Your details

First name *

Last name *

Date of birth *

Please enter your legal name so our system can match you correctly...

Please select the answer next to each item below that best describes your behaviour DURING THE PAST 6 MONTHS.

Section 1 (Inattention)

1. Fail to give close attention to details or make careless mistakes in my work or other activities *

Never or rarelySometimesOftenVery often

2. Difficulty sustaining my attention in tasks or fun activities *

Never or rarelySometimesOftenVery often

3. Don’t listen when spoken to directly *

Never or rarelySometimesOftenVery often

4. Don’t follow through on instructions and fail to finish work or chores *

Never or rarelySometimesOftenVery often

5. Have difficulty organising tasks and activities *

Never or rarelySometimesOftenVery often

6. Avoid, dislike, or am reluctant to engage in tasks that require sustained mental effort *

Never or rarelySometimesOftenVery often

7. Lose things necessary for tasks or activities *

Never or rarelySometimesOftenVery often

8. Easily distracted by extraneous stimuli or irrelevant thoughts *

Never or rarelySometimesOftenVery often

9. Forgetful in daily activities *

Never or rarelySometimesOftenVery often

Inattention score

Inattention symptom count

Section 2 (Hyperactivity)

10. Fidget with hands or feet or squirm in seat *

Never or rarelySometimesOftenVery often

11. Leave my seat in classrooms or in other situations in which remaining seated is expected *

Never or rarelySometimesOftenVery often

12. Shift around excessively or feel restless or hemmed in *

Never or rarelySometimesOftenVery often

13. Have difficulty engaging in leisure activities quietly (feel uncomfortable, or am loud or noisy) *

Never or rarelySometimesOftenVery often

14. I am “on the go” or act as if “driven by a motor” (or I feel like I have to be busy or always doing something) *

Never or rarelySometimesOftenVery often

Hyperactivity score

Hyperactivity symptom count

Section 3 (Impulsivity)

15. Talk excessively (in social situations) *

Never or rarelySometimesOftenVery often

16. Blurt out answers before questions have been completed, complete others’ sentences, or jump the gun *

Never or rarelySometimesOftenVery often

17. Have difficulty awaiting my turn *

Never or rarelySometimesOftenVery often

18. Interrupt or intrude on others (butt into conversations or activities without permission or take over what others are doing) *

Never or rarelySometimesOftenVery often

Impulsivity score

Impulsivity symptom count

Section 4 (Cognitive tempo)

19. Prone to daydreaming when I should have been concentrating on something or working *

Never or rarelySometimesOftenVery often

20. Have trouble staying alert or awake in boring situations *

Never or rarelySometimesOftenVery often

21. Easily confused *

Never or rarelySometimesOftenVery often

22. Easily bored *

Never or rarelySometimesOftenVery often

23. Spacey or “in a fog” *

Never or rarelySometimesOftenVery often

24. Lethargic, more tired than others *

Never or rarelySometimesOftenVery often

25. Underactive or have less energy than others *

Never or rarelySometimesOftenVery often

26. Slow moving *

Never or rarelySometimesOftenVery often

27. I don’t seem to process information as quickly or as accurately as others *

Never or rarelySometimesOftenVery often

SCT score

SCT symptom count

Total ADHD Score

Section 1 Symptom Count

Sum of Sections 2 and 3 Symptom Counts

Total ADHD Symptom Count

SCT Symptom Count

28. How old were you when these symptoms began?

29. In which of these settings did those symptoms impair your functioning?

School Home Work Social relationships

School difficulties

Home difficulties

Work difficulties

Social relationship difficulties

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