ATTENTION DEFICIT DISORDER-RESIDUAL TYPE: A QUESTIONNAIRE Phil Torrance MD MPH FACPM Diplomate in Psychiatry and Preventive Medicine. **Introduction** This questionnaire compiles many symptoms (the things that bother you) and signs (clues to the presence of the disorder) that trouble adult and adolescent sufferers of Attention Deficit Disorder (also known as Attention Deficit Hyperactivity Disorder, ADD, ADHD, ADHD-Residual Type, ADHD- RT, Minimal Brain Damage or Dysfunction, or Hyperactivity). The questionnaire is in the development stage and is submitted in this nascent form for your interest and personal use. I shall be very grateful for any comments you might wish to share. You may further distribute the questionnaire (not for profit) if it's accompanied by the Copyright Notice above. I am a psychiatrist who treats adolescents and adults with Attention Deficit Disorder (ADD). I derived and adapted the questionnaire items from a variety of sources and will furnish a full bibliography with it in a future metamorphosis. I'm working on a scoring system but, frankly, fear quantitation may prove to be a snare and a delusion. So far, then, it is intended as a checklist that may be self- administered and then be reviewed with a practitioner; be discussed with others who wonder if you, or they, might have ADD; or serve as a takeoff point for further investigation. Let me know what you think, through this forum or by letter or call to the address above. Please. **CAVEAT and Big-Time DISCLAIMER** There is no one (or two) symptom(s) that mean(s) for sure that you have "it" (whatever "it" is) in psychiatry or in any branch of medicine. Diagnosis is pattern recognition; the more symptoms present and identified, the closer the fit to the pattern and the more likely the diagnosis, but there is no free lunch and no sure thing. This questionnaire will not diagnose anyone; it may (hopefully) provide a place to start thinking about what could be causing your distress or disability. Please consult a professional you trust to take it from there. If in doubt, get a second opinion. Don't give up; if ADD is not the answer, something is. The only guarantee a practitioner can make is that she or he will keep working on the problem with you; find a qualified person who makes, and keeps, that promise and you will find help. **QUESTIONNAIRE INSTRUCTIONS** Instructions: Answer each question by checking or circling the one (and only one) response that seems best to indicate the degree to which the particular statement characterizes and describes your feelings, behaviors, abilities, experiences, or skills. The key word is "characterize;" this questionnaire is hunting for traits and characteristics, not just for the outlying or unusual aspects of you and your behavior. Notes at the end of the table explain some of its more obscure aspects. (SA) = Strongly Agree or Certainly Applicable, to a significantly disabling or distressing degree. A certain yes. (A) = Agree or Probably Applicable, to a moderately disabling or distressing degree. An uncertain yes, in some doubt. (D) = Disagree or Probably Not Applicable, (or, if applicable at all or ever present, only to a dubiously disabling or distressing degree). An uncertain no, in some doubt. (SD) = Strongly Disagree or Certainly Not Applicable, or, if ever present, is rarely and trivially distressing and never disabling. A certain no. **QUESTIONNAIRE BEGINS** # ITEM EXTENT TO WHICH THE ITEM APPLIES = SA A D SD 1. A major problem: confusion, trouble thinking clearly. SA A D SD 2. A major problem: depression, low self-esteem. SA A D SD 3. A major problem: difficulty in finding and keeping jobs. SA A D SD 4. A major problem: forgetfulness or poor memory. SA A D SD 5. A major problem: inability to concentrate. SA A D SD 6. A major problem: inability to establish and maintain a routine. SA A D SD 7. A major problem: inability to perform up to intellectual level in school or work. SA A D SD 8. A major problem: lack of organization. SA A D SD 9. A major problem: your job performance is below your level of competence. SA A D SD 10. A major problem: poor discipline. SA A D SD 11. You often turn to intense physical or mental activity, or to drugs or alcohol, to self-medicate and self- regulate. SA A D SD 12. You are often overwhelmed by what's going on around you. As a result you retreat into shyness, apathy, or solitary intellectual pursuits. SA A D SD 13. Daydreamer: Quietly suffering and not disturbing anyone in school, yet internally (mentally) hyperactive, often overlooked as a child, you grew up to become "the absent-minded professor." SA A D SD 14. Your major internal goal is to get organized by living on the edge, responding to crisis or to physical challenge. You are a risk taker, pressing for the next challenge that organizes and calms you. SA A D SD 15. Your inner world is constantly shifting and changing. SA A D SD 16. Your relationships and friendships are frenetic, superficial, and feel unattached; you're unable to sit with another and maintain the attention needed to sustain intimacy. SA A D SD 17. You can distract