Adult ADHD Screening Test – Leeds Confederation

Step 1 of 36

Find a Time and Place to Complete
Choose a quiet, comfortable space where you won’t be interrupted. Expect to need to spend around an hour to complete the questionnaire. You will need to complete the form in one sitting as there is not the option to save it halfway through.
Fill in the Screening Form
Answer the questions about your experiences and history. This helps our ADHD Navigation Team understand your needs.
Submit and Get Your Report
When you’ve finished the form: A PDF report with your results will be emailed to you and to the ADHD Triage Team. If you don’t see the email in your inbox, please check your junk folder.
What Happens Next
After reviewing your responses, a member of the ADHD Navigation Team will contact you to discuss your results and guide you through the next steps, which may include support, advice, or referral for further assessment.👩‍⚕️

Your data is fully secure and encrypted. Responses will be shared with Leeds Confederation Of Doctors for your assessment and stored safely on our encrypted systems in accordance with our Privacy Policy.

I have read and understood the above(Required)

Please read the following carefully before starting.

Take your time answering the questions. Accuracy is more important than speed ⌚

There are no right or wrong answers 😎

Give as much detail as you can. Detailed answers will help your GP or Doctor to determine the best course of action ✍

Unless otherwise directed, answer the questions based on how you have felt and conducted yourself over the past 6 months

What happens at the end of the test?

A summary of your assessment, including your score on the ASRS scale, will be emailed to the Leeds ADHD triage service.

The PDF document can also be downloaded by yourself at the end of the test.

PLEASE NOTE: It is advised to complete the test on a private device if you wish to download your report at the end of the test.

Age

What gender do you identify with?(Required)

Male

Female

Trans woman

Trans man

Non-binary

All other gender identities

Prefer not to say

If other please specify

Ethnicity

Do you consider yourself to have a disability(Required)

Yes

Prefer not to say

Does this health condition impact or may impact your ability to work?

Yes

Prefer not to say

If yes – please specify main health condition.

When considering your overall health, how many individual health conditions do you consider yourself to have?

What best describes your current employment status?

In work (full time)

In work (part time)

Off sick (Less than 4 weeks)

Off sick (More than 4 weeks)

Not employed but looking for work

Not employed and not looking for work

Retired

Prefer not to say

Have there been any adjustments to facilitate your employment?

In work with usual roles and responsibilities

In work with reasonable adjustments in place

Not applicable

Prefer not to say

In the last 6 months, have you had sickness absence from work due to your health for more than 7 days?

Yes

Prefer not to say

At the start of the service how many points would you give your curent work ability? (0-completely unable to work to 10-completely able to work)

At the start of the service, how likely do you feel you are lose/leave your job due to your symptoms/health in the next 12 months?

At the start of the service, how confident do you feel in your ability to manage your health conditions/symptoms in your work environment?

Select your highest level of academic achievement

GCSEs

A Levels / IB Diploma

BTEC

NVQ / Apprenticeship

HND

HNC

Degree

Postgraduate Degree

None

Other

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

Never

Rarely

Sometimes

Often

Very Often

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How often do you have difficulty getting things in order when you have to do a task that requires organisation?

Never

Rarely

Sometimes

Often

Very Often

This field is hidden when viewing the form

How often do you have problems remembering appointments or obligations?

Never

Rarely

Sometimes

Often

Very Often

This field is hidden when viewing the form

When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

Never

Rarely

Sometimes

Often

Very Often

This field is hidden when viewing the form

How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?

Never

Rarely

Sometimes

Often

Very Often

This field is hidden when viewing the form

How often do you feel overly active and compelled to do things, like you were driven by a motor?

Never

Rarely

Sometimes

Often

Very Often

This field is hidden when viewing the form

How often do you make careless mistakes when you have to work on a boring or difficult project?

Never

Rarely

Sometimes

Often

Very Often

How often do you have difficulty keeping your attention when you are doing boring or repetitive work?

