Attention Deficit Hyperactivity Disorder (ADHD): Adults

Diagnosis and Treatment Guideline

Background 2
Screening Recommendations/Initial Work-up 2
Diagnosis 3
Treatment
Goals 7
Lifestyle Modifications/Non-Pharmacologic Options 7
Pharmacologic Options 10
Follow-up/Monitoring 12
Evidence Summary/References 12
Clinician Lead and Guideline Development 13
Appendix 1. 6-item Adult ADHD Self-Report Scale 14
Appendix 2. 18-item Adult ADHD Self-Report Scale 15

Most recent comprehensive literature review: February 2011

Guidelines are systematically developed statements to assist patients and providers in choosing appropriate health
care for specific clinical conditions. While guidelines are useful aids to assist providers in determining appropriate
practices for many patients with specific clinical problems or prevention issues, guidelines are not meant to replace
the clinical judgment of the individual provider or establish a standard of care. The recommendations contained in the
guidelines may not be appropriate for use in all circumstances. The inclusion of a recommendation in a guideline
does not imply coverage. A decision to adopt any particular recommendation must be made by the provider in light of
the circumstances presented by the individual patient.

ADHD Diagnosis and Treatment Guideline: Adults 1

Copyright 20112012 Group Health Cooperative. All rights reserved.
Background
According the National Institute of Mental Health, ADHD affects approximately 4.4 percent of adults. And
more than 80% of adults with ADHD have comorbidities such as anxiety, depression, antisocial
personality disorder, neurodevelopmental disorders, substance misuse, or mood and sleep disorders.
These comorbidities may complicate diagnosis and affect treatment and outcomes.

Follow-up studies of children with ADHD have shown that symptoms of the condition persist into
adulthood in 1066% of cases, with an estimated 15% retaining most of their symptoms and an
estimated 50% experiencing persistence of some symptoms. Some symptoms, such as hyperactivity,
tend to decrease with age due to adaptation, neurodevelopment, and self-medication; however, attention
deficit may persist.

The function of individuals who have symptoms of ADHD is significantly dependent upon contextual
factors. While two patients may have a similar score using ADHD evaluation tools, their unique living or
occupational environments may result in differing levels of impairment. For this reason, the diagnosis and
indications for treatment interventions must be determined on an individual basis.

Screening Recommendations and Initial Primary Care Work-up

Table 1. Recommendations for screening for ADHD

Eligible population Test Score Interpretation
Adult patients suspected 6-item Adult ADHD 03 marks in the Unlikely to have ADHD, no need
of having ADHD Self-Report Scale darkly shaded for additional evaluation
(ASRS-v1.1, Appendix 1) boxes
4 or more marks in Symptoms suggest possibility of
the darkly shaded ADHD and need for additional
boxes evaluation

[Additional screening recommendations are found on the following page]

ADHD Diagnosis and Treatment Guideline: Adults 2

 Table 2. Additional screening recommendations for ADHD and comorbidities prior to referral to
Behavioral Health Services or other ADHD specialist
Eligible population Assessment
Adult patients who have Ask additional follow-up questions: (Expert opinion)
symptoms consistent with ADHD What difficulty are these symptoms causing in your life?
How old were you when these symptoms first occurred?
What kind of help are you looking for?
Screen for depression.
Use the first two questions of the PHQ-9. If the patient answers 2 or higher to
either, use the full PHQ-9.
Screen for alcohol and/or drug misuse or diversion.
Use the AUDIT and DAST screening tools.
Cardiac history and exam if the patient is likely to receive a stimulant
medication, including:
History
History of cardiovascular symptoms, such as exercise syncope or
undue breathlessness
Family history of cardiac disease
Exam
Heart rate
Blood pressure
Weight
Cardiovascular examination
Exercise

Order an ECG if patient has a past medical or family history of serious cardiac
disease, a history of sudden death in young family members, or abnormal
findings on cardiac examination.

Consider a stress test if the patient participates in strenuous exercise.

Rule out alternative medical diagnoses, such as hyperthyroidism.

