ADHD Focus Finder

Intake & Assessment

Assessor: Jessica Hanlon, NCC, MHC-LP

FocusFinder
c/o Behavioral Health Associates
 Name:__________________________________________

Patient Health Questionnaire

Over the last two weeks, how often have you been bothered by any of the following problems? (Circle to indicate your
answer)
PHQ9 More than half Nearly
Not at all Several days of the days everyday
1. Little interest or pleasure in doing things 0 1 2 3
2. Feeling down, depressed, or hopeless 0 1 2 3
3. Trouble falling or staying asleep, or sleeping too 0 1 2 3
much
4. Feeling tired or having little energy 0 1 2 3
5. Poor appetite or overeating 0 1 2 3
6. Feeling bad about yourself – or that you are a failure 0 1 2 3
or have let yourself or your family down
7. Trouble concentrating on things, such as reading the 0 1 2 3
newspaper or watching television
8. Moving or speaking so slowly that other people have 0 1 2 3
noticed? Or the opposite – being so fidgety or
restless that you have been moving around a lot
more than usual
9. Thoughts that you would be better off dead or 0 1 2 3
hurting yourself in some way

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at
home, or get along with other people?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

GAD-7 More than half Nearly

Not at all Several days of the days everyday
1. Feeling nervous, anxious or on edge 0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that is hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful might happen 0 1 2 3

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at
home, or get along with other people?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

 Name: ____________________________________

The Mood Disorder Questionnaire (MDQ)

The questionnaire should be used as a starting point. It is not a substitute for a full medical evaluation. Bipolar disorder is a
complex illness, and an accurate, thorough diagnosis can only be made through a personal evaluation by your doctor. However,
a positive screen here may suggest that you might benefit from seeking such an evaluation from your doctor. Regardless of the
questionnaire results, if you or someone you know has concerns about your mental health, please contact your physician or
another healthcare professional.

INSTRUCTIONS: Please answer each question as best you can.

1. Has there ever been a period of time when you were not your usual self and… YES NO
… you felt so good or so hyper that other people thought you were not your normal self or you were so
hyper that you got into trouble?
… you were so irritable that you shouted at people or started fights or arguments?
… you felt much more self-confident than usual?
… you got much less sleep than usual and found that you didn’t really miss it?
… you were more talkative or spoke much faster than usual?
… thoughts raced through your head or you couldn’t slow your mind down?
… you were so easily distracted by things around you that you had trouble concentrating or staying on
track?
… you had much more energy than usual?
… you were much more active or did many more things than usual?
… you were much more social or outgoing than usual, for example, you telephoned friends in the middle
of the night?
… you were much more interested in sex than usual?
… you did things that were unusual for you or that other people might have thought were excessive,
foolish, or risky?
… spending money got you or your family in trouble?
2. If you checked YES to more than one of the above, have several of these ever happened during the same
period of time?
How much a problem did any of these cause you – like being able to work; having family, money or legal troubles;
getting into arguments or fights?
o No Problem o Minor Problem o Moderate Problem o Serious Problem
3. Have any of your blood relatives (i.e. children, siblings, parents, grandparents, aunts, uncles) had manic-
depressive illness or bipolar disorder?
4. Has a health professional ever told you that you have a manic-depressive illness or bipolar disorder?
 Name:__________________________________________

