- 1.____As a child there were at least two of the following ADD symptoms that created chronic and frequent problems for you or the adults in your life such as: distractibility, impulsivity, daydreaming, restlessness, always on the go, chronic complaints of not listening from parents or teachers, chronic problems with fidgetiness, chronic disorganization or sloppiness, or there were serious problems with homework (doing it, completing it, or turning it in).
- 2.___During childhood you were either
a) diagnosed by a health professional with ADD(AD/HD); or you were classified by a school system either with PI (Perceptually Impaired) or NI (Neurologically Impaired).
b) born prematurely with low birth weight, suffered head injury with loss of consciousness and memory, or there was a history of several persistent sleep problems such as night terrors, sleepwalking, or sleep apnea.
- 3.____There was a family history (a parent, grandparent, sibling, or child) with either significant and dysfunctional inattention, lives of others.impulsivity, hyperactivity, distractibility and ADD or ADD like symptoms that have caused significant disruption in their lives or the
Try to rate each question below on a scale of 0-4
0=Never or Not At All
1=Rarely or Just a Little
2=Sometimes, Occasionally or Somewhat
3=Frequently, Pretty Much, Moderately
4=Very Much, Very Frequently, That's It, That's Me
- 4.____Your life has been characterized by a sense of underachievement and/or experience of not living up to your potential in several areas; or you have always had to work harder or longer than others to achieve the same results. You may be a chronic underachiever. Work, school, and/or relationships are much harder for you than for most others you know. Yet you know you can do so much better. You have learned to work harder and longer at goals that are important to you.
- 5.____Some aspect of sleep has been a chronic problem such as being a night owl, being unusually difficult to wake up in the mornings, or having a restless active sleep with bed covers disheveled each morning. You may have learned to pursue activities or jobs that start in the morning. (If you have been a loud snorer, a screening for sleep apnea may be requested during your evaluation.)
- 6.____There is a tendency to leave a trail of belongings or piles throughout your home or workplace. At work people close your office door when there are visitors in the vicinity. Your spouse/partner is embarrassed to have visitors because of the clutter.
- 7.____At home, work or school it has been very difficult to stay focused on boring tasks, and when trying to focus, your mind keeps wandering, daydreaming or losing attention, focus and concentration; for example: you may have to re-read any material that is boring (You may never have completed reading any books in your lifetime.); in group meetings you find it hard to stay focused unless you are leading the discussion; even in casual conversations you find it very hard to stay focused unless the topic is very interesting. Consequently you either lead discussions, or become shy and withdrawn in social settings. A potentially dysfunctional aspect of the focusing problem is associated with getting superfocused so intensively on something that there is almost no awareness of anything else. The superfocus can be an asset in certain situations.
- 8.____Hurt feelings can escalate more rapidly than for others into mood swings, impulsive remarks, arguing, short fuse reactions, quick temper, roller coaster over-reactions, or withdrawal and sulking. Anxiety or depression may have been more of a problem than for most of your peers. Thoughts may shift so rapidly that emotions get triggered without your being aware of which of the many thoughts triggered the mood. If you are male the emotions are more likely externalized or acted out; if you are female the emotions are more likely internalized and turned into depression and chronic anxiety.
- 9.____You have been accused of being very active in several of the following areas: chronic restless thinking, chronic fidgeting with hands, feet, hair; chronic talkativeness; chronic restlessness feelings; chronic jumping from one activity to another before completing tasks; chronic tendency to interrupt others, finish others sentences; chronic inability to wait in lines or traffic. Sitting at a desk for long hours without opportunities to move around would feel like punishment. (These behaviors are to the degree that others may have repeatedly complained about them to you. You may feel that your mind jumps around so much that you can't keep up with the pace or the direction.)
- 10.____There are problems organizing things and planning for the future in several areas of your life. (For example: your days are very often or mostly a spontaneous reaction to events; according to significant others in your life, your desk, garage, house, office, car, yard, and daytimer are very disorganized; you may have no daytimer, life insurance, detailed plans for the future, or reasonable goals; priorities are extremely difficult to develop on a day to day, weekly, or even yearly basis; time management has become a curse word in your vocabulary; "late" has become your middle name; long term projects are a nightmare for you; you are chronically in a hurry. There may have been a time in your life when you found lying irresistible, not realizing the future consequences of such behavior.)
- 11.____Sustaining attention and following through have been long term problems in several areas of your life. People have complained that you never finish things you start unless it's "your thing". You find yourself being described as having enthusiastic beginnings and poor endings. Significant others chronically nag or pester you to complete projects that you started. When working on projects or tasks that are not of your choosing, distractibility becomes nearly unbearable because either sounds, movements, thoughts, memories, or other environmental events distract you from the task. Procrastination has become one of your middle names. Goals have gotten sidetracked by needless worry, poor time management, low self esteem, distractions, boredom, disorganization, or for unknown reasons. The problem has caused significant unhappiness and either you, your spouse, or your boss complain about it.
