ADHD Self-Assessment

 
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Introduction
ADHD

Attention Deficit / Hyperactivity Disorder (ADHD) Self Assessment 

If you're considering an ADHD assessment, please complete the ADHD Self-Report form. We'll review your form and contact you about the next steps if you meet the criteria.

We understand that the length of the form can be challenging, but the information is necessary for providing this service. Please fill out this form as much as you can.

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Right to Choose

Due to high demand, the Oxfordshire ADHD service is currently closed to new referrals, so you’ll need to exercise your right to be referred under the "NHS Right to Choose legislation."

Different providers under Right to Choose may have varying processes, and you may need to fill out additional questionnaires. The provider may also require a covering letter or completed form from your GP.

Please be aware you cannot use Right to Choose if you are:

  • already receiving mental health care following an elective referral for the same condition
  • referred to a service that is commissioned by a local authority, for example a drug and alcohol service (unless commissioned under a Section 75 agreement)
  • accessing urgent or emergency (crisis) care
  • accessing services delivered through a primary care contract
  • detained in a secure setting. This includes people in or on temporary release from prisons, courts, secure children’s homes, certain secure training centres, immigration removal centres or young offender institutions
  • serving as a member of the armed forces (family members in England have the same rights as other residents of England).

There are also restrictions on who a patient can direct their care to. The provider must:

  • a commissioning contract with any Integrated Care Board (ICB) or NHS England for the required service
  • have the service and team led by a consultant or a mental healthcare professional

Learn about the right to choose process

There are a wide range of Right To Choose providers. We strongly encourage you to choose one that has been assisted by our local ICB (Integrated Care Board) as meeting their quality criteria.

Find local and national support for ADHD

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Personal Details
Do you need an interpreter? : *
I would like to add a significant friends/relatives who may be contacted if I cannot be contacted?: *
Additional contact details
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Adult ADHD Self-Report Scale Part A

Please select each item below that best describes your behaviour during the past six months.

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Adult ADHD Self-Report Scale Part B

Please select each item below that best describes your behaviour during the past six months.

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Current Symptoms

How often do you experience these 27 symptoms?

Please select each item below that best describes your behaviour during the past six months.

Section 1 (Inattention)

 

Section 2 (Hyperactivity)

 

Section 3 (Impulsivity)

Section 4 (Sluggish Cognitive Tempo)

 

Section 5 (Summary)

Did you experience any of these 27 symptoms at least “Often” or “Very Often”? : *
Did you tick an “Often” or “Very Often” above?
If so, in which of these settings did those symptoms impair your functioning? : *
Please tick the box next to all of the areas that apply to you.
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Childhood Symptoms

Please select each item below that best describes your behaviour when you were a child between 5 and 12 years of age.

Section 1 (Inattention)

Section 2 (Hyperactivity-Impulsivity)

 

Section 3 (Summary)

Did you experience any of these 18 symptoms at least “Often” or “Very Often”?: *
Did you tick an “Often” or “Very Often” above?
If so, in which of these settings did those symptoms impair your functioning? : *
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Personal History
Pregnancy length, complications, sickness, mother history of smoking, alcohol, long stays in hospital, breastfeeding, siblings. Any events you and/or your family consider to be relevant.
Comparison with siblings if applicable, period achieving milestones e.g., walking, talking. Any events you and/or your family consider to be relevant.
Brief academic performance, peer comparison, writing progress, friendships, bullying history, “in trouble events”, injuries. Any events you and/or your family consider to be relevant.
Academic performance, peers comparison, friendships, bullying, “in trouble events”, injuries, alcohol/substances, relationships. Any events you and/or your family consider to be relevant.
Brief description of the grades if attended. Expectations or difficulties. Comparison with peers.
Brief history of your educational/employment history, children.
Brief summary of your current social circumstances e.g., housing, employment, relationships, hobbies, goals.
Family background (parents, siblings): education, employment, marital status, frequent history of re-location. Any events you and/or your family consider to be relevant.
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Privacy Consent

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Providing NHS Services

Beaumont Street Surgery
19 Beaumont Street
Oxford
Oxfordshire
OX1 2NA

Elms Road Surgery
Elms Road
Oxford
OX2 9JS

Telephone: 01865 240501