Attention Questionnaire 3u452c

ATTENTION QUESTIONNAIRE Please answer the following questions about your attention as it applies to daily functioning by ticking the box which offers the best description. I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII.

Seem to lack mental energy to do activities. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Am slow to respond when asked a question or when participating in conversations. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Can’t keep mind on activity or thought because mind keeps wandering. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Can’t keep mind on activity or thought because mind feels “spacey” or “blank”. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Can only concentrate for very short periods of time. Miss details or make mistakes because level of concentration decreased. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Easily get off track if other people milling about nearby. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Easily distracted by surrounding noise. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Trouble paying attention to conversation, if more than one other person. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Easily lose place if task or thinking interrupted. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Easily overwhelmed if task has several components. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree Difficult to pay attention to more than one thing at a time. 1. Strongly disagree ; 2. Disagree; 3. Neutral; 4. Agree; 5. Strongly agree