Executive
Function Questionnaire
Executive functions include planning, managing time, remembering, and reasonably controlling emotional states. The clinician's assessment of an individual's answers to the questions below (and also of the individual's family's answers, if possible) can help determine whether a patient is experiencing a deficit in executive functions.
For a number of reasons, simply adding up or analyzing an individual's scores on all the questions is not useful for making the diagnosis of ADD. A common cause of Executive Function Disorder is ADD, but there are other causes as well, such as depression, Alzheimer's, schizophrenia, and anxiety. In addition, research has shown that two different people often give very different scores about the same individual's executive functions. Clinical judgment and experience are required to interpret the answers and make the proper diagnosis. The main value of the questionnaire is to identify issues that are important to consider when carrying out an evaluation and following a person's progress over the course of treatment.
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Scoring
key |
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0 -
doesn't describe me at all |
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1 -
describes me somewhat |
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2 -
describes me pretty well |
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3 -
describes me very well |
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Score |
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INITIATION |
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I
have trouble getting started doing things |
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I
procrastinate |
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COMPLETION |
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I
have trouble completing things |
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EXECUTION |
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I
don't do tasks efficiently (good job in short time) |
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It
is hard for me to do two or three tasks in a row. |
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I
don't always do what needs to be done. |
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DISTRACTION |
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I am
easily distracted |
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PERSEVERANCE
AND FOCUS |
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I
don't stick to tasks that are optional |
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I
can't stick to a task even if I have to |
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I
often switch from doing one thing to another |
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INATTENTIVENESS |
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I
don't pay attention when I should |
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I
day dream/space out |
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I
have trouble listening while others speak to me |
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I am
absent minded |
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MEMORY |
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I have trouble remembering things I want to do |
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I
get so deeply into one thing that I forget others |
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I
have trouble with my short term memory |
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I
lose or misplace things |
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TIME |
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I
confuse appointment times |
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I
forget appointments |
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I am
often late for appointments |
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FUTURE
AWARENESS AND PLANNING |
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I
have trouble making plans long in advance |
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I
let my gas tank needle get close to empty |
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I
rarely get to trains at least 10 minutes early |
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ORGANIZATION |
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I
get disorganized |
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My
personal work area is messy |
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I put on my seat belt after the car has started moving |
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I don't prioritize or plan my day |
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I can't work well without structure or direction |
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I
have difficulty taking command of my time. |
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I
waste a lot of time doing nothing. |
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PHYSICAL
ACTIVITY |
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I
need to keep walking, moving around |
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I
have trouble sitting still, I fidget |
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FRUSTRATION/IMPULSIVENESS |
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I
get angry easily |
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I am
easily frustrated |
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I
get impatient easily |
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I
interrupt when other people are talking |
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I am
impulsive, do things without thinking |
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I
don't express or communicate my anger constructively |
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ANXIETY |
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I
focus and concentrate better if I am somewhat anxious. |
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MULTI-TASKING
(parallel) |
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I
have trouble doing more than one thing at a time well |
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I
often try to do more than one task at a time |
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I
tend to make things more complicated than they need to be |
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MULTI-TASKING
(serial) |
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I
dislike tasks that require a long series of steps |
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SLEEP |
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I
have trouble getting to sleep because my mind is going |
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UNCATEGORIZED |
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I
get so deeply into one thing that I forget other things I have to do |
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I
believe that there is usually a quick solutions to problems |
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I do
not like to commit because I don't know how I will feel in the long term |
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Copyright Marc Schwartz, MD, 2000-2007, New
Haven, CT. All rights reserved.
Version 2.34