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. Very
Never Rarely Sometimes Often Often
1. How often do you have trouble wrapping up the final
details of a project, once the challenging parts have been 0 1 2 3 4
done?
2. How often do you have difficulty getting things in order
0 1 2 3 4
when you have to do a task that requires organization?
3. How often do you have problems remembering
0 1 2 3 4
appointments or obligations?
4. When you have a task that requires a lot of thought, how
0 1 2 3 4
often do you avoid or delay getting started?
5. How often do you fidget or squirm with your hands or feet
0 1 2 3 4
when you have to sit down for a long time?
6. How often do you feel overly active and compelled to do
0 1 2 3 4
things, like you were driven by a motor?
PART A
7. How often do you make careless mistakes when you have
0 1 2 3 4
to work on a boring or difficult project?
8. How often do you have difficulty keeping your attention
0 1 2 3 4
when you are doing boring or repetitive work?
9. How often do you have difficulty concentrating on what
people say to you, even when they are speaking to you 0 1 2 3 4
directly?
10. How often do you misplace or have difficulty finding things
0 1 2 3 4
at home or at work?
11. How often are you distracted by activity or noise around
0 1 2 3 4
you?
12. How often do you leave your seat in meetings or other
0 1 2 3 4
situations in which you are expected to remain seated?
13. How often do you feel restless or fidgety? 0 1 2 3 4
14. How often do you have difficulty unwinding and relaxing
0 1 2 3 4
when you have time to yourself?
15. How often do you find yourself talking too much when you
0 1 2 3 4
are in social situations?
16. When you’re in a conversation, how often do you find
yourself finishing the sentences of the people you are 0 1 2 3 4
talking to, before they can finish them themselves?
17. How often do you have difficulty waiting your turn in
0 1 2 3 4
situations when turn taking is required?
18. How often do you interrupt others when they are busy? 0 1 2 3 4
PART B

How old were you when these problems first began to occur? ____________________________________________________
 WEISS SYMPTOM RECORD II
PATIENT: _____________________________________________________________________________________________

INFORMANT: __________________________________________________________________________________________

DATE: _____________________

This is a problem checklist. Not all the items will be appropriate for you. Please indicate the level of difficulty associated with
each item:
None: This is not a problem or concern. Any challenges are age-appropriate
Mild: Some difficulty (somewhat)
Moderate: This is a problem (pretty much)
Severe: This is a serious problem (very much)
NA: Not applicable. Check this column if the item is not a problem or not relevant to you.

Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) items scored 2 or 3

ATTENTION 314.00 ADHD COMBINED TYPE 314.01

Attention to details or makes careless mistakes

Holding attention or remaining focused

Listening or mind seems elsewhere

Instructions or finishing work

Organizing (e.g. time, messy, deadlines)

Avoids or dislikes activities requiring effort

Loses or misplaces things

Easily distracted

Forgetful (e.g. chores, bills, appointments) /9 (>5/9)

HYPERACTIVITY AND IMPULSIVITY 314.01

Fidgets or squirms

Trouble staying seated

Runs about or feels restless inside

Loud or difficulty being quiet

Often on the go

Talks too much

Blurts out comments

Dislikes waiting (e.g. taking turns or in line)

Interrupts or intrudes on others (e.g. butting in) /9 (>5/9)

OPPOSITIONAL 313.81

Loses temper

Easily annoyed

Angry and resentful

Argues

Defiant

Deliberately annoys other people

Blames other people rather than themselves

Spiteful /8 (≥4/8)

1
 WEISS SYMPTOM RECORD II

Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

DEVELOPMENT AND LEARNING

Wetting, (after age 5)

Soiling (after age 4)

Reading

Spelling

Math

Writing

AUTISM SPECTRUM

Difficulty with talking back and forth

Unusual eye contact or body language

Speech is odd (monotone, unusual words)

Restricted, fixed, intense interests

Odd, repetitive movements (e.g. flapping)

Does not easily "chit chat"

MOTOR DISORDERS

Repetitive noises (e.g. sniffing, throat clearing)

Repetitive movements (blinking, shrugging)

Clumsy

PSYCHOSIS

Hearing voices that are not there

Seeing things that are not there

Scrambled thinking

Paranoia (feeling people are against you)

DEPRESSION

Sad or depressed most of the day Must be present

Lack of interest or pleasure most of the day Must be present
Weight loss, weight gain or change in appetite

Difficulty sleeping or sleeping too much ≥5/9>2wks

Agitated

Slowed down

Feels worthless

Tired, no energy

Hopeless, pessimistic

Withdrawal from usual interests/people

Decrease in concentration

2
 WEISS SYMPTOM RECORD II

Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

MOOD REGULATION 296.0(manic) .6(mixes) .5(depressed)

Distinct period(s) of intense excitement

Distinct period(s) of inflated self-esteem, grandiose

Distinct period(s) of increased energy ≥3 >1wk

Distinct period(s) of decreased need for sleep

Distinct Period(s) of racing thoughts or speech

Irritable behaviour that is out of character

Rage attacks, anger outbursts, hostility

SUICIDE

Suicidal thoughts

Suicide attempt(s) or a plan

ANXIETY

Intense fears (e.g. heights, crowds, spiders)

Fear of social situations or performing 309.21

Panic attacks 300.23

Fear of leaving e.g. the house, public transportation.

