1)  I often have difficulty concentrating on what people say to me, even if they are speaking to me directly.
◦ Yes
◦ No
◦ Not Sure

2)  I often have problems remembering appointments or obligations.
◦ Yes
◦ No
◦ Not Sure

3)  When I’m in a conversation, I often finish the sentences of the people I’m talking to, before they can finish.
◦ Yes
◦ No
◦ Not Sure

4)  I often have difficulty keeping my attention on boring or repetitive work.
◦ Yes
◦ No
◦ Not Sure

5)  I tend to engage in high-risk behaviors (i.e. speeding, gambling, etc.)
◦ Yes
◦ No
◦ Not Sure

6) When I have a task that requires a lot of thought, I often avoid or delay getting started.
◦ Yes
◦ No
◦ Not Sure

7) I feel like I have underachieved compared to others my age.
◦ Yes
◦ No
◦ Not Sure

8)  I make careless mistakes when I have to work on a boring or difficult project.
◦ Yes
◦ No
◦ Not Sure

Half way done!

9)  It is difficult for me to sleep or wind down at the end of the day.
◦ Yes
◦ No
◦ Not Sure

10) I have difficulty waiting my turn (i.e., at the bank) and become frustrated easily.
◦ Yes
◦ No
◦ Not Sure

12)  I find myself overwhelmed easily by organizational planning.
◦ Yes
◦ No
◦ Not Sure

13)  I often misplace or have difficulty finding things at home or at work.
◦ Yes
◦ No
◦ Not Sure

14)  I have failed more than I should in life.
◦ Yes
◦ No
◦ Not Sure

15)  I have to get up very often when seated at my desk, in meetings or in other situations in which I’m expected to remain seated.
◦ Yes
◦ No
◦ Not Sure

16)  I tend to space out during meetings or conversations, especially if not interested.
◦ Yes
◦ No
◦ Not Sure

17) I often start a project or task without reading or listening to directions carefully.
◦ Yes
◦ No
◦ Not Sure