Never

Rarely

Sometimes

Often

Very Often

How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?

Never

Rarely

Sometimes

Often

Very Often

How often do you misplace or have difficulty finding things at home or at work?

Never

Rarely

Sometimes

Often

Very Often

How often are you distracted by activity or noise around you?

Never

Rarely

Sometimes

Often

Very Often

How often do you leave your seat in meetings or other situations in which you are expected to remain seated?

Never

Rarely

Sometimes

Often

Very Often

How often do you feel restless or fidgety?

Never

Rarely

Sometimes

Often

Very Often

How often do you have difficulty unwinding and relaxing when you have time to yourself?

Never

Rarely

Sometimes

Often

Very Often

How often do you find yourself talking too much when you are in social situations?

Never

Rarely

Sometimes

Often

Very Often

When you're in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?

Never

Rarely

Sometimes

Often

Very Often

How often do you have difficulty waiting your turn in situations when turn taking is required?

Never

Rarely

Sometimes

Often

Very Often

How often do you interrupt others when they are busy?

Never

Rarely

Sometimes

Often

Very Often

MOBILITY – Please select the statement that best describes your mobilty today?

I have no problems in walking about

I have slight problems in walking about

I have moderate problems in walking about

I have severe problems in walking about

I am unable to walk about

This field is hidden when viewing the form

EQ1

SELF-CARE Please select the statement that best describes your self-care today?

I have no problems washing or dressing myself

I have slight problems washing or dressing myself

I have moderate problems washing or dressing myself

I have severe problems washing or dressing myself

I am unable to wash or dress myself

This field is hidden when viewing the form

EQ2

USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities) Please select the statement that best describes your health today?

I have no problems doing my usual activities

I have slight problems doing my usual activities

I have moderate problems doing my usual activities

I have severe problems doing my usual activities

I am unable to do my usual activities

This field is hidden when viewing the form

EQ3

PAIN / DISCOMFORT Please select the statement that best describes your health today?

I have no pain or discomfort

I have slight pain or discomfort

I have moderate pain or discomfort

I have severe pain or discomfort

I have extreme pain or discomfort

This field is hidden when viewing the form

EQ4

ANXIETY / DEPRESSION Please select the statement that best describes your health today?

I am not anxious or depressed

I am slightly anxious or depressed

I am moderately anxious or depressed

I am severely anxious or depressed

I am extremely anxious or depressed

This field is hidden when viewing the form

EQ5

On a scall of 1 being worst health you can imagine, to 100 being the best helth you can imagine, how is your overall health?

The next section will ask about your symptoms.

Please answer the questions thoroughly, giving as much detail as you can ✍

If you need help with this section, try asking a parent, friend or somebody else who knows you well for help. Often, their insights are extremely helpful.

Do any of these symptoms apply to you?

Select as many or few options as you like.

Lack of attention to detail

Trouble staying focused

Frequent spaciness

Difficulty following instructions

Lack of organization

Easily distracted

Forgetfulness

Often misplacing possessions

Difficulty sustaining mental effort

Procrastination

Difficulty starting tasks

Difficulty completing tasks

Lack of motivation

Difficulties with time planning

Chronic lateness

Low self-esteem

Hard to stay focused

Difficulty controlling emotions

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Hidden-Do any of these

Nil input

If there are other symptoms you feel we have missed from our list, please list them here

Enter as much detail as you can. The more information you give, the more likely it is that you will benefit from an accurate assessment.

This field is hidden when viewing the form

Hidden-Other symptoms

Nil input

Give some examples of how your symptoms have recently impacted you (at work, at home, relationships etc)

Enter as much detail as you can. The more information you give, the more likely it is that you will benefit from an accurate assessment.

Have you ever been diagnosed with any of the following by a GP/Psychiatrist/Psychologist?

Select as many or few options as you like.

