NCSR Adult ADHD Interview

NCS-R-AHDH-ADULT 11/21/02
NCS-R Adult ADHD Interview

A Semi-Structured Clinical Interview to Assess ADHD in Childhood and Adulthood
Developed for use in the National Comorbidity Survey – Replication Project
Study: Site:
Respondent: Respondent No.:
Interviewer: Interviewer No.:
Date of
Phone Number: Interview:
Address:
Time interview began:
ended:
Time spent on Notes, Ratings:
Contact log (attempts to reach respondent):
Edited and checked by: Date:
The NCS-R Adult ADHD Interview was developed for the purpose of clinical reappraisal in the National Cormorbidity
Survey – Replication, 2002, by Lenard Adler, MD; Tom Spencer, MD; Molly Howes, Ph.D.; Margaret E. Guyer, Ph.D.; and
Elizabeth Mainzer Gagnon, Ph.D.
1
INTRODUCTION
Hello, my name is ___________ from SCHOOL / AGENCY / PROJECT NAME . Thank you for agreeing to this interview.
I will be asking you several questions about your experiences. I’ll be making some notes as we go along. I will also be tape-
recording this interview. The tape will be used for quality control purposes. When the study is complete, we will destroy the
tapes. At any point you may let me know that you would like me to stop taping or destroy the tapes. Do I have your
permission to tape this interview?
(Note: Interviewer must obtain permission prior to turning on the recorder, as well as on the tape itself.)
Permission granted to tape the interview Yes ______ No ______
2) INFORMED CONSENT
I want to make sure that you understand what we will be doing and that you still want to complete today’s interview. As you
know, your participation is completely voluntary. You may choose to end the interview at any time. If there is any question
that you don’t want to answer, tell me and we will skip it.
I will be asking you questions about different problems or difficulties that you may have had at times in your life. In some
places I may refer back to the first interview that you completed for us and you may notice that some of the questions are
similar. We’re asking that you don’t try to remember what you said before. Listen to the questions today and answer them
honestly in the way they make sense to you today.
It’s also important that you understand that your answers to the questions will be kept confidential. This means that your
name isn’t on the interview. It means that no one other than research staff will know how you answered the questions. There
is an exception to this rule: If I am concerned that you or someone else may be in danger of serious harm, then I have to take
steps to make sure that everyone is safe. If possible, I will tell you about my concerns.
Do you have any questions?
Would you like to participate in the interview today? Yes ______ No ______
DEMOGRAPHIC DATA
SEX: 1 male
2 female
What’s your date of birth? DOB: ______ ______ ________

month day year
AGE: ______
Are you presently located at (ADDRESS)?
IF NOT: What is your location at the

moment?
Whom do you live with? MARITAL STATUS 1 married or living with P004
(most recent): someone as if married
2 widowed
Have you ever been married or had a long term 3 divorced or annulled
relationship? 4 separated
5 never married
Any children? (What are their ages?) __________________________________________
IF YES: How many? __________________________________________
2
EDUCATION HISTORY
How far did you get in school? YEARS OF EDUCATION:

(How much schooling have you had?)
IF FAILED TO COMPLETE A __________________________________________

PROGRAM IN WHICH THEY WERE
ENROLLED: Why didn’t you finish? __________________________________________
Did you interrupt your schooling for any reason? __________________________________________

Transfer from one program to another?
Were your grades reflective of your ability? Did

anything interfere with your school performance?
As a child, did you repeat any grades? Which ones? GRADE RETENTION: 1 NO
Why did that happen? P005
2 YES
IF NECESSARY: As a child, were your grades
reflective of your ability? Did anything interfere with
your school performance?
WORK HISTORY
What kind of work do you do?
(Do you work outside of your home?)
Are you working now?
IF YES: How long have you worked

there?
IF LESS THAN 6 MONTHS: Why did you leave

your last job?
Have you always done that kind of work?
IF NO: What kind of work have you done?
How many jobs have you held in the past ten years? # JOBS IN PAST 10 YEARS___________________ P006
How many times have you been fired from a job? # TIMES FIRED_______________________ P007
What happened?
HISTORY OF DISABILITY/IMPAIRMENT
IF UNKNOWN: Has there ever been a period of
time when you were unable to work or go to
school?
IF YES: When? Why was that?
CURRENT INCOME
How are you supporting yourself now?
IF NECESSARY: How long have you been
retired/on disability? What are you on disability
for?
3
CURRENT MEDICAL ISSUES AND SUBSTANCE

USE
Do you take any medications or vitamins?
How often do you drink alcohol?

How much?
How often do you use street/recreational drugs?
HISTORY OF SUBSTANCE USE:
How long did this period last?
How many periods like this have you had?
Has anyone else ever been concerned about your

drinking or use of drugs?
Have you ever used medications in a way other than the

way they were prescribed?
Have you ever had treatment for alcohol or drugs?
4
PAST PERIODS OF PSYCHOPATHOLOGY
Have you ever seen anybody for emotional or

psychiatric problems? ___________________________________________
IF YES: Could you tell me what that was ___________________________________________

for (in your own words)?
___________________________________________
IF NO: Have you ever had emotional or
psychiatric problems that you didn’t discuss with a Treatment for emotional problems 1 NO P010
doctor or anyone like that? with a mental health 2 YES
professsional _____
IF NO: Was there ever a time when you,
or someone else, thought you should see
someone because of the way you were
feeling or acting?
Have you ever taken any medications (for emotional or Taken psychiatric medication: 1 NO P011
psychiatric problems)? 2 YES
Can you tell me briefly what that was for?

______________________________________
___________________________________________
___________________________________________
___________________________________________
Have you ever been in a hospital for treatment of Number of previous psychiatric hospitalizations
psychiatric or emotional problems? (Do not include transfers) 0
1
IF YES: What was that for? (How many 2
times?) 3
4
IF GIVES AN INADEQUATE ANSWER, 5 (or
P012
CHALLENGE GENTLY: more)
e.g., Wasn’t there something else? People
don’t usually go to (psychiatric) hospitals ____________________________________________________
just because they are (own words).
__________________________________
____________________________________________________
____________________________________________________
_________________________
5
CURRENT SOCIAL FUNCTIONING
How have you been spending your free time?