Diagnosis
General Approach
Diagnosis is typically made by a mental health provider. Primary care providers can make a
diagnosis if they have expertise or training in adult ADHD. In addition:
o Masters level therapists can assess for adult ADHD.
o Psychologists can provide additional consultation if the clinical interview and rating scale
data are not sufficient to clarify diagnosis (see Table 3, psychological testing).
o Psychiatrists can provide consultation if there are additional questions regarding
diagnosis/role of comorbid conditions, particularly if there are questions regarding
psychopharmacological management.
Diagnosis is based on comprehensive clinical and psychosocial assessment, impact of symptoms
on functioning, developmental history, and review of rating scales.
Rating scales alone are not sufficient to make a diagnosis of adult ADHD.
Contextual factors play a significant role in determining an individuals level of functioning. While
two patients may have a similar ADHD severity level, their different living or occupational
environments may result in different levels of difficulty or impairment.
Diagnosis requires determining that symptoms:
o Began in childhood and have persisted through life, and
o Are not explained by other diagnoses, and
o Have resulted in, or are associated with moderate or severe psychological, social, and/or
educational or occupational impairment.
ADHD Diagnosis and Treatment Guideline: Adults 3
 Table 3. Diagnosis of ADHD
Diagnostic approach
Assess clinical and psychosocial
status
Establish developmental history of Establish history of ADHD symptoms in childhood (preferably before
ADHD
Assess impact of symptoms on
functioning
Use rating scale
Collect observer reports
(e.g., partner, parent, friend)
Rule out psychiatric comorbidities
Psychological testing
Rule out learning disability
[Table 3. footnotes found on the following page]
ADHD Diagnosis and Treatment Guideline: Adults
Action
Assess current mental status and review behavioral and symptomatic
concerns in the different settings of the persons life.
the age of 7), either retrospectively or prospectively.
Preferred: Use behavioral symptoms noted in school records or information
from parents or sibling.
Acceptable: Use patient self-report when collateral information is not
available.
Confirm symptoms have clinically significant impact on social,
educational, or occupational functioning.
and
Confirm impairment exists in at least two different, important settings
(e.g., home and work).
Use the 18-item Adult Self-Report Scale (ASRS-v1.1, Appendix 2); consider
likelihood of ADHD if score on part A is 4 or more. The frequency scores in
part B provide additional cues and can serve as further probes into the
patients symptoms.
Use interview or rating scale to corroborate presence of ADHD symptoms.
Consider using the full version of the ASRS and modifying the language for
observer usage.
Many psychiatric conditions have symptoms of impairment in attention,
concentration, difficulty with task completion, or inappropriate behavior.
Assess presence of comorbid symptoms:
Depression (PHQ-9)
Alcohol (AUDIT)
Drug misuse (DAST-10)
Anxiety (GAD-7)
As appropriate, also assess for symptoms of bipolar disorder.
Testing is typically not necessary to diagnose ADHD.
Patients with adult ADHD frequently have difficulties with what is referred to
as executive function (e.g., impulse control, organization and planning,
working memory, sustained attention). But not all adults with ADHD have
these difficulties, and there are adults who have executive functioning
deficits who do not have ADHD (i.e., difficulties may be associated with a
learning disability or history of brain trauma).
Executive function difficulties can typically be identified through clinical
interview/observation; however, testing may be helpful to:
Determine the extent and severity of difficulties with executive
functioning for treatment planning.
Determine the extent of comorbid disorders and their impact on
symptoms and treatment of ADHD (if this hasnt been clarified in the
clinical interview).
Consider referral to Speech, Language, and Learning for assessment.
4
[Table 3. footnotes from the previous page]

1
Additional scales that might be helpful in certain circumstances:
Barkley Adult ADHD Rating Scale IV (BAARS IV), which has normative information by specific age group,
ADHD subtype (e.g., inattentive, hyperactive/impulsive, and combined), and retrospective report (i.e., presence
of symptoms in childhood).
Achenbach adult rating scales, if there is need for a rating scale to assess severity of a wide range of mental
health symptoms.

Not recommended (diagnostic testing): Brain imaging (e.g., SPECT, PET scan, MRI, or CT) is not
recommended for diagnosing adult ADHD.

