mind alive David - PERSONAL PROFILE QUESTIONNAIRE; V. DISENGAGEMENT

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PERSONAL PROFILE QUESTIONNAIRE
V. DISENGAGEMENT
Identify the symptom(s) that you have felt during the past year.
For each symptom, circle the number which indicates the frequency at which
you perceive that symptom.
0: Never
2: Most of the time
1: Some of the time
3: Constant/Overwhelming
Symptoms
Frequency
Difficulty paying close attention to details
0
1
2
3
Difficulty sustaining attention in tasks
0
1
2
3
Difficulty organizing tasks and activities
0
1
2
3
Avoiding tasks that require mental effort
0
1
2
3
Losing things necessary for tasks or activities
0
1
2
3
Easily distracted
0
1
2
3
Difficulty following instructions and making mistakes
0
1
2
3
Forgetful in daily activities
0
1
2
3
Fidgets with hands or feet or squirms in seat
0
1
2
3
Always ‘‘on the go’’
0
1
2
3
Interrupts or intrudes on others
0
1
2
3
Difficulty waiting for one’s turn
0
1
2
3
Often late for events and appointments
0
1
2
3