What are the screening questions for Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD Screening Questions

Begin screening with the Adult ADHD Self-Report Scale (ASRS-V1.1) Part A, which requires only 6 questions and is considered positive if 4 or more items are marked "often" or "very often." 1

Core Screening Questions by Symptom Domain

Inattentive Symptoms (9 questions)

The following questions assess inattention, with a positive screen requiring 5 or more symptoms present for at least 6 months 2:

• Poor attention to detail - Do you make careless mistakes or overlook details in work or tasks? 2
• Difficulty concentrating or sustaining attention - Do you have trouble keeping your attention on tasks or activities? 2
• Seems preoccupied - Do you have difficulty shifting focus even when spoken to directly? 2
• Difficulty completing tasks - Do you frequently get distracted or side-tracked before finishing tasks? 2
• Organizational challenges - Do you experience chronic lateness for appointments or deadlines, messiness, or disorganized work? 2
• Reluctance for sustained mental effort - Do you avoid or dislike tasks requiring sustained mental effort (e.g., preparing reports, reviewing lengthy papers)? 2
• Difficulty tracking belongings - Do you frequently lose items required for task completion? 2
• Easily distracted - Are you easily distracted by external stimuli or unrelated thoughts? 2
• Frequently forgetful - Do you forget daily activities, appointments, or obligations? 2

Hyperactive-Impulsive Symptoms (9 questions)

The following questions assess hyperactivity-impulsivity, with a positive screen requiring 5 or more symptoms present for at least 6 months 2:

• Frequent fidgeting - Do you frequently fidget (e.g., tapping a desk, moving hands or feet)? 2
• Difficulty sitting still - Do you find it difficult to sit still for prolonged periods? 2
• Inner restlessness - Do you experience feelings of inner restlessness or agitation? 2
• Often loud and disruptive - Are you often loud or disruptive in social situations? 2
• Always on the go - Do you feel like you're always on the go, making it difficult for others to keep up? 2
• Talks excessively - Do you talk excessively in conversations? 2
• Frequently interrupts - Do you frequently interrupt others or have difficulty restraining yourself from sharing your perspectives? 2
• Highly impatient - Do you have difficulty waiting (e.g., waiting in line, waiting your turn)? 2
• Intrudes into others' activities - Do you often intrude into others' activities or take over what others are doing? 2

Critical Diagnostic Requirements

Beyond the screening questions, the following criteria must be confirmed 1, 3:

• Symptom onset before age 12 years - Symptoms must have been present in childhood, even if not formally diagnosed 1, 3
• Duration of at least 6 months - Symptoms must persist for at least 6 months 2, 1
• Present in ≥2 settings - Symptoms must cause impairment in multiple settings (e.g., work, home, social situations) 1
• Functional impairment - Symptoms must cause significant functional impairment in daily life 1

ADHD Subtypes Based on Screening Results

The pattern of positive responses determines the subtype 2:

• Predominantly inattentive type: 5 or more inattentive symptoms but <5 hyperactive-impulsive symptoms 2
• Predominantly hyperactive-impulsive type: 5 or more hyperactive-impulsive symptoms but <5 inattentive symptoms 2
• Combined type: 5 or more inattentive symptoms AND 5 or more hyperactive-impulsive symptoms 2

Additional Assessment After Positive Screen

If the initial screening is positive, further evaluation should include 2, 1:

• Complete ASRS Part B - Provides comprehensive symptom assessment beyond the initial 6-question screener 2
• Collateral information - Have a spouse, parent, or close friend complete the ASRS about the patient, as adults with ADHD often underestimate their symptoms 2, 1, 3
• Functional impairment assessment - Use the Weiss Functional Impairment Rating Scale-Self (WFIRS-S) to measure ADHD-specific impairment in domains like home management, work, relationships, and time management 2, 3

Common Pitfalls to Avoid

• Relying solely on self-report - Adults with ADHD frequently underestimate their symptoms and impairments; collateral information is essential 1, 3
• Failing to establish childhood onset - ADHD symptoms must have been present before age 12, even if not previously diagnosed 3
• Overlooking functional impairment - Screen for difficulties in managing home tasks (cooking, cleaning), keeping track of appointments, and organizational challenges 2
• Missing comorbid conditions - Screen for substance use disorders, mood and anxiety disorders, which commonly co-occur with ADHD 3