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  1. Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist Instructions. The questions on the back page are designed to stimulate dialogue between you and your patients and to help confirm if they may be suffering from the symptoms of attention-deficit/hyperactivity disorder (ADHD).

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  2. Download and print a PDF of the ASRS-v1.1, a tool to help screen for ADHD in adult patients. The checklist has 18 questions based on DSM-IV-TR criteria and two subscales: Inattention and Hyperactivity.

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  3. Adult ADHD Self-Report Scale (ASRS) Symptom Checklist. Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Never.

  4. Copeland Symptom List Adult Attention Deficit Disorder. This checklist was developed from the experience of many specialists in the field of Attention Disorders and Hyperactivity. It is designed to help determine whether you, or someone you are rating, has ADHD or ADD and in which area(s) difficulties are experienced.

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  5. DSM-5 Diagnostic Criteria for ADHD. Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social ...

  6. The content of the questionnaire also reflects the importance that DSM-IV places on symptoms, impairments, and history for a correct diagnosis. For additional details on the ADHD-ASRS v1.1, please visit: http://www.hcp.med.harvard.edu/ncs/asrs.php. Updates based on the DSM-5 version of the screening scale.

  7. diagnosis of ADHD. Recent studies have shown that a substantial proportion of individuals with adult ADHD were not diagnosed or recognized in childhood.3 Use the Adult ADHD self-report scale (ASRS-V1.1) symptom checklist to screen patients for ADHD.6 The ASRS-V1.1 is designed to encourage dialogue between you and your patient to identify if they

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