This page contains links to citations from Understanding Baffling Clients, the book's references, resources for college students, and a sample questionnaire for the initial psychiatric evaluation.

Citations

Chapter 3

Genesight is one of several companies that do genetic testing. Their website explains more. https://genesight.com/for-clinicians/

Chapter 4

Self-injury is not synonymous with suicidal behavior. Here is a comprehensive discussion of non-suicidal self-injurious behavior. Hooley,et al (2020) https://pmc.ncbi.nlm.nih.gov/articles/PMC6959491/

Assessing violence risk is critical but beyond the scope of this book. You may add to your knowledge about the risk of violence by reading this article by Drummond: Assessing Violence Risk Practice. https://div12.org/assessing-violence/ Drummond (2022)

Chapter 5

Ask about medical illnesses or situations that are associated with psychosis. Here is a link to an article on psychosis from The Cleveland Clinic that addresses these: https://my.clevelandclinic.org/health/symptoms/23012-psychosis

Chapter 6

Suppose you suspect your client has been chronically exposed to toxins from work or living situations. In that case, you may want the doctor to test for heavy metals and other environmental and industrial toxins. According to Ecowatch, there are several environmental and industrial toxins. They include persistent organic pollutants (POPs) like dioxin, volatile organic compounds (VOCs), phthates, polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), polyfluoroalkyl substances (PFASs), and some metals like lead, arsenic, copper, aluminum, cadmium, and mercury. https://www.ecowatch.com/environmental-toxins-guide.html

Chapter 11

Listen for evidence that might suggest they have attention deficit hyperactivity disorder. For more on this, go to my YouTube video Disastrous Fallacies about ADHD https://www.youtube.com/watch?v=V3V9sjIwyEI

You will find an explanation of how to take an alcohol history in this work on the medical school website about alcohol history taking: https://medschool.co/history/basics/alcohol-history-taking

The Foundations of Clinical Medicine of the University of Washington discusses how to take a substance use history here: https://uw.pressbooks.pub/fcmtextbook/chapter/substance-use-history/

If your history is suggestive of your client having an antisocial personality disorder, you may get some further clues by giving them the Disgust Scale. Find more about it on the Disgust Scale Home Page: https://people.stern.nyu.edu/jhaidt/disgustscale.html.

Familiarize yourself with the typical symptoms of these common mental disorders. This book assumes you already have this foundation of knowledge. This knowledge helps you understand the many clients whose presentations are not baffling and who more easily fit into diagnostic categories. Review them in the Diagnostic and Statistical Manual V. The Cleveland Clinic discusses the DSM-5 here: https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5

Chapter 12

Evaluating mental status is most crucial in deciding suicidal risk, violence risk, and the presence of psychosis or mania. Jeffrey P. Kahn and Andre Barciela Veras, in their March 2022 article in Current Psychiatry, proposed different subtypes of psychosis and identified early mental status changes to help you identify psychosis early: https://www.mdedge.com/psychiatry/article/252208/schizophrenia-other-psychotic-disorders/psychoses-5-comorbidity-defined/page/0/4

Dr Ziad Nasreddine of Moca Cognition invented the Montreal Test of Cognitive Ability, the MOCA, which is helpful when you have questions about your client’s cognition. (https://www.mocacognition.com/the-moca-test/).

Dr. Marshal Folstein and Dr. Susan Folstein created the Mini-Mental State Exam, the MMSE (https://meded.temertymedicine.utoronto.ca/sites/default/files/assets/resource/document/mini-mental-state-examinationmmse.pdf), as another standardized screening instrument.

Chapter 14

Arlin Cuncic with Verywellmind has written an interesting article about the Imposter Syndrome: Is Imposter Syndrome Holding You Back from Living Your Best Life? Here is the link: https://www.verywellmind.com/imposter-syndrome-and-social-anxiety-disorder-4156469 (2024).

According to Arlin Cuncic, if you have imposter syndrome, aren’t perfect, don’t know everything about the subject, need help, or aren’t superbly accomplished, you may feel like an imposter and fear being exposed.