yourself out of one feeling state or emotion into another, but you can't stick with any one feeling state long enough for a sense of satisfaction or completion. SA A D SD 18. You have a feeling of drivenness (may feel as if at the mercy of some "inner force"). SA A D SD 19. You seem immature, with fleeting passions, childlike enthusiasms, and a lagging behind in achieving or negotiating lifesteps and milestones. SA A D SD 20. You have distressing interpersonal problems (relationships, friendships, getting along with others, "always feeling misunderstood"). SA A D SD 21. Intimacy is very hard for you. You have learned to avoid it, from being too distracted and restless to stay long in any close relationship. You can't commit. SA A D SD 22. You typically feel withdrawn and lethargic. SA A D SD 23. You constantly look for a new stimulus to tear you away from your prior focus. SA A D SD 24. You have "overreactive" moods; are easily disgruntled, discouraged, and depressed to a degree (you and) others believe to be out of proportion to the precipitating stress. SA A D SD 25. You are graded (labeled by teachers, supervisors, other authorities) as an underachiever in school and work, not performing up to your abilities, "lazy." . SA A D SD 26. You are aware of not living up to your abilities, so you consistently feel frustrated, angry, and depressed. SA A D SD 27. You have a gnawing feeling you are not living up to your potential in major life areas. SA A D SD 28. You usually present unevenly, with (sometimes conspicuous) success in some areas of life and utter failure in others. This inconsistency, particularly because of the apparent willfulness of the deficient behaviors, frustrates you and others. SA A D SD 29. Other problems: You may have a mood disorder, an impulse disorder, an obsessive-compulsive disorder, a substance abuse problem, or an anxiety disorder. You may have been called treatment refractory (You have been through many doctors and treatments without benefit; "nothing helps"). SA A D SD 30. Alcoholism: You have associated alcoholism or problem drinking [severe cases of untreated ADD]. SA A D SD 31. Addiction: You have associated addiction(s), either to substances or to such activities as gambling (prevalence greatly increased in adolescents and adults with previously untreated ADD) (DCD). SA A D SD 32. Ambivalence: Although you actively seek structure as an alternative to feeling lost, uncertain, or disorganized, that same structure feels confining or even physically uncomfortable (e.g., needing order but hating it, needing a boss to tell you what to do, but hating being told what to do). SA A D SD 33. Serious legal and behavioral problems may also be present. (DCD) SA A D SD 34. Anxiety disorders (disabling or distressing, pervasive anxiety symptoms) may also be present. (DCD) SA A D SD 35. Social: You are or feel "bad" (unacceptable, shamed). SA A D SD 36. Social: You can't tolerate being alone and typically feel empty or "at a loss" when not focused by the company of others. SA A D SD 37. Social: You suffer repeated failures in social functioning (may feel as if you never "fit in"), and you expect (so you try to avoid) more failures. SA A D SD 38. Associated behaviors: You may have severe behavioral abnormalities such as fits of rage or of loss of self-control [in severe cases of untreated ADD]. SA A D SD 39. Attention: You have variable, poorly controlled attention; sometimes unfocused and sometimes overfocused "locked on"). SA A D SD 40. Attention: You don't pay close enough attention to details and make careless mistakes in schoolwork, work, or other activities. SA A D SD 41. Attention: You have disabling or distressing inability to pay or sustain attention in tasks or play activities. SA A D SD 42. Attention: Others mistake your attention problems for motivation problems (you're unfairly accused of not trying or caring). SA A D SD 43. Attentional deficits: You have had problems with paying or sustaining attention since childhood (e.g., problems in school, underachieving report cards). SA A D SD 44. Boredom: You are particularly easily and frequently bored. SA A D SD 45. Boredom: Although you are easily bored, you find a variety of mental and physical techniques to keep yourself stimulated (e.g., frantic exercising, or shopping). SA A D SD 46. Childhood diagnosis-?why hasn't your ADD been diagnosed before? Perhaps your ADD was mild or compensated by high intelligence or socioeconomic advantage. Perhaps a dysfunctional family, health care system, or school system kept ignoring the clues. SA A D SD 47. Compensation: You must work harder than others for success in work or school by using effortful compensatory mechanisms (e.g., overachieving dedication to long hours of homework). SA A D SD 48. Creativity: You have high creativity, intuition, natural intelligence, or puzzle-solving ability (often such exceptional ability compensates for ADD enough that it hadn't previously attracted attention). SA A D SD 49. Daydreaming: You characteristically stare into space and report daydreaming, or have been accused or labeled by authorities