Adult ADHD-RS-IV* with Adult Prompts†

The ADHD-RS-IV with Adult Prompts is an 18-item scale based on the DSM-IV-TR® criteria for ADHD that provides a rating of the severity of symptoms. The adult prompts serve as a guide to explore more fully the extent and severity of ADHD symptoms and create a framework to ascertain impairment. The first 9 items assess inattentive symptoms and the last 9 items assess hyperactive-impulsive symptoms.
Scoring is based on a 4-point Likert-type severity scale:
0 = none, 1 = mild, 2 = moderate, 3 = severe. Clinicians should score the highest score that is generated for the prompts for each item.
Example: If one prompt generates a “2” and all others are a “1,” by convention, the rating for that item is still a “2” Significant symptoms in clinical trials are generally considered at least a “2” – moderate.

1. Carelessness
Do you make a lot of mistakes (in school or work)?
0 1 2 3
Is this because you’re careless?
0 1 2 3
Do you rush through work or activities?
0 1 2 3
Do you have trouble with detailed work? Do you not check your work?
Do people complain that you’re careless?
0 1 2 3
Are you messy or sloppy?
0 1 2 3
Is your desk or workspace so messy that you have difficulty finding things?
0 1 2 3
2. Difficulty sustaining attention in activities. Do you have trouble paying attention when watching movies, reading, or attending lectures? Or on fun activities such as sports or board games? Is it hard for you to keep your mind on school or work? Do you have unusual trouble staying focused on boring or repetitive tasks?
0 1 2 3
Does it take a lot longer than it should to complete tasks because you can’t keep your mind on the task? Is it even harder for you than some others you know?
0 1 2 3
Do you have trouble remembering what you read and do you need to re-read the same passage several times?
0 1 2 3
3. Doesn’t listen
Do people (spouse, boss, colleagues, friends) complain that you don’t seem to listen or respond (or daydream) when spoken to or when asked to do tasks? A lot?
0 1 2 3
Do people have to repeat directions? Do you find that you miss the key parts of conversations because of drifting off in your own thoughts? Does it cause problems?
0 1 2 3
4. No follow through
Do you have trouble finishing things (such as work or chores)? Do you often leave things half done and start another project? Do you need consequences (such as deadlines) to finish? Do you have trouble following instructions (especially complex, multistep instructions that have to be done in a certain order with different steps)?
0 1 2 3
Do you need to write down instructions, otherwise you will forget them?
0 1 2 3
5. Can’t organize
Do you have trouble organizing tasks into ordered steps? Is it hard prioritizing work and chores?
0 1 2 3
Do you need others to plan for you?
0 1 2 3
Do you have trouble with time management? Does it cause problems?
0 1 2 3
Does difficulty in planning lead to procrastination and putting off tasks until the last moment possible?
0 1 2 3
6. Avoids/dislikes tasks requiring sustained mental effort. Do you avoid tasks (work, chores, reading, board games) that are challenging or lengthy because it’s hard to stay focused on these things for a long time?
0 1 2 3
Do you have to force yourself to do these tasks? How hard is it?
0 1 2 3
Do you procrastinate and put off tasks until the last moment possible?
0 1 2 3
7. Loses important items. Do you lose things (eg, important work papers, keys, wallet, coats, etc.)? A lot? More than others?
0 1 2 3
Are you constantly looking for important items?
0 1 2 3
Do you get into trouble for this (at work or at home)? Do you need to put items (eg, glasses, wallet, keys) in the same place each time, otherwise you will lose them?
0 1 2 3
8. Easily distractible
Are you ever very easily distracted by events around you such as noise (conversation, TV, radio), movement, or clutter?
0 1 2 3
Do you need relative isolation to get work done?
0 1 2 3
Can almost anything get your mind off of what you are doing, such as work, chores, or if you’re talking to someone?
0 1 2 3
Is it hard to get back to a task once you stop?
0 1 2 3
9. Forgetful in daily activities
Do you forget a lot of things in your daily routine? Like what? Chores? Work? Appointments or obligations?