You also may link to Martin Huecker et al.’s article Imposter Phenomenon at

https://www.ncbi.nlm.nih.gov/books/NBK585058/ for additional information.

My pathology professor at the Medical College of Georgia, Dr. Luther Otkin

Chapter 15

Clients use different defense mechanisms to avoid the anxiety of becoming aware. These defenses include some combination of denial, projection, displacement, regression, rationalization, reaction formation, repression, or sublimation.

Ryan Baily and Jose Pico discuss these and other defense mechanisms in Stat Pearls at https://www.ncbi.nlm.nih.gov/books/NBK559106/ (Bailey, R, Pico, J) 2025

Robert van Reekum et al. have written an excellent article on apathy entitled Apathy: Why Care? Reekum (2005). Here is the link: https://psychiatryonline.org/doi/full/10.1176/jnp.17.1.7)

Chapter 19

It’s challenging to end a relationship with a person with pathological narcissism. Here is an exceptional article by Perpetua Neo, DClinPsy, from Mindbodygreen, on how to leave a pathological narcissist. She gives 12 tips and tells you what to expect. https://www.mindbodygreen.com/articles/breaking-up-with-a-narcissist Neo (2023)

This article may help you understand the neuropsychiatric basis for borderline personality disorder: The Neurobiology of Borderline Personality Disorder by Katerine S. Pier, MD and Lea K. Marin, MD M.P.H. Pier (2016). Here is the link: https://www.psychiatrictimes.com/view/neurobiology-borderline-personality-disorder

Chapter 20

An article in Neurochemistry International by V. Sreeja and others is entitled Pharmacogenetics of selective serotonin reuptake inhibitors (SSRI): A serotonin reuptake transporter (SERT) based approach can be found here:

https://www.sciencedirect.com/science/article/abs/pii/S0197018623002000

The Expanded Biology of Serotonin, an article by M. Berger and others in the Annual Review of Medicine, can be found at https://pmc.ncbi.nlm.nih.gov/articles/PMC5864293/ .

Serotonin Transporter Gene Polymorphisms and Selective Serotonin Reuptake Inhibitor Tolerability: Review of Pharmacogenetic Evidence is an article in Pharmacotherapy by Zhu and others found at https://pubmed.ncbi.nlm.nih.gov/28654193/

Some clients have good ego strength

Consider the use of lithium, which has been shown to reduce suicidal ideas even at low doses. It is not advertised because it is so inexpensive. Here is an article by SK Sarai, HM Mekala, and S Lippmann entitled Lithium Suicide Prevention: A Brief Review and Reminder in Innov. Clin Neuroscience https://pmc.ncbi.nlm.nih.gov/articles/PMC6380616/

I want to add to this brief discussion of how clients with suicidal risk trigger feelings in therapists by referring you to these resources:

Colorado State University has a website with warning signs, links to other resources, and assessment tools. It is https://health.colostate.edu/suicide-prevention/

Clinical Manual for the Assessment and Treatment of Suicidal Patients by Dr. John Chiles, et al. https://psychiatryonline.org/doi/book/10.1176/appi.books.9781615378982

Stronger than Death by Sue Chance

Choosing to Live: How to Defeat Suicide Through Cognitive Therapy by Thomas E. Ellis.

The National Suicide Hotline 1-800-273-8255

The Transgender Suicide Prevention Hotline 1-877-565-8860

The American Association of Suicidology https://suicidology.org/

The American Foundation for Suicide Prevention https://afsp.org/about-afsp/

Suicide Prevention Resource Center https://sprc.org/

The Virtual Helpbox App https://www.research.va.gov/research_in_action/Virtual-Hope-Box-smartphone-app-to-prevent-suicide.cfm

Chapter 21

Variations in estrogen metabolism affect the brain. Just scanning this complex article may give you an idea of the importance of estrogen in brain function: Estrogen effects on the brain: actions beyond the hypothalamus via novel mechanisms by Bruce S. McEwen et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480182/.

