ADHD - Chris Aiken, MD

Inattentive Symptoms

For each symptom, ask for examples from childhood as well as recent months...

A. Do you often overlook details or make careless mistakes?

YES NO

B. Is it often hard to stay focused while working, reading, or in lectures and meetings?

YES NO

C. Do others say that you don't seem to listen in conversation?

YES NO

D. Do you often struggle to complete tasks?

YES NO

E. Do you often struggle to organize tasks or manage time?

YES NO

F. Do you often procrastinate on tasks that require a lot of concentration or attention?

YES NO

G. Do you often lose things like your wallet, keys, or phone?

YES NO

H. Are you often easily distracted by little things, like noises or people talking?

YES NO

I. Do you often forget routine tasks like returning calls, paying bills, or keeping appointments?

YES NO

Notes on Inattention (Onset? Problems it caused? What makes it better/worse?):

Hyperactive Symptoms

For each symptom, ask for examples from childhood as well as recent months...

A. Do you often fidget, squirm, or tap when you have to sit for a long time?

YES NO

B. Do you often stand when should stay seated? How was that in your childhood?

YES NO

C. Are you often physically restless?

YES NO

D. Do others say you are loud or talk too much during quiet activities?

YES NO

E. Do you often feel "driven by a motor" or always on the go?

YES NO

F. Do people say you talk too much?

YES NO

G. Do you often finish other’s sentences or blurt out answers before they've finished the question?

YES NO

H. Is it often hard to wait your turn, like when standing in line or stuck in traffic?

YES NO

I. Do you often interrupt others when they are talking or busy?

YES NO

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What problems have these symptoms [inattention and hyperactivity] caused at work, school, or home? With family or friends?

Work School Home Family Friends NONE

Are other causes of cognitive problems present?

Chronic psychiatric disorder

History of substance use disorder

Sleep deprivation

Sleep apnea

Learning disorders

Intellectual disability

Adverse medication effects

Endocrine disorder

Menopause

Neurologic disorder

Traumatic brain injury

Small vessel ischemic disease

Structural brain lesions

Inflammatory illness

Recent chemotherapy

Toxin exposure

Prenatal cocaine exposure

NONE

Are the symptoms better explained by these disorders, or are both ADHD and other causes present (optional)?

Notes on Hyperactivity (Onset? Problems it caused? What makes it better/worse?):

Childhood onset

The diagnosis requires several symptoms before age 12. If you need to change that answer, scroll back to page one (with PREVIOUS button).