Jasper/Goldberg ADHD Screening Examination – V5

1990, 1991, 1992, 1993 Larry Jasper & Ivan Goldberg

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

Your initials
Date of birth