Adult ADHD Intake – DIVA

This assessment asks about the presence of specific ADHD symptoms that you experienced during your childhood and adulthood, asking for specific examples from you. The questions are based on the official criteria for ADHD in the DSM-5. For each question please answer:

  • Yes or No if the symptom is currently present in adulthood giving examples.
  • Yes or No if the symptom was present in childhood giving examples.

Both adulthood and childhood need to be investigated in order to be able to establish the diagnosis of ADHD.

Symptoms of attention-deficit



A1 Do you often fail to give close attention to details, or do you make careless mistakes in your work or during other activities? Examples:

  • Careless mistakes in work / schoolwork
  • Work is inaccurate
  • Too much time needed to complete tasks

Section

A1 Adulthood: Symptom present?
A1 Childhood: Symptom present?

A2 Do you often have difficulty sustaining your attention in tasks? And how was that during childhood (in play activities)? Examples:

  • Difficulty keeping attention on work / schoolwork
  • Needing structure to avoid becoming distracted
  • Quickly becoming bored of activities

Section

A2 Adulthood: Symptom present?
A2 Childhood: Symptom present?

 

A3 Does it often seem as though you are not listening when you are spoken to directly? And how was that during childhood? Examples:

  • Not knowing what co-workers / partners / parents/teachers have said
  • Questions having to be repeated

Section

A3 Adulthood: Symptom present?
A3 Childhood: Symptom present?

 

A4 Do you often not follow through on instructions and often fail to finish chores or duties in the workplace? And how was that during childhood (in schoolwork)? Examples:

  • Starts tasks but quickly loses focus and is easily sidetracked
  • Not completing things

Section

A4 Adulthood: Symptom present?
A4 Childhood: Symptom present?

 

A5 Do you often find it difficult to organise tasks and activities? And how was that during childhood? Examples:

  • Difficulty keeping materials and belongings in order
  • Messy room / desk and/or work
  • Arriving late

Section

A5 Adulthood: Symptom present?
A5 Childhood: Symptom present?

 

A6 Do you often avoid (or do you dislike, or are you reluctant to engage in) tasks that require sustained mental effort? And how was that during childhood? Examples:

  • Avoidance of tasks that require a lot of concentration
  • Often postpones boring or difficult tasks.

Section

A6 Adulthood: Symptom present?
A6 Childhood: Symptom present?

 

A7 Do you often lose things that are necessary for tasks or activities? And how was that during childhood?

  • Spends a lot of time searching for things
  • Gets in a panic if other people move things around

Section

A7 Adulthood: Symptom present?
A7 Childhood: Symptom present?

 

A8 Are you often easily distracted by extraneous stimuli? And how was that during childhood?

  • After being distracted, has difficultly picking up the thread again
  • Easily distracted by noises or events / looking our window

Section

A8 Adulthood: Symptom present?
A8 Childhood: Symptom present?

 

A9 Are you often forgetful in daily activities? And how was that during childhood?

  • Forgets appointments or instructions
  • Has to be frequently reminded of things

Section

A9 Adulthood: Symptom present?
A9 Childhood: Symptom present?

 

 Symptoms of hyperactivity-impulsivity


 

H/I 1 Do you often fidget with or tap hands or feet, or do you often squirm in your seat? And how was that during childhood?

  • Tapping with a pen or playing with something
  • Able to control restlessness, but feels stressed as a result

Section

H1 Adulthood: Symptom present?
H1 Childhood: Symptom present?

 

H/I 2 Do you often leave your seat in situations where it is expected that you remain seated? And how was that during childhood?

  • Making excuses in order to walk around
  • Often stands up while eating or leaves desk / school desk

Section

H2 Adulthood: Symptom present?
H2 Childhood: Symptom present?

 

H/I 3 Do you often feel restless? And how was that during childhood?

  • Feeling restless inside
  • Always moving around, perhaps where it is inappropriate

Section

H3 Adulthood: Symptom present?
H3 Childhood: Symptom present?

 

H/I 4 Do you often find it difficult to engage in leisure activities quietly? And how was that during childhood (in play activities)?

  • Unable to watch TV or films quietly
  • Asked to be quieter or calm down

Section

H4 Adulthood: Symptom present?
H4 Childhood: Symptom present?

 

H/I 5 Are you often “on the go” or do you often act as if “driven by a motor”? And how was that during childhood?

  • Constantly busy
  • Others find you restless or difficult to keep up with

Section

H5 Adulthood: Symptom present?
H5 Childhood: Symptom present?

 

H/I 6 Do you often talk excessively? And how was that during childhood

  • Known as a chatterbox
  • Not giving others room during a conversation

Section

H6 Adulthood: Symptom present?
H6 Childhood: Symptom present?

 

H/I 7 Do you often blurt out an answer before questions have been completed? And how was that during childhood?

  • Interrupts others before sentences are finished
  • Coming across as being tactless

Section

H7 Adulthood: Symptom present?
H7 Childhood: Symptom present?

 

H/I 8 Do you often find it difficult to await your turn? And how was that during childhood?

  • Difficultly waiting turn in group activities
  • Becomes quickly impatient

Section

H8 Adulthood: Symptom present?
H8 Childhood: Symptom present?

 

H/I 9 Do you often interrupt or intrude on others? And how was that during childhood?

  • Interrupts the conversations of others
  • Unable to wait

Section

H9 Adulthood: Symptom present?
H9 Childhood: Symptom present?

Areas Of Life Affected


 

C1 How have these symptoms impaired your life in the area of work and education? Please give examples.

  • Lower educational level than expected based on IQ
  • Comments from teachers about behaviour or concentration
  • Limited impairment through compensation of external structure

Section

Adult Work/education Impairment present?
Childhood education Impairment present?

 

C2 How have these symptoms impaired your life in the area of family and relationships? Please give examples.

  • Frequent arguments with partners or family 
  • Strained relationships

Section

Adulthood relationship and/or family Impairment present?
Childhood family Impairment present?

 

C3 How have these symptoms impaired your life socially? Please give examples.

  • Conflicts as a result of communication problems
  • Being teased
  • Being a bully

Section

Adulthood social contacts Impairment present?
Childhood social contacts Impairment present?

 

C4 How have these symptoms impaired your life in the area of hobbies and free time? Please give examples.

  • Having to play lots of sport to be able to relax
  • Sensation seeking and/or taking too many risks
  • Tired quickly of hobbies

Section

Adulthood free time / hobbies Impairment present?
Childhood freetime / hobbies Impairment present?

 

C5 How have these symptoms impaired your life in the area of your confidence and self image? Please give examples.

  • Negative self-image due to experiences of failure
  • Excessive intense reaction to criticism

Section

Adulthood self-confidence / self image Impairment present?
Childhood self-confidence / self image Impairment present?