Welcome to The ADHD Center of North Dallas!

Behavior Checklist for Adults


Please fill this form out completely. Select the number that indicates how frequently or how much each item describes you.


0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

- 1.) I am easily distracted.
- 2.) I don’t plan ahead: I’m impulsive.
- 3.) I make careless mistakes or have trouble paying close attention to details or make careless to details.
- 4.) I fidget (with my hands or feet) or squirm in my seat.
- 5.) I have trouble keeping my attention focused at work or during fun activities.
- 6.) It’s hard for me to sit still for long: I leave my seat when I am not supposed to.
- 7.) I don't listen when people speak directly to me.
- 8.) I feel restless.
- 9.) I have trouble following through on instructions and fail to finish things I started.
- 10.) I am noisy and have difficulty doing things quietly.

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

- 11.) I have difficulty organizing tasks and activities.
- 12.) I am always on the go, as if driven by a motor.
- 13.) I avoid, dislike, or am reluctant to engage in work that requires sustained mental effort.
- 14.) I talk too much.
- 15.) I lose things necessary for tasks or activities (lists, pencils, cell phone, keys, books, tools, etc).
- 16.) I blurt out answers before questions have been completed.
- 17.) I have trouble awaiting my turn.
- 18.) I am forgetful in my daily activities.
- 19.) I interrupt or intrude on others accidentally.
- 20.) I am moody with a lot of ups and downs.

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

- 21.) I say things without thinking.
- 22.) I didn’t achieve up to my potential.
- 23.) I have a tendency to be immature.
- 24.) I have feelings of guilt and regret.
- 25.) I’m not sure of myself.

0=Not at All 2=Somewhat 4=Very Much

- 26.) As a child I was unpopular, didn’t keep friends long, and didn’t get along with other children.
- 27.) Overall, I was a poor student or slow learner.
- 28.) I had trouble with mathematics or numbers in school

Checklist By Richard Cowles, PsyD. Designed for the ADHD Center of North Dallas 2009.