CAARS-Self-Report: Long Version (CAARS-S:L) by C. K. Conners, Ph.D., D. Erhardt, Ph.D., & E. P. Sparrow, M.A. Client ID: Gender: MF Birthdate: /__/, Age: Today’s Dat feed Mout by Yer Mosh Dy Yer Instructions: Listed below are items conceming behaviors or problems sometimes experienced by adults. Read each item carefully and decide how ‘much or how frequently each item describes you rexently. Indicate your response for each item by ercling the number that corresponds to your choice, Use the following seale: 0 =Not at all, never, = Just litle, once in-a while; 2= Pretty much, often; an 3 = Very much, very frequently. Tr Tike we dorag Bove ina! 2 Tose things necessary for tasks or activities (@2, to-do lists, pencils, books, or tool). 3.1 don’t plan ahead, 4 Thur out things ‘S. Lamarisk-taker ofa daredevil. 6 get down on myself. Lo Adon’t finish things | start & Tamewsily frustrated 9. Ttalk too much. | 10. am always onthe go, as if driven by a motor. We mdisorganized| 12. Tsay things without thinking 13. 16S hard for me t@ stay i one place very Tong: 14, Thave trouble doing leisure activities quit. 15. Peanot sure of myself. 16. Ws hard for me to keep track of several things at once. 17 malas movisig even when f should be stil 18 forget to remember things 19); T have a short fase/hot temper. 20. mbored easly. ‘21. Tleave my seat when I am not supposed to. 2 Thave trouble waiting inline or taking tums with others 23. Tsai throw tantrums. 24 Thave trouble keeping my attention focused wien working 25. /seek out fast paded, exciting activities. 26, 1 avoid new challenges because I lack faith in my abilities. 21, igs estless inside even if Tam siting sil. 28. Things | hear or see distract me from what I'm doing 29." Lam forgetful in my daily activities. 30. Many things set me off easily. 31, 1 dislike quiet, introspective activites. 32. [lose things that I need. 33, Ihave trouble listening to what other people are saying. lo coo oD eo soc c pesc ec ec ecRgoSCaDeo5O loo OOM EEE OSE GEBGELEdeLEsBoBoBe Items continued on back page... BEMEHS Ses Siottits rat eeas, Ot Rina wo Sci oon tensa fx sims cre eatCAARS-Self-Report: Long Version (CAARS-S:L) by C. K. Conners, Ph.D., D. Erhardt, Ph.D., & E. P. Sparrow, M.A. Tea Not ata, “encedes” Peay Verma ery cer "hae ene gen Se Tamraamiderachoeer, ee Be 435. T interrupt others when talking. 0 i a 2 36 Seabigeplenchobin fader: 0 1 2 3 37. Lact okay on the obtside, but inside I'm unsure of myself. 8 4 2 3 36 Lam abways oft thse ie : ® 6 ee 39, T make comments/fenarks that {wish I could take back, 0 1 2 3 40, Tean't get things done unless there's an absolute deadline 0 4 2 3 4l...Lfidget (with my hands or fect) or squirm. in my seat. ° ES a #2. Tinake careless mistakes or have trouble paying clase aitention to det 0 ie He z oi 43. T step on people's foes without meaning to. 0 1 2 3 “4A, have trouble wetting started on a task. 0 1 Z 3 45. L intrude on others? activities. 0 1 2 3 Ab. Makes great dea of effort formic to sit stil: $e Gas ee 47, My moods are unpredictable. 0 A 2 3 48. “Idontt like Homework r job activities where I have to think a fot ° 1 2 3 49,_I'mabsent-minded in daily activites o i 2 3 50. Lamirestiess or overactive, 6 + ae 51, Fdepend on others to Keep my life inorder and atlend to the details, 0 q 2 3 SST aan other peo ts without meaning to. 0 1 2 3 ‘$3. Sometimes my attention narrows so much that I'm oblivious to everything else; ‘other times it’s so broad that everything distracts me. ° 4 2 * 54) [fend to squirm of fidget. 0 1 rs 55. Lean't keep my mind on something unless it’s really interesting. ° 1 2 3 ‘56, I wish I had gteatef confidence in my abilities ° 1 Dees 47. Lean’ sit still for very long, 0 1 2 3 138. [ge answers toiguestions befine the questions have been completed: 0 4 Sess '59, [like to be up andion the go rather than being in one place. 0 1 2 s ‘0, Uhave trouble finishing job tasks or schoolwork. ° 1 2 3 GL lamiiiable. | o 4 2 2 ‘62, Tintemnpt others When they are Working or playing! o 4 2 x ‘63, My past failures make ithard for me to believe in myself. 0 1 zs 3 ‘64 Fam distracted wifen things are going on around me. 0 4 2 3 65. [have probloms organizing my tasks and activities. ° 1 2 3 (6, inisjudée bow: honiit takes todo something ot go somewhere: 0 # gina BEMIS (rch Sous oat. aac Se en onan") lear au =e eaCAARS-Self-Report: Long Version (CAARS-S:L) by C. K. Conners, Ph.D., D. Erhardt, Ph.D., & E. P. Sparrow, Ph.D. Client ID: Birthdate:__/__ Age: Month | Day Yow ‘Today’s Date: __/ Moa De Gender: MF (Gecko) Name: Instructions: Transfer cireled numbers into unshaded boxes across each row, as indicated on either side of the scoring grid. Each circled number will be copied once or twice. Tras ca cla amber Bow Ts ach ied mmr teow i box tt is ino a nu bx tt ok ie ees eves tht ok ke i tant ne met eet o a 2" « 2 1 0O «3 2 a oO oO 1 2 3 2 eee 2 1 0 ‘0 FS 2 es a" *?" 1 oO ‘0 a e Sea oe" 2 1 oO oO mt 2 3s s 23 2 = ‘oC a ia a 2 o> a3 2 + 0 ‘0 1 ta 3 7 - 2 re 1 oO 0 4 i 3 * a 3 2 1 ‘e+ oO 1 2 3 . a3 es a oo} 0 i. ‘2 3° |e «3 ” 2 3 oO 0O v2 ¥€ “3 a wo 3” 2 1 0. sg ° 1 = oe - 2 1 0 0 + 2 7, 2 eel 2 1 0 ‘0 i ‘2 ae o 3 2 oe ‘0 oO 1 * 3 1s 2 3 2 7. ‘0 0 1 - 3 * a) 3 2 1 ‘0 - “oO a 2 : ae a 3" <2 1 oO 7) 4 - °° we - . a) 4 : a 3 1” os 2 1 0 oO a 2 3.1» os 2 1 0 ca 4 2 3 niet 2 1 0 = 4 0 4 2 a «3 a tt - oO 4 2 3 a 21/8 ee ed 0 2 2 0 i 2 Blu «3 | 74m BEE) 0 si 0 1 2 ar o 3 2 1 oO 0 a 2 oi is o 3 2 4: o's ‘0 i es) a 3S 2 1 ‘0 0 + < 3 ™ o 3 2 1 ° Oeuuiaee 2 3)" ls o 3 2 Tt o 0 + cf 3 ” a 3 2 t “90 oO a 2 3 a «3 2 t o "| 4 0 i 2 ita «3 2 1 0 s = 0 af 2 Bis Moatiticiipesraacs A BC BF FES Geen aes Inconsistency Index scorinainstvcams) Is the Inconsistency Index nt ene eee omer. | TOL Sor rene? Piepebene Feta efene seit iniee, yes Ono ae I L Intemererin yetheeny - ‘Spurn Sle eee! lee) et) foe fel ce +f ]+ fascia tyClient 1D: Females 18 to 29 years of age Females 30 t9 39 years of age Females 40 to 49 years of age 4 = Females 50 years of age or older | | pop CAARS-Self-Report: Long Version (CAARS-S: . Inattention/Memory Problems 3. Hyperactvity/Restlessness ImpulsivitylEmotional Labilty Problems with Self-Concept Gender: MF E. DSMAV Inatientive Symptoms F. DSMHV Hyporactive-Impuisive Symptoms G. DSMV ADHD Symptoms Total H. ADHD Index — Profile For Females A B c D E F G H aeeees| = & |e = 5 ea = es a ae e 23 5 & aa ® Ries ana ¢ ne BEBE AUS a & 0 ee ee SSS ae ee 8 % 11 8 Did Os a § wen ghana went & S - paeg sees @aen e : jae S bene Seo” = Baan S ne. BARS & See ae —— : toe ee Bake tte oe BS" a @ : 2 emis s Bogatk ta ol Fae 2 [so —— 10 = eee ee oe 3 eal Gomes oa $ Pima ge geass Sagat 1 Bees e257 S ja. 66 6 : heer] Sees ¢ouhn 7 Tee B 2 bs 1 poe seed beet feta & 4 : : parece Ba Se ener ee Gs een amet B baat gna eonen egeeaonee Bitte Sine Set tare License jg Pi eg gs tae 3 ao a ee 3 raat See gt ee eee oe 2 3 i the ope ea Soe 3 e 5 : 38 iacits s = E sis ia : ae z 2 Pe a STS Suh PEE ae Biltik ee : a feo: :& 2 ae eee : oe & ESWC Oe TNS A RUE OBClient ID: Gender: MF (GreOn Birthdate:__/__/ Age: ‘Today's Date:__/__/___ Name. Seca by Yer Wish Var A, Inattention’Memory Problems. DSW-IV inattentive Symptoms B. HyperactvityiRestlessness. ——-F. DSM-IV Hyperactive-Impuleive Symptoms . ImpulsivityfEmotional Labilty G. DSM-IV ADHD Symptoms Total D. H. ADHD Index M1 = Males 18 to 29 years of age M2 = Malas 30 to 39 years of ago M3 = Malas 40 to 49 years of age M4 = Malas 50 years of age or older Problems with Self-Concept 1 em ne wv v0 MOA HNO ] ~ TB Be dy diode Gao dav die De gor Brazeage = 4 882 0 | ae Be t 8 * eae eres | oS 2 a ee a | tS : BS 3| eae z| a 3 a 3 8 ne ee Se 2] 2 fae fa 13 3) : ~ S| 3 3 : 1g : $ z : : 3 = : 7 ort [git ij aaa Pana atte 3 ‘ ting HH oan Petre SA ge eg 3 pit eee $ Lt Pi 4