Adult ADHD Self-Report Scale

The Adult Self-Report Scale is a questionnaire used to help screen for possible ADHD in adults. The results can help identify symptoms that may need further assessment and discussion with your doctor or healthcare professional.

Patient First Name *

Patient Last Name *

Date Of Birth *

Your name *

Your relationship to the patient *

Select GP *

Please answer the questions below, rating this person based upon your observations over the last 6 months.

There are no right or wrong answers. Do not spend too much time on any statement.

1. How often does this person have trouble wrapping up the final details of a project, once the challenging parts have been done?

2. How often does this person have difficulty getting things in order when they have to do a task that requires organization?

3. How often does this person have problems remembering appointments or obligations?

4. When this person has a task that requires a lot of thought, how do they avoid or delay getting started?

5. How often does this person fidget or squirm with their ands or feet when they have to sit down for a long time?

6. How often does this person seem overly active and compelled to do things, like they were driven by a motor?

7. How often does this person make careless mistakes when they have to work on a boring or difficult project?

8. How often does this person difficulty keeping their attention when they are doing boring or repetitive work?

9. How often does this person have difficulty concentrating on what people are saying, even when they are speaking to the person directly?

10. How often does this person misplace or have difficulty finding things at home or at work?

11. How often is this person distracted by activity or noise around them?

12. How often does this person leave their seat in meetings or other situations in which they are expected to remain seated?

13. How often does this person appear restless or fidgety?

14. How often does this person have difficulty unwinding and relaxing when they have time to themselves?

15. How often does this person talk too much when in social situations?

16. When this person is in a conversation, how often do they finish the sentence of the people they are talking to, before they can finish them themselves?

17. How often does this person have difficulty waiting their turn in situations when turn taking is required?

18. How often does this interrupt others?

Is there anything else you would like to add or say about this person from your observations?

Part ALow: 9 or less Mild to Moderate: 10-13 High: 14-17 Very High: 18 or more

Part BLow: 19 or less Mild to Moderate: 20-26 High: 27-32 Very High: 33 or more

TotalLow: 30 or less Mild to Moderate: 31-39 High: 40-49 Very High: 50 or more

Inattentiveness subscale

Hyperactivity/Impulsivity subscale

*Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.