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Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Instructions

The questions on the following pages are designed to stimulate dialogue between you and your patients and to help confirm whether they may be experiencing the symptoms of attention-deficit/hyperactivity disorder (ADHD).

Description: The Symptom Checklist is an instrument consisting of eighteen DSM-IV-TR criteria. Six of the eighteen questions were found to be most predictive of symptoms consistent with ADHD. These six questions form the basis for the ASRS v1.1 Screener and constitute Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions.


Symptoms

  1. Ask the patient to complete both Part A and Part B of the Symptom Checklist by marking an 'X' in the box that most closely represents the frequency of occurrence for each symptom.

  2. Score Part A. If four or more marks appear in the darkly shaded boxes within Part A, then the patient exhibits symptoms highly consistent with adult ADHD, and further investigation is warranted.

  3. The frequency scores on Part B provide additional cues and can serve as further probes into the patient's symptoms. Pay particular attention to marks appearing in the darkly shaded boxes. The frequency-based response is more sensitive for certain questions. No total score or diagnostic likelihood is used for these twelve questions. The six questions in Part A have been found to be most predictive of the disorder and are best used as a screening instrument.
     

Impairments

  1. Review the entire Symptom Checklist with your patients to evaluate the level of impairment associated with the symptom.

  2. Consider work/school, social, and family settings.

  3. Symptom frequency is often associated with symptom severity; therefore, the Symptom Checklist may also aid in the assessment of impairments. If your patients have frequent symptoms, you may want to ask them to describe how these problems have affected their ability to work, manage household tasks, or interact with others, such as their spouse or significant other.

​

History

  1. Assess the presence of these symptoms or similar symptoms in childhood. Adults with ADHD need not have been formally diagnosed in childhood. When evaluating a patient's history, look for evidence of early-appearing and long-standing problems with attention or self-control. Some significant symptoms should have been present in childhood, but the full symptomology is not required.​​​​​​

Please answer the questions below, rating yourself on each criterion using the scale provided. As you answer each question, place an 'X' in the box that best describes how you have felt and behaved over the past six months. Please give this completed checklist to your healthcare professional for discussion during today's appointment.

Part A

1. How often do you have trouble wrapping up the final details of a project once the challenging parts have been completed?
Never
Rarely
Sometimes
Often
Very Often
2. How often do you have difficulty getting things in order when a task requires organization?
Never
Rarely
Sometimes
Often
Very Often
3. How often do you have problems remembering appointments or obligations?
Never
Rarely
Sometimes
Often
Very Often
4. When you have a task that requires a lot of thought, how often do you avoid or delay starting it?
Never
Rarely
Sometimes
Often
Very Often
5. How often do you fidget or squirm with your hands or feet when you have to sit for a long time?
Never
Rarely
Sometimes
Often
Very Often
6. How often do you feel overly active and compelled to do things, as if you were driven by a motor?
Never
Rarely
Sometimes
Often
Very Often

Part B

7. How often do you make careless mistakes when working on a boring or difficult project?
Never
Rarely
Sometimes
Often
Very Often
8. How often do you have difficulty maintaining your attention when doing boring or repetitive work?
Never
Rarely
Sometimes
Often
Very Often
9. How often do you have difficulty concentrating on what people are saying to you, even when they are speaking directly to you?
Never
Rarely
Sometimes
Often
Very Often
10. How often do you misplace or have difficulty finding things at home or work?
Never
Rarely
Sometimes
Often
Very Often
11. How often are you distracted by activity or noise around you?
Never
Rarely
Sometimes
Often
Very Often
12. How often do you leave your seat in meetings or other situations where you are expected to remain seated?
Never
Rarely
Sometimes
Often
Very Often
13. How often do you feel restless or fidgety?
Never
Rarely
Sometimes
Often
Very Often
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
Never
Rarely
Sometimes
Often
Very Often
15. How often do you find yourself talking too much in social situations?
Never
Rarely
Sometimes
Often
Very Often
16. When in a conversation, how often do you find yourself finishing others' sentences before they can finish them themselves?
Never
Rarely
Sometimes
Often
Very Often
17. How often do you have difficulty waiting your turn in situations where turn-taking is required?
Never
Rarely
Sometimes
Often
Very Often
18. How often do you interrupt others when they are busy?
Never
Rarely
Sometimes
Often
Very Often

Fill the details bellow:

The Value of Screening for Adults with ADHD

Research suggests that the symptoms of ADHD can persist into adulthood, having a significant impact on the relationships, careers, and even the personal safety of your patients who may be experiencing it.1-4 Because this disorder is often misunderstood, many individuals who have it do not receive appropriate treatment and, as a result, may never reach their full potential. Part of the problem is that it can be difficult to diagnose, particularly in adults.

The Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was developed in conjunction with the World Health Organization (WHO), and the Workgroup on Adult ADHD, which included the following team of psychiatrists and researchers:

  • Lenard Adler, MD Associate Professor of Psychiatry and Neurology New York University Medical School

  • Ronald C. Kessler, PhD Professor, Department of Health Care Policy Harvard Medical School

  • Thomas Spencer, MD Associate Professor of Psychiatry Harvard Medical School

As a healthcare professional, you can use the ASRS v1.1 as a tool to screen for ADHD in adult patients. Insights gained through this screening may suggest the need for a more in-depth clinical interview. The questions in the ASRS v1.1 are consistent with DSM-IV criteria and address the manifestations of ADHD symptoms in adults. The questionnaire's content also reflects the importance DSM-IV places on symptoms, impairments, and history for a correct diagnosis.4

The checklist takes approximately five minutes to complete and can provide information that is critical for supplementing the diagnostic process.

References:

  1. Schweitzer JB, et al. Med Clin North Am. 2001;85(3):10-11, 757-777.

  2. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. 1998.

  3. Biederman J, et al. Am J Psychiatry. 1993;150:1792-1798.

  4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association. 2000: 85-93.

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