Green Meadows Adult Psychiatry 3301 South Providence Road Building E Columbia, MO 65203 PHONE: (573) 882-2511 FAX: (573) 884-4515 ADULT ADHD INVENTORY NAME: ________________________________ DATE OF BIRTH: ________________ DATE: ____________________ Instructions: Rate each statement by placing the appropriate number that fits how you feel about the statement in the space to the left of each item. If an item does not apply to you, write NA for “not applicable.” 0 – This statement does not describe me at all. 1 – This statement describes me to a slight degree. 2 – This statement describes me to a moderate degree. 3 – This statement describes me to a large degree. 4 – This statement describes me to a very large degree. INATTENTION/CONCENTRATION 1. ___ It is hard for me to stick to one thing for a long period of time (except TV, computer games, or socializing). 2. ___ People complain that I don’t listen. 3. ___ I tune in and out during lectures or speeches. 4. ___ It is hard for me to study for long periods of time. 5. ___ When reading, often my eyes scan the words, but my mind is somewhere else. 6. ___ In group situations, I sometimes lose track of the conversation. 7. ___ I lose my place when I am reading. 8. ___ I have trouble keeping my thoughts organized. 9. ___ I have always had a tendency to tune out or drift away in the middle of a page or conversation DISTRACTIBILITY 10. ___ I become easily sidetracked. 11. ___ I am constantly noticing or thinking of things unrelated to the task I am doing. 12. ___ I jump from topic to topic in conversation. 13. ___ It is hard for me to keep focused on long-term projects. 14. ___ A 5 minute break from studying or paper-work can easily become an hour- long break if I’m not careful. 15. ___ If I don’t do something when I think of it, I usually forget to do it later. 16. ___ It is very hard for me to study or concentrate if people are talking nearby. IMPULSIVITY/SELF-CONTROL 17. ___ I “got in trouble” in school for talking or misbehaving. 18. ___ I tend to “go with my feelings” and often don’t think before I act. 19. ___ I interrupt others in conversation. 20. ___ Sometimes I hurt people’s feelings without meaning to because I speak before I think. 21. ___ I am a risk taker. 22. ___ I make decisions quickly. 23. ___ When I have a job to do, I just dive in and figure it out as I go. 24. ___ I have had more than my share of speeding tickets or car accidents. RESTLESSNESS 25. ___ I eat quickly. 26. ___ I need to move or exercise frequently. 27. ___ I sometimes bother people around me by tapping, jiggling, or moving. 28. ___ I have trouble slowing down. 29. ___ I can’t sit still for very long. 30. ___ I am very talkative. 31. ___ I often feel bored and impatient. 32. ___ In classes, large groups, or church/temple, I feel restless and fidgety. 33. ___ I have to get up and move around when I study. 34. ___ Sometimes I feel like I am driven by a motor. HYPERFOCUSING 35. ___ Sometimes I become so involved in what I’m doing that I completely lose track of time. 36. ___ When people talk to me or call me when I’m engrossed in something, I frequently don’t hear them. TIME MANAGEMENT 37. ___ I have trouble being on time. 38. ___ I tend to procrastinate. 39. ___ I am unrealistic about how long a task will take. 40. ___ I tend to make too many commitments. 41. ___ I am often late for appointments or meetings. 42. ___ No matter how good my intentions are, I end up (or used to end up) having “all-nighters” before exams, or when papers are due. SELF-DISCIPLINE 43. ___ I have difficulty sticking to my plans for “self-improvement.” 44. ___ I can’t tear myself away from activities I like, even when I know I will be late for something. 45. ___ I usually do what I like, and put things off that I ought to do. 46. ___ The only way I can get myself to do boring projects or tasks is to wait until the deadline. 47. ___ I have started and dropped many interests. 48. ___ I have been called lazy. 49. ___ I have been called irresponsible. SLEEP/AROUSAL PROBLEMS 50. ___ I have very irregular sleep patterns. 51. ___ Falling asleep at night has always been difficult for me. 52. ___ I am a restless sleeper. 53. ___ It is hard for me to wake up in the morning. 54. ___ I often oversleep. 55. ___ When sitting in class or studying, I quickly feel tired, no matter how much sleep I got the night before. 