Worrying and/or anxious most days 300.02

Nervous, can't relax 300.81

Obsessive thoughts (e.g. germs, perfectionism)

Compulsive rituals (e.g. checking, hand washing) 300.01

Hair pulling, nail biting or skin picking

Preoccupation with physical complaints

Chronic pain 300.30

STRESS RELATED DISORDERS

Physical abuse

Sexual abuse

Neglect

Other severe trauma

PTSD

Flashbacks or nightmares

Avoidance

Intrusive thoughts of traumatic events

 WEISS SYMPTOM RECORD II

Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

SLEEP

Trouble falling asleep or staying asleep

Excessive daytime sleepiness

Snoring or stops breathing during sleep

EATING

Distorted body image

Underweight

Binge eating

Overweight

Eating too little or refusing to eat

CONDUCT 312.8

Verbal aggression

Physical aggression

Used a weapon against people (stones, sticks etc.)

Cruel to animals

Physically cruel to people

Stealing or shoplifting

Deliberately sets fires

Deliberately destroys property

Frequent lying

Lack of remorse or guilt

Lack of empathy or concern for others /15(> 3/15)

SUBSTANCE USE

Misuse of prescription drugs

Alcohol > 14 drinks/week or 4 drinks at once

Smoking or tobacco use

Marijuana

Other street drugs

Excessive over the counter medications

Excessive caffeine (colas, coffee, tea, pills)

 WEISS SYMPTOM RECORD II

Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

ADDICTIONS

Gambling /3 (≥3)

Excessive internet, gaming or screen time

Other addiction _______________________________

PERSONALITY

Self-destructive

Stormy, conflicted relationships

Self-injurious behaviour (e.g. cutting) BPD 301.83

Low self-esteem

Manipulative

Self-centered NPD 301.81

Arrogant

Suspicious

Deceitful with no remorse

Breaking the law or antisocial behaviour

ASP 301.7

Tends to be a loner

OTHER (Please indicate any other difficulties)

This scale is copyrighted by Margaret Danielle Weiss, MD PhD. The scale can be used by clinicians and researchers free of charge and
can be posted on the Internet or replicated as needed. Please contact Dr. Weiss at [email protected] if you wish to post the
scale on the Internet, use it in research or plan to create a translation.
 Testing Day:
CLINICAL INTERVIEW

1
Client Name: ____________________________

Birthdate: _______________________________

Date of Assessment: ______________________

ADHD Clinical Interview

Sleep

1. How well do you sleep?

__________________________________________________________________________

2. What time do you go to sleep? _____________

3. What time do you wake up? _________________

4. Do you sleep all night through or do you wake during the night? # of nights per week _______

5. What is your routine in the evenings?

__________________________________________________________________________

6. The bedroom environment:

o Humidity

o Temperature

o Lighting

o Comfort (mattress)

Diet

1. Typical diet: _______________________________________________________________________

2. Water consumption ____ oz per day
3. # of take out meals per week _____
4. Fruits ________
5. Veg __+____
6. Proteins_______
7. Carbs ________
8. Snacks _______________________________________________________________________

2
 9. Usual hours of eating: M: ______ A: _______ E: ________ S: _______
10. eat and drink before bed:_____________
11. eating enough throughout the day: ____________
12. drinking sugary or caffeinated drinks before bed (tea, coffee, fizzy drinks) ______________

Daily

1. Can you tell me a bit about your daily routine?

__________________________________________________________________________

2. How would you describe your ability to manage time and tasks?

__________________________________________________________________________
3. Do you find it challenging to keep track of appointments and deadlines?

