Harold Robert Meyer and The ADD Resource Center 01/23/2025
I know paperwork can be especially draining with ADHD. I appreciate you taking it on.
This assessment tool should be completed honestly.
Before using it, pick out only the items that will fit your situation and your tolerance for filling out this tedious form. But it will be worth the time.
Date: ____________ Time:(AM/PM/24h) ___________ to _____________ Location/Format: □ In-person □ Virtual
□ Home □ Out of home
Rate each item from 1-5 (1 = Very Low, 5 = Very High)
Task Clarity: ___
Motivation Level: ___
Anxiety Level: ___
Rate each item from 1-5 (1 = Poor, 5 = Excellent)
Focus Quality: ___
Task Completion: ___
Energy Management: ___
Session Effectiveness: ___
What worked well?
What could be improved?
Notable distractions or interruptions:
Calculate averages from daily sessions:
Average Focus Quality: ___ Average Task Completion: ___ Average Session Effectiveness: ___ Number of Sessions Completed: ___ Consistency Rate (sessions attended/scheduled): ___%
Compared to the previous month:
□ Improved □ Maintained □ Declined
Task Completion Trend: ____________ Focus Quality Trend: ____________ Energy Management Trend: ____________
Rate body double dynamic from 1-5:
Professional Boundaries Maintained: ___ Communication Effectiveness: ___ Scheduling Reliability: ___ Overall Working Relationship: ___
Based on this month’s data:
Adjustments Needed:
Goals for Next Month:
ADHD Symptom Management (Rate 1-5):
Cost-Benefit Review:
□ Continue Current Arrangement □ Modify Arrangement (specify changes needed) □ Consider Alternative Support Methods □ Terminate Arrangement
Check any that apply during review periods:
□ Declining session effectiveness scores □ Increasing anxiety before sessions □ Boundary violations or role confusion □ Scheduling conflicts becoming frequent □ Dependency patterns emerging □ Communication breakdown □ Relationship strain □ Decreased motivation to attend sessions
If three or more items are checked, implement immediate review and adjustment protocol.
© 2025 The ADD Resource Center. All rights reserved. 01/23/2025
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