Jasper/Goldberg Adult ADD Screening Examination - Version 5.0

The items below refer to how you have behaved and felt DURING MOST OF YOUR ADULT LIFE.  If you have usually been one way and recently have changed, your responses should reflect  HOW YOU HAVE USUALLY BEEN. Circle one of the numbers that follows each item using the following scale:

 0 = Not at all                 1 = Just a little               2 = Somewhat

 3 = Moderately                 4 = Quite a lot                       5 = Very much
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1.  At home, work, or school, I find my mind wandering from tasks that are uninteresting or difficult.               

0   1   2   3   4   5

2.  I find it difficult to read written material unless it is very interesting or very easy.                          

0   1   2   3   4   5

3.  Especially in groups, I find it hard to stay focused on what is being said in conversations.                              0   1   2   3   4   5 4.  I have a quick temper...a short fuse.               0   1   2   3   4   5 5.  I am irritable, and get upset by minor annoyances.  0   1   2   3   4   5 6. I say things without thinking, and later regret having said them.                                          0   1   2   3   4   5

7.  I make quick decisions without thinking enough about their possible bad results.                        

0   1   2   3   4   5

8.  My relationships with people are made difficult by my tendency to talk first and think later.            

0   1   2   3   4   5

9.  My moods have highs and lows.                      

0   1   2   3   4   5

10.  I have trouble planning in what order to do a series of tasks or activities.                               

0   1   2   3   4   5

11.  I easily become upset.                            

0   1   2   3   4   5

12.  I seem to be  thin skinned  and many things upset me.

0   1   2   3   4   5

13.  I almost always am  on the go.                     0   1   2   3   4   5 14.  I am more comfortable when moving than when sitting still. 0   1   2   3   4   5 15.  In  conversations, I start to answer questions before  the questions have been fully asked.                             0   1   2   3   4   5 16.  I usually work on more than one project at a time, and fail to finish many of them.

0   1   2   3   4   5

17.  There is a lot of "static" or "chatter" in my head.

0   1   2   3   4   5

18.  Even when sitting quietly, I am usually moving my hands or feet.

0   1   2   3   4   5

19.  In group activities it is hard for me to wait my turn.                                             

0   1   2   3   4   5

20.  My mind gets so cluttered that it is hard for it to function.                                        

0   1   2   3   4   5

21.  My thoughts bounce around as if my mind is a pinball machine.

0   1   2   3   4   5

22.  My brain feels as if it is a television set with all the channels going at once.                           

0   1   2   3   4   5

23.  I am unable to stop daydreaming.                  

0   1   2   3   4   5

24.  I am distressed by the disorganized way my brain works.

0   1   2   3   4   5

 

                                                        TOTAL ________________

  

This is a screening examination for Adult ADD.  It is not a diagnostic test.  Scores over 70 are associated with a high probability of ADD.  The diagnosis of ADD can only be made on the basis of a detailed history and mental status examination.  High scores on this examination may result from anxiety, depression or mania.  These conditions must be ruled out before a diagnosis of Adult ADD can be made.