__________________________________________________________________________

Attention and Focus

4. How often do you find your mind wandering when you're supposed to be focused on a task?

__________________________________________________________________________

5. Are there specific activities or tasks that you find particularly difficult to concentrate on?

__________________________________________________________________________

6. Do you often make careless mistakes because you're not paying close attention?

__________________________________________________________________________

Hyperactivity and Impulsivity

7. Do you find it difficult to sit still for long periods of time?

__________________________________________________________________________

8. How often do you feel restless or fidgety?

__________________________________________________________________________

3
9. Do you tend to act quickly without thinking through the consequences?

__________________________________________________________________________

Organization and Planning

10. How do you usually keep track of your tasks and responsibilities?

__________________________________________________________________________

11. Do you often feel overwhelmed by the number of tasks you need to complete?

__________________________________________________________________________

12. How frequently do you lose items like keys, paperwork, or your phone?

__________________________________________________________________________

Emotional Regulation

13. How do you typically handle stressful situations?

__________________________________________________________________________

14. Do you often feel frustrated or impatient?

__________________________________________________________________________

15. How do you manage feelings of anger or irritability?

__________________________________________________________________________

Social Interactions

16. Do you find it challenging to maintain relationships with friends or family?

__________________________________________________________________________

4
17. How often do you interrupt others during conversations?

__________________________________________________________________________

18. Do you find it hard to wait your turn in situations like lines or group activities?

__________________________________________________________________________

Academic and Work Performance

Likert scale of 1-5

Procrastination _______

Time Management Skills ________

Organization ___________

Impulse Control ___________

19. How were your experiences in school, particularly with focus and completing assignments?

__________________________________________________________________________

20. How do you find managing tasks and projects at work?

__________________________________________________________________________

21. Have you faced any challenges in maintaining consistent performance at your job?

__________________________________________________________________________

Personal Reflection

22. Have you noticed any patterns in your behavior that you think might be related to attention or
hyperactivity issues?

__________________________________________________________________________

23. What strategies have you tried to help manage these challenges, and how effective have they been?

__________________________________________________________________________

5
24. Are there specific goals you would like to achieve that you feel are hindered by your current challenges?

__________________________________________________________________________

Symptom History and Development

25. When did you first start noticing symptoms related to attention or hyperactivity?

__________________________________________________________________________

26. Were there any significant life events that seemed to impact these symptoms?

__________________________________________________________________________

27. Do you have any family members who have been diagnosed with ADHD or similar conditions?

__________________________________________________________________________

Impact on Daily Life

28. How do your symptoms affect your daily activities and quality of life?

__________________________________________________________________________

29. In what areas of your life do you feel the most impact from these symptoms?

__________________________________________________________________________

30. What support systems do you currently have in place to help you manage these challenges?

__________________________________________________________________________

Goals and Expectations

31. What do you hope to achieve through this assessment and potential treatment?

__________________________________________________________________________

6
32. How can I support you in reaching your goals?

__________________________________________________________________________

33. Is there anything else you’d like to share that you think is important for me to know?

__________________________________________________________________________

7
Assessments
Client Information
Client Name
Date of birth (age)

Assessment Information
Assessment Adult ADHD Self-Report Scale v1.1 (ASRS)
Date administered
Assessor Jessica Hanlon
Time taken

Results
Number Percentile
Criterion (Part A) N/A
Additional Symptoms (Part B) N/A
Total Score

ADHD Subtypes
Raw Score Items Endorsed (%)
Inattentive
Hyperactive/Impulsive (Motor)
Hyperactive/Impulsive (Verbal)

Interpretive Text
There are ___ or more responses in Part A that are above / below
the specific severity levels. Therefore, the symptom profile of this
individual is considered to be consistent / inconsistent with an
ADHD diagnosis in adults. Check Part B symptoms for more
information on the impact of attention on daily life.