as daydreaming or "spacey." SA A D SD 50. Defiance: Defiant behavior may also be present. (DCD) SA A D SD 51. Deficits: You have associated skill difficulties (clue for LD) in reading, writing, math, memory, or organizational skills. (DCD) SA A D SD 52. Dependence: You depend inappropriately on others, not so much for emotional support or mentoring as for quasi-parental discipline. SA A D SD 53. Depression: You often feel a pervasive sense of impending doom: "if nothing has gone wrong, it's just about to." SA A D SD 54. Depression: Persons with ADD often feel severely depressed. (DCD) SA A D SD 55. Details: You often fail to give close attention to details in schoolwork or other activities. SA A D SD 56. Different: You often feel like an alien who doesn't fit in. SA A D SD 57. Discipline: You do better in situations that are structured by others. SA A D SD 58. Disorganization: Sometimes the resolution of a conflict makes you feel a lack of directedness with disorganization, emptiness, and boredom (e.g., you feel at a serious loss when the crisis is over). SA A D SD 59. Disruptive. You often are, or are regarded as, a seriously disruptive influence. SA A D SD 60. Distractibility: Your distractibility might be due to a Learning Disability (DCD) SA A D SD 61. Distractibility: You are very easily distracted and often want to "tune out" in the middle of a page or conversation. SA A D SD 62. Hyperfocus: Sometimes you have the ability to hyperfocus ("as if in a trance") on interesting material or topics). SA A D SD 63. Distractibility: Extraneous, unimportant stimuli (e.g., sounds, movement, conversations) often distract you. SA A D SD 64. Education: You have always struggled with your education (clue for LD) (DCD) SA A D SD 65. Energy: You appear to have little initiative and poor motivation, or feel you have a low energy level or are sluggish or drowsy (this feels in marked contrast to an internal "hyperactivity" that you perceive as "racing thoughts"). SA A D SD 66. Excitement: You crave high stimulation, new thrills, and new sensations; you look for action in the environment that reflects, matches, or organizes your internal energetic, hyperactive disorganization. SA A D SD 67. Excitement: You seek high-stimulus situations, needing them to organize and calm you. SA A D SD 68. Failure: You suffer an overwhelming sense of failure (even in the face of apparent success). SA A D SD 69. Family history: You have family members (blood relatives) who have had ADD or manic-depressive illness (bipolar disorder), whether formally diagnosed or not. SA A D SD 70. Focus: You may be able to focus intently on things you enjoy for a very long time. To focus so well you have to block out other stimuli, so you appear to be in a trance and people often complain that they can't get your attention. SA A D SD 71. Focus inconsistent: You may be able to pay attention and concentrate very well one time and very poorly the next. SA A D SD 72. Focus inconsistent: You are known for "tuning in and out." SA A D SD 73. Following through: Without close supervision, you often have difficulty following through on instructions from others (e.g., you frequently fail to finish homework, chores, or jobs). SA A D SD 74. Following through: Your difficulty following through is not due to deliberately oppositional behavior or failing to understand the instructions, but it may seem that way to such authorities as parents and teachers. SA A D SD 75. Followthrough: You characteristically have fast starts and many projects going at once, but poor followthrough. SA A D SD 76. Forgetful: You are often forgetful (absentminded) in daily activities. SA A D SD 77. Friends: You have difficulty making and keeping friends (other people find you difficult). SA A D SD 78. Frustration: You are easily frustrated. SA A D SD 79. Hyperactive: You run about or climb excessively in inappropriate situations. SA A D SD 80. Hyperactive: You often leave (or can barely resist leaving) your seat in classroom or in other situations where remaining seated is expected (you may have a strong impulse to pace in meetings, for example). SA A D SD 81. Hyperactivity: Anxiety from LD could cause your hyperactivity. (DCD) SA A D SD 82. Hyperactivity: Your childhood hyperactivity may have been integrated, lessened, modified, or evolved into fidgeting; jiggling; tapping; or feeling tense, restless, or nervous; with difficulty relaxing or sleeping. SA A D SD 83. Hypersensitivity: You overreact to noise and distraction. SA A D SD 84. Hypertalkative: You often talk, or are perceived to talk, excessively (loud, long, and a lot). SA A D SD 85. Immature: "Peter Pan syndrome;" some say you have never grown up. SA A D SD 86. Immature: Your teachers, employers, parents, or spouse believe you lack maturity or can't work independently. SA A D SD 87. Impulsive: You appear to have poor self-control. SA A D SD 88. Impulsive: You appear to ignore the impact of your actions or words on others. SA A D SD 89. Impulsive: You have problems playing or engaging in leisure activities quietly. SA A D SD 90. Impulsive: You have trouble thinking