Adult ADHD Screening Test – Leeds Confederation

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?

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.

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.

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

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

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)

This field is hidden when viewing the form

TodayDateHidden

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

This field is hidden when viewing the form

Overall Health Score Today:

This field is hidden when viewing the form

EQ-5D-5L ScoreCalculation

By clicking ‘Generate Report’ below, you confirm you have read and are in agreement with our Clinical Disclaimer, Terms of Use and Privacy Policy. We will never sell your information to third parties.

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