100
90
80
70
60
50
40
30
20
10
0
re

ve

r)

al)
oto
o

nti

erb
Sc

I (M
tte

I (V
tal

Ina

H/
To

H/

Page 1 of 3
 Client Initials

Scoring and Interpretation Information

Three separate metrics are computed:

-Part A (items 1-6. Scores range from 0 to 6)

If the respondent scores 4 or more in Part-A, then the symptom
profile of the individual is considered to be highly consistent with an
ADHD diagnosis in adults (Adler et al., 2006; Kessler et al., 2007).

-Part B (items 7-18. Scores range from 0 to 12)

The frequency scores on Part B provide additional cues and can
serve as further probes into the patient’s symptom severity and the
impact that inattention or hyperactivity has on their life.

- Total Score (and percentile) (scores range from 0 to 18)

Over and above the key interpretation metrics from Part A and Part
B, the total score (sum of part A and B) is converted into a percentile
to contextualise responses in comparison to normative data (22,397
adults; Adler et al., 2018). For example, a percentile of 90
represents that the respondent scored higher than 90 percent of
other typical adults in their age range in the community.

These percentiles compare total scores to age related peers, so it is

imperative to ensure the correct client data of birth is entered for the
client.

While Part A contains the items that have been found to be most
predictive of ADHD, looking at the total score (and percentile) can
also be informative about diagnosis in cases where the Part A score
was only 3. This scale should always be used in conjunction with a
clinical interview to provide additional clinical information important
for diagnosis.

Depending on the question, responses are either scored as 0 or 1.

On items 1-3, 9, 12, 16, and 18 ratings of sometimes, often, or very
often are assigned one point (ratings of never or rarely are assigned
zero points). For the remaining 11 items, ratings of often or
very often are assigned one point (ratings of never, rarely, or
sometimes are assigned zero points).

Client Responses
Never Rarely Sometimes Often Very Often

PART A -
1 How often do you have trouble wrapping up the final details 0 0 1 1 1
of a project, once the challenging parts have been done?

How often do you have difficulty

2 getting things in order when you have 0 0 1 1 1
to do a task that requires organisation?

Page 2 of 3
 Client Initials

Client Responses (cont.)

Never Rarely Sometimes Often Very Often

How often do you have problems

3 remembering appointments or 0 0 1 1 1
obligations?
When you have a task that requires
4 a lot of thought, how often do you 0 0 0 1 1
avoid or delay getting started?
How often do you fidget or squirm
5 with your hands or feet when you 0 0 0 1 1
have to sit down for a long time?
How often do you feel overly active
6 and compelled to do things, like you 0 0 0 1 1
were driven by a motor?
PART B -
7 How often do you make careless mistakes when 0 0 0 1 1
you have to work on a boring or difficult project?
How often do you have difficulty
8 keeping your attention when you are 0 0 0 1 1
doing boring or repetitive work?
How often do you have difficulty
9 concentrating on what people say to you, 0 0 1 1 1
even when they are speaking to you directly?
How often do you misplace or have
10 difficulty finding things at home or at 0 0 0 1 1
work?
How often are you distracted by
11
activity or noise around you? 0 0 0 1 1
How often do you leave your seat in
12 meetings or other situations in which 0 0 1 1 1
you are expected to remain seated?
How often do you feel restless or
13
fidgety? 0 0 0 1 1
How often do you have difficulty
14 unwinding and relaxing when you 0 0 0 1 1
have time to yourself?
How often do you find yourself
15 talking too much when you are in 0 0 0 1 1
social situations?
When you’re in a conversation, how often do
you find yourself finishing the sentences of the
16 people you are talking to, before they can finish 0 0 1 1 1
them themselves?
How often do you have difficulty
17 waiting your turn in situations when 0 0 0 1 1
turn taking is required?
How often do you interrupt others
18
when they are busy? 0 0 1 1 1

Page 3 of 3

Powered by TCPDF (www.tcpdf.org)

