Welcome to your ATTENTION DEFICIT / HYPERACTIVITY DISORDER SCREENING 1. I often have my mind off the task I am doing. Yes No None 2. I often get sidetracked from the task I am doing. Yes No None 3. I often forget obligations, appointments, errands, appointments, payments, or doing tasks. Yes No None 4. I often procrastinate to get started when the task requires mental effort (avoid filling out forms, long readings). Yes No None 5. I often have difficulties organizing my belongings or have difficulties managing time (deadlines, appointments). Yes No None 6. I often have difficulty finding important things I misplace or loose at home or at work (mobile phone, glasses, wallet, school or work material) Yes No None 7. I often make careless mistakes (overlook or miss details) at work or school. Yes No None 8. I often have difficulties staying focused or paying attention to what is being said during conferences, class, conversations, or reading. Yes No None 9. I am easily distracted by noise or activity around me. Yes No None 10. I often fidget or tap hands or feet, or move in my seat when I have to remain seated for a long time. Yes No None 11. I often feel I am driven by a motor, overly active. Yes No None 12. I often have difficulties remaining seated during meetings or other situations. Yes No None 13. I often feel restless, or difficulties relaxing during my free time. Yes No None 14. I often talk excessively. Yes No None 15. I often finish the sentences for other people or answer before they have finished the question. Yes No None 16. I have difficulties waiting for my turn (lines, conversations…) Yes No None 17. I often interrupt others while they are talking or playing or use their things without their permission. Yes No None 18. I am loud in social or play situations. Yes No None 19. Did you experience some of these problems before you were 12 years old? Yes No None 20. Have these problems affected your family, school, or social life significantly? Yes No None Time's up