___________________________________________
___________________________________________
Who do you spend time with?
___________________________________________
___________________________________________
What do you worry about most?
___________________________________________
___________________________________________
6
ADULTHOOD MODULE
For the next parts of this interview, I will be asking you questions about experiences during the past twelve months that is,
since (MONTH, YEAR). Then I will ask you about the same or similar experiences during your childhood. Some of these
questions will resemble the questions in your earlier interview, but please just listen to the questions now and answer them as
truthfully as you can. Of course, you may still skip any questions you don’t want to answer.
CIDI ADHD STEM QUESTIONS:
- SKIP
+ In the earlier interview, you said that between the ages of

kindergarten and second grade, there was a period lasting six months 1 2 3 SC001
or longer when you had a lot more trouble with concentration than NO YES, but YES,in
most children: Things like not being able to keep your mind on what not in the the past
you were doing, losing interest very quickly in games or work, trouble past 12 12
finishing what you started without being distracted, and not listening months months
when people speak to you.
Have these types of things been a problem for you in the past 12
months?
? Between the ages of kindergarten and second grade, did you ever
have a period lasting six months or longer when you had a lot more
trouble with concentration than most children? With things like not
being able to keep your mind on what you were doing, losing interest
very quickly in games or work, trouble finishing what you started
without being distracted, and not listening when people spoke to you?
Have these types of things been a problem for you in the past 12
months?
- SKIP
+ You said in the earlier interview that you had a time before the age of 1 2 3 SC002
seven lasting six months or longer when you were very restless and NO YES, but YES,in
fidgety and so impatient that you would often interrupt people and not in the the past
have trouble waiting your turn. past 12 12
Has this been true of you on the past 12 months? months months
? Did you ever have a time before the age of seven lasting six months or
longer when you were very restless and fidgety and so impatient that
you would often interrupt people and have trouble waiting your turn?
Has this been true of you on the past 12 months?
Obtain brief description:
Can you tell me about that?

Which of these things have been the biggest problem for you?
7
ADULT MODULE - PAST TWELVE MONTHS
KSADS: DSM-IV CRITERION FOR ADULT ADHD:
INTERVIEWER: If respondent is on medication for ADHD, rate each symptom for periods in the past 12 months when
he/she was not on medication. Some people may be sufficiently medicated, leading to a coding of ‘6’ for the past 12 months.
In that case, ascertain when the specific symptom was most recently a problem. Adjacent to the ‘6’ coding, indicate the
period during which you assessed the symptom and how the symptom would have been coded at that time (i.e. 1-4).
Standard probes include:

Can you give me (an) example(s)?
How would other people describe/view you in this regard?
What kinds of problems does this cause you in your daily/work/family life?
If you did have other obligations/were working now, how would this interfere with your functioning?
1. Makes a Lot of Careless Mistakes
In the past 12 months … 1 Not present. AD201
Do (did) you make a lot of mistakes (in school) or work ? 2 Mild: Occasionally makes careless
Is (was) this because you’re careless? mistakes.
3 Moderate: Often fails to give close

Do you rush through work, or activities? attention to details or makes careless
mistakes in schoolwork, work or other
Do you have trouble with detailed work? activities.
Do you not check your work ? 4 Severe
Do people complain that you’re careless? 6 Absent or false due to therapeutic

medication.
8 Present or true due to medical condition.

Are (were) you messy or sloppy?
Is your desk or workspace so messy that you have difficulty 9 Inadequate information
finding things?
8
2. Difficulty Sustaining Attention on Tasks/Play Activities
In the past 12 months: 1 Not present. AD202
Do (did) you have trouble paying attention such as watching 2 Mild: Occasionally has difficulty
movies, reading or lectures ? sustaining attention on tasks or play
activities.
Or on fun activities such as sports or board games?
3 Moderate: Often has difficulty
sustaining attention in tasks or play
Is it hard for you to keep your mind on school or work ? activities.
Do you have unusual trouble staying focused on boring or
repetitive tasks? 4 Severe
Does it take a lot longer than it should to complete tasks 6 Absent or false due to therapeutic
because you can’t keep your mind on the task? medication.
Is (was) it even harder for you than some others you know ? 8 Present or true due to medical
condition.
Do you have trouble remembering what you read and do you
need to re-read the same passage several times? 9 Inadequate information.
9
3. Doesn't Listen
2 Mild: Occasionally doesn't listen.
Do (did) people (your wife, boss, colleagues, friends) complain 3 Moderate: Often does not seem to listen
that you don’t seem to listen or respond (or daydream) when when spoken to directly.
spoken to or when asked to do tasks?
4 Severe
A lot?
6 Absent or false due to therapeutic
Do people have to repeat directions? medication.
Do you find that you miss the key parts of conversations because 8 Present or true due to medical condition.
of drifting off in your own thoughts?”
9 Inadequate information.
Does (did) it cause problems?
4. Difficulty Following Instructions
Do (did) you have trouble finishing things...work, chores, ? 2 Mild: Occasionally has difficulty
following instructions. Problem has
Do you often leave things half done and start another project? only minimal effect on functioning.
Do you need consequences (such as deadlines) to finish? 3 Moderate: Often does not follow
through on instructions and fails to finish
Do (did) you have trouble following instructions? (especially schoolwork, chores, or duties in the
complex, multistep instructions that have to be done in a certain workplace (not due to oppositional
order with different steps) behavior or failure to understand
instructions).
Do you need to write down instructions, otherwise you will
forget the task at hand?” 4 Severe

medication.
10
5. Difficulty Organizing Tasks
Do (did) you have trouble organizing things into ordered steps? 2 Mild: Occasionally disorganized.
Problem has only minimal effect on
functioning.
Is it hard prioritizing work and chores?
3 Moderate: Often has difficulty
Do you need others to plan for you ? organizing tasks and activities.
Do you have trouble with time management? 4 Severe
Dos (did) it cause problems? 6 Absent or false due to therapeutic

medication.
Do you procrastinate and put off tasks until the last moment 8 Present or true due to medical condition.
possible?”
6. Dislikes/Avoids Tasks Requiring Attention
Do (did) you avoid tasks (work, chores, reading board games ) 2 Mild: Occasionally avoids tasks that
that are challenging or lengthy because it’s hard to stay focused require sustained attention, and/or
on these things for a long time? expresses mild dislike for these tasks.
3 Moderate: Often avoids, dislikes, or is