before you speak or act. SA A D SD 91. Impulsive: You may do "bad" things impulsively. SA A D SD 92. Impulsive: You often blurt out answers to questions before the questions have been completed. SA A D SD 93. Impulsive: You often get into dangerous situations because you haven't considered the possible consequences of an action (e.g., run into street without looking). SA A D SD 94. Impulsive: You often have a real problem waiting your turn in games or group interactions (in school, you wave your hand and shout out the answer before being called on). SA A D SD 95. Impulsive: You often interrupt or intrude on others (e.g., butt into conversations or games). SA A D SD 96. Impulsive: You often shift from one uncompleted activity to another. SA A D SD 97. Impulsive: Others accuse you of acting impulsively and making snap decisions. SA A D SD 98. Inaccurate self-perception. You may "read" situations and the impact of other people with great intuitive insight, but you don't understand or anticipate the impact you have on them. SA A D SD 99. Inconsistency: You have strikingly inconsistent performance. SA A D SD 100. Insight: You have poor insight into how to recognize, understand, or address your ADD symptoms. SA A D SD 101. Intimacy: You can't sustain close emotional or cognitive contact for very long. SA A D SD 102. Intimacy: You characteristically become bored, distracted, and discouraged in relationships. SA A D SD 103. Intimacy: You have real problems developing effective and efficient interpersonal working relationships, much less intimate personal relationships. SA A D SD 104. Intimacy: You withdraw from others, expecting failure in relationships. SA A D SD 105. Intimacy: You overreact or underreact in interpersonal situations. SA A D SD 106. Irresponsible: Experience has conditioned you to believe you really are lazy and irresponsible. SA A D SD 107. Job: You have deficient job performance and satisfaction. SA A D SD 108. Judgment: You are regarded as often showing poor judgment. SA A D SD 109. Lazy: You've been called lazy or unmotivated so often you have come to believe it. SA A D SD 110. Learning disabilities: You may also have some learning disabilities (as do 30% to 80% of children with ADD) (DCD). SA A D SD 111. Listen: You don't seem to listen to what is said to you (it's hard to get your attention). SA A D SD 112. Loose cannon: People usually assume ADD behaviors are deliberate and controllable. These behaviors keep occurring in spite of your best efforts to conform, to use time efficiently, and to be self-disciplined. This often leads others to believe you're a rebel or a "loose cannon on the deck" who doesn't care whether or not you perform well on the job. SA A D SD 113. Loses: You often lose things necessary for tasks or activities at school, home, or the workplace (e.g., toys, pencils, books, assignments, or tools). SA A D SD 114. Misbehavior: Severely disordered behavior may also be present. (DCD) SA A D SD 115. Moods: You have rapidly changing moods (moodiness, mood swings). SA A D SD 116. Moods: You have marked mood swings or depressed feelings, especially when leaving someone or winding up a project. SA A D SD 117. Motivation: Your inconsistency is labeled as not trying. SA A D SD 118. Motivation: You may lose motivation and stop trying. SA A D SD 119. Motivation variable: You may seem unmotivated to engage in goal-directed activities (e.g., schoolwork, chores, or work on the job) although your motivation to engage in favored or passive activities (e.g., hobbies, watching television, or listening to music) may be unimpaired. SA A D SD 120. Organization: You have constant trouble getting organized and suffer a tendency for little things to add up to create what seem like huge obstacles. SA A D SD 121. Organization: You often have difficulty organizing and completing goal-directed tasks and activities. SA A D SD 122. Overwhelmed: You have a pervasive sense of being easily overwhelmed by life. SA A D SD 123. Overwhelmed: You often feel or appear depressed or overwhelmed. SA A D SD 124. A personality disorder (characteristically inflexible and maladaptive traits and coping strategies that lead to distress and disability) may also be present. (DCD) SA A D SD 125. Personality: You may suffer associated delinquency (destructiveness) [in severe cases]. SA A D SD 126. Powerless: You often feel you have no will power. SA A D SD 127. Procrastination: You characteristically procrastinate (in ADD, an acquired fear response). SA A D SD 128. Procrastination: You are known for chronic procrastination, with or without the conscious fear that you won't be able to do something right. SA A D SD 129. Relationships: You have impaired interpersonal relationships or an inability to sustain relationships over time. SA A D SD 130. Repetition: Developing attention to detail, and a tolerance for repetitive tasks, may be your greatest and most frustrating problem. SA A D SD 131. Restlessness: Instead of running and climbing about like the ADD child, you have excess nervous energy; pacing, drumming your fingers, and feeling edgy when trying to sit