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Please fill out this questionnaire to provide some background information about you and the issues you have been experiencing. If you need extra time, you can always save the answers and revist them later.

Your email
Your Age
Gender
Country

Pre-Existing Conditions

Do you have any of the following? This can be either diagnosis or self-diagnosed. Choose as many as option as you like, or none if not applicable.

Your social behaviour

When you’re having a conversation with someone, do you prefer to look:

Think about your daily routine

Would you say you follow the same schedule every day of the week, and don’t like unexpected events?

Feeling embarrassed

Do you have trouble understanding what people mean when they say they feel embarrassed for someone else?

Do you often fail to give close attention to details?

Do you make careless mistakes in your work or during other activities? And how was that during childhood (in schoolwork or during other activities)?

Examples adulthood

Examples childhood

Do you often have difficulty sustaining your attention in tasks?

Examples adulthood

Examples childhood

Does it often seem as though you are not listening when you are spoken to directly?

Examples adulthood

Examples childhood

Do you often not follow through on instructions?

Or often fail to finish chores or duties in the workplace? And how was that during childhood (in schoolwork)?

Examples adulthood

Examples childhood

Do you often find it difficult to organise tasks and activities?

Examples adulthood

Examples Childhood

Do you often avoid tasks that require sustained mental effort?

Examples adulthood

Examples childhood

Do you often lose things that are necessary for tasks or activities?

Examples adulthood

Examples childhood

Are you often easily distracted by extraneous stimuli?

Examples adulthood

Examples childhood

Are you often forgetful in daily activities?

Examples adulthood

Examples childhood

Do you often fidget with or tap hands or feet, or squirm in your seat?

Examples adulthood

Examples childhood

Do you often leave your seat in situations where it is expected that you remain seated?

Examples adulthood

Examples childhood

Do you often feel restless?

Examples adulthood

Examples childhood

Do you often find it difficult to engage in leisure activities quietly?

Examples adulthood

Examples childhood

Are you often “on the go” or do you often act as if “driven by a motor”?

Examples adulthood

Examples childhood

Do you often talk excessively?

Examples adulthood

Examples childhood

Do you often blurt out an answer before questions have been completed?

.. and how was that during childhood?

Examples adulthood

Examples childhood

Do you often find it difficult to await your turn?

.. and how was that during childhood?

Examples adulthood

Examples childhood

Do you often interrupt or intrude on others?

.. and how was that during childhood?

Examples adulthood

Examples childhood

In which areas do you have or had problems with these symptoms?

Examples adulthood: Work/education

Examples childhood: Education

In which areas do you have or had problems with these symptoms?

Examples adulthood: Relationship and/or family

Examples childhood: Family

Congratulations on completing part 1 of your test

As part of your assessment, you would need to answer a few more questions.