Diagnostic Questionnaires
In my practice, once a patient has made an appointment to be seen, but prior to the first visit, the patient is asked to complete three questionnaires that will make the intake process more informative and efficient. The questionnaires are:
An ADD Symptom Survey
An ADD History Questionnaire
An ADD-related Medical Questionnaire to screen for medical conditions and treatments that might affect the diagnosis and treatment processes
If you are interested in using these questionnaires in your practice, they are available as PC Excel spreadsheets. The Symptom Survey contains embedded mini-programs to help you carry out analyses on the data. There are instructions on how to download the questionnaires at the bottom of this page. Once downloaded, you can print them out or email them to new patients for them to fill out and mail back to you before their first session.
The initial questions of the ADD Symptoms Survey are shown below:
| Using the Scoring Key below, enter your answers in the column headed by | |||
| "Self-rating". Score the symptoms as they have been for the past few years. | |||
| In the columns to the right of the self rating scores, mark with an X up to five or so symptoms | |||
| that bother you the most and up to five that have been noted by others the most. | |||
| Scoring key | |||
| Doesn't describe me at all, happens very rarely, no problem : | 0.0 | ||
| Describes me somewhat, happens sometimes, a mild problem: | 1.0 | ||
| Describes me pretty well, happens often, a moderate problem: | 2.0 | ||
| Describes me very well, happens usually, a severe problem: | 3.0 | ||
| Bothers | Noted by | ||
| Self-rating | you most | others | |
| When a task requires a lot of thought, I delay getting started | 0.0 | ||
| I have trouble completing tasks and projects | 0.0 | ||
| I am easily distracted by my own thoughts | 0.0 | ||
| I forget to do things I have in mind (to do, buy) | 0.0 | ||
| My mind usually wanders while I am reading | 0.0 | ||
| I don't prioritize or plan my day | 0.0 | ||
| I have difficulty organizing tasks/activities | 0.0 | ||
| I can't keep more than a few ideas in mind at the same time | 0.0 | ||
| I can't find things I have filed or stored | 0.0 | ||
| I interrupt others when they are talking | 0.0 | ||
| When I am talking with someone, I look at or listen to other things that are going on | 0.0 |
After the patient has completed the Symptom Survey Questionnaire, two computerized analyses are carried out. The first compares the patient's responses to the ADD Symptom Survey to the diagnostic criteria for adult ADD. A sample patient's responses are displayed below:
| To meet the most commonly used diagnostic criteria for inattentive ADD, patients usually | |
| rate six or more of the 9 items below as 2 or above. The symptoms should have been present | |
| for six or more months. | |
| I have trouble doing tasks that require sustained mental effort | 3.0 |
| I have trouble listening while others speak to me | 2.0 |
| I have trouble keeping my attention on what I am doing | 2.0 |
| I have difficulty organizing tasks/activities | 1.0 |
| I am easily distracted by noises, sights, etc | 2.0 |
| I don't follow through or finish my work | 3.0 |
| I don't give close attention to details and make careless mistakes | 1.0 |
| I lose things I need for tasks or other activities | 1.0 |
| I am forgetful in daily activities at home or at work | 3.0 |
| Number of items scored 2 or higher | 6 |
| To meet the most commonly used diagnostic criteria for hyperactivity/impulsivity, patients | |
| usually score six or more of the 9 items below as 2 or higher. The symptoms should | |
| have been present for six or more months. | |
| I feel on the go, driven by a motor | 1.0 |
| Even if I'm not bored, I need to keep walking, moving around | 1.0 |
| I can't sit still even in a situation when most people are seated | 0.0 |
| When I'm bored, I fidget with my hands or feet, squirm in my seat | 2.0 |
| I talk too much | 2.0 |
| I interrupt others when they are talking | 1.0 |
| I blurt out answers before the question has been completed | 1.0 |
| I have difficulty waiting my turn | 0.0 |
| Number of items scored greater 2 or higher | 3 |
| In addition to the symptoms, a person must also have clear impairment in two or three | |
| settings… | |
| My symptoms interfere with my personal relationships | 2.0 |
| My symptoms interfere with my work or schooling | 3.0 |
| My symptoms interfere with my family relationships | 2.0 |
| and there must be clear psychological distress… | |
| My symptoms make me depressed | 1.0 |
| My symptoms lower my self esteem | 1.0 |
| My symptoms make me anxious | 3.0 |
The above analysis suggests that the patient's self assessment of his/her symptoms meets the criteria for Attention Deficit Disorder but not of the Hyperactive type.
In the second analysis, the patient's responses to the Symptom Survey items are grouped into executive function categories. This makes it easier to determine the areas of function that may respond to medication or coaching or therapy. For example,
| Analysis of Executive Functions | |
| Scoring key | |
| Doesn't describe me at all, happens very rarely, no problem : | 0.0 |
| Describes me somewhat, happens sometimes, a mild problem: | 1.0 |
| Describes me pretty well, happens often, a moderate problem: | 2.0 |
| Describes me very well, happens usually, a severe problem: | 3.0 |
| Self-rating | |
| TASK INITIATION | |
| When a task requires a lot of thought, I delay getting started | 2.0 |
| I remember to do things but still only do them at the last minute or when it's too late | 3.0 |
| If there's no deadline, I work very inefficiently | 2.0 |
| I wait until the last moment before starting tasks | 3.0 |
| Average for TASK INITIATION | 2.5 |
| MAINTAINING FOCUS | |
| I lose the thread of a story I am hearing | 2.0 |
| I go from topic to topic when I talk | 1.0 |
| I have trouble doing tasks that require sustained mental effort | 2.0 |
| I have trouble keeping my attention on what I am doing | 1.0 |
| Average for MAINTAINING FOCUS | 1.5 |
| WORK COMPLETION | |
| I have trouble completing tasks and projects | 3.0 |
| I have trouble wrapping up the final details of a project | 3.0 |
| I don't follow through or finish my work | 3.0 |
| Average for WORK COMPLETION | 3.0 |
| MENTAL ENERGY | |
| I often don't have enough mental energy to keep doing things | 3.0 |
| I feel like I don't have enough mental energy to start doing things | 1.0 |
| Average for MENTAL ENERGY | 2.0 |
The next step would be to review the patient's responses to the ADD History Questionnaireto determine how the disorder may have affected him or her throughout their lifetime and to get a family history relevant to ADD diagnosis and treatment.
The first two sets of items of the ADD History Questionnaire are as follows:
| Childhood history of ADD | y/n/d | Explain, if necessary |
| As a child, I.... had to repeat one or more grades | y | |
| fidgeted a lot, couldn't sit still | y | |
| was distractible, had a short attention span | n | |
| had a lot of discipline problems |