Do you have to force yourself to do these tasks ? reluctant to engage in tasks that require
how hard is (was) it? sustained mental effort (such as
homework).
Do you procrastinate and put off tasks until the last moment 4 Severe
possible?
medication.
11
7. Loses Things
Do (did) you lose things? (i.e. important work papers, keys, 2 Mild: Occasionally loses things.
wallet, coats, etc.)?
3 Moderate: Often loses things necessary
A lot? for tasks or activities (e.g., toys, school
More than others? assignments, pencils, books, or tools).
Are you constantly looking for important items? 4 Severe
Do (did) you get into trouble for this? (work, home) 6 Absent or false due to therapeutic
medication.
Do you need to put items (eg. glasses, wallet, keys) in the same 8 Present or true due to medical condition.
place each time, otherwise you will lose them?”
8. Easily Distracted
Are (were) you ever very easily distracted by events around 2 Mild: Occasionally distracted.
you such as noise (conversation, tv, radio), movement, or
clutter? 3 Moderate: Is often easily distracted by
extraneous stimuli (e.g., attention often
Do you need relative isolation to get work done ? disrupted by minor distractions other
kids would be able to ignore).
Can (could) almost anything get your mind off of what you are 4 Severe
(were) doing … like work, chores or if you're talking to
someone? 6 Absent or false due to therapeutic
medication.
Is it hard to get back to a task once you stop ?
8 Present or true due to medical
condition.
12
9. Forgetful in Daily Activities
Do (did) you forget a lot of things in your daily routine? 2 Mild: Occasionally forgetful.
Like what? chores? work? appointments or obligations? 3 Moderate: Often is forgetful in daily
activities.
Do you forget to bring things to work such as work materials or
assignments due that day? 4 Severe
Do you need to write regular reminders to yourself to do most 6 Absent or false due to therapeutic
activities or tasks, otherwise you will forget? medication.
10. Fidget
Can (could) you sit still or are (were) you always moving your 2 Mild: Occasionally fidgets with hands or
hands, feet, or in your chair? feet or squirms in seat.
Do (did) you tap your pencil or your feet ? 3 Moderate: Often fidgets with hands or
A lot? feet or squirms in seat.
Do people notice?
4 Severe
Do you regularly play with your hair or clothing?
medication.
Do you consciously resist fidgeting or squirming?
9 Inadequate information
13
11. Difficulty Remaining Seated
Do (did) you have trouble staying in your seat? 2 Mild: Occasionally has difficulty
at work? remaining seated when required to do
in class? so.
at home, i.e. watching t.v., eating dinner?
in church or temple? 3 Moderate: Often leaves seat in
classroom or in other situations in
which remaining seated is expected.
Do you chose to walk around rather than sit?
4 Severe
Do you have to force yourself to remain seated?
Is it difficult for you to sit through a long meeting or lecture?
medication.
Do you try to avoid going to functions that require you to sit
still for long periods of time?” 8 Present or true due to medical
condition.
12. Restlessness (Runs or Climbs Excessively)
Are you physically restless? 2 Mild: Occasionally runs about or climbs

excessively. Problem has only minimal
Ddo you feel restless inside? a lot? effect on functioning. (In adolescents,
may be limited to a subjective feeling of
restlessness.)
3 Moderate: Often runs about or climbs

Do you feel more agitated when you cannot exercise on an excessively in situations in which it is
almost daily basis? inappropriate. (in adolescents, may be
limited to a subjective feeling of
restlessness.)
4 Severe

medication.
14
13. Difficulty Playing Quietly/Leisure Time
Did you have a hard time playing quietly? 2 Mild: Occasionally has difficulty
playing quietly.
During leisure activity (non structured times or on your own 3 Moderate: Often has difficulty playing
such as reading a book , listening to music, playing a board or engaging in leisure activities quietly.
game), are you agitated or dysphoric?
4 Severe
Do you always need to be busy while on vacation? 6 Absent or false due to therapeutic
medication.
9 Inadequate Information
14. On the Go/Acts Like Driven by Motor
Is it hard for you to slow down? 2 Mild: Occasionally acts “driven by a

motor.”
Do you feel like you (often) have a lot of energy and that you
always have (had) to be moving, are (were) always “on the go”? 3 Moderate: Is often “on the go” or often
acts as if "driven by a motor."
Do you feel like you you’re driven by a motor?
4 Severe
Do you feel unable to relax ?
medication.
15
15. Talks Excessively
Do (did) you talk a lot? 2 Mild: Occasionally talks excessively.

all the time?
more than other people ? 3 Moderate: Often talks excessively.
4 Severe
Do people complain about your talking?
Is (was) it a problem? 6 Absent or false due to therapeutic
medication.
Are you often louder than the people you are talking to? 8 Present or true due to medical condition.
16. Blurts Out Answers
Do (did) you give answers to questions before someone finishes 2 Mild: Occasionally talks out of turn.
asking?
3 Moderate: Often blurts out answers
Do you say things before it is your turn? before questions have been completed.
Do you say things that don’t fit into the conversation?
4 Severe
Do you do things without thinking ?
A lot? 6 Absent or false due to therapeutic
medication.
16
17. Difficulty Waiting Turn
Is it hard for you to wait your turn in conversation, in lines, 2 Mild: Occasionally has difficulty
while driving)? waiting his/her turn.
Are you frequently frustrated with delays? 3 Moderte: Often has difficulty waiting
his/her turn.
Does (did) it cause problems?
4 Severe
Do you put a great deal of effort into planning to not be in
situations where you might have to wait? 6 Absent or false due to therapeutic
medication.
18. Interrupts or Intrudes
Do (did) you talk when others are talking without waiting until 2 Mild: Occasionally interrupts others.
they're finished?
3 Moderate: Often interrupts or intrudes
Do (did) you butt into others conversations before being invited. on others (e.g., butts into conversations
or games).
Do (did) you interrupt others activities?
4 Severe
Is it hard for you to wait to get your point across in
conversations or at meetings? 6 Absent or false due to therapeutic
medication.
17
19. Duration
For how long have you had trouble (list symptoms that were 1 Not present. AD219
positively endorsed)?
2 Symptoms persist less than 6 months.
3 Symptoms persist at least 6 months.
20. Some impairment in 2 or more settings

