potential")

History of frequent behavior problems in school (mostly for males)

History of bedwetting past age 5

Family history of ADD, learning problems, mood disorders or substance abuse problems

Short Attention Span / Distractibility

*Short attention span, unless very interested in something

*Easily distracted, tendency to drift away (although at times can be hyperfocused)

Lacks attention to detail, due to distractibility

Trouble listening carefully to directions

Frequently misplaces things

Skips around while reading, or goes to the end first, trouble staying on track

Difficulty learning new games, because it is hard to stay on track during directions

Easily distracted during sex, causing frequent breaks or turn-offs during lovemaking

Poor listening skills

Tendency to be easily bored (tunes out)

Restlessness

Restlessness, constant motion, legs moving, fidgeting

Has to be moving in order to think

Trouble sitting still, such as trouble sitting in one place for too long, sitting at a desk job for long periods, sitting through a movie

An internal sense of anxiety or nervousness

Impulsivity

Impulsive, in words and/or actions (spending)

Say just what comes to mind without considering its impact (tactless)

Trouble going through established channels, trouble following proper procedure, an attitude of "read the directions when all else fails"

Impatient, low frustration tolerance

A prisoner of the moment

Frequent traffic violations

Frequent, impulsive job changes

Tendency to embarrass others

Lying or stealing on impulse

Poor Organization

Poor organization and planning, trouble maintaining an organized work/living area

Chronically late or chronically in a hurry

Often have piles of stuff

Easily overwhelmed by tasks of daily living

Poor financial management (late bills, check book a mess, spending unnecessary money on late fees)

Problems Getting Started and Following Through

Chronic procrastination or trouble getting started

Starting projects but not finishing them, poor follow through

Enthusiastic beginnings but poor endings

Spends excessive time at work because of inefficiencies

Inconsistent work performance

Negative Internal Feelings

Chronic sense of under achievement, feeling you should be much further along in your life than you are

Chronic problems with self-esteem

Sense of impending doom

Mood swings

Negativity

Frequent feeling of demoralization or that things won't work out for you 

Relational Difficulties

Trouble sustaining friendships or intimate relationships, promiscuity

Trouble with intimacy

Tendency to be immature

Self-centered; immature interests

Failure to see others' needs or activities as important

Lack of talking in a relationship

Verbally abusive to others

Prone to hysterical outburst

Avoids group activities

Trouble with authority

Short Fuse

Quick responses to slights that are real or imagined

Rage outbursts, short fuse

Frequent Search For High Stimulation

Frequent search for high stimulation (bungee jumping, gambling, race track, high stress jobs, ER doctors, doing many things at once, etc.)

Tendency to seek conflict, be argumentative or to start disagreements for the fun of it

Tendency To Get Stuck (thoughts or behaviors)

Tendency to worry needlessly and endlessly

Tendency toward addictions (food, alcohol, drugs, work)

Switches Things Around

Switches around numbers, letters or words

Turn words around in conversations

Writing/Fine Motor Coordination Difficulties

Poor writing skills (hard to get information from brain to pen)

Poor handwriting, often prints

Coordination difficulties

The Harder I Try The Worse It Gets

Performance becomes worse under pressure.

Test anxiety, or during tests your mind tends to go blank

The harder you try, the worse it gets

Work or schoolwork deteriorates under pressure

Tendency to turn off or become stuck when asked questions in social situations

Falls asleep or becomes tired while reading

Sleep/Wake Difficulties

Difficulty falling asleep, may be due to too many thoughts at night

Difficulty coming awake (may need coffee or other stimulant or activity before feeling fully awake)

Low Energy

Periods of low energy, especially early in the morning and in the afternoon

Frequently feeling tired

Sensitive To Noise Or Touch

Startles easily

Sensitive to touch, clothes, noise and light


 
 

© 2005 River Crest Hospital • 1636 Hunters Glen • San Angelo, TX 76901 • 1-800-777-5722

 

River Crest Hospital is owned and operated by a subsidiary of Universal Health Services, Inc., one of the leading hospital management companies.

For more information on the company, visit www.uhsinc.com.

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