Chapter 23

I have found Thomas Fogarty’s concepts helpful in working with families. Below is a link to his collected papers: http://cflarchives.org/thomasfogartymdcollectedpapers.html

This article is one of his seminal articles: http://cflarchives.org/images/Triangles.pdf

Chapter 26

If you help fretful, anxious parents deal with their anxiety, you will free up their kids to make mistakes and discover they aren’t so fragile after all. You may explore the dynamics of this more by reading about the Good Enough Mother, a term coined by D.W. Winnicott, who in 1953 wrote an article entitled Transitional objects and transitional phenomena; a study of the first not-me possession in The International Journal of Psychoanalysis, 34, 89–97.

This link from the Seleni Institute explains the concept. https://seleni.org/advice-support/2018/3/14/the-gift-of-the-good-enough-mother

Chapter 27

I am reminded of the behavioral shaping techniques experimenters used to get a bird to peck for seeds in the left direction. They ignore every movement of the bird in the right direction and then drop grain each time the bird looks to the left. They shape the birds’ behavior by reinforcing the desired behavior and ignoring the negative. S.G. Friedman, Ph.D. explains this in Shaping New Behaviors in Good Bird Magazine reprinted on this site https://www.behaviorworks.org/files/articles/Shaping%20New%20Behaviors.pdf

This article from Positive Psychology covers using positive therapy in more detail and offers active listening and exercise techniques. How to Practice Active Listening:16 Examples and Techniques. https://positivepsychology.com/active-listening-techniques/ O’Bryan (2022)

Chapter 28

Another tell might be your choosing a diagnosis for your client that is considered pejorative in popular parlance. My residency program wisely made Dr. Thomas Main’s article The Ailment required reading for first-year residents. It shows how risky it can be for a patient to unwittingly frustrate the doctor’s expectation that the patient will get well. Here is the link: https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/j.2044-8341.1957.tb01193.x

Main (1959)

It may take weeks or months to see the full effect of taking l-methylfolate, but clients tell me it makes such a difference. They are not as fearful of going into social situations. They don’t dread being a little anxious because they know they can calm down. To learn more about this, go to this link: https://genesight.com/genetic-insights/understanding-the-mthfr-gene-mutation/

Chapter 30

Understanding how the brain works can help you better understand unusual client situations. Below is a comprehensive video overview from Visceral.Labs69-wo7su: The Four Main Brain Networks (Salience, Default Mode, Central Executive, Task Positive) https://www.youtube.com/watch?v=cfwQDS8r80s 2023.

Chapter 31

People who overdo it have trouble taking vacations. You may remember going on vacation rates as a 13-point stress on the Social Readjustment Rating Scale, often called the Holmes and Rahee Stress Scale. Saul McLeod explains the Social Readjustment Rating Scale in Simple Psychology at this link: https://www.simplypsychology.org/srrs.html.

Chapter 32

In the European Journal of Psychotraumatology, Onno van der Hart’s article explores this more. It is entitled The Use of Imagery in Phase 1 Treatment of Clients with complex dissociative disorders. Here is the link https://pmc.ncbi.nlm.nih.gov/articles/PMC3402145/

Chapter 33

I encourage you to view my YouTube video called Misconceptions about People with high-functioning autism. Here is the link: https://www.youtube.com/watch?v=hLn6D4NujVU

In a July 2025 MDEdge article, Patricia Wendling discussed research published that same month in Nature Genetics. She noted that researchers had identified four clinically distinct autism subtypes and their underlying genetic signals. This research may lead to further changes in how autistic people are described. https://www.mdedge.com/psychiatry?summaryguid=2025a1000isl&ecd=WNL_PSYCH_250728_mdedge&uac=3006SK&sso=true (Wendling) 2025

In her Netflix Special called Nannette and her TED talk, Hannah Gadsby shared her insights into what it is like to be autistic and what her thought process is like. You can find her TED talk at https://www.ted.com/speakers/hannah_gadsby.

Explore the Pathological (or Extreme) Demand Avoidance concept and see if it applies to your clients. PDA is an unusual resistance to ordinary social demands and even to demands the client wants for themselves. The Extreme Demand Avoidance Questionnaire, which was used with children, has been adapted for use with adults. You can find it here at https://embrace-autism.com/eda-qa/

You will learn about penguin pebbling and other ways people with autism express their wish to connect with others when you read an excellent discussion by Myth@neurowonderful at this Stimpunks Foundation site: https://stimpunks.org/2022/01/22/the-five-neurodivergent-love-languages-2/.

