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Self Screening Questionnaires

"Your Mood - Should You be Concerned"
To help evaluate your mood, fill out the nine symptom check list.

 

Sometimes people find themselves feeling transienty blue or down. They are having a "bad day". But sometimes these feelings continue for many days or weeks. They are having a bad time. The bad time may be accompanied by losing interest or pleasure in doing things, problems in sleeping, loss of appetite and feeling tired, feeling hopless and having little energy. If you or someone you know has these concerns, use this self screening questionnaire and refer to the resources for further help and information.

 

Click for Questionnaire if you are concerned about mood


"Your Eating - Should You be Concerned"
Sometimes people find themselves preoccupied with weight, shape, and eating. If you or someone you know has these concerns, use this self-screeing questionnaire, and refer to the resources and references for further help and information.

 

Click for Questionnaire if you are concerned about weight, shape, and eating


"Attention Deficit/Hyperactivity Disorder (ADHD)"
Are you concerned that you are suffering from the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) ?

 

Consider completing a checklist that can provide information that is critical to supplement the diagnostic process. The checklist takes about 5 minutes. If the checklist results suggest that you are suffering from the symptoms of ADHD call Dr. Burton Lerner (212) 496-8491 to schedule an appointment with a mental health service clinician.

 

Click for Questionnaire if you are concerned about Attention Deficit/Hyperactivity Disorder (ADHD)


The Value of Screening for Adults with ADHD
Research suggests that the symptoms of ADHD can persist into adulthood, having a significant impact on the relationships, careers, and even the personal safety of your patients who may suffer from it. Because this disorder is often misunderstood, many people who have it do not receive appropriate treatment and, as a result, may never reach their full potential. Part of the problem is that it can be difficult to diagnose, particularly in adults.

 

The Adult ADHD Self-Report Scale (ASRS-vI.I) Symptom Checklist was developed in conjunction with the World Health Organization (WHO), and the Workgroup on Adult ADHD.

Adult ADHD Self-Report Scale (ASRS-vI.I) Symptom Checklist Instructions
The questions are designed to stimulate dialogue between you and your doctor to help confirm if you may be suffering from the symtoms of attention-deficit/hyperactivity disorder (ADHD).

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 symptoms consistent with ADHD. These six questions are the basis for the ASRS vI.I Screener and are also Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions.

 

Instructions:

 

Symptoms

 

1. Complete both Part A and Part B of the Symptom Checklist by marking an X in the box that mostly closely represents the frequency of occurrence of each of the symptoms.

 

2. Score Part A. If four or more marks appear in the darkly shaded boxes with Part A then you have symtoms highly consistent with ADHD in adults and further investigation is warranted.

 

3. The frequency scores on Part B provide additional cues and can serve as further probes into your 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 twelve questions. It has been found that six questions in Part A are the most predictive of the disorder and are best for use as a screening instrument.



  
     
        
  
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