for ADHD - CME InstituteADULT ADHD SELF-REPORT SCALE (ASRS-V1.1) SYMPTOM CHECKLIST INSTRUCTIONS DESCRIPTION: The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR

The Clinician’s Toolbox is a convenient online resource for physicians and their patients with attention deficit/hyperactivity disorder (ADHD). Clinicians may

download the complete Toolbox or individual components as needed. Supported by an educational grant from Shire.

Clinician’s ToolboxFact Sheet for Parents

Medication Guide (Web Link)

ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist Instructions

ADHD Self-Report Scale (ASRS-v1.1)

Selected Rating ScalesInternet Resources for

Patients and Their Families

Tools for Patients: Weekday Planner

Medication Log Homework Log Classroom Behavior Log

for ADHD

http://www.adhdmedicationguide.com

ADHD Description

ADHD is a common childhood developmental disorder that can continue through adolescence and adulthood. The key symptoms of ADHD are inattention, hyperactivity, and impulsivity.

ADHD has 3 subtypes:Predominantly Inattentive Type

Inattention is primary•Symptoms include:•

making careless mistakes•being easily distracted•being disorganized and forgetful•

Predominantly Hyperactive/Impulsive TypeHyperactivity/impulsivity is primary•Symptoms include:•

fidgeting•running or climbing excessively•talking excessively•

Combined TypeInattention and hyperactivity/impulsivity are both present•

Generally, symptoms of inattention and hyperactivity/impulsivity are equally present in children. In adolescence, hyperactive symptoms may tend to decline, sometimes replaced with an inner sense of restlessness, while symptoms of inattention and impulsivity persist.

ADHD Diagnosis

To diagnose ADHD, trained personnel, such as pediatricians, psychologists, social workers, psychiatrists, or other medical doctors, must complete a thorough evaluation. The basic diagnostic criteria for ADHD require that the symptoms are more frequent or severe than is age appropriate and that they create significant impairment in at least 2 areas of life (eg, home, school, social settings).

To establish an ADHD diagnosis, your child’s doctor should:Complete a medical evaluation to rule out physical causes for the symptoms•Eliminate other psychiatric conditions or substance use as the cause of the symptoms•Assess your child’s school, social, and emotional functioning, as well as his/her developmental •levelTake a complete patient history and include informant reports from parents and teachers•

ADHD Treatment

Properly treating ADHD can reduce symptoms and the impairments they cause. Treatment programs that use several strategies work best and can include:

Behavioral interventions•Child and parent education on the diagnosis and treatment of ADHD•Educational programs targeted to meet the special needs of the child•Training for parents•Medications•

Medications used to treat ADHD include both stimulants and nonstimulants. Stimulants can be prescribed in long-acting and short-acting formulations. Not all medications will work for your child, and your doctor may need to try more than one medication to find the best fit.Adler LA. Using Diagnostic and Assessment Tools for Adolescents With ADHD: Clinician’s Toolbox. April 2011.

http://www.cmeinstitute.com/psychlopedia/childadolescent/2dat/default.asp

Attention-Deficit/Hyperactivity Disorder (ADHD)Fact Sheet for Parents

having difficulty sustaining attention•avoiding tasks requiring sustained mental effort•

blurting out answers•having difficulty taking turns•interrupting or intruding upon •others

ADULT ADHD SELF-REPORT SCALE (ASRS-V1.1) SYMPTOM CHECKLIST INSTRUCTIONS

DESCRIPTION:The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR criteria. Six of the eighteen questions were found to be the most predictive of symptomsconsistent with ADHD. These six questions are Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions.

INSTRUCTIONS:

SYMPTOMS

1: Ask the patient to complete both Part A and Part B of the Symptom Checklist bymarking an X in the box that most closely represents the frequency of occurrenceof each of the symptoms.

2: Score Part A. If four or more marks appear in the darkly shaded boxes within Part A then the patient has symptoms highly consistent with ADHD in adults andfurther investigation is warranted.

3: The frequency scores on Part B provide additional cues and can serve as furtherprobes into the patient’s symptoms. Pay particular attention to marks appearing in the dark shaded boxes. The frequency-based response is more sensitive with certain questions. No total score or diagnostic likelihood is utilized for the twelvequestions. It has been found that the six questions in Part A are the most predictive of the disorder and are best for use as a screening instrument.

IMPAIRMENTS

1: Review the entire Symptom Checklist with your patients and evaluate the level of impairment associated with the symptom.

2: Consider work/school, social and family settings.