0 1 2 3
Do you forget to bring things to work, such as work materials or assignments due that day?
0 1 2 3
Do you need to write regular reminders to yourself to do most activities or tasks, otherwise you will forget?
0 1 2 3
Adult ADHD-RS-IV* with Adult Prompts†
10. Squirms and fidgets
Can you sit still or are you always moving your hands or feet, or fidgeting in your chair?
0 1 2 3
Do you tap your pencil or your feet? A lot? Do people notice?
0 1 2 3
Do you regularly play with your hair or clothing?
0 1 2 3
Do you consciously resist fidgeting or squirming?
0 1 2 3
11. Can’t stay seated
Do you have trouble staying in your seat? At work?
0 1 2 3
In class? At home (eg, watching TV, eating dinner)?
0 1 2 3
In church or temple?
0 1 2 3
Do you choose to walk around rather than sit?
0 1 2 3
Do you have to force yourself to remain seated?
0 1 2 3
Is it difficult for you to sit through a long meeting or lecture?
0 1 2 3
Do you try to avoid going to functions that require you to sit still for long periods of time?
0 1 2 3
12. Runs/climbs excessively. Are you physically restless?
0 1 2 3
Do you feel restless inside? A lot?
0 1 2 3
Do you feel more agitated when you cannot exercise on an almost daily basis?
0 1 2 3
13. Can’t play/work quietly
Do you have a hard time playing/working quietly?
0 1 2 3
During leisure activity (non-structured times or on your own such as reading a book, listening to music, playing a board game), are you agitated or dysphoric? Do you always need to be busy after work or while on vacation?
0 1 2 3
14. On the go, “driven by a motor” Is it hard for you to slow down?
0 1 2 3
Do you feel like you (often) have a lot of energy and that you always have to be moving, are always “on the go”?
0 1 2 3
Do you feel like you’re driven by a motor?
0 1 2 3
Do you feel unable to relax?
0 1 2 3
15. Talks excessively
Do you talk a lot? All the time? More than other people?
0 1 2 3
Do people complain about your talking? Is it a problem?
0 1 2 3
Are you often louder than the people you are talking to?
0 1 2 3
16. Blurts out answers
Do you give answers to questions before someone finishes asking?
0 1 2 3
Do you say things before it is your turn?
0 1 2 3
Do you say things that don’t fit into the conversation?
0 1 2 3
Do you do things without thinking? A lot?
0 1 2 3
17. Can’t wait for turn
Is it hard for you to wait your turn (in conversation, in lines, while driving)?
0 1 2 3
Are you frequently frustrated with delays? Does it cause problems?
0 1 2 3
Do you put a great deal of effort into planning to not be in situations where you might have to wait?
0 1 2 3
18. Intrudes/interrupts others
Do you talk when others are talking, without waiting until you are acknowledged?
0 1 2 3
Do you butt into others’ conversations before being invited?
0 1 2 3
Do you interrupt others’ activities?
0 1 2 3
Is it hard for you to wait to get your point across in conversations or at meetings?
0 1 2 3
* From ADHD Rating Scale-IV: Checklists, Norms and Clinical Interpretation. Reprinted with permission of The Guilford Press: New York. © I998 George J. DuPaul, Thomas J. Power, Arthur A. Anastopoulos and Robert Reid. This scale may not be reproduced in any form without written permission of The Guilford Press. www.guilford.com
†Prompts developed by Lenard Adler, MD, Thomas Spencer, MD, and Joseph Biederman, MD.
©2003 New York University and Massachusetts General Hospital. All rights reserved. DO NOT REPRODUCE WITHOUT WRITTEN PERMISSION OF MASSACHUSETTS GENERAL HOSPITAL OR NEW YORK UNIVERSITY.
THERE ARE NO WARRANTIES REGARDING THIS ATTENTION DEFICIT HYPERACTIVITY DISORDER RATING SCALE IV AND ADULT PROMPTS (“SCALE”), EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION, IMPLIED WARRANTIES
OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, AND ALL OTHER REPRESENTATIONS OR WARRANTIES OF ANY KIND ARE HEREBY DISCLAIMED. New York University and the Massachusetts General Hospital shall neither exercise control over nor interfere with the physician-patient relationship of users of this Scale and shall not be responsible for any use made of this Scale, including any medical decisions regarding the care and treatment of patients using the Scale.
GAD-7 Anxiety