Chapter 34

If a client misses several days of Lamictal and doesn’t start over with the small starting dose, they are putting themselves at risk for Stevens Johnson’s syndrome, which can be life-threatening. The Mayo Clinic discusses it here: https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936 . It may be inconvenient to call pharmacies on the weekend or go the extra mile, but the consequences of not doing so are too significant. You may be tempted to set limits, but this is not the time.

Chapter 37

I have mentioned my dog, Sophie, and you may have seen her in my YouTube videos about college. You may click on this link https://www.youtube.com/playlist?list=PL8Hb1mIKF05i5KhUX_8zAs4LD783Rd3sH

or google YouTube How to Get Ready for College in Trying Times Duffey.

References

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Bailey R.& Pico J. (2023) Defense mechanisms. StatPearls Publishing, 2025 Jan https://www.ncbi.nlm.nih.gov/books/NBK559106/

Bandler, R. & Grinder J. (1979) Frogs into princes: Neurolinguistic programming. Real People’s Press

Berger, M., & Gray, J. & Roth, B. (2018) The expanded biology of serotonin Annual Review of Medicine . 2009;60:355–366. doi: 10.1146/annurev.med .60.042307.110802

Bojanic L. et al. (2020). Early post-discharge suicide in mental health patients: Findings from a national clinical survey. Frontiers in Psychiatry11:502. https://doi.org/10.3389/fpsyt.2020.00502

Bouregeault, C., (2008) The wisdom Jesus: Transforming heart and mind- A new perspective on Christ and his message Shambhala Publications

Brown ,N.,(2020) Children of the self-absorbed: A grownup’s guide to getting over narcissistic parents New Harbinger Press

Chodron.P. (2022) Don’t bite the hook: Finding freedom from anger, resentment, and other destructive emotions. Shambhala Publications

Cuncic, A. (2024) Is Imposter Syndrome Holding You Back from Living Your Best Life? Verywellmind https://www.verywellmind.com/imposter-syndrome-and-social-anxiety-disorder-4156469

Drummond, D. et.al. (2022) Assessing Violence Risk Practice. Section VII Working Group on Violence Risk Assessment of the Society of Clinical Psychology. https://div12.org/assessing-violence/

Elgin, S. (1985) The gentle art of self-defense. Dorset Pr

Folstein, M., Folstein, S., & McHugh, P, (1975).” Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3),189-198 (https://meded.temertymedicine.utoronto.ca/sites/default/files/assets/resource/document/mini-mental-state-examinationmmse.pdf),

Forward, S. & Frazier D. (2019) Emotional blackmail: When the people in your life use fear, obligation, and guilt to manipulate you. Harper Paperbacks

Friedman, S.(2006) Shaping new behaviors Good Bird ™ Magazine, Vol 2-1, 2006:16-18 www.goodbirdinc.com reprinted on the internet through Behavior Works https://www.behaviorworks.org/files/articles/Shaping%20New%20Behaviors.pdf

Furman, D.et al. (2019). Chronic inflammation in the etiology of disease across the lifespan. Nature Medicine, Dec 5;25,(12):1822-1832. doi: 10.1038/s41591-019-0675-0

Gill, J.D. (2022) Doing psychotherapy: A primer. Kindle Direct Publishing

Greenson, R (1959) The classic psychoanalytic approach. In S. Arieti (ed.)

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Hertz, R. (2012) That’s Disgusting: Unraveling the Mysteries of Repulsion. W.W. Norton & Company

Hooley, J., Fox et al (2020) Nonsuicidal self-injury: Diagnostic challenges and current perspectives Neuropsychiatric Disease and Treatment. 2020 Jan 10;16:101–112. doi: 10.2147/NDT.S198806

Hope, L, (2011) Help me live:20 things people with cancer want you to know Clarkson Potter/Ten Speed.

