Adult ADHD Followup ASRS Scale

Adult ADHD Self-Report Scale

Section A (SCREEN)
[select name="Q1" value="never=0|rarely=0|sometimes=1|often=1|very often=1"] <-- 1. Trouble wrapping up the final details of a project, once the challenging parts have been done?
[select name="Q2" value="never=0|rarely=0|sometimes=1|often=1|very often=1"] <-- 2. Difficulty getting things in order when you have to do a task that requires organization?
[select name="Q3" value="never=0|rarely=0|sometimes=1|often=1|very often=1"] <-- 3. Problems remembering appointments or obligations?
[select name="Q4" value="never=0|rarely=0|sometimes=0|often=1|very often=1"] <-- 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
[select name="Q5" value="never=0|rarely=0|sometimes=0|often=1|very often=1"] <-- 5. Fidget or squirm with your hands or feet when you have to sit down for a long time?
[select name="Q6" value="never=0|rarely=0|sometimes=0|often=1|very often=1"] <-- 6. Feel overly active and compelled to do things, like you were driven by a motor?

Section B (SEVERITY)
[select name="Q7" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 7. Make careless mistakes when you have to work on a boring or difficult project?
[select name="Q8" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 8. Difficulty keeping your attention when you are doing boring or repetitive work?
[select name="Q9" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 9. Difficulty concentrating on what people say to you, even when they are speaking to you directly?
[select name="Q10" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 10. Misplace or have difficulty finding things at home or at work?
[select name="Q11" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 11. Distracted by activity or noise around you?
[select name="Q12" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 12. Leave your seat in meetings or other situations in which you are expected to remain seated?
[select name="Q13" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 13. Feel restless or fidgety?
[select name="Q14" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 14. Difficulty unwinding and relaxing when you have time to yourself?
[select name="Q15" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 15. Talking too much when you are in social situations?
[select name="Q16" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 16. Finishing the sentences of the people you are talking to, before they can finish them themselves?
[select name="Q17" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 17. Difficulty waiting your turn in situations when turn taking is required?
[select name="Q18" value="never=0|rarely=1|sometimes=2|often=3|very often=4"] <-- 18. Interrupt others when they are busy?

Section B (SEVERITY) Result --> [calc value="score2=+(Q7)+(Q8)+(Q9)+(Q10)+(Q11)+(Q12)+(Q13)+(Q14)+(Q15)+(Q16)+(Q17)+(Q18);score2>47?'Section B - Average frequency of symptoms = VERY OFTEN':score2>35?'Section B - Average frequency of symptoms = OFTEN':score2>23?'Section B - Average frequency of symptoms = SOMETIMES':score2>11?'Section B - Average frequency of symptoms = RARELY':'Section B - Average frequency of symptoms = NEVER'" memo="interpretation"]

[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: 
[link url="//www.ncbi.nlm.nih.gov/pubmed/15841682" memo="#1"] Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005 Feb;35(2):245-56. 
[link url="http://www.aafp.org/afp/2012/0501/p890.html memo="#2"] Post RE, Kurlansik SL. Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults. Am Fam Phys. 2012 May 1;85(9):890-896.[/conditional]