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Attention and Impulsivity Screen
Page 1 out of 1
Q1. I often fail to give close attention to detail or make careless mistakes in work or other activities.
Yes
No
Q2. I often have difficulty sustaining attention in tasks or activities.
Yes
No
Q3. I am told that I often do not seem to listen when spoken to directly.
Yes
No
Q4. I often do not follow through on instructions and fail to finish duties in the workplace (not due to failure to understand instructions).
Yes
No
Q5. I often have difficulty organizing or prioritizing tasks and activities
Yes
No
Q6. I often avoid, dislike, or am reluctant to engage in tasks that require sustained mental effort.
Yes
No
Q7. I often lose things necessary for tasks or activities (e.g., presentation materials, contact information, books, or tools)
Yes
No
Q8. I am often easily distracted by extraneous stimuli.
Yes
No
Q9. I am often forgetful in daily activities.
Yes
No
Q10. I often spend inordinate time and attention on trivial details.
Yes
No
Q11. I often have trouble waiting my turn (e.g., while driving my car or in a queue), leading to jumping ahead in line.
Yes
No
Q12. I often blurt out comments that are rude or insulting.
Yes
No
Q13. I often interrupt or intrude on others (e.g., butt into conversations).
Yes
No
Q14. I am often nervous or anxious.
Yes
No
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