 Wender Utah Rating Scale (WURS)
Name: Date:__________________________

Not at all or Mildly Moderately Quite Very

AS A CHILD I WAS (OR HAD): very slightly a Bit much
1. Active, restless, always on the go 0 1 2 3 4
2. Afraid of things 0 1 2 3 4
3. Concentration problems, easily distracted 0 1 2 3 4
4. Anxious, worrying 0 1 2 3 4
5. Nervous, fidgety 0 1 2 3 4
6. Inattentive, day dreaming 0 1 2 3 4
7. Hot or short tempered, low boiling point 0 1 2 3 4
8. Shy, sensitive 0 1 2 3 4
9. Temper outbursts, tantrums 0 1 2 3 4
10. Trouble stick-to-it-tiveness, not following through, failing to 0 1 2 3 4
finish things started
11. Stubborn, strong willed 0 1 2 3 4
12. Sad or blue, depressed, unhappy 0 1 2 3 4
13. Incautious, dare-devilish, involved in pranks 0 1 2 3 4
14. Not getting a kick out of things, dissatisfied with life 0 1 2 3 4
15. Disobedient with parents, rebellious, sassy 0 1 2 3 4
16. Low opinion of myself 0 1 2 3 4
17. Irritable 0 1 2 3 4
18. Outgoing, friendly, enjoy company of people 0 1 2 3 4
19. Sloppy, disorganized 0 1 2 3 4
20. Moody, ups and downs 0 1 2 3 4
21. Angry 0 1 2 3 4
22. Have friends, popular 0 1 2 3 4
23. Well organized, tidy, neat 0 1 2 3 4
24. Acting without thinking, impulsive 0 1 2 3 4
25. Tendency to be immature 0 1 2 3 4
26. Feel guilty, regretful 0 1 2 3 4
27. Losing control of myself 0 1 2 3 4
28. Tendency to be or act irrational 0 1 2 3 4
29. Unpopular with other children, didn’t keep friends for long, 0 1 2 3 4
didn’t get along with other children
30. Poorly coordinated, did not participate in sports 0 1 2 3 4
31. Afraid of losing control of self 0 1 2 3 4
32. Well-coordinated, picked first in games 0 1 2 3 4
33. (for women only) Tomboyish 0 1 2 3 4
34. Running away from home 0 1 2 3 4
35. Getting into fights 0 1 2 3 4
36. Teasing other children 0 1 2 3 4
37. Leader, bossy 0 1 2 3 4
38. Difficulty getting awake 0 1 2 3 4
39. Follower, lead around too much 0 1 2 3 4
40. Trouble seeing things from someone else’s point of view 0 1 2 3 4
41. Trouble with authorities, trouble with school, visits to 0 1 2 3 4
principles office
42. Trouble with police, booked, convicted 0 1 2 3 4
MEDICAL PROBLEMS AS A CHILD:
43. Headaches 0 1 2 3 4
44. Stomach aches 0 1 2 3 4
45. Constipation 0 1 2 3 4
46. Diarrhea 0 1 2 3 4
47. Food allergies 0 1 2 3 4
48. Other allergies 0 1 2 3 4
49. Bedwetting 0 1 2 3 4

AS A CHILD IN SCHOOL:
50. Overall a good student, fast 0 1 2 3 4
51. Overall a poor student, slow learner 0 1 2 3 4
52. Slow reader 0 1 2 3 4
53. Slow in learning to read 0 1 2 3 4
54. Trouble reversing letters 0 1 2 3 4
55. Problems with spelling 0 1 2 3 4
56. Trouble with mathematics or numbers 0 1 2 3 4
57. Bad handwriting 0 1 2 3 4
58. Able to read pretty well, but never really enjoyed reading 0 1 2 3 4
59. Not achieving up to potential 0 1 2 3 4
60. Repeated grades (which grades?) 0 1 2 3 4
_________________________
61. Suspended or expelled (which 0 1 2 3 4
grades?)_____________________
 Name:__________________________________________

The Epworth Sleepiness Scale

The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness. The
test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0, no chance of dozing, to 3, high
chance of dozing. When you finish the test, add up the values of your responses. Your total score is based on a scale of 0 to 24.
The scale estimates whether you are experiencing excessive sleepiness that possibly requires medical attention.

How Sleepy Are You?

