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ASSESSMENT ADHD
- Example: Do you start tasks enthusiastically but struggle to complete small details, like organizing files or finishing paperwork?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Provide a specific example from work, school, or home.
- Example: Do you struggle to prioritize tasks, manage time, or keep your workspace tidy?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Describe how this affects your daily responsibilities.
- Example: Do you forget meetings, miss deadlines, or rely heavily on reminders or others to stay on track?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Share a recent instance and its impact.
- Example: Do you procrastinate on tasks like writing reports, studying, or planning complex projects?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Provide an example of a task you delayed and why.
How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
- Example: Do you tap your fingers, bounce your leg, or play with objects during meetings or classes?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Describe a situation where this was noticeable.
- Example: Do you feel an urge to stay busy or find it hard to relax without constant activity?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Notes: Explain how this affects your daily routine or downtime.
Part B: Additional ADHD Symptoms
These questions provide further detail on inattention and hyperactivity/impulsivity symptoms to assess severity and functional impact.
Inattention Symptoms
- Example: Do you overlook details in repetitive tasks, like filling out forms or checking work?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you lose focus during routine tasks, like reading emails or doing chores?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you zone out during conversations or need things repeated?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you frequently lose keys, phones, or important documents?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do background noises, conversations, or visual stimuli make it hard to focus?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you get up during meetings, classes, or other formal settings when expected to stay seated?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
Hyperactivity/Impulsivity Symptoms
- Example: Do you feel an internal need to move or struggle to stay calm in quiet settings?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you find it hard to sit quietly or relax without engaging in some activity?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you dominate conversations or struggle to regulate how much you speak?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you blurt out answers or interrupt during discussions without intending to?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you struggle to wait in lines, during games, or in group activities?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
- Example: Do you struggle to wait in lines, during games, or in group activities?
- Frequency: Never / Rarely / Sometimes / Often / Very Often
GAD-7 Core Screening Questions
These seven questions form the GAD-7 scale and assess the frequency of key anxiety symptoms. A total score of 5 or more suggests possible anxiety, with scores of 5–9 (mild), 10–14 (moderate), and 15–21 (severe) indicating increasing severity.
- Example: Have you felt jittery, tense, or unable to relax? Describe a specific situation where this occurred.
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Provide details about when and where you felt this
- Example: Do you find yourself worrying excessively about things like work, health, or relationships, even when you try to stop?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Share an example of what you worry about and how it
- Example: Do you worry about multiple aspects of your life (e.g., finances, family, or daily tasks) at the same time?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: List the main things you’ve been worrying
- Example: Do you feel restless or find it hard to unwind, even in calm situations?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe a time when you struggled to
- Example: Do you pace, fidget, or feel an urge to move due to anxiety?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Provide an example of when this restlessness
- Example: Do you snap at others or feel frustrated more quickly than usual?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Share a recent situation where you felt irritable
- Example: Do you experience a sense of dread or fear about future events?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe what you fear might happen and how often this thought
PHQ-9 Core Screening Questions
These nine questions form the PHQ-9 scale and assess the frequency of key depression symptoms. A total score of 5 or more suggests possible depression, with scores of 5–9 (mild), 10–14 (moderate), 15–19 (moderately severe), and 20–27 (severe) indicating increasing severity.
- Example: Have you lost interest in activities you used to enjoy, such as hobbies, socializing, or work?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe a specific activity you’ve lost interest in and when this
- Example: Have you felt sad, low, or unable to see hope for the future?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Share a recent situation where you felt this
- Example: Do you have difficulty falling asleep, wake up frequently, or sleep excessively?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe your sleep patterns and how they’ve affected
- Example: Do you feel exhausted or lack the energy to complete daily tasks, even after rest?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Provide an example of how fatigue has impacted your
- Example: Have you lost your appetite or been eating more than usual, perhaps as a way to cope?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe changes in your eating habits and any related weight
- Example: Do you feel guilty, worthless, or overly critical of yourself?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Share an example of a situation where you felt this
- Example: Do you find it hard to focus on tasks or follow conversations due to your mood?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe a specific instance where concentration was
- Example: Have others noticed you being sluggish or unusually restless due to your mood?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Provide an example of how your behavior has
- Example: Have you had thoughts of death, self-harm, or suicide, even if you wouldn’t act on them?
- Frequency: Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
- Notes: Describe any such thoughts and their If you are experiencing these thoughts, please contact a healthcare professional or a crisis line 911 and Suicide crises line 988