Huecker, M. et al. (2023) Imposter Phenomenon National Library of Medicine Stat Pearls

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Kahn, J., & Veras, B. (2022, March) Psychosis: The 5 Comorbidity-defined subtypes Current Psychiatry. 2022 March;21(3):22-31 | doi: 10.12788/cp.0221

Kaplan, A. (2011, May 23) Can a suicide scale predict the unpredictable? Psychiatric Times

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Mattis-Namgyel, E. (2011) The power of an open question: The Buddha’s path to freedom. Shambhala Publications

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Resources for your diverse college student clients

The following website not only contains support resources but describes assistive technology available for students with autism, cognitive deficits, hearing deficits, ADHD, and other physical disabilities. https://www.affordablecollegesonline.org/ college-resource-center/resources-for-students-with-disabilities/

American Muslim Health Professionals indicates that they are concerned with advocacy, health education, and career development. Moreover, they are an empowerment organization. They note they have an outreach of seven thousand health professionals and students working toleverage the educational background and skills of Muslims in the health care sector to improve the health of Americans.

The Asperger/Autism Network (AANE) indicates that they “work with individuals, families, and professionals to help people with Asperger Syndrome and similar autism spectrum profiles building meaningful, connected lives.” Find more at https://www.aane.org

Campus Pride is a national nonprofit organization for student leaders and campus groups. It works to develop a safer college environment for LGBT students. https://www . campuspride.org

Gender Diversity provides education and support services and can use Skype for individual consultations. http://www.genderdiversity.org/individual-support/

The Center for Global Education: An international resource center lists programs available for international students.

The College Autism Network puts together people who are working to help college students on the autism spectrum have a better college experience and improve their access and success. Investigate at https://collegeautismnetwork.org

LGBT National Help Center, which also has a hotline (888-843-4564) and youth chat line serving youth through age twenty-five (800-246-7743). Their link is https://www . glbthotline.org/

Lost-n-Found Youth assists homeless LGBT youth and is based in Atlanta, Georgia

The National Society of Black Engineers is a sizeable student-run organization that seeks to provide personal and

professional opportunities for success by improving the recruitment and retention of Black and other minority engineers. http://nsbe.org/

SACNAS indicates it is “an inclusive organization dedicating to fostering the success of Chicanos/Hispanics and Native Americans, from college students to professionals, in attaining advanced degrees, careers, and positions of leadership in STEM.” Web source: https://www.sacnas.org/who-we-are/ mission-impact/

Many colleges offer SafeSpace training programs to students and faculty who want to learn more about the transgender community, available resources, and how to be an ally best.

The Steve Fund is dedicated to the mental health and emotional well-being of students of color. You can text 741741 to talk to a live, trained crisis counselor. They have a Knowledge Center as well. Look up www.stevefund.org

Resources for students and non-students alike:

Everything You Ever Wanted to Know About Trans* (But Were Afraid to Ask) by Brynn Tannehill is as comprehensive as its title suggests.

At NAMI’s website (https://www.nami.org/Find-Support/ LGBTQ) you will find leads to multiple resources and a discussion of the stressors facing members of the LGBTQIA community. The site can help you if you want to locate an LGBTQIA-inclusive provider. The site mentions the Trevor Project. It has a toll-free twenty-four-hour national suicide hotline for LGBTQIA youth, which is 866-488-7386. The Trevor Project site is https://www.thetrevorproject.org/. They have online chat and confidential text messaging. To chat, you link to http://www.thetrevorproject.org/pages/get-help-now#tc or text “Trevor” to 202-304-1200 for confidential text messaging.

PFLAG’s website notes that PFLAG offers support, education, and advocacy to unite LGBT people with family, friends, and al lies and advance equality. https://pflag.org/

If you would like more knowledge about the LGBTQ community and help with being an ally for the community, check out Straight for Equality at http://www . straightforequality.org/about

Trans Lifeline is a national crisis hotline for transgender people in the United States staffed entirely by other trans and non-binary people. Their number is 877-565-8860.

Questionnaire Suggestions

You may want to choose among these commonly asked questions to create your own questionnaire for your initial evaluations. These questions are an accumulation from various sources I have read over the years and are not original with me.

Present Illness

Please describe what prompted you to come to see me. (For example, do you have symptoms that trouble you, worries, hurts, regrets, resentments, fears, or life questions?)

