ADHD Questionnaire
ADHD Questionnaire designed to screen for symptoms of Attention-Deficit/Hyperactivity Disorder in children or adults.
Participant Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
Never
Rarely
Sometimes
Often
Very Often
How often do you have difficulty getting things in order when you have to do a task that requires organization?
Never
Rarely
Sometimes
Often
Very Often
How often do you have problems remembering appointments or obligations?
Never
Rarely
Sometimes
Often
Very Often
How often do you avoid or delay getting started on a task that requires a lot of thought?
Never
Rarely
Sometimes
Often
Very Often
How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
Never
Rarely
Sometimes
Often
Very Often
Are there specific situations or times when the symptoms are more noticeable?
Do these behaviors affect academic, occupational, or social functioning?
Completed By
Self
Parent
Teacher
Other
Name
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: