• 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. Please give this completed checklist to your healthcare professional to discuss during today’s appointment.

  • Part A

  • Part B

  • This field is for validation purposes and should be left unchanged.


ASRS v1.1 is an 18-item self-report inventory used to screen for ADHD in adults

Scores Produced

Total: 0 – 72
Part A: 0 – 6
Part B: 0 – 12


  • If Part A is greater than or equal to 4, the patient has symptoms highly consistent with ADHD in adults and further investigation may be warranted
  • There are no thresholds for Part B, but these individual scores can provide additional cues and can serve as further probes into the patient’s symptoms
  • Total may be used to track change over time with treatment