by Ivan Goldberg, MD
1346 Lexington Ave. NYC 10128
Voice: +1 212 876-7800 Fax: +1 212 737-0473
i...@phantom.com / psycom...@genie.geis.com
adult add assessment FORM 1
This list of the symptoms of Adult ADD may help you conceptualize what is
going on.
Symptoms of Adult ADD
1. Persistent Motor Hyperactivity
A. Restlessness
B. Inability to relax
C. Always "on the go"
D. Talking Excessively
2. Attention Deficits
A. Distractibility (possibly with hyperfocusing at times)
B. Lack of "stick-to-itiveness"
C. Forgetfulness --- losing or misplacing things
D. Inability to concentrate on conversations and/or reading
E. Frequently feeling bored.
3. Affective Symptoms
A. Definite spontaneous and reactive shifts from normal mood to
depression or excitement
B. Often feels bored
4. Disorganization
A. Disorganization - inability to complete tasks at home, job, or
school
B. Haphazardly shifts from one activity to another
5. Temper Outbursts
A. Frustration leading to explosive short-lived outbursts
B. Transient loss of control
C. Easily provoked
6. Impulsivity
A. Makes decisions quickly and without reflection
B. Unable to delay speech or action without experiencing
discomfort
C. Impulsive spending, changing of plans, etc.
7. Stress Intolerance
A. Stress sensitivity
B. Easily flustered or "hassled"
C. Difficulty resolving conflicting demands
D. Loss of organization with stress
E. Despite stress sensitivity may do fine during major emergencies
adult add assessment FORM 2
The following self-administered scale may provide data supporting the
diagnosis of Adult ADD. Be sure to see the note that follows the scale
Jasper-Goldberg Adult ADD Screening Examination - Version 5.0
The items below refer to how you have behaved and felt DURING MOST OF
YOUR ADULT LIFE. If you have usually been one way and recently have
changed, your responses should reflect HOW YOU HAVE USUALLY BEEN.
Circle one of the numbers that follows each item using the following
scale:
0 = Not at all 1 = Just a little 2 = Somewhat
3 = Moderately 4 = Quite a lot 5 = Very much
- - - - - - - - - - - - -
1. At home, work, or school, I find my mind wandering from tasks
that are uninteresting or difficult. 0 1 2 3 4 5
2. I find it difficult to read written material unless it is very
interesting or very easy. 0 1 2 3 4 5
3. Especially in groups, I find it hard to stay focused on what is being
said in conversations. 0 1 2 3 4 5
4. I have a quick temper...a short fuse. 0 1 2 3 4 5
5. I am irritable, and get upset by minor annoyances.
0 1 2 3 4 5
6. I say things without thinking, and later regret having
said them. 0 1 2 3 4 5
7. I make quick decisions without thinking enough about
their possible bad results. 0 1 2 3 4 5
8. My relationships with people are made difficult by my
tendency to talk first and think later. 0 1 2 3 4 5
9. My moods have highs and lows. 0 1 2 3 4 5
10. I have trouble planning in what order to do a series of
tasks or activities. 0 1 2 3 4 5
11. I easily become upset. 0 1 2 3 4 5
12. I seem to be thin skinned and many things upset me.
0 1 2 3 4 5
13. I almost always am on the go. 0 1 2 3 4 5
14. I am more comfortable when moving than when sitting still.
0 1 2 3 4 5
15. In conversations, I start to answer questions before the questions
have been fully asked. 0 1 2 3 4 5
16. I usually work on more than one project at a time, and fail to
finish many of them. 0 1 2 3 4 5
17. There is a lot of "static" or "chatter" in my head.
0 1 2 3 4 5
18. Even when sitting quietly, I am usually moving my hands or feet.
0 1 2 3 4 5
19. In group activities it is hard for me to wait my turn.
0 1 2 3 4 5
20. My mind gets so cluttered that it is hard for it to function.
0 1 2 3 4 5
21. My thoughts bounce around as if my mind were a pinball machine.
0 1 2 3 4 5
22. My brain feels as if it were a television set with all the
channels going at once. 0 1 2 3 4 5
23. I am unable to stop daydreaming. 0 1 2 3 4 5
24. I am distressed by the disorganized way my brain works.
0 1 2 3 4 5
TOTAL ________________
Copyright (c) 1993, 1994 by Larry Jasper & Ivan Goldberg
NOTE:
This is a screening examination for Adult ADD. It is not a diagnostic
test. Scores over 70 are associated with a high probability of ADD.