Over the last two weeks, how often have you been bothered by the following problems?
0- Not at all
1- Several days
2- More than half the days
3- Nearly every day
1. Feeling nervous, anxious, or on edge
0 1 2 3
2. Not being able to stop or control worrying
0 1 2 3
3. Worrying too much about different things
0 1 2 3
4. Trouble relaxing
0 1 2 3
5. Being so restless that it is hard to sit still
0 1 2 3
6. Becoming easily annoyed or irritable
0 1 2 3
7. Feeling afraid, as if something awful might happen
0 1 2 3

Column totals: Record how many times you answered with each number.
Example: If you marked questions 1, 2, and 3 as a level 2... You would put the number 3 on the #2 space below.
#0_____ +
#1 _____ +
#2 _____ +
#3 _____ =
Total score _______
If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult

Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.
Reproduced with permission
PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
NAME: DATE:
Over the last 2 weeks, how often have you been bothered by any of the following problems? Please circle 1 number for each question.
0- Not at all
1- Several days
2- More than half the days
3- Nearly every day
1. Little interest or pleasure in doing things
0 1 2 3
2. Feeling down, depressed, or hopeless
0 1 2 3
3. Trouble falling or staying asleep, or sleeping too much
0 1 2 3
4. Feeling tired or having little energy
0 1 2 3
5. Poor appetite or overeating
0 1 2 3
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
0 1 2 3
8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety or restless that you have been moving around a lot more than usual
0 1 2 3
9. Thoughts that you would be better off dead, or of hurting yourself
add columns + +
(Healthcare professional: For interpretation of TOTAL, TOTAL: please refer to accompanying scoring card).
10. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
0 Not difficult at all
1 Somewhat difficult
2 Very difficult
3 Extremely difficult
. . . . . . . . . . . . . . . . . . . . . .
Scoring: add up all checked boxes on PHQ-9
Total Score Depression Severity
1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
For initial diagnosis:
1. Patient completes PHQ-9 Quick Depression Assessment.
2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive disorder. Add score to determine severity.
Consider Major Depressive Disorder
- if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)
Consider Other Depressive Disorder
- if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2)
Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient.
Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. To monitor severity over time for newly diagnosed patients or patients in current treatment for depression:
1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment.
2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3
3. Add together column scores to get a TOTAL score.
4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score.
5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention.

PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a
trademark of Pfizer Inc.
YOUNG MANIA RATING SCALE (YMRS)

GUIDE FOR SCORING ITEMS
The purpose of each item is to rate the severity of that abnormality in the patient. When several keys are given for a particular grade of severity, the presence of only one is required to qualify for that rating.
The keys provided are guides. One can ignore the keys if that is necessary to indicate severity, although this should be the exception rather than the rule.
Scoring between the points given (whole or half points) is possible and encouraged after experience with the scale is acquired. This is particularly useful when severity of a particular item in a patient does not follow the progression indicated by the keys.
Specify one of the reasons listed below by putting the appropriate number in adjacent box.

1 . ELEVATED MOOD
0 - Absent
1 - Mildly or possibly increased on questioning
2 - Definite subjective elevation; optimistic, self-confident; cheerful; appropriate to content
3 - Elevated, inappropriate to content; humorous
4 - Euphoric; inappropriate laughter; singing

2. INCREASED MOTOR ACTIVITY ENERGY
0 - Absent
1 - Subjectively increased
2 - Animated; gestures increased
3 - Excessive energy; hyperactive at times; restless (can be calmed)
4 - Motor excitement; continuous hyperactivity (cannot be calmed)

3. SEXUAL INTEREST
0 - Normal; not increased
1 - Mildly or possibly increased
2 - Definite subjective increase on questioning
3 - Spontaneous sexual content; elaborates on sexual matters; hypersexual by self-report 4 - Overt sexual acts (toward patients, staff, or interviewer)

4. SLEEP
0 - Reports no decrease in sleep
1 - Sleeping less than normal amount by up to one hour
2 - Sleeping less than normal by more than one hour
3 - Reports decreased need for sleep
4 - Denies need for sleep

5. IRRITABILITY
0 - Absent
2 - Subjectively increased
4 - Irritable at times during interview; recent episodes of anger or annoyance on ward
6 - Frequently irritable during interview; short, curt throughout
8 - Hostile, uncooperative; interview impossible

6. SPEECH (Rate and Amount)
0 - No increase
2 - Feels talkative
4 - Increased rate or amount at times, verbose at times
6 - Push; consistently increased rate and amount; difficult to interrupt
8 - Pressured; uninterruptible, continuous speech

7. LANGUAGE - THOUGHT DISORDER
0 - Absent
1 - Circumstantial; mild distractibility; quick thoughts
2 - Distractible; loses goal of thought; change topics frequently; racing thoughts
3 - Flight of ideas; tangentiality; difficult to follow; rhyming, echolalia
4 - Incoherent; communication impossible

8. CONTENT
0 — Normal
2 - Questionable plans, new interests
4 - Special project(s); hyper-religious
6 - Grandiose or paranoid ideas; ideas of reference
8 - Delusions; hallucinations

9. DISRUPTIVE - AGGRESSIVE BEHAVIOR
0 - Absent, cooperative
2 - Sarcastic; loud at times, guarded
4 - Demanding; threats on ward
6 - Threatens interviewer; shouting; interview difficult
8 - Assaultive; destructive; interview impossible

10. APPEARANCE
0 - Appropriate dress and grooming
1 - Minimally unkempt
2 - Poorly groomed; moderately disheveled; overdressed
3 - Disheveled; partly clothed; garish make-up
4 - Completely unkempt; decorated; bizarre garb

11. INSIGHT
0 - Present; admits illness; agrees with need for treatment 1 - Possibly ill
2 - Admits behavior change, but denies illness
3 - Admits possible change in behavior, but denies illness
4 - Denies any behavior change

Dr. Jeffrey S Barkin MD, DLFAPA