3: Symptom frequency is often associated with symptom severity, therefore theSymptom Checklist may also aid in the assessment of impairments. If your patients have frequent symptoms, you may want to ask them to describe how theseproblems have affected the ability to work, take care of things at home, or getalong with other people such as their spouse/significant other.

HISTORY

1: Assess the presence of these symptoms or similar symptoms in childhood. Adultswho have ADHD need not have been formally diagnosed in childhood. In evaluating a patient’s history, look for evidence of early-appearing and long-standing problems with attention or self-control. Some significant symptomsshould have been present in childhood, but full symptomology is not necessary.

ADULT ADHD SELF-REPORT SCALE (ASRS-V1.1) SYMPTOM CHECKLIST

Patient Name ______________________________________ Today’s Date _________________

Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As youanswer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months.Please give this completed checklist to your healthcare professional to discuss during today’s appointment.

PART A1. How often do you have trouble wrapping up the final details of a

project, once the challenging parts have been done?

2. How often do you have difficulty getting things in order when youhave to do a task that requires organization?

3. How often do you have problems remembering appointments orobligations?

4. When you have a task that requires a lot of thought, how often doyou avoid or delay getting started?

5. How often do you fidget or squirm with your hands or feet when youhave to sit down for a long time?

6. How often do you feel overly active and compelled to do things, likeyou were driven by a motor?

PART B7. How often do you make careless mistakes when you have to work on

a boring or difficult project?

8. How often do you have difficulty keeping your attention when youare doing boring or repetitive work?

9. How often do you have difficulty concentrating on what people sayto you, even when they are speaking to you directly?

10. How often do you misplace or have difficulty finding things at homeor at work?

11. How often are you distracted by activity or noise around you?

12. How often do you leave your seat in meetings or other situations inwhich you are expected to remain seated?

13. How often do you feel restless or fidgety?

14. How often do you have difficulty unwinding and relaxing when youhave time to yourself?

15. How often do you find yourself talking too much when you are insocial situations?

16. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?

17. How often do you have difficulty waiting your turn in situationswhen turn taking is required?

18. How often do you interrupt others when they are busy?

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Adapted with permission © 2004 World Health OrganizationThe Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was developed in conjunction with the World Health Organization (WHO), and the Workgroup on Adult ADHD that included the following team of psychiatrists and researchers: Lenard Adler, MD, New York University Medical School; Ronald C. Kessler, PhD, Harvard Medical School; and Thomas Spencer, MD, Harvard Medical School.

ADHD Rating Scale URLAchenbach Child Behavior Check List http://www.aseba.org/forms/schoolagecbcl.pdf

AdolACDSv1.2 Contact [email protected]

Adult ASRS v1.1 Symptom Checklist http://www.hcp.med.harvard.edu/ncs/asrs.php

ADHD Rating Scale-IV http://www.guilford.com/cgi-bin/cartscript.cgi?page=pr/dupaul2.htm

BASC-2 http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAa30000

BRIEF http://www4.parinc.com/Products/Product.aspx?ProductID=BRIEF

Brown ADD Scales http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8029-240

Conners’ 3rd Edition http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=Conners_3

SNAP-IV Rating Scale http://www.adhd.net/

Vanderbilt ADHD Rating Scale http://www.nichq.org/adhd_tools.htmlAbbreviations: CDS = Clinical Diagnostic Scale; ADD = attention-deficit disorder; ASRS = Adult ADHD Self Report Scale; BASC-2 = Behavior Assessment System

for Children, 2nd Edition; BRIEF = Behavior Rating Inventory of Executive Function; SNAP = Swanson, Nolan, and Pelham.Adler LA. Using Diagnostic and Assessment Tools for Adolescents With ADHD: Clinician’s Toolbox. April 2011.

http://www.cmeinstitute.com/psychlopedia/childadolescent/2dat/default.asp

Selected Attention-Deficit/Hyperactivity Disorder (ADHD)Rating Scales

Organization URLPrimary ResourcesAdhdNews.com http://www.adhdnews.com/

ADHD Parents Medication Guide http://www.parentsmedguide.org

Attention Deficit Disorder Association (ADDA) http://www.add.org/

Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncbddd/adhd/

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD)

http://www.chadd.org/

insideADHD.org http://www.insideadhd.org

Mayo Clinic http://www.mayoclinic.com/health/adult-adhd/DS01161

National Institute on Drug Abuse (NIDA) http://www.drugabuse.gov/Infofacts/ADHD.html

