Testing of Child and Adult ADHD, Dyslexia and other Learning Disorders

19 Johnson Street
Newburyport, MA 01950
978-465-2999

35 Bedford Street
Suite 7
Lexington, MA 02420
781-860-7733

118 Maplewood Ave.
Portsmouth, NH 03801
603-433-8954

Adult ADHD Testing Assessment Attention Deficit Hyperactivity Disorder Massachusetts New Hampshire Tests ADD Treatment Counseling Diagnostic Symptons Signs Adult Help

Symptoms of Attention Deficit Disorder, ADD, ADHD and Attention Problems in Adults

Instructions: Please answer all questions. Click on the appropriate boxes to add a check mark. Submit this form for a printable version and bring it to your evaluation.

Adult's name:

Age:

	Never	Seldom	Often	Always
1. Whenever I follow directions (recipes, assemble furniture, etc.), I follow each step just as it is presented to me in sequence.
2. I have trouble putting my thoughts down on paper.
3. I feel overwhelmed by all the things I have to do.
4. Noises distract me.
5. Tasks which need persistence frustrate me.
6. My mind races ahead with lots of ideas.
7. I have trouble sitting passively still at lectures and presentations.
8. I finish the home projects I start.
9. I easily lose interest in tasks.
10. I do not have much patience with difficult tasks.
11. Other people talking while I work is distracting.
12. While talking, I go from one topic to another.
13. I need to be reminded of my daily schedule/duties or appointments.
14. I see others as being more organized than I am.
15. My responsibilities are numerous and barely manageable.
16. The quality of my work suffers because of my lack of concentration.
Please add any additional comments/concerns:

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