[DSM-IV diagnostic criteria found on the following page]

ADHD Diagnosis and Treatment Guideline: Adults 5

DSM-IV Diagnostic Criteria

Table 4. Formal criteria for ADHD diagnosis (pediatric and adult)

Diagnostic Criteria
approach
DSM-IV 1 Presence of either of the following (1 or 2):

1. Six (or more) 2 of the following symptoms of inattention have persisted for at least
6 months to a degree that is maladaptive and inconsistent with developmental level:
Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
Often has difficulty sustaining attention in tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores,
or duties in the workplace (not due to oppositional behavior or failure to understand
instructions).
Often has difficulty organizing tasks and activities.
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (such as schoolwork or homework).
Often loses things necessary for tasks or activities (e.g., toys, school assignments,
pencils, books, or tools).
Is often easily distracted by extraneous stimuli.
Is often forgetful in daily activities.

or

2. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at
least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
Often fidgets with hands or feet or squirms in seat.
Often leaves seat in classroom or in other situations in which remaining seated is
expected.
Often runs about or climbs excessively in situations in which it is inappropriate (in
adolescents or adults, may be limited to subjective feelings of restlessness).
Often has difficulty playing or engaging in leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor."
Often talks excessively.
Impulsivity
Often blurts out answers before questions have been completed.
Often has difficulty waiting turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
Additional criteria
Some hyperactive-impulsive or inattentive symptoms that caused impairment were
present before age 7.
Some impairment from the symptoms is present in two or more settings (e.g., at
school/work and at home).
There must be clear evidence of clinically significant impairment in social,
academic, or occupational functioning.
1
When DSM-V is published in 2013, the following changes are expected:
The three subtypes of childhood ADHD will no longer be identified as separate conditions.
The age of onset will be extended up to age 12.
Reduction of symptom threshold for diagnosis from six to four symptoms.
2
European Consensus Statement established that a threshold of four out of nine symptoms in the DSM-IV criteria of
either domain of inattention or hyperactivity-impulsivity is sufficient to indentify impairment in adults with a history of
childhood onset and significant impairment.

ADHD Diagnosis and Treatment Guideline: Adults 6

Treatment

Goal

The primary goal of treatment is to minimize the impact of ADHD symptoms on patient functioning while
maximizing the patients ability to compensate or cope with any remaining difficulties.

General Approach

If the patient has comorbid conditions, treat the more severe disorder(s) first. For example, if the
patient is both depressed and has ADHDand if the ADHD is having the biggest impact on the
patients functioningtreat ADHD first.
Once the most severe disorder is treated, it is important to continue treatment of other comorbid
disorders (e.g., depression and ADHD both need to be treated in order to maximize treatment
effectiveness).
Education about ADHD is essential to assist the patient in making informed decisions about
pharmacotherapy and the importance of behavioral and lifestyle changes.
Pharmacotherapy should be considered one component of a comprehensive treatment program
that addresses psychological, behavioral, educational, or occupational needs.

Lifestyle Modifications/Non-Pharmacologic Options

Educating Patients about ADHD

Table 5. Discussion points for educating patients about ADHD

Topic Discussion points
ADHD properties ADHD waxes and wanes in its intensity throughout life and in certain
circumstances.
Follow-up studies of children with ADHD have shown that symptoms of the
condition persist into adulthood in 1066% of cases, with an estimated 15%
retaining most of their symptoms and an estimated 50% experiencing some
symptoms.
More than 80% of adults with ADHD have comorbidities such as anxiety,
depression, antisocial personality disorder, neurodevelopmental disorders,
substance misuse, or mood and sleep disorders. The comorbidities may
complicate diagnosis and affect treatment and outcomes.
Diagnosis ADHD is diagnosed using a comprehensive psychological assessment,
developmental history, and rating scales. (Describe assessment procedure to
patient, including possible tests.)
ADHD is a valid disorder recognized by many established organizations.
Individuals with ADHD may have difficulty functioning in their lives; this does
not mean they are lazy or unintelligent.
Individuals with ADHD may have been told something is wrong with them and
that they cannot change; this is not true.
Treatment options A cure for ADHD does not currently exist.
Treatment includes psychosocial interventions and pharmacotherapy.
Psychosocial interventions are designed to help patients learn to manage and
cope with their symptoms and function better in life.
Pharmacological treatments have risks as well benefits, and may sometimes be
limited due to safety concerns (e.g., patient has additional health problems
such as heart disease or substance abuse).

