Adult ADHD Symptoms

Please fill out the following form to help us understand your condition.

First Name

Email Address

Last Name

Date of Birth

1. Fail to give close attention to details or make careless mistakes in my work or other activities

Never or rarely

Sometimes

Often

Very often

2. Difficulty sustaining my attention in tasks or fun activities

Never or rarely

Sometimes

Often

Very often

3. Don’t listen when spoken to directly

Never or rarely

Sometimes

Often

Very often

4. Don’t follow through on instructions and fail to finish work or chores.

Never or rarely

Sometimes

Often

Very often

5. Have difficulty organizing tasks and activities

Never or rarely

Sometimes

Often

Very often

6. Avoid, dislike, or am reluctant to engage in tasks that require sustained mental effort

Never or rarely

Sometimes

Often

Very often

7. Lose things necessary for tasks or activities

Never or rarely

Sometimes

Often

Very often

8. Easily distracted by extraneous stimuli or irrelevant thoughts.

Never or rarely

Sometimes

Often

Very often

9. Forgetful in daily activities

Never or rarely

Sometimes

Often

Very often

10. Fidget with hands or feet or squirm in seat

Never or rarely

Sometimes

Often

Very often

11. Leave my seat in meetings or in other situations in which remaining seated is expected

Never or rarely

Sometimes

Often

Very often

12. Shift around excessively or feel restless or hemmed in

Never or rarely

Sometimes

Often

Very often

13. Have difficulty engaging in leisure activities quietly (feel uncomfortable, or am loud or noisy)

Never or rarely

Sometimes

Often

Very often

Thanks for submitting!

ADHD Symptoms as a Child

(Form 3)

Please fill out the following form to help us understand your condition.

First Name

Email Address

Last Name

Date of Birth

What best describes your behaviour when you were a child BETWEEN 5 AND 12 YEARS OF AGE

1. Failed to give close attention to details or make careless mistakes in my work or other activities

Never or rarely

Sometimes

Often

Very often

2. Difficulty sustaining my attention in tasks or fun activities

Never or rarely

Sometimes

Often

Very often

3. Didn’t listen when spoken to directly

Never or rarely

Sometimes

Often

Very often

4. Didn't follow through on instructions and fail to finish work or chores.

Never or rarely

Sometimes

Often

Very often

Had difficulty organising tasks or activities

Never or rarely

Sometimes

Often

Very often

6. Avoided, disliked, or reluctant to engage in tasks that require sustained mental effort

Never or rarely

Sometimes

Often

Very often

7. Lost things necessary for tasks or activities

Never or rarely

Sometimes

Often

Very often

8. Easily distracted by extraneous stimuli or irrelevant thoughts.

Never or rarely

Sometimes

Often

Very often

9. Forgetful in daily activities

Never or rarely

Sometimes

Often

Very often

10. Fidgeted with hands or feet or squirmed in seat

Never or rarely

Sometimes

Often

Very often

11. Left my seat in classroom or in other situations in which remaining seated was expected

Never or rarely

Sometimes

Often

Very often

12. Shifted around excessively or felt restless or hemmed in

Never or rarely

Sometimes

Often

Very often

13. Had difficulty engaging in leisure activities quietly (felt uncomfortable, or was loud or noisy)

Never or rarely

Sometimes

Often

Very often

14. Was “on the go” or acted as if “driven by a motor” (or felt like I had to be busy or always doing something)

Never or rarely

Sometimes

Often

Very often

15. Talked excessively (in social situations)

Never or rarely

Sometimes

Often

Very often

16. Blurted out answers before questions had been completed, completed others’ sentences, or jumped the gun

Never or rarely

Sometimes

Often

Very often

17. Had difficulty awaiting my turn

Never or rarely

Sometimes

Often

Very often

18. Interrupted or intruded on others (butted into conversations or activities without permission or took over what others were doing)

Never or rarely

Sometimes

Often

Very often

Please provide examples of any difficulties experienced at home, if any

Please provide examples of any difficulties experienced at school, if any

Please provide examples of any difficulties experienced with social relationships, if any

Adult ADHD Symptoms

Adult ADHD Symptoms

Adult ADHD Symptoms

Adult ADHD Symptoms

ADHD Symptoms as a Child (Form 3)

What best describes your behaviour when you were a child BETWEEN 5 AND 12 YEARS OF AGE

ADHD Symptoms as a Child

(Form 3)