Bonnie Connor, PhD
PSY 22446
1105 Kennedy Place, Suite 6
Davis, CA 95616
T: 530.750.1700
F: 800.390.1612

 

Instructions: The Adult ADHD Self-Report Scale (ASRS-5) is a screening tool for ADHD. For each question, please rate how often you have experienced the symptoms over the past six (6) months using the five-point scale below.

0 = Never
1 = Rarely (a few times a year)
2 = Sometimes (once a month or less)
3 = Often (a few times a week or more)
4 = Very often (most of the time)

 

 
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1. How often do you have trouble concentrating on what people say to you?
 
2. How often do you have trouble finding things?
 
3. How often are you distracted by noise or activity?
 
4. How often do you leave your seat in meetings or other situations?
 
5. How often do you feel restless or fidgety?
 
6. How often do you have trouble unwinding or relaxing?
 

Please add up your score

If your total score is 14 or more, please answer the following with a YES or NO. Feel free to include examples.

A1. Do you often fail to give close attention to detail, or do you make careless mistakes in your work or during other activities?

And was that also during childhood?

 A2. Do you often find it difficult to sustain your attention on tasks?

And was that also during childhood?

 A3. Does it often seem as though you are not listening when you are spoken to directly?

And was that also during childhood?

A4. Do you often fail to follow through on instructions and do you often fail to finish jobs or fail to meet obligations at work?

And was that also during childhood? (when doing schoolwork as opposed to when at work)

 A5. Do you often find it difficult to organise tasks and activities?

And was that also during childhood?

 A6. Do you often avoid (or do you have an aversion to, or are you unwilling to do) tasks which require sustained mental effort?

And was that also during childhood?

A7. Do you often lose things that are needed for tasks or activities?

And was that also during childhood?

 A8. Are you often easily distracted by external stimuli?

And was that also during childhood?

 A9. Are you often forgetful during daily activities?

And was that also during childhood?


H1. Do you often move your hands or feet in a restless manner, or do you often fidget in your chair?

And was that also during childhood?

H2. Do you often stand up in situations where the expectation is that you should remain in your seat?

And was that also during childhood?

 H3. Do you often feel restless?

And was that also during childhood?

 H4. Do you often find it difficult to engage in leisure activities quietly?

And was that also during childhood?

 H5. Are you often on the go or do you often act as if “driven by a motor”?

And was that also during childhood?

 H6. Do you often talk excessively?

And was that also during childhood?

 H7. Do you often give the answer before questions have been completed?

And was that also during childhood?

 H8. Do you often find it difficult to await your turn?

And was that also during childhood?

 H9. Do you often interrupt the activities of others, or intrude on others?

And was that also during childhood?

 H10. Have your symptoms interfered with, or reduced the quality of, social, academic, or occupational functioning?

And was that also during childhood?

    

 

 

Used with permission: Kessler, R. C., Adler, L. A., Mroczek, D. K., Petukhova, M., & Samedy, A. J. (2019). The Adult ADHD Self-Report Scale (ASRS-5). World Health Organization.

Used with permission: Kooij, J. J. S., Francken, M. H., & Bron, T. I. (2019). Diagnostic Interview for ADHD in adults (3rd ed.; DIVA-5). DIVA Foundation.