National Institute of Mental Health (NIMH) http://www.nimh.nih.gov/health/publications/ attention-deficit-hyperactivity-disorder/complete-index.shtml

National Resource Center on AD/HD http://www.help4adhd.org/

Related ResourcesADHD Coaches Organization (ACO) http://www.adhdcoaches.org/

LD Online http://ldonline.org

National Center for Learning Disabilities http://www.ncld.org

WebMD http://www.webmd.com/add-adhd/default.htm

Adler LA. Using Diagnostic and Assessment Tools for Adolescents With ADHD: Clinician’s Toolbox. April 2011. http://www.cmeinstitute.com/psychlopedia/childadolescent/2dat/default.asp

Attention-Deficit/Hyperactivity Disorder (ADHD) Internet Resources for Patients and Their Families

Tools for ADHD Patients*

*Inflexxion, Inc. Inside ADHD.org. http://www.insideadhd.org. Accessed March 18, 2011.

The goal of treating children and adolescents with attention-deficit/hyperactivity disorder (ADHD) is to relieve symptoms and the impairments that they cause. Encouraging your patients and their families to use the tools included in this packet is one way to help them overcome the challenges posed by ADHD. Have parents choose which forms will be most helpful for their child. For example, the Homework Log might not be that helpful if the child’s teacher provided a detailed syllabus, but the Weekday Planner might be useful for organizing chores and after-school activities. Also, the Medication Log might be particularly useful when initiating or changing a medication.

Weekday Planner

Parents should print a copy of the Weekday Planner at the beginning of each week and help their teenager fill it out and update it daily. The planner should record and track all scheduled or regularly occurring activities. This will help to establish and maintain a regular routine for the adolescent.

Medication Log

If medication is used to treat the patient’s ADHD, an everyday record helps in determining whether the medication is effective and in tailoring treatment. At the beginning of each week, parents should print a copy of the Medication Log and then ensure that their teenager updates it daily. At the end of the week, the adolescent should complete the bottom portion of the assessment, rating their feelings for the entire week.

Homework Log

This tool can help teenagers stay on top of their homework assignments, not only by recording the actual assignment, but also by recording details of the assignment, such as the materials needed and the due date, and then providing a record of completed assignments . Parents should print a copy of the Homework Log and ensure that their adolescent updates it daily. Homework Logs should be kept in the teenager’s book bag and should be consulted every day.

Classroom Behavior Log

For patients who need to improve specific behaviors or who need monitoring in certain classes, the Classroom Behavior Log can help to record and track their progress. Parents should determine in which of their teenager’s classes it might be appropriate to monitor their behavior, print out a copy of the Classroom Log for each of those classes, and then discuss with the teacher whether it might be helpful in targeting their child’s behavioral problems. Teachers should update the log daily and give the parents the log at the end of the week.

Please go to insideADHD.org to see the entire toolkit of downloadable tools for patients and their families.

http://insideadhd.org

insideADHD.org Focusing together on ADHD

Weekday Planner Having your teen keep a checklist of the day's activities can be a great way to establish and reinforce a sense of routine throughout his or her day. WHO SHOULD USE THIS TOOL? The Weekday Planner is meant to be filled out by your teen. HOW SHOULD IT BE USED? Print out a copy of the Weekday Planner for your teen at the beginning of each week, and help him or her fill it out. It should be updated daily and used to record and track all activities that are scheduled or reoccurring regularly. Make sure your teen keeps it somewhere safe but accessible. Make it his or her responsibility to update the Weekday Planner frequently.


Weekday Planner

Monday

Tuesday

Wednesday

Thursday

Friday

Morning

Breakfast Pack up for school Take medication

___________________


___________________


___________________


___________________


___________________

School

___________________

___________________

Books for homework

___________________

___________________

Books for homework

___________________

___________________

Books for homework

___________________

___________________

Books for homework

___________________

___________________

Books for homework

After School

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

___________________

Evening

___________________

___________________

___________________

Homework Dinner Lay out clothes for Tues. Brush teeth

___________________

___________________

___________________

Homework Dinner Lay out clothes for Weds. Brush teeth

___________________

___________________

___________________

Homework Dinner Lay out clothes for Thurs. Brush teeth

___________________

___________________

___________________

Homework Dinner Lay out clothes for Fri. Brush teeth

___________________

___________________

___________________

Dinner Brush teeth


Medication Log If your teenager takes medication for ADHD, it can be useful to keep a day-to-day record of the impact of the medication. This information can be extremely useful to your teen's health care provider - especially if teen child has just started taking medication, or if there has been a change in his or her current medication regimen. A medication log can help your teen's health care provider see whether or not the medication is having its intended impact. WHO SHOULD USE THIS TOOL? Your teen should be responsible for updating the medication log each day and keeping it in a safe place. HOW SHOULD IT BE USED? Have your teen update the medication log each day of the week. The bottom half of the tool is to be completed at the end of each week. It asks your teen to evaluate his or her level of different ADHD symptoms experienced through the course of the entire week. Present the completed medication logs to your health care provider. The prescribing clinician will be able to get a better idea of how effective a medication has been for your teen.