have these things (list positive symptoms) caused trouble for
you at work? 2 Mild: Impairment in only one setting.
With your family?
With friends and colleagues? 3 Moderate: Some impairment from the
symptoms is present in two or more
settings (e.g., at school and at home).
4 Severe

medication.
21. Assess clinically significant impairment

how much trouble have these things (list positive symptoms)
caused for you at work? 2 Mild.
With your family?
With friends and colleagues? 3 Moderate: There must be clear evidence
of clinically significant impairment in
Give me an example. social, academic or occupational
functioning.
4 Severe

medication.
18
ADDITIONAL CLINICAL QUESTIONS (10 +4)
1. Wastes or mismanages time
Do you waste or mismanage time? 1 Not present. AD222
Do you have difficulty keeping track of time? 2 Mild.
Is it hard for you to remember how much time has passed when 3 Moderate:
you are doing activities.
4 Severe
Is this a problem at work?
When doing tasks at home (paying bills, doing the laundry)? medication.
When tending to personal hygiene (showering, bathing, shaving)? 8 Present or true due to medical condition.
2. Has trouble planning ahead or preparing for upcoming events
Do you have trouble planning ahead or preparing for upcoming 1 Not present. AD223
projects or events?
2 Mild.
Does it seem that completing large projects presents more
problems than finishing smaller tasks, on shorter time schedules 3 Moderate:
to completion?
4 Severe
Does planning family functions (birthday parties, anniversary
dinners, etc.) create problems for you? 6 Absent or false due to therapeutic
medication.
19
3. Lacks self-discipline
Do you feel that you lack sufficient self-discipline? 1 Not present. AD224
Is it hard for you to start or complete tasks that you are not 2 Mild.
interested in or have difficulty doing?
3 Moderate:
Does your significant other have to constantly remind you to do
these kind of things? 4 Severe
Does someone at work need to provide you with these kind of 6 Absent or false due to therapeutic
reminders? medication.
4. Has difficulty arranging work by its priority or importance;

can’t prioritize well
Do you have difficulty arranging work by its priority or 1 Not present. AD225
importance?
2 Mild.
Does everything seem to have equal importance to you.
3 Moderate:
Do you find that you look back at how you spent your day and
see that you were side tracked doing tasks that were often less 4 Severe
important than the more pressing ones?
Does your significant other feel that you don’t do the important medication.
things promptly?
Do you find that you put off important work tasks, chores at
home, or financial matters (such as paying taxes)? 9 Inadequate information.
20
5. Has a hard time keeping track of several things at once
Do you have a hard time keeping track of several things at once? 1 Not present. AD226
Do you feel overwhelmed when you have to perform several 2 Mild.

tasks at once?
Does this make you feel anxious or like your “circuits are 3 Moderate:
overloaded?”
4 Severe
Do you notice that others can keep more things in mind than you
are? 6 Absent or false due to therapeutic
medication.
Do you have to always write down lists of tasks to accomplish,
otherwise you will forget the things you need to do? 8 Present or true due to medical condition.
Is it critical for you to keep a “to-do” list?
Are you forgetful when you go to the grocery store?
6. Bores easily
Do you bore easily? 1 Not present. AD227
Do you always need to busy? 2 Mild.
If something is not interesting, do you get bored easily? 3 Moderate:
Is it very hard for you to sit through lectures, concerts, talks? In 4 Severe
groups, work or school?
Are you always looking for something new so that you will not medication.
be bored?
21
7. Depends on others to keep life in order and attend to details
Do you depend on others to keep life in order and attend to 1 Not present. AD228
details?
2 Mild.
Do you depend on your significant other, parent or sibling to keep
things organized at home? 3 Moderate:
Do you depend on a co-worker or assistant to keep you organized
at work? 4 Severe
Is it a significant burden to you (in terms of organization) when 6 Absent or false due to therapeutic
this party is unavailable? medication.
Would you be able to function without this kind of support? 8 Present or true due to medical condition.
8. Can’t get things done unless there is an absolute deadline
Do you not get things done unless there is an absolute deadline? 1 Not present. AD229
Is it hard for you to complete tasks in a timely fashion prior to the 2 Mild.
date that they due?
3 Moderate:
Do you have trouble setting internal deadlines on projects?
4 Severe
Is it necessary for you to have a clear deadline on projects in
order to complete them? 6 Absent or false due to therapeutic
medication.
Do you leave everything to the last minute so that each project
becomes a crisis? 8 Present or true due to medical condition.
22
9. Cannot complete tasks in the allotted time; needs extra time to

finish satisfactorily
Do you find that you cannot complete tasks in the allotted time; 1 Not present. AD230
Do you often need extra time to finish satisfactorily?
Do you need extra time to complete school work or job tasks? 2 Mild.
3 Moderate:
Does it take you longer to complete work than co-workers? 4 Severe

Does it take you longer to get things done around your home as
compared to your significant other? 6 Absent or false due to therapeutic
medication.
Do you find that you constantly hurry to complete tasks in 9 Inadequate information.
allotted time?
If you do complete the task on time, does it not live up to

appropriate standards because you’ve hurried through completing
it?
10. Remembers some ideas of the details in required reading,

but has difficulty grasping the main idea
Do you have trouble remembering what you read? 1 Not present. AD231
Do you remember some points, but often do not recall the central 2 Mild.
concepts?
3 Moderate:
Do you find that you regularly have to re-read passages in order
to understand what the author intended? 4 Severe
Do you find that you finish a book or article and wonder to 6 Absent or false due to therapeutic
yourself what it was that you just read? medication.
23
11. Mood changes frequently
Is your mood very changeable? 1 Not present. AD232
Do you find yourself getting overly excited or depressed, beyond 2 Mild.

