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The questionnaire below is intended for the individual who has ADHD/ADD. If you are the spouse of someone who has ADHD, you can fill out this questionnaire instead.

Looking to be diagnosed?

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Marital Impact Checklist : Spouse with ADHD fills this out

Are you currently in couples therapy?
Type of ADHD you have

Statement 1:

I don't respond when spoken to

1. Do you do this?
1.1 Does this make your spouse feel unloved, unimportant, or ignored?
1.2 How negatively does this impact your marriage?

Statement 2:

I "zone" out of conversations

2. Do you do this?
2.1 Does this make your spouse feel unloved, unimportant, or ignored?
2.2 How negatively does this impact your marriage?

Statement 3:

I don’t remember being told things

3. Do you do this?
3.1 Does this make your spouse feel unloved, unimportant, or ignored?
3.2 How negatively does this impact your marriage?

Statement 4:

 

I have difficulty making eye

contact during conversations

4. Do you do this?
4.1 Does this make your spouse feel unloved, unimportant, or ignored?
4.2 How negatively does this impact your marriage?

Statement 5:

I don’t finish household projects

5. Do you do this?

Statement 6:

I am chronically late

6. Do you do this?
5.1 Does this make your spouse feel unloved, unimportant, or ignored?
5.2 How negatively does this impact your marriage?
6.1 Does this make your spouse feel unloved, unimportant, or ignored?
6.2 How negatively does this impact your marriage?

Statement 7:

I take on too many commitments

7. Do you do this?
7.1 Does this make your spouse feel unloved, unimportant, or ignored?
7.2 How negatively does this impact your marriage?

Statement 8:

I try to do too much in a short time

8. Do you do this?
8.1 Does this make your spouse feel unloved, unimportant, or ignored?
8.2 How negatively does this impact your marriage?

Statement 9:
 

I under-estimate the time needed to complete a task

9. Do you do this?
9.1 Does this make your spouse feel unloved, unimportant, or ignored?
9.2 How negatively does this impact your marriage?

Statement 10:
 

I pay bills late

10. Do you do this?
10.1 Does this make your spouse feel unloved, unimportant, or ignored?
10.2 How negatively does this impact your marriage?
How many people will be present?
Choose a time

Thanks for submitting! You do not need to do anything. You will get an appointment with a link within 24 hours!

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