Turned Leaf Psychiatry

Adult ADHD Screening Questionnaire (ASRS v1.1)

Over the past six months, how often have you experienced each of the following?

Before you begin

The Adult ADHD Self-Report Scale (ASRS v1.1) is an educational screening questionnaire, not a diagnosis. A result that suggests symptoms consistent with adult ADHD does not mean that you have ADHD. Sleep disorders, thyroid problems, anxiety, depression, trauma, substance use, chronic pain, and life stress can all cause overlapping problems with attention, restlessness, and follow-through. A diagnosis requires a clinical evaluation that looks at your history since childhood and at how symptoms affect more than one part of your life.

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Part A: The six screening questions

These six items carry the most weight in the ASRS screen. Please answer all of them.

Questionnaire progress0 of 6 answered

Part B: Additional symptoms (optional)

These twelve items are not part of the screening cutoff, but they help describe the pattern and are useful to bring to an appointment.

Part C: History and impact (optional)

Were several of these symptoms present before you were about 12 years old?
Do these symptoms cause difficulty in more than one setting, such as work or school and also home or relationships?
How much have these symptoms made it difficult to do your work, take care of things at home, or get along with other people?

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    This questionnaire is educational only. It does not diagnose any condition and does not create a patient–provider relationship. To discuss your results, call Turned Leaf Psychiatry at (601) 494-5503, Monday through Friday, 9:00 AM to 4:00 PM.