Adult ADHD Self-Report Scale (ASRS-v1.1) Checklist
This file contains the Adult ADHD Self-Report Scale which aids in identifying ADHD symptoms in adults. It includes assessment questions and scoring instructions. Healthcare professionals can utilize this tool for better diagnosis and treatment planning.
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How do I fill this out?
Filling out the ASRS-v1.1 checklist is straightforward. Start by marking responses on each criterion based on your experiences over the past six months. Review the completed checklist with your healthcare professional for further insights.

How to fill out the Adult ADHD Self-Report Scale (ASRS-v1.1) Checklist?
1
Ask the patient to complete both Part A and Part B of the Symptom Checklist.
2
Score Part A by checking for marks in the shaded boxes to identify ADHD symptoms.
3
Interpret frequency scores in Part B for additional symptom analysis.
4
Discuss the results with the patient to evaluate the impact on their daily life.
5
Consider referring the patient for further assessment if necessary.
Who needs the Adult ADHD Self-Report Scale (ASRS-v1.1) Checklist?
1
Adults seeking diagnosis for ADHD symptoms.
2
Healthcare professionals administering ADHD evaluations.
3
Counselors assessing attention-related issues.
4
Researchers studying adult ADHD prevalence.
5
Individuals who suspect they have ADHD.
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What are the instructions for submitting this form?
To submit the completed ASRS-v1.1 checklist, provide it directly to your healthcare provider during your appointment. You may also scan and email the checklist to your provider's office if instructed. Ensure that any physical copies are submitted directly at the office for further evaluation.
What are the important dates for this form in 2024 and 2025?
Currently, there are no specific dates related to the ASRS form for 2024 and 2025. It is recommended to stay updated with healthcare guidelines for any changes concerning ADHD assessments.

What is the purpose of this form?
The purpose of the Adult ADHD Self-Report Scale (ASRS-v1.1) is to assist healthcare professionals in diagnosing ADHD in adults accurately. By utilizing this checklist, practitioners can evaluate symptoms and understand their impacts. This ultimately helps in providing appropriate interventions and support for those diagnosed.

Tell me about this form and its components and fields line-by-line.

- 1. Patient Name: The name of the individual completing the checklist.
- 2. Today's Date: The date on which the checklist is being completed.
- 3. Symptom Checklist: A series of questions assessing ADHD symptoms.
What happens if I fail to submit this form?
Failing to submit the ASRS v1.1 can lead to missed diagnoses and prolonged symptoms. Regular assessments are crucial for appropriate treatment.
- Misdiagnosis Risk: Without proper submission, ADHD symptoms may not be accurately identified.
- Delayed Treatment: Not submitting can impede timely interventions and support.
- Increased Symptoms: Failure to assess can lead to worsening symptoms affecting daily life.
How do I know when to use this form?

- 1. Initial Self-Assessment: As a first step in recognizing potential ADHD symptoms.
- 2. Clinical Evaluation: Used by healthcare providers during patient assessments.
- 3. Follow-Up Evaluation: To evaluate progress or changes in symptoms over time.
Frequently Asked Questions
What is the Adult ADHD Self-Report Scale?
The ASRS is a screening tool used to assess adult ADHD symptoms based on DSM-IV criteria.
How do I complete the ASRS v1.1 checklist?
Mark an 'X' in the boxes corresponding to your experiences over the past six months.
Who can use the ASRS v1.1?
It is designed for adults who suspect they have ADHD and for healthcare professionals evaluating symptoms.
Is the ASRS v1.1 reliable?
Yes, it is based on validated criteria for ADHD and has been developed by experts in the field.
How long does it take to fill out the ASRS v1.1?
Completing the checklist typically takes about 5 minutes.
What should I do with my completed ASRS v1.1?
Share it with your healthcare provider to discuss the results and next steps.
Can I edit the ASRS PDF?
Yes, you can edit the PDF using PrintFriendly's editing tools.
How can I share my completed ASRS checklist?
Use the sharing options available on PrintFriendly to email or link the document.
What is the purpose of the ASRS v1.1?
It helps identify adult ADHD symptoms to facilitate diagnosis and treatment.
Is there a scoring system for the ASRS?
Yes, specific scoring methods are detailed in the checklist for analyzing symptoms.
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