[Table 5. continues on the following page]

ADHD Diagnosis and Treatment Guideline: Adults 7

[Table 5. continued from the previous page]

Topic Discussion points

Strategies for successful
management
Resources for additional
information
Establishing structure helps ADHD patients initiate, engage, and complete
tasks. Tools to assist them with organization (e.g., planners, calendars,
checklists, sticky notes, smart phones, PDAs) are important ways of assisting
adults with ADHD to cope with their lack of organizational skills
Adults with ADHD do best when they pick vocations and hobbies that are
interesting and stimulating to them.
Establishing a social support network helps adult patients with ADHD manage
their daily lives. By participating in community-based ADHD support groups,
patients can both get support (e.g., I am not the only one who has these
difficulties) and learn how to manage and cope with their symptoms.
Having a healthy lifestyle (exercise, good diet, plenty of sleep) also helps adults
with ADHD feel better about themselves and cope with their symptoms.
Substance use can often worsen ADHD symptoms and limit treatment benefits.
To improve symptoms and overall health, engagement with support systems to
manage substance use (e.g., health care providers, family, or community
groups) can be helpful.
See Patient Education on InContext for information on the many ADHD books, Web
sites, and community resources that are available.

Cognitive Behavioral Therapy (CBT)

Optimally, CBT should be combined with pharmacological treatments that improve the core ADHD
symptoms of inattention, impulsivity, hyperactivity, and/or distractibility.

Consider CBT when:

It can be used in combination with medications, or especially when medications alone have
proved to be only partially effective or ineffective.
The patient has made an informed choice not to use medications or is intolerant of them.
The patient has difficulty accepting the diagnosis of ADHD and adhering to a medication regimen.
The patient has a comorbid condition such as depression or anxiety that could benefit from CBT.
Symptoms are remitting and psychological treatment is considered sufficient for targeting residual
(mild-to-moderate) functional impairment.

CBT framework
The basic framework/rationale for CBT is as follows:
Adults with ADHD have had core impairments since childhoodsuch as distractibility,
disorganization, difficulty with following through on tasks, and impulsivitythat prevent them from
learning or using effective coping skills to deal with basic life tasks (e.g., work, school, and
relationships).
The lack of effective coping skills over time leads to repeated failure experiences and chronic
underachievement. This results in an inability to manage symptoms and continued functional
impairment.
As a result of this chronic failure, adults have received much negative feedback from their
parents, partners, teachers, and peers, leading to negative thoughts and feelings (e.g., I am no
good, I am a failure). These negative feelings can result in an avoidance of coping efforts out of
fear of failure and lead to comorbid disorders such as depression or anxiety.

ADHD Diagnosis and Treatment Guideline: Adults 8

Key components of CBT
The CBT approach is typically short-term and structured and includes: agenda setting, monitoring
progress toward goals, skill building using worksheets and lessons, and assignment and review
of homework. The therapy focuses on:
o Behavioral skills training, specifically the teaching of compensatory skills to cope with the
core ADHD impairments (see Table 6 for more information).
o Addressing dysfunctional patterns of thought associated with avoidance, procrastination,
attentional shifts, and mood difficulties.
CBT for adults with ADHD has been found to be effective when delivered in a group format.

Table 6. Recommended skills training for CBT treatment of ADHD

Skill training
Organization and planning
Problem-solving
Distraction management
Procrastination management
Details of teaching
Promote consistent use of organizational aids such as calendars,
checklists, electronic devices, whiteboards, sticky notes, etc.
Develop triage system for mail and other papers.
Structure the day and the environment.
Develop problem-solving skills.
Learn to look at a situation rationally.
Learn to adaptively think about problems and stressors through positive
self-talk.
Learn to identify and disrupt negative thoughts.
Build and maximize ones attention span. This includes breaking tasks
into smaller steps that correspond with an individuals attention span.
Learn to effectively use a timer and other distractibility reminders.
Develop motivational skills to deal with problems with procrastination.

Not Recommended (Non-Pharmacologic Options)

Studies and reports on complementary/alternative treatments for ADHD have only featured child subjects.
According to the organization Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD),
the following have not been shown to be effective:
Elimination of sugar, salicylates, or artificial coloring from diet
Nutritional supplements such as glyconutritional supplements, fatty acid supplementation,
megadose vitamins, amino acid supplementation, or herbals
Sensory integration training
Antimotion sickness medication
Anti-fungal medication for Candida
Chiropractic treatments
Optometric vision training
Metronome training
Neurofeedback

More information on these treatments is available in this CHADD document:

http://www.help4adhd.org/documents/WWK6.pdf [PDF]

ADHD Diagnosis and Treatment Guideline: Adults 9

Pharmacologic Options
Drug treatment should be the first-line approach for adults with ADHD with either moderate or severe
levels of impairment, unless the patient would prefer a psychological approach (NICE 2008).