what situations would dictate?
3 Moderate:
Do others comment about how changeable your moods are?
Are you known as being moody? 4 Severe

medication.
12. Easily hassled or frequently feel overwhelmed
Do you frequently feel easily hassled or overwhelmed? 1 Not present. AD233

like you can’t take it anymore?
2 Mild.
Do you feel kind of like you cannot put another thought into your
brain? 3 Moderate:
Does that feeling of being overwhelmed effect your ability to 4 Severe

interact with others?
Do other people see you as getting easily overwhelmed? medication.
24
13. Difficulty expressing anger appropriately at others; doesn’t

stand up for self
Is it hard for you to express anger appropriately? 1 Not present. AD234
Do you sometimes find that you do not stand-up for yourself and 2 Mild.
do not let others know when they have offended you?
3 Moderate:
Do you keep the anger inside to the point when you do let it out,
it comes out too strongly? 4 Severe
Do those who care about you feel that they have to stand-up for 6 Absent or false due to therapeutic
you? medication.
14. Sensitive to criticism
Are you overly sensitive or have your feelings bruised easily? 1 Not present. AD235
Are you know as being touchy?
Do you take perceived offenses too much to heart? 2 Mild.
3 Moderate:
Do you have a hard time letting go when you feel that you have 4 Severe
been wronged? Do you feel it deeply for a long time?
medication.
Do you tend to overly defend yourself when others are critical of 8 Present or true due to medical condition.
you?
Do you take replying to other’s perception of you to a more 9 Inadequate information.
significant level than is necessary?
25
ADHD RATING SCALE-IV: Adult Version

The next questions are a little different. I’m going to read a series of questions about how often you have various problems and I want you
to answer by telling me if each problem occurs never, rarely, sometimes, often, or very often. Here’s the first one:
(IF NEC: Does that happen never, rarely, sometimes, often, or very often?)
Never Rarely Sometimes Often Very Often
1. How often do you make careless mistakes when

you have to work on a boring or difficult project? 0 1 2 3 4 AD301
2. How often do you fidget or squirm with your

hands or feet when you have to sit down for a long 0 1 2 3 4 AD302
time?
3. How often do you have difficulty keeping your

attention focused when you are doing boring or 0 1 2 3 4 AD303
repetitive work?
4. How often do you leave your seat in meetings or

other situations in which you are expected to remain 0 1 2 3 4 AD304
seated?
5. How often do you have difficulty concentrating on

what people say to you, even when they are speaking 0 1 2 3 4 AD305
to you directly?
6. How often do you feel restless or fidgety?

0 1 2 3 4 AD306
7. How often do you have trouble wrapping up the

final details of a project, once the challenging parts 0 1 2 3 4 AD307
have been done?
8. How often do you have difficulty unwinding and

relaxing when you have time to yourself? 0 1 2 3 4 AD308
9. How often do you have difficulty getting things in

order when you have to do a task that requires 0 1 2 3 4 AD309
organization?
10. How often do you feel overly active and

compelled to do things, like you were driven by a 0 1 2 3 4 AD310
motor?
11. When you have a task that requires a lot of

thought, how often do you avoid or delay getting 0 1 2 3 4 AD311
started?
26
12. How often do you find yourself talking too much

when you are in social situations? 0 1 2 3 4 AD312
13. How often do you misplace or have difficulty

finding things at home or at work? 0 1 2 3 4 AD313
14. When you’re in a conversation, how often do

you find yourself finishing the sentences of the 0 1 2 3 4 AD314
people that you are talking to, before they can finish
them themselves?
15. How often are you distracted by activity or noise

around you? 0 1 2 3 4 AD315
16. How often do you have difficulty waiting your

turn in situations when turn-taking is required? 0 1 2 3 4 AD316
17. How often do you have problems remembering

appointments or obligations? 0 1 2 3 4 AD317
18. How often do you interrupt others when they are

busy? 0 1 2 3 4 AD318
19. How often do you waste or mismanage time?

0 1 2 3 4 AD319
20. How often do you have trouble making a plan

and sticking to it when you are in a situation where 0 1 2 3 4 AD320
planful behavior is needed?
21. How often do you have difficulty prioritizing

work when you are in a situation where setting 0 1 2 3 4 AD321
priorities is needed?
22. How often do you depend on others to keep your

life in order and attend to details? 0 1 2 3 4 AD322
23. How often do you put things off until the last
minute? 0 1 2 3 4 AD323
24. How often is it hard for you to complete tasks

satisfactorily in the allotted time? 0 1 2 3 4 AD324
25. How often do you have trouble remembering the

main idea in things that you have read? 0 1 2 3 4 AD325
27
26. How often do you find that your mood is easily

changeable? 0 1 2 3 4 AD326
27. How often do you feel more easily hassled or

overwhelmed than other people in your situation? 0 1 2 3 4 AD327
28. How often do you have a hard time controlling

your temper? 0 1 2 3 4 AD328
29. How often are your feelings easily hurt when you
are criticized? 0 1 2 3 4 AD329
28
KSADS: DSM-IV CRITERION FOR CHILDHOOD ADHD:

RATE PERIOD WHEN RESPONDENT’S EXPERIENCE OF EACH SYMPTOM WAS MOST SEVERE; INDICATE
DATES EVALUATED
NOTE: If respondent was on medication for ADHD as a child, rate behavior for periods when he/she was not on medication.
Now, I’m going to ask you a few more specific questions about these types of problems during your childhood. For these next
questions regarding your childhood, we are asking about the period of time before you became a teenager, roughly the time
corresponding to elementary or primary school.
1. Makes a Lot of Careless Mistakes
Did you make a lot of careless mistakes at school? 1 Not present. AD101
Did you often get problems wrong on tests because you didn't 2 Mild: Occasionally made careless
read the instructions right? mistakes.
Did you often leave some questions blank by accident? 3 Moderate: Often failed to give close
Forget to do the problems on both sides of a handout? attention to details or made careless
mistakes in schoolwork, work or other
How often did these types of things happen? activities.
Did your teacher ever say you should pay more attention to 4 Severe
detail?
medication.
Indicate Age/Grade of Onset:

_____________
2. Difficulty Sustaining Attention on Tasks/Play Activities
Was there ever been a time when you had trouble paying 1 Not present. AD102
attention in school?
2 Mild: Occasionally had difficulty
Did it affect your schoolwork? sustaining attention on tasks or play
activities.
Did you get into trouble because of this?
3 Moderate: Often had difficulty
When you were working on your homework, did your mind sustaining attention in tasks or play
wander? activities.
What about when you were playing games? 4 Severe
Did you forget to go when it was your turn? 6 Absent or false due to therapeutic
medication.

condition.

