Questionaire

NOTE You may download and reproduce this questionnaire as long as you include the following statement: "This educational material is made available, courtesy of Dr. Daniel Amen and ADDult Support of Washington for Adults with ADD, a non-profit organization based in Tacoma, whose purpose is to educate adults and the professionals who treat them about Attention Deficit Disorder. Our address is PO Box 7804, Tacoma, WA. 98407-0804. Tel 253-759-5085, email: addult@addult.org and web site: www.ADDult.org."   This page as a whole (including HTML coding and layout) may be copied on the condition that all links are maintained. If you have any questions, please contact Balance Check. at Balance_Check@bigfoot.com
 

In conjunction with other diagnostic techniques, Dr Amen says he, "uses the following general adult ADD checklist to help further define ADD symptoms. No ADD adult has all of the symptoms, but if you notice a strong presence of more than 20 of these symptoms, there is a strong likelihood of ADD."

Read this list of behaviors and rate yourself (or the person who has asked you to rate him or her) on each behavior listed. Use the following scale and place the appropriate number next to the item. For purposes of this questionaire, both ADD and ADHD are lumped into the single term ADD.

**IMPORTANT: This is not a tool for self-diagnosis. Its purpose is simply to help you determine whether ADD may be a factor in the behavior of the person you are assessing using this checklist. An actual diagnosis can be made only by an experienced professional.

Past History

 __*History of ADD symptoms in childhood, such as distractibility, short attention span, impulsivity or restlessness. (Absent a head injury, ADD doesn't start at age 30.)

__History of not living up to potential in school or work (report cards with comments
such as "not living up to potential")

 __History of frequent behavior problems in school (mostly for males)

 __History of bedwetting past age 5

 __Family history of ADD, learning problems, mood disorders or substance abuse problems

Short Attention Span/Distractibility

 __*Short attention span, unless very interested in something

__*Easily distracted, tendency to drift away (although at times can be hyper focused)

 __Lacks attention to detail, due to distractibility

 __Trouble listening carefully to directions

 __Frequently misplaces things

__Skips around while reading, or goes to the end first, trouble staying on track

__Difficulty learning new games, because it is hard to stay on track during directions

__Easily distracted during sex, causing frequent breaks or turn-offs during lovemaking

__Poor listening skills

__Tendency to be easily bored (tunes out)

Restlessness

__Restlessness, constant motion, legs moving, fidgeting

__Has to be moving in order to think

__Trouble sitting still, such as trouble sitting in one place for too long, sitting at a desk
job for long periods, sitting through a movie

 __An internal sense of anxiety or nervousness

 
Impulsivity

 __Impulsive, in words and/or actions (spending)

__Say just what comes to mind without considering its impact (tactless)

__Trouble going through established channels, trouble following proper procedure, an attitude of "read the directions when all else fails"

__Impatient, low frustration tolerance

__A prisoner of the moment

__Frequent traffic violations

__Frequent, impulsive job changes

__Tendency to embarrass others

__Lying or stealing on impulse

 
Poor Organization

__Poor organization and planning, trouble maintaining an organized work/living area

__Chronically late or chronically in a hurry

__Often have piles of stuff

__Easily overwhelmed by tasks of daily living

__Poor financial management (late bills, check book a mess, spending unnecessary money on late fees)

 
Problems Getting Started and Following Through

 __Chronic procrastination or trouble getting started

__Starting projects but not finishing them, poor follow through

__Enthusiastic beginnings but poor endings

__Spends excessive time at work because of inefficiencies

__Inconsistent work performance
 

Negative Internal Feelings

 __Chronic sense of under achievement, feeling you should be much further along in your life than you are

 __Chronic problems with self-esteem

__Sense of impending doom

__Mood swings

__Negativity

 __Frequent feeling of demoralization or that things won't work out for you

Relational Difficulties

__Trouble sustaining friendships or intimate relationships, promiscuity

__Trouble with intimacy

__Tendency to be immature

__Self-centered; immature interests

__Failure to see others' needs or activities as important

__Lack of talking in a relationship

__Verbally abusive to others

__Prone to hysterical outburst

__Avoids group activities

__Trouble with authority
 

Short Fuse

 __Quick responses to slights that are real or imagined

__Rage outbursts, short fuse

Frequent Search For High Stimulation

__Frequent search for high stimulation (bungee jumping, gambling, race track, high stress jobs, ER doctors, public defender, doing many things at once, etc.)

__Tendency to seek conflict, be argumentative or to start disagreements for the fun of it

 
Tendency To Get Stuck (thoughts or behaviors)

 __Tendency to worry needlessly and endlessly

__Tendency toward addictions (food, alcohol, drugs, work)

Switches Things Around

 __Switches around numbers, letters or words

__Turn words around in conversations

 
Writing/Fine Motor Coordination Difficulties

 __Poor writing skills (hard to get information from brain to pen)

__Poor handwriting, often prints

__Coordination difficulties

 
The Harder I Try The Worse It Gets

__Performance becomes worse under pressure.

 __Test anxiety, or during tests your mind tends to go blank

__The harder you try, the worse it gets

__Work or schoolwork deteriorates under pressure

__Tendency to turn off or become stuck when asked questions in social situations

 __Falls asleep or becomes tired while reading

Sleep/Wake Difficulties

 __Difficulty falling asleep, may be due to too many thoughts at night

 __Difficulty coming awake (may need coffee or other stimulant or activity before feeling fully awake)

 
Low Energy

 __Periods of low energy, especially early in the morning and in the afternoon

 __Frequently feeling tired

 
Sensitive To Noise Or Touch

 __Startles easily

__Sensitive to touch, clothes, noise and light

When you have completed the above checklist, calculate the Total Score: _______

 Total Number of Items with a score of three (3) or more: _______

 Score for Item #1: _______

 Score for Item #6: _______

 Score for Item #7: _______

Dr. Amen suggests: "More than 20 items with a score of three or more indicates a strong tendency toward ADD. Note: The three items with * are essential to make the diagnosis.

He adds: "One of the most common ways I diagnose ADD in adults is when parents reluctantly tell me that they have tried their child's medication and that they found it very helpful. They report it helped them concentrate for longer periods of time. They became more organized and were less impulsive. Trying your child's medication is not something I recommend!"