Rate every item, then print or save as PDF to upload to the portal.

PsychConcierge PLLC

Adult ADHD Observer Rating Scale

Collateral report · completed by a parent, partner, or other close informant

You are completing this form about someone you know well. For each item, mark the rating that best describes the patient’s behavior over the past 6 months, using the four-point scale to the right (0 = Never or Rarely, 1 = Sometimes, 2 = Often, 3 = Very Often). When you have finished, print the form or save it as a PDF and upload it through the secured messaging portal so that the clinician may review it during the appointment.

Section A Behavior over the past 6 months · items 1–18
 
Never or Rarely(0)
Sometimes(1)
Often(2)
Very Often(3)
1.Overlooks details or makes careless errors in work, tasks, or other activities
2.Fidgets with or taps the hands or feet, or squirms while seated
3.Has trouble holding attention on tasks or on enjoyable activities
4.Rises from the seat when remaining seated is expected
5.Seems not to listen even when addressed directly
6.Comes across as physically restless
7.Does not follow through on instructions and leaves work or duties unfinished
8.Finds it hard to take part in leisure or downtime quietly
9.Struggles to organize tasks, activities, and belongings
10.Appears to be in constant motion, as though driven by a motor
11.Avoids or resists activities that demand sustained mental effort
12.Talks excessively
13.Loses items needed for tasks or daily activities
14.Blurts out an answer before the question is complete
15.Is drawn off task easily by surrounding activity or stray thoughts
16.Has difficulty waiting for a turn
17.Is forgetful in the course of daily routines
18.Interrupts or intrudes on the conversations or activities of others
Section B Interference with functioning · areas 1–10

To what degree do the behaviors marked in Section A interfere with the patient’s ability to function in each of the following areas of life?

 
Never or Rarely(0)
Sometimes(1)
Often(2)
Very Often(3)
1.Home life with immediate family
2.Work or occupation
3.Social interactions with others
4.Activities and dealings in the community
5.Educational activities
6.Dating or marital relationship
7.Management of money
8.Operation of a motor vehicle
9.Leisure or recreational activities
10.Management of daily responsibilities

For office use. Return this completed form to the clinician for review at the patient’s appointment.

Collateral (observer) report adapted from the symptom criteria for attention-deficit/hyperactivity disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Item descriptors reworded for this form; no proprietary rating scale is reproduced.