The diagnosis of ADD can only be made on the basis of a detailed history
and psychiatric examination. Symptoms resembling those of ADD may result
from anxiety, depression, mania, and other disorders. These conditions
must be ruled out by a psychiatrist before a diagnosis of Adult ADD can be
made.
If prior to taking this examination you think you have a 50:50 chance of
having ADD, and if the score is over 70 on the test, you then have a 95%
chance of having ADD. This assumes that a medical and psychiatric
evaluation has ruled out other causes of attentional problems.
adult add assessment FORM 3
The following self-administered scale may provide data documenting
progress being made during the treatment of Adult ADD. This scale should
be completed prior to the start of a new treatment and weekly thereafter.
Jasper-Goldberg Adult ADD Progress Examination - Version 5.0
The items below refer to how you have behaved and felt DURING THE PAST
WEEK, INCLUDING TODAY.
Circle one of the numbers that follows each item using the following
scale:
0 = Not at all 1 = Just a little 2 = Somewhat
3 = Moderately 4 = Quite a lot 5 = Very much
- - - - - - - - - - - - -
1. At home, work, or school, I find my mind wandering from tasks
that are uninteresting or difficult. 0 1 2 3 4 5
2. I find it difficult to read written material unless it is very
interesting or very easy. 0 1 2 3 4 5
3. Especially in groups, I find it hard to stay focused on what is being
said in conversations. 0 1 2 3 4 5
4. I have a quick temper...a short fuse. 0 1 2 3 4 5
5. I am irritable, and get upset by minor annoyances.
0 1 2 3 4 5
6. I say things without thinking, and later regret having
said them. 0 1 2 3 4 5
7. I make quick decisions without thinking enough about
their possible bad results. 0 1 2 3 4 5
8. My relationships with people are made difficult by my
tendency to talk first and think later. 0 1 2 3 4 5
9. My moods have highs and lows. 0 1 2 3 4 5
10. I have trouble planning in what order to do a series of
tasks or activities. 0 1 2 3 4 5
11. I easily become upset. 0 1 2 3 4 5
12. I seem to be thin skinned and many things upset me.
0 1 2 3 4 5
13. I almost always am on the go. 0 1 2 3 4 5
14. I am more comfortable when moving than when sitting still.
0 1 2 3 4 5
15. In conversations, I start to answer questions before the questions
have been fully asked. 0 1 2 3 4 5
16. I usually work on more than one project at a time, and fail to
finish many of them. 0 1 2 3 4 5
17. There is a lot of "static" or "chatter" in my head.
0 1 2 3 4 5
18. Even when sitting quietly, I am usually moving my hands or feet.
0 1 2 3 4 5
19. In group activities it is hard for me to wait my turn.
0 1 2 3 4 5
20. My mind gets so cluttered that it is hard for it to function.
0 1 2 3 4 5
21. My thoughts bounce around as if my mind were a pinball machine.
0 1 2 3 4 5
22. My brain feels as if it were a television set with all the
channels going at once. 0 1 2 3 4 5
23. I am unable to stop daydreaming. 0 1 2 3 4 5
24. I am distressed by the disorganized way my brain works.
0 1 2 3 4 5
TOTAL ________________
Copyright (c) 1993, 1994 by Larry Jasper & Ivan Goldberg
|| Ivan Goldberg, MD ~ ||
|| i...@phantom.com psycom...@genie.geis.com psy...@netcom.com ||
|| Voice = +1 212 876 7800 Fax = +1 212 737 0473 ||
|| NY Psychopharmacologic Inst. 1346 Lexington Ave NYC 10128 ||
Larry MacDonald champ...@WELL.sf.ca.us
Deliberate
Orgasm Duet