This questionnaire was developed in conjunction with the World Health Organization (WHO) and the Workgroup on Adult ADHD, and is intended for people ages 18 and older.
Circle the number that best describes how you have felt and conducted yourself over the past six months. Add up your total and give the completed questionnaire to your healthcare professional during your next appointment to discuss the results. A score of 11 points or higher indicates that your symptoms may be consistent with Adult ADHD.
|1. How often do you have difficulty getting things in order when you have to do a task that requires organization?||0||1||2||3||4|
|2. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?||0||1||2||3||4|
|3. How often are you distracted by activity or noise around you?||0||1||2||3||4|
|4. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?||0||1||2||3||4|
|5. How often do you feel restless or fidgety?||0||1||2||3||4|
|6. How often do you have difficulty waiting your turn in situations when turn taking is required?||0||1||2||3||4|
The six-question Adult Self-Report Scale-Version1.1 (ASRS-V1.1) Screener is a subset of the WHO's 18-question Adult ADHD Self-Report Scale-Version1.1 (Adult ASRS-V1.1) Symptom Checklist. Download the full checklist from the Harvard School of Medicine.
ASRS-V1.1 Screener COPYRIGHT © 2003 World Health Organization (WHO). Reprinted with permissionof WHO. All rights reserved.