Depression

Generalised Anxiety Disorder

Obsessive-Compulsive Disorder (OCD)

Post-traumatic stress disorder (PTSD)

Agoraphobia

Panic Disorder

Other Anxiety Disorder

Psychotic Disorder (Any)

Bipolar

Personality Disorder (Any)

Traumatic Brain Injury

Substance Misuse Disorder

Alcohol Misuse Disorder

Other

Describe any other mental health issues you are experiencing

Enter as much detail as you can. The more information you give, the more likely it is that you will benefit from an accurate assessment.

This field is hidden when viewing the form

Nil health issues

Nil

Have you ever been arrested, charged, or convicted of a crime?

Yes

Prefer not to say

This field is hidden when viewing the form

Please summarise the trouble you have been in with the police.

Enter as much detail as you can. The information will assist in achieving an accurate assessment.

Have you ever experienced any heart problems?

Yes

What diagnosis or symptoms do you have related to your heart health?

Enter as much detail as you can. The information will support an accurate assessment. Include details of hypertension/diabetes etc. Please inform your GP directly about any symptoms that they are not aware of.

School experience

It is important that you answer this section thoroughly as possible.

Inadequate information regarding early years and schooling is one of the most common causes for a GP referral to be rejected by the psychiatry team.

Approximately how old were you when you first began to notice symptoms?

Infancy (under 4 years)

Early primary school (4 – 7 years)

Later primary school (7 – 11 years)

Early secondary school (11 – 14 years)

Later secondary school (14 – 16 years)

17+ years

How would you summarise your school experience and behaviour?

Select as many or few options as you like.

Class clown

Poor academic attainment

Hyperactivity

Couldn’t sit still

Dismissed from class frequently

Difficulty focusing

Suspended / excluded form school

Made to work in isolation

Frequently told off for talking in class

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Hidden-Summarise school

Nil input

In your own words, describe the particular struggles your symptoms caused you at school.(Required)

Enter as much detail as you can. The more information you give, the more likely it is that you will benefit from an accurate assessment.

This field is hidden when viewing the form

Hidden-anythingelse

Nil input

Did parents, teachers or fellow pupils comment on your behaviour?

Yes

What did they say?(Required)

Enter as much detail as you can. The more information you give, the more likely it is that you will benefit from an accurate assessment.

Have you used any illegal substances/drugs in the past 6 months?

Yes

Why did you decide to embark on a journey towards managing your symptoms?

Select as many or few options as you like.

Understanding if I have a diagnosable condition

Become more productive

Perform better at work

Learn to create healthy relationships

Improve mental health

Eliminate impulsive behaviour

Eliminate stress and anxiety

Become a better student

Learn to act on long-term goals

Be able to maintain focus

This field is hidden when viewing the form

Hidden- Motivations

Nil input

Is there anything else that you would like to mention that you feel you haven't shared?

This field is hidden when viewing the form

Hidden-Other input

Nil input

Which assessment types would you find acceptable?

NHS Service

NHS – Right to Choose

Self-pay

Your ASRS Self Test and Symptom History Report pack (6-page PDF) is almost ready 👩‍⚕️

To generate your report pack and see your results, please enter your details below.

Please make sure the information you provide below is correct ✍

If no email is received after you click ‘Generate Report’, try checking your spam folder.

Your title(Required)

Your name(Required)

First Name Surname

Your home address

Address Line 1 Address Line 2 City County Postcode

Your date of birth (dd/mm/yyyy)(Required)

Day

Month

Year

This field is hidden when viewing the form

TodayDateHidden

DD slash MM slash YYYY

Your email address(Required)

Note: Your 6-page PDF Self Test and Symptom History Report pack will be sent to this email address.

Enter Email Confirm Email

GP Surgery name

Select your current GP

This field is hidden when viewing the form

ScoreCalculation

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Overall Health Score Today:

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EQ-5D-5L ScoreCalculation

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Scheduled Maintenance

Adult ADHD Screening Test Guide

Please read the following carefully before starting.

What happens at the end of the test?

The next section will ask about your symptoms.

School experience