56. ___ I tend to fall asleep for catnaps if I sit down or lie down to relax. ORGANIZATIONS/STRUCTURE 57. ___ I rarely plan my day. 58. ___ I tend to be messy. 59. ___ Other people have complained about my disorganization or messiness. 60. ___ I have trouble keeping up with several simultaneous projects. 61. ___ I become overwhelmed when I have too many choices. 62. ___ I have difficulty keeping my checkbook balanced. 63. ___ I try to get organized; but it never lasts long. 64. ___ I often pay bills late. 65. ___ It is hard for me to prioritize things I need to do. STIMULANTS 66. ___ I tend to forget appointments. 67. ___ I rely on others to be my reminder. 68. ___ I tend to misplace personal items. 69. ___ I lose my car keys. 70. ___ I forget what my parents, spouse, or others ask me to do. 71. ___ It is hard for me to remember things I intend to do. 72. ___ If I don’t write it down, I’ll forget it. 73. ___ Even if I write things down, I often misplace the note. FRUSTRATION TOLERANCE 78. ___ I have been called impatient. 79. ___ I become easily frustrated. 80. ___ It is hard to tolerate people who do thing slowly. 81. ___ I hate to wait. 82. ___ I tend to give up quickly if I can’t figure out how to do something. 83. ___ I fought frequently as a child. 84. ___ I have a short fuse. 85. ___ If someone raises her or his voice at me, I yell back. 86. ___ I have punched holes in walls or doors out of anger. 87. ___ I usually become angry if I am criticized. 88. ___ It is almost impossible for me to remain calm if someone is acting in an angry manner toward me. 89. ___ I tend to be moody. EMOTIONAL LABILITY 90. ___ My feelings (positive or negative) are very intense. 91. ___ I have “thin skin.” 92. ___ I have very intense premenstrual symptoms of moodiness or emotionality. 93. ___ I tend to overreact. 94. ___ I cry more often than my friends do. 95. ___ As a child, I was teased for getting upset. ACADEMICS 96. ___ I have been called an underachiever. 97. ___ School seemed boring and frustrating for as long as I can remember. 98. ___ My grades went down in junior high compared to elementary school. 99. ___ My siblings were better students than I was. 100. ___ I was diagnosed with learning problems. 101. ___ My teachers and parents always felt I was unmotivated in school. 102. ___ My grades varied from A’s to F’s. 103. ___ My low grades were often a result of not turning in homework. 104. ___ Even when I studied hard for tests, during the exam I “blanked out” and couldn’t remember information. 105. ___ Careless errors have frequently lowered my grades. ANXIETY/DEMORALIZATION/DEPRESSION 106. ___ I have had periods when I felt depressed for weeks or months. 107. ___ I have felt so anxious and overwhelmed that I felt like quitting my job/school. 108. ___ I worry a lot about my future. 109. ___ I’m afraid I’ll never “get my act together.” 110. ___ I have occasionally felt suicidal. 111. ___ Often I drink or party just to get my mind off my troubles. 112. ___ I have taken medication for anxiety or depression. 113. ___ Sometimes I can’t get out of bed because I feel so overwhelmed. 114. ___ I have headaches, neck aches, or backaches from tension and worry. 115. ___ I worry endlessly about trivial things. SELF-ESTEEM AND CONFIDENCE 116. ___ I tend to put myself down. 117. ___ I try to avoid competitive situations. 118. ___ I overreact to criticism. 119. ___ I can’t take being teased. 120. ___ I worry a lot about making mistakes. 121. ___ I am always “messing up.” OPPOSITIONAL TENDENCIES 122. ___ I was a “difficult child.” 123. ___ I don’t like being told what to do. 124. ___ I argue a lot. 125. ___ I have been called stubborn. 126. ___ I have had many disagreements with my parents, spouse, or friends. 127. ___ I have been fired or have had arguments with supervisors on jobs. SOCIAL/INTERPERSONAL 128. ___ I was teased a lot as a kid. 129. ___ I had trouble getting along with other kids. 130. ___ I always felt “different” as a child. 131. ___ I have been called bossy. 132. ___ Sometimes I am too blunt or critical. 133. ___ Though I don’t mean to be, I have been called inconsiderate. 134. ___ I tend to have conflicts with roommates or co-workers. FAMILY HISTORY 135. ___ There is a history of alcoholism in my family. 136. ___ There is a history of depression in my family. 137. ___ Other family members (including cousins, aunts, uncles) have been diagnosed as hyperactive or learning disabled. 138. ___ One of my parents says they were a lot like me when they were younger.