Past Psychiatric Treatment

If you have ever been an inpatient at a psychiatric hospital, please list places and dates.

If you have ever seen an outpatient counselor, psychologist, social worker, minister, or psychiatrist for any past nervous problems, please list them. Give dates as close as possible and describe why you saw them.

If you have ever had any psychological testing, please list dates and locations.

Medical History

Are you allergic to any medication?

Do you have other allergies (for example, hay fever, food allergies)?

Please list all surgical operations you have had.

Please list all medications you are currently taking. Include over-the-counter medications, herbs, and other health foods.

Please list your physicians. When was your last physical examination?

If you have a history of a symptom, circle it:

Have you ever been knocked out or lost consciousness (from a fall, playing sports, an accident, blow to the head)?

Mononucleosis?

Bad taste and burning sensation in your throat at night when you lie down that seems to come up from your stomach?

Regular pains in your jaw joint; does it pop or click?

Muscles that ache constantly?

Do you have an infection or virus?

Periods of diarrhea mixed with constipation?

Asthma?

Tired all the time?

Do you have frequent headaches?

Do you have migraine headaches?

Diabetes?

Sinus problems?

High blood pressure?

Heart attack?

Irregular heartbeats?

Past Psychiatric Medication History

If you have ever taken any medication in the past from you family physician or from a psychiatrist for nervous problems or for depression, please list them, along with your response and any major side effects they gave you.

How often do you drink alcohol?

Have you had any problems from drinking?

When you drink alcohol, do you have trouble limiting how much you drink?

After drinking, do you ever have problems remembering what happened?

What role have illicit drugs, including marijuana, played in your life?

Developmental History

Where were you born?

Did your mother have trouble with labor or delivery? Were you born prematurely?

From what you have heard people say, did you crawl, walk, and talk around the same age as other children?

If you were adopted, how old were you then?

If you were adopted, how old are your adoptive parents and what is your relationship like with them? Are your adoptive parents of the same sex?

Family History

How old is your biological mother, and how would you describe her and your relationship?

How old is your biological father, and how would you describe him and your relationship?

If you parents divorced, how old were you when it happened?

Did you have a stepmother, and what role did she play in your life?

Did you have a stepfather, and what role did he play in your life?

Please list your sisters, half-sisters, and stepsisters. Where do they live, and how are they doing? What are they like?

Please list your brothers, half-brothers, and stepbrothers. Where do they live, and how are they doing? What are the like?

How much were your grandparents involved in your life? Do you have children? What are their ages?

Is there a history in your family of members being sad, depressed, anxious, or having problems with drugs or alcohol? If so, who?

Relationship History

What is your relationship status? Has there been a recent breakup? What can you say about your current and past relationships?

School History

What has school been like for you? What kind of grades did you make? Did you make friends easily? Did you play sports? Were you bullied?

Job History

What jobs have you had and what were they like? Were you harassed at work? How did you come to leave them?

What else do you need to tell me that has not been asked?

Review of Symptoms

Check the items that apply to how you have been recently:

Feel irritable

Feel sad or down

Feel consistently more tired than I usually do

Worry about my body and health more than usual for me.

Don’t enjoy things like I used to

Don’t eat nearly as much as I used to

Eat for comfort more

Are sleeping too much

Are having trouble falling or staying asleep

Feel worthless and am quicker to criticize myself

Find myself feeling guilty a lot

Read all of these first, then check the one or two answers that fit you the best:

I have no suicidal thoughts.

I feel like cutting or burning myself, but I don’t have any interest in killing myself.

Under a lot of pressure, I may briefly feel I would rather be dead than have to handle things sometimes.

Suicidal thoughts go through my head but I don’t feel like I really want to die.

More and more, I am having intrusive suicidal thoughts that trouble me.

I have unbearable feeling states, but I know they will pass and I can cope with them.

I have unbearable feeling states and it seems like suicide is the only way to cope with them.

I have spent some time recently thinking about how to kill myself.

I intend to kill myself one day.

I have decided on a plan to kill myself.

I have thought about killing myself and started to act on my impulse but stopped.