Medication & Dosage:

Medication Log

Week of: ______________

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

At what time(s) did you take your medication?

Did you eat before or after you took your medication?

Yes, before

Yes, after

No

Yes, before

Yes, after

No

Yes, before

Yes, after

No

Yes, before

Yes, after

No

Yes, before

Yes, after

No

Yes, before

Yes, after

No

Yes, before

Yes, after

No

When did you notice the effects of the medication?

Immediately

It took a while

Never

Immediately

It took a while

Never

Immediately

It took a while

Never

Immediately

It took a while

Never

Immediately

It took a while

Never

Immediately

It took a while

Never

Immediately

It took a while

Never

How long did the effects of the medication last?

How did you feel this week?

I was able to focus and pay attention

Less Same More I didn’t lose or misplace things

Less Same More

I completed my assignments and chores

Less Same More It was hard for me to work/play quietly

Less Same More

I was able to stay neat and organized

Less Same More I felt like my mind was "sped up"

Less Same More

I was able to sit still when I had to

Less Same More I moved/fidgeted my hands or feet a lot Less Same More

I waited for my turn without interrupting

Less Same More I felt nervous

Less Same More


Homework Log Using an organized system of reminders and checklists can help students keep up-to-date with their homework assignments for the week. The Homework Log allows your teen to remember not just his or her homework assignments for each day, but also the materials required to complete them, their due dates, and checkboxes to indicate whether they have been turned in. Teachers vary in the way they assign homework: some expect the student to write down the assignment, in which case this Homework Log would be helpful. In other cases the teacher may hand out each day's or a week's worth of assignments at a time, which could take the place of the log if they are kept in the binder. WHO SHOULD USE THIS TOOL? This homework log should be updated daily by the student and verified and initialed by the parents. HOW SHOULD IT BE USED? Have your teen update the Homework Log as they are given new assignments. Make sure your teen indicates what materials are needed to complete the homework assignment. Every night, verify that your teen has finished the day's homework assignments, and/or your teen has expressed a need for help (and will ask the teacher the following day). Once you have verified this, initial the log. Long-term projects are often divided into smaller, more manageable steps. These tasks can also be tracked using the Homework Log. Make sure the Homework Log is kept in a safe place in your teen's binder or book bag.


Homework Log

Name:

For the week of:

Description

Assigned by:

Parent’s Initials:

Due date:

Turned In:

Assignment:

Books/Materials needed: Help needed: Y / N

Assignment:


Assignment:


Assignment:


Assignment:


Assignment:



Classroom Behavior Log If your teen is working towards meeting particular behavior goals, it’s important to have a record of his or her specific behaviors over time. Determine which class(es) your teen has the most behavioral difficulty in, and discuss with that teacher whether a daily classroom behavior log would be a helpful way to target specific behavioral problems. Sometimes, students with ADHD may only have difficulty with their behavior in certain classes, so using a classroom behavior log may not be appropriate for every class. WHO SHOULD USE THIS TOOL? This tool is meant to be used by your teen’s teacher(s) to track his or her classroom behavior during the course of a week. HOW SHOULD IT BE USED? The Classroom Behavior Log can be given to your teen’s teacher(s) to update daily, as a record of his or her behavior in class.


Student’s Name:

Teacher’s Name:

Classroom Behavior Log

Week of:___________

Monday Tuesday Wednesday Thursday Friday Arrived prepared with materials

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Arrived on time

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Stayed in seat

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Raised hand when answering questions

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Did not socialize excessively w/ classmates

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Was respectful to teacher

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Used classroom time efficiently

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Other behavior: _____________________

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Yes No Note:

Documents

for ADHD - CME InstituteADULT ADHD SELF-REPORT SCALE (ASRS-V1.1) SYMPTOM CHECKLIST INSTRUCTIONS DESCRIPTION: The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR