ADHD New Quality of Life Questionnaire

Adult ADHD Quality of Life Questionnaire (AAQoL)
The following questions are about how ADHD has impacted your life over the PAST 2
WEEKS. Please answer each question by circling your response. There are no right
or wrong answers.
1. During the PAST 2 WEEKS, how difficult Not Somewha

A little A lot Extremely
has it been for you to: at all t
Keep the house/apartment clean or uncluttered

1 2 3 4 5
...........................................................................
Manage your finances (such as cashing checks,
balancing your checkbook, paying bills on
1 2 3 4 5
time)
...........................................................................
Remember important things
1 2 3 4 5
...........................................................................
Get your shopping done (such as for food,
clothes or household items) 1 2 3 4 5
...........................................................................
Pay attention when interacting with others
1 2 3 4 5
...........................................................................
2. During the PAST 2 WEEKS, how often Sometim Very

Never Rarely Often
have you felt: es Often
Overwhelmed
1 2 3 4 5
...........................................................................
Anxious
1 2 3 4 5
...........................................................................
Depressed
1 2 3 4 5
...........................................................................
You have not been able to meet others’
expectations of you (either at home or at 1 2 3 4 5
work)
You annoyed people
1 2 3 4 5
...........................................................................
Getting things done requires too much effort
1 2 3 4 5
.........................................................................
People are frustrated with you
1 2 3 4 5
.........................................................................
Contact Information: Meryl Brod, PhD, President, The BROD GROUP - 219 Julia Ave., Mill Valley, CA 94941
Tel: 415-381-5532, Fax: 415-381-0653, Email: mbrod@thebrodgroup.net; Website: www.thebrodgroup.net
!1
2. During the PAST 2 WEEKS, how often Sometim Very
Never Rarely Often
have you felt: es Often
You have overreacted in difficult or
stressful situations 1 2 3 4 5
.........................................................................
Your energy is well spent (has positive results) 1 2 3 4 5
Able to enjoy time spent with others
1 2 3 4 5
.........................................................................
You can successfully manage your life
1 2 3 4 5
.........................................................................
As productive as you would like to be
1 2 3 4 5
.........................................................................
!2
!3
AAQoL Psychometric Assessment
4/23/2014
3. During the PAST 2 WEEKS, how troubled Not Somewha

have you been by: at all t
Tension in relationships
1 2 3 4 5
.........................................................................
Not having quality time to spend with others
1 2 3 4 5
.........................................................................
4. During the PAST 2 WEEKS, how bothered Not Somewha

have you been by: at all t
Feeling fatigued
1 2 3 4 5
.........................................................................
Fluctuations (ups and downs) in your emotions
1 2 3 4 5
.........................................................................
5. During the PAST 2 WEEKS, how much of Not Somewha

a problem has it been for you to: at all t
Complete projects or tasks (either at work or at

home) 1 2 3 4 5
.........................................................................
Get started with tasks you don’t find interesting
1 2 3 4 5
.........................................................................
Balance multiple projects
1 2 3 4 5
.........................................................................
Get things done on time
1 2 3 4 5
.........................................................................
Keep track of important items (such as keys,
wallet) 1 2 3 4 5
.........................................................................
6. During the PAST 2 WEEKS, how Sometime Very

Not
often have you felt: Never Rarely
s
Often
Often
Applicabl
e
Good about yourself

1 2 3 4 5 ----
...........................................................................
People enjoy spending time with you
1 2 3 4 5 ----
...........................................................................
!4
6. During the PAST 2 WEEKS, how Sometime Very
Not
often have you felt: Never Rarely
s
Often
Often
Applicabl
e
Your intimate relationship is going
well emotionally 1 2 3 4 5 ❑
...........................................................................
Thank you!
!5

ADHD New Quality of Life Questionnaire

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ADHD New Quality of Life Questionnaire

Uploaded by

Copyright:

Available Formats

Adult ADHD Quality of Life Questionnaire (AAQoL)

1. During the PAST 2 WEEKS, how difficult Not Somewha

Keep the house/apartment clean or uncluttered

2. During the PAST 2 WEEKS, how often Sometim Very

3. During the PAST 2 WEEKS, how troubled Not Somewha

4. During the PAST 2 WEEKS, how bothered Not Somewha

5. During the PAST 2 WEEKS, how much of Not Somewha

Complete projects or tasks (either at work or at

6. During the PAST 2 WEEKS, how Sometime Very

Good about yourself

You might also like