ADHD Self-Report Scale Symptom Checklist

Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, circle the number in the box that best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your therapist to discuss during today’s appointment.
1. How often do not give attention to detail or make careless mistakes in schoolwork or other activities?
2. How often do you have difficulty paying attention in tasks or play activities?
3. How often do you have difficulty listening when spoken to directly?
4. How often do you not follow through on instructions and fail to finish schoolwork or chores?
5. How often do you have difficulty getting organized?
6. How often do avoid, disklike or put off doing tasks that require mental effort such as homework?
7. How often do you misplace or have difficulty finding things?
8. How often are you distracted by activity or noise around you?
9. How often are you forgetful during daily activities?
10. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
11. How often do you leave your seat in situations in which you are expected to remain seated, such as in the classroom?
12. How often do run or climb when and where it is inappropriate?
13. How often do you have difficulty playing quietly or enjoying leisure activities quietly?
14. How often do you feel overly active and compelled to do things, like you were driven by a motor?
15. How often do you find yourself talking too much when you are in social situations?
16. How often do you shout out the answer to a question before it has been completed?
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
18. How often do you interrupt or intrude on others when they are busy such as butting into a conversation or games?