Before initiation of stimulant treatment for adults with ADHD:

Establish that a cardiac history and assessment has been performed.
Inform patients that no clinical trials exist on long-term stimulant therapy for adults with ADHD;
the safety of long-term use is not known.
Inform patients of the risk of time-limited dysphoria if stimulant therapy is discontinued after long-
term use.
Inform patients of the other risks of stimulant therapy, including elevation of blood pressure,
cardiac arrhythmia and death, sleep disturbance, anorexia, mood or behavior disturbance,
psychological dependence, and abuse potential.

Initiate ADHD medications at the lowest possible dose and titrate slowly. Before switching
medications, titrate to the maximum dose (if there are no side effects).

For information on side effects, contraindications, formulary status (e.g., prior authorization), and other
pharmacy-related issues, see the Group Health Formulary, the Healthwise Knowledgebase, or other
resources.

Table 7. Recommended pharmacologic options for adults with ADHD

Medication dosage forms Initial dose 1 Titration schedule Maximum
recommended
daily dose
1st line 2
Recommended unless patient has a history of substance misuse or diversion with risk for relapse, or a cardiac
or other medical condition for which stimulants would be contraindicated.
Amphetamine mixed salts 10 mg daily in the Increase by 10 mg every 60 mg
(Adderall XR) morning 7 days as needed.

2nd line 2
Alternative recommendation unless patient has a history of substance misuse or diversion with risk for relapse,
or a cardiac or other medical condition for which stimulants would be contraindicated.
Methylphenidate HCL ER 10 mg daily in the Increase by 10 mg every 60 mg
morning 7 days as needed.
or
Methylphenidate HCL ER 18 mg daily in the Increase by 18 mg every 72 mg 3
(generic Concerta) morning 7 days as needed.
or
Dextroamphetamine SR 10 mg daily in the Increase by 10 mg every 40 mg
morning 7 days (typically dosed twice
daily) as needed.
3rd line
First-line for patients if stimulants are contraindicated (e.g., cardiac condition or history of substance misuse or
diversion).
Atomoxetine (Strattera) [PA] 4 40 mg daily in the Increase to 80 mg after 100 mg
morning 3 days. May increase to
100 mg after 24 additional
weeks as needed.

[Table 7. continues on the following page]

ADHD Diagnosis and Treatment Guideline: Adults 10

[Table 7. continued from the following page]

Medication dosage forms Initial dose 1 Titration schedule Maximum

recommended
daily dose
Other alternatives
First-line agent for patients with a history of substance misuse or diversion with risk for relapse (unless the
patient is abusing alcohol).
Bupropion IR 100 mg twice daily x 7 days, After 4 weeks at 100 mg 450 mg (IR)
then increase to 100 mg three times daily, increase
three times daily to 150 mg three times
or daily.
Bupropion SR 150 mg daily in the morning After 4 weeks at 150 mg 400 mg (SR)
x 7 days, then increase to twice daily, increase to
150 mg twice daily 200 mg twice daily.
(Consider starting at lower
or
doses [e.g., 100 mg].)
Bupropion XR 150 mg daily in the morning After 4 weeks at 150 mg 450 mg (XR)
daily, increase to 300 mg
daily.
1
Consider starting at lower doses for those with small body habitus or history of medication sensitivity or intolerability.
2
Long-acting stimulants are acceptable first-line treatments for adult ADHD; they are convenient and have decreased
potential for diversion or abuse. Short-acting formulations are also available and may be appropriate in certain
populations. Examples include:
Patients who have a well-established therapeutic relationship with their primary care provider.
Patients who require supplemental dosing in the late afternoon/evening.
Patients who can manage ADHD symptoms by using stimulants on an as-needed basis.
3
The Canadian ADHD Resource Alliance (CADDRA) guideline recommends doses up to 108 mg daily; the maximum
dose approved by the FDA is 72 mg daily.
4
Atomoxetine prior authorization criteria: For use in patients who have ADHD and:
Have failed at least two formulary stimulant agents of different classes.
Have a tic disorder or Tourette syndrome (1st line).
Have a contraindication for stimulants (1st line).

ADHD Diagnosis and Treatment Guideline: Adults 11

Follow up/Monitoring
At all follow-up visits:
Assess whether the patients behavioral or functional goals are being met.
Consider using the 6-item ASRS to determine degree of treatment effectiveness.