_____________
29
3. Doesn't Listen
Was it hard for you to remember what your parents and teachers 1 Not present. AD103
said?
2 Mild: Occasionally didn't listen.
Did your parents or teachers complain that you didn't listen to
them when they talked to you? 3 Moderate: Often did not seem to listen
when spoken to directly.
Did you "tune people out"?
4 Severe
Did you get into trouble for not listening?
medication.

_____________
4. Difficulty Following Instructions
Did your teachers complain that you didn't follow instructions? 1 Not present. AD104
When your parents or your teacher told you to do something, 2 Mild: Occasionally had difficulty
was it sometimes hard for you to remember what they had said to following instructions. Problem had
do? only minimal effect on functioning.
Did it get you into trouble?
3 Moderate: Often did not follow through
Did you lose points on your assignments for not following on instructions and failed to finish
directions or not completing the work? schoolwork, chores, or duties in the
workplace (not due to oppositional
Did you forget to do your homework or forget to turn it in? behavior or failure to understand
instructions).
Did you get into trouble at home for not finishing your chores or
other things your parents asked you to do? 4 Severe
How often? 6 Absent or false due to therapeutic

medication.

_____________
30
5. Difficulty Organizing Tasks
Was your desk or locker at school a mess? 1 Not present. AD105
Did it make it hard for you to find the things you needed? 2 Mild: Occasionally disorganized.
Problem had only minimal effect on
Did your teacher complain that your assignments were messy or functioning.
disorganized?
3 Moderate: Often had difficulty
When you did your worksheets, did you usually start at the organizing tasks and activities.
beginning and do all the problems in order, or did you like to
skip around? 4 Severe
Did you often miss problems? 6 Absent or false due to therapeutic

medication.
Did you have a hard time getting ready for school in the
morning? 8 Present or true due to medical condition.

_____________
6. Dislikes/Avoids Tasks Requiring Attention
Were there some kinds of schoolwork you hated doing more than 1 Not present. AD106
others? Which ones? Why?
2 Mild: Occasionally avoided tasks that
Did you try to get out of doing your assignments? required sustained attention, and/or
expressed mild dislike for these tasks.
Did you pretend to forget about your homework to get
out of doing it? 3 Moderate: Often avoided, disliked, or
was reluctant to engage in tasks that
About how many times a week did you not do your required sustained mental effort (such as
homework? homework).
4 Severe

medication.

_____________
31
7. Loses Things
Did you lose things a lot? 1 Not present. AD107
Your pencils at school? 2 Mild: Occasionally lost things.

Homework assignments?
Things around home? 3 Moderate: Often lost things necessary for
tasks or activities (e.g., toys, school
About how often did that happen? assignments, pencils, books, or tools).
4 Severe

medication.

_____________
8. Easily Distracted
Was there ever a time when little distractions would make it 1 Not present. AD108
very hard for you to keep your mind on what you were doing?
2 Mild: Occasionally distracted.
Like if another kid in class asked the teacher a question while
the class was working quietly, was it ever hard for you to keep 3 Moderate: Was often easily distracted
your mind on your work? by extraneous stimuli (e.g., attention
often disrupted by minor distractions
When there was an interruption, like when the phone rang, was other kids would be able to ignore).
it hard to get back to what you were doing before the
interruption? 4 Severe
Were there times when you could keep your mind on what you 6 Absent or false due to therapeutic
were doing, and little noises and things didn't bother you? medication.
How often were they a problem? 8 Present or true due to medical

condition.

_____________
32
9. Forgetful in Daily Activities
Did you often leave your homework at home, or your books or 1 Not present. AD109
coats on the bus?
2 Mild: Occasionally forgetful.
Did you leave your things outside by accident?
3 Moderate: Often was forgetful in daily
How often did these things happen? activities.
Did anyone ever complain that you were too forgetful? 4 Severe

medication.

_____________
10. Fidget
Did people often tell you to sit still, to stop moving, or stop 1 Not present. AD110
squirming in your seat?
Your teachers? 2 Mild: Occasionally fidgeted with hands
Parents? or feet or squirmed in seat.
Did you sometimes get into trouble for squirming in your seat 3 Moderate: Often fidgeted with hands or
or playing with little things at your desk? feet or squirmed in seat.
Did you have a hard time keeping your arms and legs still? 4 Severe
How often?
medication.

_____________
33
11. Difficulty Remaining Seated
Was there ever a time when you got out of your seat a lot at 1 Not present. AD111
school?
Did you get into trouble for this? remaining seated when required to do
so.
Was it hard to stay in your seat at school?
3 Moderate: Often left seat in classroom
What about dinnertime? or in other situations in which
remaining seated was expected.
4 Severe

medication.

condition.

_____________
12. Runs or Climbs Excessively
Did you get into trouble for running down the hall in school? 1 Not present. AD112
Did your mom often have to remind you to walk instead of run 2 Mild: Occasionally ran about or climbed
when you were out together? excessively. Problem had only minimal
effect on functioning. (In adolescents,
Did your parents or your teacher complain about you climbing may be limited to a subjective feeling of
things you shouldn't? What kinds of things? How often did this restlessness.)
happen?
3 Moderate: Often ran about or climbed
excessively in situations in which it was
inappropriate. (in adolescents, may be
limited to a subjective feeling of
IF NECESSARY: When you were an adolescent, did you feel restlessness.)
restless a lot? Feel like you had to move around, or that it was
very hard to stay in one place? 4 Severe

medication.

