So this is a big long checklist thing my pdoc gave me to fill out. I posted another topic asking about it and thought it might not be a bad idea to just put it out here to see. It could be something good to take to the doc (??). I'm not sure how to format it here so this is what happened when I pasted it in. It should have spaces to place numbers as well as check boxes. I have it in Microsoft Word if that's easier. I could probably email it if requested.
General Adult ADD Symptom Checklist
In conjunction with other diagnostic techniques, Daniel G. Amen, MD. (publisher of MindWorks Press) 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, a professional diagnosis may be advisable."
Please read this list of behaviors and rate each behavior listed below. Use the following scale and place the appropriate number on the line to the left of each item.
*****NOTE** the lines aren't there so I'm not sure how you want to do it. I guess you could print it out....???*****
0 = never 1 = rarely 2 = occasionally 3 = frequently 4 = very frequently
Past History 1. History of ADD symptoms in childhood, such as distractibility, short attention span, impulsivity or restlessness. ADD doesn't begin at age 20.
2. History of not living up to potential in school or work (report cards with comments such as "not living up to potential")
3. History of frequent behavior problems in school (mostly for males).
4. History of bed wetting past age 5.
5. Family history of ADD, learning problems, mood disorders, or substance abuse problems.
Short Attention Span/Distractibility 6. Short attention span, unless very interested in something.
7. Easily distracted, tendency to drift away (although at times can be hyper focused).
8. Lacks attention to detail, due to distractibility.
9. Trouble listening carefully to directions.
10. Frequently misplaces things.
11. Skips around while reading, or goes to the end first, trouble staying on track.
12. Difficulty learning new games, because it is hard to stay on track during directions.
13. Easily distracted during sex, causing frequent breaks or turn-offs during lovemaking.
14. Poor listening skills.
15. Tendency to be easily bored (tunes out).
Restlessness 16. Restlessness, constant motion, legs moving, fidgetiness.
17. Has to be moving in order to think.
18. 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.
Impulsivity 20. Impulsive, in words and/or actions (spending).
21. Say just what comes to mind without considering its impact (tactless).
22. Trouble going through established channels, trouble following proper procedure, an attitude of "read the directions when all else fails"
23. Impatient, low frustration tolerance.
24. A prisoner of the moment.
25. Frequent traffic violations.
26. Frequent, impulsive job changes.
27. Tendency to embarrass others.
28. Lying or stealing on impulse.
Poor Organization 29. Poor organization and planning, trouble maintaining an organized work/living area.
30. Chronically late or chronically in a hurry.
31. Often have piles of stuff.
32. Easily overwhelmed by tasks of daily living.
33. Poor financial management (late bills, check book a mess, spending unnecessary money on late fees)
34. Some adults with ADD are very successful, but often only if they are surrounded with people who organize them.
Problems Getting Started and Following Through 35. Chronic procrastination or trouble getting started.
36. Starting projects but not finishing them, poor follow through.
37. Enthusiastic beginnings but poor endings.
38. Spends excessive time at work because of inefficiencies.
39. Inconsistent work performance.
Negative Internal Feelings 40. Chronic sense of underachievement, feeling you should be much further along in your life than you are.
41. Chronic problems with self-esteem.
42. Sense of impending doom.
43. Mood swings.
44. Negativity.
45. Frequent feeling of demoralization or that things won't work out for you.
Relational Difficulties 46. Trouble sustaining friendships or intimate relationships, promiscuity.
47. Trouble with intimacy.
48. Tendency to be immature.
49. Self-centered; immature interests.
50. Failure to see others' needs or activities as important.
51. Lack of talking in a relationship.
52. Verbally abusive to others.
53. Proneness to hysterical outburst.
54. Avoids group activities.
55. Trouble with authority.
Short Fuse 56. Quick responses to slights that are real or imagined.
57. Rage outbursts, short fuse.
Frequent Search For High Stimulation 58. Frequent search for high stimulation (bun gee jumping, gambling, race track, high stress jobs, ER doctors, doing many things at once, etc.)
59. Tendency to seek conflict, be argumentative, or to start disagreements for the fun of it.
Tendency To Get Stuck (thoughts or behaviors)60. Tendency to worry needlessly and endlessly.
61. Tendency toward addictions (food, alcohol, drugs, work).
Switches Things Around 62. Switches around numbers, letters, or words.
63. Turn words around in conversations.
Writing/Fine Motor Coordination Difficulties 64. Poor writing skills (hard to get information from brain to pen).
65. Poor handwriting often prints.
66. Coordination difficulties.
The Harder I Try The Worse It Gets 67. Performance becomes worse under pressure.
68. Test anxiety, or during tests your mind tends to go blank.
69. The harder you try, the worse it gets.
70. Work or schoolwork deteriorates under pressure.
71. Tendency to turn off or become stuck when asked questions in social situations.
72. Falls asleep or becomes tired while reading.
Sleep/Wake Difficulties 73. Difficulties falling asleep may be due to too many thoughts at night.
74. Difficulty coming awake (may need coffee or other stimulant or activity before feeling fully awake)
Low Energy 75. Periods of low energy, especially early in the morning and in the afternoon.
76. Frequently feeling tired.
Sensitive To Noise Or Touch 77. Startles easily.
78. Sensitive to touch, clothes, noise, and light.
1. Total Score: __________
2. Total Number of Items with a score of three (3) or more: __________
3. Score for Item #1: __________
4. Score for Item #6: __________
5. Score for Item #7: __________
21 or more items with a score of three or more, suggests a strong tendency toward ADD. Items 1, 6, and 7 are more indicative of people with ADD.
The following checklist is intended to broach the subject of ADD and to increase one's awareness that an ADD condition may be present. It may also suggest whether or not a professional diagnosis should be sought.
• Words like “slow”, “lazy”, “dumb”, etc. have been used as descriptors.
• Becomes lost or confused when traveling.
• Academic classes such as history and social studies were more difficult than shop classes or vice versa.
• Unemployed often or employed at jobs below one’s skills.
• Attempted suicide.
• Have now or have had drug or alcohol problems.
• Was convicted of criminal offenses.
• Quit school before graduation.
• Reverses words, letters, or numbers
• Did or does have difficulty telling left and right.
• Has lost job(s) or quit because of inability to do the work.
• Is left handed or ambidextrous (use both).
• Impossible to make simple line drawings.
• Frequently loses place when reading.
• Has difficulty or is slow when copying information
• Handwriting is difficult, or hard to read.
• Is generally known to be clumsy.
• Has nervous tics or involuntary movements.
• Keeping “time” to music is difficult.
• Has a hard time keeping still.
• Exhibits either shyness or boldness.
• Has difficulty getting along with peers.
• Verbal language is disjointed or confused.
• Needs reassurance when attempting non-physical tasks.
• Avoids reading whenever possible
• Mathematics is difficult.
• It was difficult to learn to tell time.
• Has trouble learning and/or using weights and measures such as: inches, ounces, feet, pounds, miles, etc.
• Has difficulty following directions.
• Has difficulty with organization of time and/or things.
• It is often difficult to be on time.
• Becomes confused under pressure when hurried.
• Has a difficult time making decisions.
• Daydreaming interferes with things to be done.
• Has difficulty concentrating on a single thing.
• Has difficulty with sequencing (keeping track) events, time, due dates, assignments, etc..
• How difficult was it to maintain your focus when taking/doing this checklist?