Name *
please rate yourself on each of the symptoms listed below
0 is never experience, 4 is very frequently experience
Easily distracted
Have difficulty sustaining attention span for most tasks in play, school, or work
Have trouble listening when others are talking
Have difficulty following through (procrastination) on tasks or instructions
Have difficulty keeping an organized area (room, desk, book bag, filing cabinet, locker, etc.)
Have trouble with time, for example, frequently late or hurried, tasks take longer than expected, projects or homework are "last-minute" or turned in late
Have a tendency to lose things
Make careless mistakes, poor attention to detail
Daydream excessively
Complain of being bored
Appear apathetic or unmotivated
Tired, sluggish, or slow-moving
Spacey or seem preoccupied
Restless or hyperactive
Have trouble sitting still
Fidgety, in constant motion (hands, feet, body)
Noisy, have a hard time being quiet
Act as if "driven by a motor"
Talk excessively
Impulsive (don't think through comments or actions before they are said or done)
Have difficulty waiting your turn
Interrupt or intrude on others (e.g., butts into conversations or games)
Worry excessively or senselessly
Super organized
Oppositional, argumentative
Have a strong tendency to get locked into negative thoughts; have the same thought over and over
Have a tendency toward compulsive behavior
Have an intense dislike of change
Have a tendency to hold grudges
Have trouble shifting attention from subject to subject
Have difficulty seeing options in situations
Have a tendency to hold on to own opinion and not listen to others
Have a tendency to get locked into a course of action, whether or not it is good for the person
Need to have things done a certain way or you become very upset
Others complain that you worry too much
Have periods of quick temper of rage with little provocation
Misinterprets comments as negative when they are not
Irritability tends to build, then explode, then recede; are often tired after a rage
Have periods of spaciness or confusion
Have periods of panic and/or fear for no specific reason
Perceive visual changes, such as seeing shadows or objects changing shape
Have frequent periods of déjà vu (feelings of being somewhere before even though you have never been there)
Sensitive or mildly paranoid
Have headache or abdominal pain of uncertain origin
Have a history of a head injury or a family history of violence or explosiveness
Have dark thoughts, may involve suicidal or homicidal thoughts
Have periods of forgetfulness or memory problems
Have a short fuse or periods of extreme irritability
Low energy
Frequently irritable
Have a tendency to be socially isolated
Have frequent feelings of hopelessness, helplessness, or excessive guilt
Have lowered interest i things that are usually considered fun
Undergo sleep changes (too much or too little)
Have chronic low self-esteem
Angry or aggressive
Sensitive to noise, light, clothes or touch
Undergo frequent or cyclic mood changes (highs and lows)
Inflexible, rigid in thinking
Demand to have your way, even when told no multiple times
Have periods of mean, nasty, or insensitive behavior
Have periods of increased talkativeness
Have periods of increased impulsivity
Display unpredictable behavior
Way of thinking is grandiose or "larger than life"
Talk fast
Feel that thoughts go fast
Appear anxious or fearful