_____________
34
13. Difficulty Playing Quietly
Did your parents or teachers often tell you to quiet down when 1 Not present. AD113
you were playing?
playing quietly.
Did you have a hard time playing quietly?
3 Moderate: Often had difficulty playing
or engaging in leisure activities quietly.
4 Severe

medication.
9 Inadequate Information

_____________
14. On the Go/Acts Like Driven by Motor
Was it hard for you to slow down? 1 Not present. AD114
Could you stay in one place for long, or were you always on the 2 Mild: Occasionally acted as if “driven
go? by a motor.”
How long could you sit and watch TV or play a game? 3 Moderate: Was often “on the go” or
often acted as if "driven by a motor."
Did people tell you to slow down a lot?
4 Severe

medication.

_____________
35
15. Talks Excessively
Did people say you talked too much? 1 Not present. AD115
Did you get into trouble at school for talking when you were not 2 Mild: Occasionally talked excessively.
supposed to?
3 Moderate: Often talked excessively.
Did people in your family complain that you talked too much?
4 Severe

medication.

_____________
16. Blurts Out Answers
At school, did you sometimes call out the answers before you 1 Not present. AD116
were called on?
2 Mild: Occasionally talked out of turn.
Did you talk out of turn at home?
3 Moderate: Often blurted out answers
Answer questions your parents were asking your siblings? before questions had been completed.
4 Severe
How often?
medication.

_____________
36
17. Difficulty Waiting Turn
Was it hard for you to wait your turn in games? 1 Not present. AD117
What about in line in the cafeteria or at the water fountain? 2 Mild: Occasionally had difficulty
waiting his/her turn.
3 Moderate: Often had difficulty waiting

his/her turn.
4 Severe

medication.

_____________
18. Interrupts or Intrudes
Did you get into trouble for talking out of turn in school? 1 Not present. AD118
Did your parents, teachers, or any of the kids you knew complain 2 Mild: Occasionally interrupted others.
that you cut them off when they were talking?
3 Moderate: Often interrupted or intruded
Did kids complain that you broke in on games? on others (e.g., butted into conversations
or games).
Did this happen a lot? 4 Severe

medication.

_____________
37
19. Duration
For how long did you have trouble with _____ (list symptoms 1 Not present. AD119
that were positively endorsed)?
2 Symptoms persisted less than 6 months.
3 Symptoms persisted at least 6 months.
20. Age of Onset
IF NECESSARY: How old were you when you first started 1 Not present. AD120
having trouble (list symptoms)?
2 Onset of symptoms since 7 years of age.
Did you have these problems in kindergarten?
3 Some hyperactive-impulsive or
First Grade? inattentive symptoms that caused
impairment were present before age 7.
Specify:_____________________
21. Some impairment in 2 or more settings
Did these things (list positive symptoms) cause trouble for you 1 Not present. AD121
in school?
With your family? 2 Mild: Some impairment in only one
With other kids? setting.
3 Moderate: Some impairment from the

symptoms was present in two or more
settings (e.g., at school and at home).
4 Severe

medication.
22. Assess clinically significant impairment
How much trouble did these things (list positive symptoms) 1 Not present. AD122
cause for you in school?
With your family? 2 Mild.
With other kids?
3 Moderate: There must be clear evidence
Give me an example. of clinically significant impairment in
social, academic or occupational
functioning.
4 Severe

medication.
38
ADULT’S GLOBAL ASSESSMENT of FUNCTIONING
RATE SUBJECT’S LEVEL OF GENERAL FUNCTIONING DURING THE MOST SEVERE PERIOD OF
ADHD SYMPTOMS IN THE PAST 12-MONTHS
AD236
G.A.F. SCORE: _______ (SEE NEXT PAGE.)
39
DSM-IV Axis V: Global Assessment of Functioning (G.A.F.) Scale
Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not
include impairment in functioning due to physical (or environmental) limitations.
Indicate appropriate code for the LOWEST level of functioning during the week of POOREST functioning in the past 12
months. (Use intermediate level when appropriate, e.g., 45, 68, 72.) Note: Make a rating of 0 if inadequate information.
100 Superior functioning in a wide range of activities, life’s problems

never seem to get out of hand, is sought out by others because of
91 his or her many positive qualities. No symptoms.
90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good func-
tioning in all areas, interested and involved in a wide range of activities,
socially effective, generally satisfied with life, no more than everyday
81 problems or concerns (e.g., an occasional argument with family members).
80 If symptoms are present, they are transient and expectable reactions to

psychosocial stressors (e.g., difficulty concentrating after family
argument), no more than slight impairment in social, occupational, or
71 school functioning (e.g., temporarily falling behind in school work).
70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some
difficulty in social, occupational, or school functioning (e.g., occa-
sional truancy, or absences from work), but generally functioning
61 pretty well, has some meaningful interpersonal relationships.
60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional

panic attacks) OR moderate difficulty in social, occupational, or school
51 functioning (e.g., few friends, conflicts with workers).
50 Serious symptoms (e.g., suicidal ideation, several obsessional rituals,

frequent shoplifting) OR any serious impairment in social, occupational,
41 or school functioning (e.g., no friends, unable to keep a job).
40 Some impairment in reality testing or communication (e.g., speech is at times

illogical, obscure, or irrelevant) OR major impairment in several areas. Such
as work or school, family relations, judgment, thinking, or mood (e.g., depressed
man avoids friends, neglects family, and is unable to work; child frequently
31 beats up younger children, is defiant at home, and is failing in school).
30 Behavior is considerably influenced by delusions or hallucinations OR

serious impairment in communication or judgment (e.g., sometimes incoherent,
acts grossly inappropriately, suicidal pre-occupation) OR inability to function
21 in almost all areas (e.g., stay in bed all day; no job, home, or friends).
20 Some danger of hurting self or others (e.g., suicide attempts without clear
expectation of death, frequently violent, manic excitement) OR occasionally
fails to maintain minimal personal hygiene (e.g., smears feces) OR gross
11 impairment in communication (e.g., largely incoherent or mute).
10 Persistent danger of severely hurting self or others (e.g., recurrent

violence) OR persistent inability to maintain minimal personal hygiene OR
1 serious suicide act with clear expectation of death.
40
NOTES ON THIS INTERVIEW
1. Was this interview completed? YES NO AD241
If not, why was it interrupted?
Please circle parts of the interview that were not completed due to time: 18 Adult ADHD criteria AD237
14 Additional items AD238
Self-report Screener AD239
18 Child ADHD criteria AD240
2. Was it rescheduled? YES NO