I have tried to kill myself recently but few if any people know it.

I have made suicide attempts in the past.

Check this if y ou can access a firearm belonging to y ou or someone else _

Circle those that apply:

My sexual drive is less

Friends are tired of asking me to go with them because I keep saying no

I find myself crying often

I seem to be spending a lot of time caught up in thinking depressive thoughts over and over

Have you had an episode when several of these four symptoms happened all at once? Check any that may apply:

Difficulty breathing

Dread

Pounding heart

Nervousness

Circle the items that apply:

Feel nervous and anxious

Feel tense

Feel restless

Feel like I have to be vigilant and on guard for some reason

Space out for several minutes or more and can’t remember what happened while I was feeling emotionally numb

Am easily startled

Certain things frighten me much more than other people

Am in the habit of avoiding a lot of situations that others don’t need to avoid

Feel like something bad is going to happen

Worry constantly

Can’t seem to control my worrying

Find myself thinking about things over and over

Circle these items if y ou know y ou are doing these too much but feel anxious if y ou don’t do them:

Checking

Washing

Counting

Cleaning

Ordering

Keeping things that should be thrown out

Resisting temptations to do things that you know you don’t really want to do

Circle situations where y ou show at least moderate anxiety :

I am at least moderately anxious in social situations like eating in public, talking to teachers, going to a party, talking with people I don’t know well, giving a report.

I avoid groups.

I don’t raise my hand in class even when I am prepared.

I fear being embarrassed.

I am nervous in crowds

I get nervous when I have to take a test or perform in some way

To what extent have emotional symptoms disrupted y our (A) social, (B) family , or (C) school life?

A. mildly, moderately, markedly, extremely

B. mildly, moderately, markedly, extremely

C. mildly, moderately, markedly, extremely

Has there ever been a specific separate period of time (several days or week) when y ou were not y our usual self and y ou had several of these symptoms at the same time: (Circle the items that apply)

You had much less sleep but lots more energy and were more busy and productive

You were excessively happy to the point of being euphoric

You talked very rapidly and seemed unable to stop talking

You engaged in risky behavior even when not drinking

You were in a very bad mood

You overestimated your skills and what you could do or how important you are

If you want to explain something you have checked by describing it more, then write it here:

This part of the questionnaire has to do with problems y ou may have with learning and attention. Circle items that apply .

When listening in class or at work, your mind repeatedly drifts off, or loses focus, missing cues or information you want to get

Excessive difficulty getting started on tasks, e.g. homework, contacting people.

Keep noticing your mind frequently drifts when you read

Pastel backgrounds irritate you (trick question to catch over-endorsers)

Often are easily distracted or sidetracked, disrupt a task in progress and switch to doing something else which is less important

You have difficulty in comprehending and retaining things so you must read things many times over and over before you can commit them to memory or put the ideas together in your mind. You do this so much it takes you much more time to study.

Forgetful in daily activities like turning off appliances, getting things at the store, returning phone calls, keeping appointments, paying bills, doing assignments

Were born left handed and your parents made you change to use your right (trick question)

So scattered you’re late for friends, forget appointments, lose track of your money

Seem more impulsive than other people

Crawled later than other kids did

Do not finish things

Seem to always be moving or feel the need to move, tap, twist, wiggle

Friends often ask you if you are listening to them

Do not follow through with instructions

Frequently avoid tasks that require a lot of mental effort

Are always losing thing

Frequently are over-talkative

May blurt out things before thinking

Interrupt others who are talking

Have difficulty waiting in lines

Are a restless sleeper, kick your bedmate, or throw the covers off

Grind your teeth

Simply must study or work in a quiet setting because you are easily distracted otherwise

Need to have noise in the background

Nervous thoughts repeatedly interrupt you when you try to read

Have family members who struggle with similar symptoms in school

Pick just one:

Looking back at it now, you wonder if you may have had these symptoms all your life but are just noticing them now because school or work is harder

You are sure you clearly had these symptoms as a child and others noticed them

These symptoms became a problem first in middle or high school

You first noticed these symptoms only after a time when you became depressed or anxious or were injured

Haven’t noticed these symptoms before now