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Q.1
Do you feel overwhelmed in stores, at the office, or at parties?
*
Yes - frequently
Sometimes
No – never
Q.2
Does time, money, paper, or "stuff" dominate your life and hamper your ability to achieve your goals?
*
Yes - frequently
Sometimes
No – never
Q.3
Do you shut down in the middle of the day, feeling assaulted?
*
Yes - frequently
Sometimes
No – never
Q.4
Do you feel like you are "passing for normal," but you are really an impostor?
*
Yes - frequently
Sometimes
No – never
Q.5
Do you hesitate to have people over to your house because you’re ashamed of the mess?
*
Yes - frequently
Sometimes
No – never
Q.6
Do you have trouble balancing your checkbook?
*
Yes - frequently
Sometimes
No – never
Q.7
Do you feel as if life is out of control, and that it's impossible to meet demands?
*
Yes - frequently
Sometimes
No – never
Q.8
Do you feel like you're always at one end of a deregulated activity spectrum — either a couch potato or a tornado?
*
Yes - frequently
Sometimes
No - never
Q.9
Do you feel that you have better ideas than other people but are unable to organize them or act on them?
*
Yes - frequently
Sometimes
No – never
Q.10
Do you start the day determined to get organized, and end the day feeling defeated?
*
Yes - frequently
Sometimes
No – never
Q.11
Do you watch others of equal intelligence and education pass you by?
*
Yes - frequently
Sometimes
No – never
Q.12
Do you despair of ever fulfilling your potential and meeting your goals?
*
Yes - frequently
Sometimes
No – never
Q.13
Have you ever been thought of as selfish because you don't write thank-you notes or send birthday cards?
*
Yes - frequently
Sometimes
No - never
Q.14
Are you clueless as to how others manage to lead consistent, regular lives?
*
Yes - frequently
Sometimes
No – never
Q.15
Are you called "a slob" or "spacey?"
*
Yes - frequently
Sometimes
No – never
Q.16
Is your time and energy taken up with coping, staying organized, and holding it together, with no time for fun or relaxation?
*
Yes - frequently
Sometimes
No – never
Q.17
Is it impossible for you to shut out sounds and distractions that don't bother others?
*
Yes - frequently
Sometimes
No - never
Q.18
Do requests for "one more thing" at the end of the day put you over the top emotionally?
*
Yes - frequently
Sometimes
No - never
Q.19
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