Day Month Year
3. Were there any unusual circumstances or aspects of the interview situation that affected R’s answers?
Please describe:
4. Are you satisfied that this was a valid interview? YES NO AD242
If not, why not?
5. Please list any other factors that you think affected R’s responses or your coding.
6. What is the principal AXIS-I diagnosis? (This is not a formal diagnosis or based on counting DSM IV criteria. It is your
impression at this point.)
41
7. Please give your clinical impression of the presence and development of psychiatric symptoms, particularly in terms of ADHD
and related symptoms. Address any differential diagnosis questions.
42
OPTIONAL (IF TIME ALLOWS)

FAMILY HISTORY OF ADHD
Have you ever heard of an illness called “Attention

Deficit / Hyperactivity Disorder”?
PARENTS
Was either of your parents ever diagnosed with
ADHD? Father 1 NO
P013
IF SO: Which one? Their age when diagnosed? 2 YES
Was the other one ever diagnosed with ADHD?
Mother 1 NO
2 YES P014
SIBLINGS
Were any of your siblings ever diagnosed with ADHD?
IF YES: Who was it? At what age? (Any others?) Siblings 1 NO P015
2 YES
OFFSPRING
Were any of your children ever diagnosed with
ADHD? Offspring 1 NO
P016
2 YES
IF YES: How old were they when their problems in
this area became evident? (Any others?)
AUNTS/UNCLES
Do you know if any of your aunts and uncles were ever
diagnosed with ADHD? Aunts/Uncles (paternal) 1 NO P017
2 YES
IF YES: On your father’s side? How old was he/she
when they were diagnosed? (Any others?)
Aunts/Uncles (maternal) 1 NO
On your mother’s side? How old was he/she when they 2 YES P018
were diagnosed? (Any others?)
NIECES/NEPHEWS
Do you know if any of your nieces or nephews were Nieces/Nephews (familial) 1 NO P019
ever diagnosed with ADHD? 2 YES
IF YES: Were they on your side or your spouse’s side?

At what age were they diagnosed? (Any others?)
P020
Nieces/Nephews (by marriage) 1 NO
2 YES
43
LEGAL HISTORY
Have you ever had a car accident? How many? # AUTO ACCIDENTS______________
P021
How much property damage and personal injury
occurred?
When was the most recent one?
How many speeding tickets have you gotten (ever)? # SPEEDING TICKETS______________
P022
In the past year? # SPEEDING TICKETS/PAST YEAR_____
P023
How fast were you going above the speed limit?
Has your driver’s license ever been suspended or

revoked? IF SO: For what reason? LICENSE REVOKED OR SUSPENDED: 1 NO
2 YES
P024
Have you ever been arrested? For what? # ARRESTS_____________________
How many times have you had run-ins with the legal P025
authorities?
44

NCSR Adult ADHD Interview

Uploaded by

Copyright:

Available Formats

NCSR Adult ADHD Interview

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCSR Adult ADHD Interview

Uploaded by

Copyright:

Available Formats

NCS-R-AHDH-ADULT 11/21/02

NCS-R Adult ADHD Interview

Respondent: Respondent No.:

Interviewer: Interviewer No.:

Contact log (attempts to reach respondent):

Edited and checked by: Date:

Permission granted to tape the interview Yes ______ No ______

Do you have any questions?

What’s your date of birth? DOB: ______ ______ ________

Are you presently located at (ADDRESS)?

IF NOT: What is your location at the

Any children? (What are their ages?) __________________________________________

IF YES: How many? __________________________________________

How far did you get in school? YEARS OF EDUCATION:

IF FAILED TO COMPLETE A __________________________________________

Did you interrupt your schooling for any reason? __________________________________________

Were your grades reflective of your ability? Did

Are you working now?

IF YES: How long have you worked

IF LESS THAN 6 MONTHS: Why did you leave

Have you always done that kind of work?

IF NO: What kind of work have you done?

CURRENT MEDICAL ISSUES AND SUBSTANCE

Do you take any medications or vitamins?

How often do you drink alcohol?

How often do you use street/recreational drugs?

HISTORY OF SUBSTANCE USE:

How long did this period last?

How many periods like this have you had?

Has anyone else ever been concerned about your

Have you ever used medications in a way other than the

Have you ever had treatment for alcohol or drugs?

PAST PERIODS OF PSYCHOPATHOLOGY

Have you ever seen anybody for emotional or

IF YES: Could you tell me what that was ___________________________________________

Can you tell me briefly what that was for?

CURRENT SOCIAL FUNCTIONING

How have you been spending your free time?

CIDI ADHD STEM QUESTIONS:

+ In the earlier interview, you said that between the ages of

Obtain brief description:

Can you tell me about that?

ADULT MODULE - PAST TWELVE MONTHS

KSADS: DSM-IV CRITERION FOR ADULT ADHD:

Standard probes include:

1. Makes a Lot of Careless Mistakes

In the past 12 months … 1 Not present. AD201

3 Moderate: Often fails to give close

Do you not check your work ? 4 Severe

Do people complain that you’re careless? 6 Absent or false due to therapeutic

8 Present or true due to medical condition.

2. Difficulty Sustaining Attention on Tasks/Play Activities

In the past 12 months: 1 Not present. AD202

In the past 12 months … 1 Not present. AD203

2 Mild: Occasionally doesn't listen.

4. Difficulty Following Instructions

In the past 12 months … 1 Not present. AD204

6 Absent or false due to therapeutic

8 Present or true due to medical condition.

5. Difficulty Organizing Tasks

Permission granted to tape the interview Yes No

What’s your date of birth? DOB: ____