ADHD Diagnostic Interview Form

Patient details

Patient ID

Patient name

Inattention symptoms

For each item, record whether the symptom is clinically present, and add adult and childhood examples where available.

Inattention 1

Often makes careless mistakes or misses details.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 2

Often has difficulty sustaining attention.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 3

Often appears not to listen when spoken to directly.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 4

Often does not follow through or complete tasks.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 5

Often has difficulty organising tasks or activities.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 6

Often avoids or delays tasks requiring sustained mental effort.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 7

Often loses things needed for tasks or activities.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 8

Often becomes easily distracted.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Inattention 9

Often forgets daily tasks or obligations.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / impulsivity symptoms

Record current and childhood examples where clinically relevant.

Hyperactivity / Impulsivity 1

Often fidgets or feels unable to stay still.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 2

Often leaves seat when remaining seated is expected.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 3

Often feels restless or internally driven.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 4

Often has difficulty engaging quietly in leisure activities.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 5

Often feels “on the go” or driven by a motor.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 6

Often talks excessively.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 7

Often answers before questions are completed.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 8

Often has difficulty waiting their turn.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Hyperactivity / Impulsivity 9

Often interrupts or intrudes on others.

Clinical rating

Adult examples / evidence

Childhood examples / evidence

Developmental history

Background context from the patient and any collateral sources. Free text where exact recall is unlikely; numeric where useful for review.

Where was the patient born and brought up?

Any complications during the mother's pregnancy or birth?

What sort of baby was the patient?

How was the patient as a toddler?

Observations from people around the patient in early years

Age started walking (in months)

Age started talking — first words (in months)

Age started school (in years)

Additional developmental notes

Childhood onset and collateral evidence

Evidence of symptoms before age 12

Sources reviewed

Childhood evidence summary

Risk / safeguarding considerations

Risk to Self

Risk to Others

Risk FROM others

Self-Neglect

Functional impairment

Select areas where symptoms cause meaningful impairment.

Impairment notes

Differential diagnosis / exclusions

Alternative explanations considered

Final clinical impression

Diagnostic impression

Presentation

Clinical summary

Saving diagnostic interview...