Diagnostic and Behavioral Symptom Questionnaire
This questionnaire is one of three I have my patients fill out before their first scheduled visit. I then go over the questionnaire with them to verify and explore their answers. If for some reason, they are not able to complete the questionnaire beforehand, I ask them all the questions in person at the time of the visit, but I find this less efficient, and occasionally some questions get overlooked.
If you have plans to be evaluated by a clinician, you can find the c0mplete set of questionnaires on-line. You can print the questionnaire, answer the questions and bring the completed questionnaire to the clinician when you have your evaluation appointment.
The following questionnaire asks a series of questions about the patient’ executive functions. Executive functions are a set of mental abilities include staying focused, planning, managing time, organizing, remembering, and reasonably controlling emotional states. A common cause of executive function disorders is ADD, but there are other causes as well, including depression, Alzheimer’s, schizophrenia, sleep problems, anxiety, and others.
Having a patient’s responses to these questions makes it quicker and easier for a clinician to evaluate the patient for ADD. The answers will help provide information about whether a person’s symptoms meet the generally accepted requirements for the diagnosis of ADD and highlight the areas that may need coaching or therapy. A separate questionnaire gathers information about possible medical causes of symptoms and another explores the patient’s childhood and family history related to ADD.
Answer how well each statement describes you when you don’t use special aids or tricks you have developed to get around or compensate for difficulties you might have. Score each answer as follows:
0 – doesn’t describe me at all
1 – describes me somewhat or some of the time
2 – describes me pretty well or most of the time
3 – describes me very well or almost all the time
___ I have trouble getting started doing things
___I have trouble completing things
___I dislike tasks that require a long series of steps.
___I don’t do tasks efficiently (a good job in a short period of time).
___It is hard for me to do two or three tasks in a row.
___I don’t always do what needs to be done.
___I am easily distracted by things I hear or see even when I am trying to concentrate.
___I get distracted by my own thoughts.
PERSEVERANCE AND FOCUS
___I have trouble doing tasks that require keeping my attention on them for a long period of time
___I often switch from doing one thing to another even when I don’t have to.
___I have trouble keeping my attention on one task.
___I don’t pay attention when I should, make careless mistakes.
___I have trouble listening while others speak to me.
___I get so deeply into one thing that I forget others.
___I lose or misplace things.
___I forget appointments.
___I am often late for appointments.
FUTURE AWARENESS AND PLANNING
___I have trouble making plans long in advance.
___I rarely get to trains at least 10 minutes early.
___I get disorganized
___I have trouble organizing tasks.
___My personal work area is messy.
___I don’t prioritize or plan my day.
___I can’t work well without structure or direction.
___I waste a lot of time doing nothing.
PHYSICAL ACTIVITY (HYPERACTIVITY)
___I need to keep walking, moving around.
___I have trouble sitting still, I fidget.
___I am easily frustrated.
___I get impatient easily.
___I interrupt when other people are talking.
___I focus and concentrate better if I am somewhat anxious.
___I often try to do more than one task at a time.
___I tend to make things more complicated than they need to be.
___I have trouble getting to sleep because my mind is going.
Adding up an individual’s scores on the symptom questionnaire is only one part of a comprehensive evaluation of ADD. The main value of this questionnaire is to alert the clinician to issues that are important to be aware of when interviewing a patient as part of a comprehensive ADD evaluation. It can also be helpful if repeat testing is done over time to judge whether treatment is being effective.
That being said, if
- a person’s average score on these 34 questions is 2 or higher and
- the person scores six of the bolded items as 2 or higher and
- the symptoms significantly impair the person’s work, school, family, or personal activities and
- the person experiences significant stress from the effects of the symptoms and
- there is no other medical or psychological explanation for them, then…
a clinician might strongly suspect that the person has ADD.