How likely are you to doze off or fall asleep in the following situations? You should rate your chances of dozing off, not just
feeling tired. Even if you have not done some of these things recently try to determine how they would have affected you.
For each situation, decide whether or not you would have:

• No chance of dozing =0
• Slight chance of dozing =1
• Moderate chance of dozing =2
• High chance of dozing =3

Write down the number corresponding to your choice in the right hand column. Total your score below.

Situation Chance of Dozing

Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances
permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic

Total Score = ________________________

 Trail Making Test (TMT) Parts A & B

Instructions:
Both parts of the Trail Making Test consist of 25 circles distributed over a sheet of paper. In Part
A, the circles are numbered 1 – 25, and the patient should draw lines to connect the numbers in
ascending order. In Part B, the circles include both numbers (1 – 13) and letters (A – L); as in
Part A, the patient draws lines to connect the circles in an ascending pattern, but with the added
task of alternating between the numbers and letters (i.e., 1-A-2-B-3-C, etc.). The patient should
be instructed to connect the circles as quickly as possible, without lifting the pen or pencil from
the paper. Time the patient as he or she connects the "trail." If the patient makes an error, point
it out immediately and allow the patient to correct it. Errors affect the patient's score only in that
the correction of errors is included in the completion time for the task. It is unnecessary to
continue the test if the patient has not completed both parts after five minutes have elapsed.

Step 1: Give the patient a copy of the Trail Making Test Part A worksheet and a pen or
pencil.
Step 2: Demonstrate the test to the patient using the sample sheet (Trail Making Part A –
SAMPLE).
Step 3: Time the patient as he or she follows the “trail” made by the numbers on the test.
Step 4: Record the time.
Step 5: Repeat the procedure for Trail Making Test Part B.

Scoring:
Results for both TMT A and B are reported as the number of seconds required to complete the
task; therefore, higher scores reveal greater impairment.

Average Deficient Rule of Thumb

Trail A 29 seconds > 78 seconds Most in 90 seconds

Trail B 75 seconds > 273 seconds Most in 3 minutes

Sources:
• Corrigan JD, Hinkeldey MS. Relationships between parts A and B of the Trail Making Test. J
Clin Psychol. 1987;43(4):402–409.
• Gaudino EA, Geisler MW, Squires NK. Construct validity in the Trail Making Test: what
makes Part B harder? J Clin Exp Neuropsychol. 1995;17(4):529-535.
• Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. 4th ed. New York:
Oxford University Press; 2004.
• Reitan RM. Validity of the Trail Making test as an indicator of organic brain damage. Percept
Mot Skills. 1958;8:271-276.
 Trail Making Test Part A

Patient’s Name: Date:

Trail Making Test Part A – SAMPLE
 Trail Making Test Part B

Patient’s Name: Date:

Trail Making Test Part B – SAMPLE
REVIEW: POST ASSESSMENT

8
 ADHD Treatment Options

Pharmacological

• Stimulant Medication(s) Vyvanse, Adderall IR & XR, Buproprion, Concerta,

• non-stimulant - antidepressants work by increasing serotonin levels in the brain, which can help to
improve ADHD and anxiety symptoms.
• SSRIs (selective serotonin reuptake inhibitors) SNRIs (serotonin noradrenergic reuptake inhibitors),
MAOIs (mixed amphetamine salts)

Non-pharmacological

• Sleep: calm app, sleep log or app (watch), create routine

• Diet: Add: Omega 3’s (deficiency in blood)
o Eliminate: food dyes / processed foods

Mindfulness: Headspace

o changes brain structure and brain functioning

o Thickening of the prefrontal cortex: focus, planning, decision-making, and impulse control
o increases the brain’s level of dopamine
o Helps develop new connections with other parts of the brain

including those linked with executive functioning and emotional regulation.

mindfulness can improve:

• emotional regulation.
• social skills
• attention
• organization
• working memory
• self-esteem
• calmness and relaxation
• self-acceptance
• quality of sleep
• test anxiety
• hyperactivity
• impulsivity
• conduct and anger management problems
• depression
• anxiety

ADHD resources

• World Federation of ADHD

• The American Professional Society of ADHD and Related Disorders (APSARD)