ASRS Questionnaire

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Please answer the questions below, rating yourself on each of the criteria using the scale provided. For each question, place an X in the box that best describes how you have felt and behaved over the past 6 months. Once completed, please give this checklist to your healthcare professional to discuss during your appointment today.

References

Arami Illustration Checklist

Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/s0033291704002892

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East Melbourne / Telehealth

Perimenopause, Menopause, Adult ADHD, PMDD, Lifestyle Medicine & Weight Loss Management

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Monday — Friday (hours vary by day and practitioner. Check live availability when booking.)

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Eastbourne Professional Suites
62 Wellington Parade East Melbourne 3002

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03 7048 4845

 

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