still. SA A D SD 132. Restlessness: You often fidget with hands or feet or squirm in your seat (in adolescents and adults, may be limited to subjective feelings of restlessness). SA A D SD 133. Rules: You distrust and dislike structure, rules, and going through the "proper channels." SA A D SD 134. Rules: You have little inclination and less motivation to understand and follow rules. SA A D SD 135. Self-esteem: You have chronic problems with low self-esteem. Years of conditioning told you that you're a lazy, weird, undisciplined klutz, and now you believe it. Frustration and underachievement convince you there's not much hope to get better. SA A D SD 136. Self-esteem: You have pervasively eroded self- esteem. SA A D SD 137. Self-righteousness: You say whatever comes to mind without considering its impact, appropriateness, or timing. SA A D SD 138. Self-righteousness: You are noted for self- righteous candor. SA A D SD 139. Self-worth: You are unable to sustain a sense of self-worth. SA A D SD 140. Stress: You have marked intolerance for stress (easily "stressed out"). SA A D SD 141. Tasks: You are often unable to complete tasks. SA A D SD 142. Temper: You have a characteristically hot or explosive temper (you're a "hot-head"). SA A D SD 143. Temper: Your temper often gets you into trouble. SA A D SD 144. Unconventional: Not many people understand that ADDults often can't or won't do things in the conventional way, so they think you're unconventional, odd, or eccentric. SA A D SD 145. Underachievement: Despite superior conceptual ability, imagination, and creativity, you do poorly in school and at work because you fail to focus on other people's details. Then you may become damaged by criticism, develop a negative self-image as a "loser," and end up labeled as lazy, poorly motivated, and underachieving. SA A D SD 146. Underachievement: You have a sense of underachievement and of not meeting your personal goals (it feels as if you aren't doing as well as you could or as if you get results that don't reflect your efforts). SA A D SD 147. Underachievement: You have bounced around in many different jobs or careers. SA A D SD 148. Underachievement: Despite your best efforts, you consistently perform below your potential, or your restlessness thwarts your relationships and career. SA A D SD 149. Underachievement: You never really seem to get ahead, catch a break, or realize your true potential. SA A D SD 150. Underachievement: You dislike and try to avoid tasks (such as schoolwork or homework) that require sustained mental effort. SA A D SD 151. Underachievement as a student: You have never been a good student (clue for LD) (DCD). SA A D SD 152. Underachievement: You get distracted from your plans. SA A D SD 153. Underachievement: Your distractibility, hyperactivity, impulsivity, difficulty learning from experience, and not picking up on social cues ("Rebel without a clue") lead to frequent failure. SA A D SD 154. Undisciplined: You lack self-discipline. SA A D SD 155. Unmanageable: Your finances and personal relationships are in shambles. SA A D SD 156. Unmotivated: You feel, and are felt to be, unmotivated and lazy, never doing today what you can put off until tomorrow. SA A D SD 157. Worry: You have a marked tendency to worry needlessly and endlessly. SA A D SD 158. Wrong: You're always wondering what's wrong with you, your life revolves around crises, and you characteristically feel unsuccessful. SA A D SD **QUESTIONNAIRE ENDS** Notes: SA = Strongly Agree or Certainly Applicable, to a significantly disabling or distressing degree. A = Agree or Probably Applicable to a moderately disabling or distressing degree. D = Disagree or Probably Not Applicable (or, if applicable at all, only to a dubiously disabling or distressing degree). SD = Strongly Disagree or Certainly Not Applicable. ADD = Attention Deficit Disorder (with or without hyperactivity). ADDults = Adults with ADD. ADDolescents = Adolescents with ADD. (DCD) = Differential Comorbidity Diagnosis (what else could be going on). LD = learning disability. **ADDENDA** A . Summary of What Attention Deficit Disorder is: A disorder of HIA (Hyperactivity, Impulsivity, and Attentional difficulty) or HID (Hyperactivity, Impulsivity, and Distractibility) pervasively and chronically impairing function, present since childhood. B. ADD is frequently associated with other types of learning disorders: 1. Language: verbal interpretation, comprehension, or expression 2. Spatial orientation: Visual processing 3. Memory: Retrieval of specific kinds of information 4. Fine motor control: Handwriting, trouble controlling pencil, breakdown between head and paper 5. Sequencing: Order, following instructions, time organization, math, slow learning of days of the week, months of the year, telling time, class locations C. Basic Patterns in the Course (progression over the years) of ADD: Course 1: All symptoms clear in adolescence; or Course 2: Hyperactivity clears but inattention, impulsivity, and social impairment persist into adolescence and adulthood; or Course 3: All symptoms persist into adulthood. **END**