- 12.____Impulsivity has caused chronic turmoil in several areas of your life such as managing the checkbook, credit card, cash in the pocket; or in relationships where you have impulsively said things that you later regret. Complaints from your significant other about your chronic shopping or buying of things and/or returning them has not changed your behavior. You have either impulsively changed jobs, gone through red lights, refused to go through established channels of life to get things done, argued with policeman, judges, or armed robbers. You may have felt a need to do daring things on occasion that others said were crazy, foolhardy, or unbelievable. These behaviors may have brought you great success or great failure. It may feel like you don't have good enough "brakes" to deal with the many dangers of life. You may find yourself accident prone.
- 13.____Memory has caused you some concern. There may be a tendency to misplace or forget things needed for your activities such as work materials, paperwork, daytimers, kids, spouses, plans, cars, keys, conversations, time, names, steps in a sequence, direction details and others. You may feel that your memory is like the screen of a computer that with one press of a key is gone; you may feel that the screen is so full that you cannot put another piece of information in it without losing the whole picture. Yet you may remember some esoteric details of events that others completely forgot. Adaptations include using "to do" lists, daytimers, secretaries, spouses.
- 14.____For a long period of your life you were called or you considered yourself a maverick, a class clown, an alien, insatiable, crazy, stupid, irresponsible, a person who marches to a different drummer, a space cadet, a "miss fit" or other derogatory names. Your negative self critic is very strong; and it sounds like the voice of one of your siblings, parents or grammar school teachers.
- 15.____Relationships are usually a major problem. You may be excellent with first impressions being considered very romantic, highly motivated, totally attentive, and very intelligent. There may be a long history of failed or short lived relationships. Divorce from spouses and from jobs appear more common. Sustaining attention and listening consistently to the details required of a relationship may be very draining after the initial excitement and novelty of the pairing fades. Following up on the promises of the conversations may be major hurdles for the ADDer. Dealing with intrusive spouses, bosses or children can be a major challenge. Your former spouse might describe you as immature, sexually impulsive, easily distracted sexually, yet even prone to lose sexual interest quickly. An adaptation might be that you have chosen only ADD relationships.
- 16.____Low energy periods have been a lifelong problem. You have been accused of being in a fog. Engaging your mind in the morning, regardless of the amount of sleep you got, seems an impossible task. Getting started on tasks takes tremendous energy and luck. You find yourself daydreaming in many areas of your life even while driving past your exit on the parkway. Your partner is frequently heard saying wake up, pay attention, what's the matter with you. Yet your are highly creative.
- 17.____Integrating senory-motor information may be a significant source of distress. For example, you may find that in lectures you can either listen to the speaker or you can take notes, but you can't do both. When writing you find that your thoughts jump around so much that when you re-read your notes, even you can't understand them. Your handwriting may have been called "chicken scratch"; so you have learned to print whenever you write. Your writing improves when you take caffeine or other stimulants.
- 18.____The search for high stimulation is an issue for some ADDers. You may find yourself drawn to controversy, arguments, risky ventures, sexual affairs, daring stunts, dangerous sports, high pressure careers such as emergency room staff, surgeon, EMT, fire fighter, or policeman, salesman, entrepreneur, race car driver and others. (For example, professional soldier who reenlisted three times in Vietnam to volunteer as a "point man" on infantry patrol.). You feel that when the pressure is on, you perform at your best. You become superfocused, very attentive, driven and very successful or more successful than others. You may not do as well if the pressure is chronic.
- 19.____Substance abuse and learning disabilities are more commonly found in the ADD population. You or your family have a history of alcoholism or drug, gambling, sex, or other addictions; or you have had learning disabilities especially problems in reading comprehension, letter or number reversals and others. You may have been the slowest reader in your classes.
- 20.____You have found that caffeine, nicotine or other stimulants have been necessary for you to be able to focus, attend, organize, calm your mind, and achieve. You may be using far more caffeine or nicotine than the average person. (There are a significant number of ADDers who have an adverse reaction to stimulants of any kind, and cannot use them. They require other treatments or medications.) An alternative pattern is also common. You recall that at times in your life when you were engaged in daily aerobic exercise, you were far more successful, organized,attentive, focused or calm.
Total Score_____(ADD ONLY THOSE QUESTIONS YOU RATED"3 OR 4") The more questions you answered with a score of 3 or 4, the more likely it is that ADD may be present. If you obtained a score of at least 4 on one of the first three questions, and a total score on all 20 questions (3 AND 4 RATINGS ONLY) of at least 20 points, you could be a candidate for an ADD evaluation. If your total score was 40 or more, you probably have ADD and need an evaluation. Since everybody will answer yes to some of the questions, and since we have not yet established norms for this screening questionnaire, it should only be used as an informal guide to help you decide whether you should seek an evaluation by a licensed professional.