Medication Monitoring

Table 8. Recommended medication monitoring

Medication Items to monitor Frequency
All Medication adherence 1. Initially and while titrating dosage,
medications Treatment effectiveness monitor every 34 weeks;
Adverse impact on sleep or behavior
2. Then every 3 months until stable;
Adverse impact on appetite or weight
3. Once stable, every 6 months.
Stimulants Blood pressure
Heart rate
Evidence of abuse or diversion potential
Atomoxetine Blood pressure
Neuropsychiatric effects (e.g., anxiety, irritability,
hypomania, suicidal ideation)
Bupropion Blood pressure
Neuropsychiatric effects (e.g., anxiety, irritability,
hypomania, suicidal ideation)

Evidence Summary/References
This guideline was adapted from the following evidence-based guidelines:
Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA). Canadian ADHD
Practice Guidelines, Third Edition. 2011. Available online at:
http://www.caddra.ca/cms4/pdfs/caddraGuidelines2011.pdf [PDF]

Kooij S, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment
of adult ADHD: The European Network. BMC Psychiatry. 2010;10:67. Available online at:
http://www.biomedcentral.com/content/pdf/1471-244x-10-67.pdf [PDF]

Additional information was pulled from these sources:

National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity
disorder: Diagnosis and management of ADHD in children, young people and adults. NICE
Clinical Guideline 72. 2008. Available online at: http://www.nice.org.uk/CG72

Nutt DJ, Fone K, Asherson P, et al. Evidence-based guidelines for management of attention-
deficit/hyperactivity disorder in adolescents in transition to adult services and in adults. J
Psychopharmacol. 2007;21(1):1041. Available online at:
http://www.bap.org.uk/pdfs/ADHD_Guidelines.pdf [PDF]

ADHD Diagnosis and Treatment Guideline: Adults 12

Clinician Lead and Guideline Development
Clinician Lead
David K. McCulloch, MD, Clinical Improvement
Phone: 206-326-3938

Last Update
Most recent comprehensive literature review: February 2011
Interim update: October 2011

Process of Development
This guideline was adapted from the following evidence-based guidelines:
Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA), CADDRA ADHD
guidelines (2011)
European consensus statement on diagnosis and treatment of adult ADHD (2010)
National Institute for Health and Clinical Excellence (NICE), attention deficit hyperactivity
disorder: diagnosis and management of ADHD in children, young people and adults (2008)
British Association of Psychotherapists, evidence-based guidelines for management of attention-
deficit/hyperactivity disorder in adolescents in transition to adult services and in adults (2007)

The following specialties were represented on the Group Health development teams: behavioral health,
family medicine, pediatrics, and pharmacy.

ADHD Diagnosis and Treatment Guideline: Adults 13

DA-1833-1 Rev. Date 2011133
 Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
Patient Name Todays Date
Please answer the questions below, rating yourself on each of the criteria shown using the

Sometimes

Very Often
scale on the right side of the page.As you answer each question, place an X in the box that
best describes how you have felt and conducted yourself over the past 6 months. Please give

Rarely
Never

Often
this completed checklist to your healthcare professional to discuss during todays
appointment.
1. How often do you have trouble wrapping up the final details of a project,
once the challenging parts have been done?

2. How often do you have difficulty getting things in order when you have to do
a task that requires organization?
3. How often do you have problems remembering appointments or obligations?

4. When you have a task that requires a lot of thought, how often do you avoid
or delay getting started?

5. How often do you fidget or squirm with your hands or feet when you have
to sit down for a long time?
6. How often do you feel overly active and compelled to do things, like you
were driven by a motor?
Part A
7. How often do you make careless mistakes when you have to work on a boring or
difficult project?

8. How often do you have difficulty keeping your attention when you are doing boring
or repetitive work?

9. How often do you have difficulty concentrating on what people say to you,
even when they are speaking to you directly?
10. How often do you misplace or have difficulty finding things at home or at work?

11. How often are you distracted by activity or noise around you?

12. How often do you leave your seat in meetings or other situations in which
you are expected to remain seated?

13. How often do you feel restless or fidgety?

14. How often do you have difficulty unwinding and relaxing when you have time
to yourself?

15. How often do you find yourself talking too much when you are in social situations?

16. When youre in a conversation, how often do you find yourself finishing
the sentences of the people you are talking to, before they can finish
them themselves?
17. How often do you have difficulty waiting your turn in situations when
turn taking is required?

18. How often do you interrupt others when they are busy?

Part B
DA-1833 Rev. Date 2011133