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Therapist Front Page
For licensed clinicians and supervised associates

Adult inattention: a differential walkthrough

For an adult whose main concern is focus, follow-through, or disorganization. Eight steps from history to a worksheet of considerations to explore, rule-outs still open, and next steps. It organizes the questions. It does not output a diagnosis.

For licensed clinicians and supervised associates. These tools are not diagnostic instruments and are not a substitute for clinical judgment or formal assessment. They organize the questions; you make the clinical decisions, within your license and scope of practice, and with supervision if you are an associate. Diagnostic criteria live in the DSM-5-TR and ICD-11; check them directly. Nothing you enter is sent anywhere or saved, and refreshing the page clears it. Please don’t enter names or other identifying client information.

Step 1 of 8
Step 1 of 8

Presenting concern and onset

What brought the person in, and how far back it goes. Childhood onset, more than one setting, and the course over time all shape what else needs ruling out.

Main concerns described

Select all that apply, in the client’s own framing where you can.

Evidence of attention difficulties in childhood
Where that childhood picture comes from
Settings where it shows up now
Course over time
Recent changes in structure or load

A new demand can reveal a long-standing difficulty, or create a new one. Both are worth knowing.

Manual check. The DSM-5-TR and ICD-11 each set out their own expectations about onset, persistence, and how many settings are involved. This walkthrough does not restate them; check the manual’s wording directly.

Step 2 of 8

Impairment domains

How much the difficulty is costing the person right now, and what they are doing to hold it together.

Current impact by domain

Rate each from what you know so far. “Not yet asked” keeps it on the open list.

Work or academic performance
Home, chores, and daily admin
Money, bills, and paperwork
Relationships and family
Driving and personal safety
Health self-care (appointments, medications)
Self-esteem and emotional load
Compensations in place

Strong supports can hide how much effort functioning takes. Ask what happens when they fall away.

Step 3 of 8

Rule-outs and contributors

Things that can produce or worsen attention problems on their own. Anything left at “Not yet asked” shows up on the summary as an open rule-out.

Ask and refer. Medical items are for noticing and referring to the client’s primary care clinician or prescriber, not for ordering labs or adjusting medication.

Medical

Ask and refer. Physical causes belong with the client’s primary care clinician or prescriber; this step is about noticing them, not working them up.

Thyroid changes
Anemia or low iron
Vitamin B12 or other nutritional deficiency
Head injury or concussion history
Seizure history
Hormonal transitions (perimenopause, postpartum, other)
Recent or lingering illness, including post-viral symptoms
Chronic pain
Uncorrected hearing or vision problems

Sleep

Sleep loss and sleep disorders can look a lot like distractibility. Ask about a typical night and a typical day off.

Less sleep than this person needs
Insomnia (trouble falling or staying asleep)
Snoring, gasping, or witnessed pauses in breathing
Irregular or shifted schedule, including shift work
Restless or uncomfortable legs at night
Daytime sleepiness, including while driving

Substances and medications

Ask about timing: what focus is like on days with and without use, and around any medication change.

Alcohol
Cannabis
Stimulants used without a prescription
Heavy caffeine or energy drinks
Sedatives or sleep aids
Opioids
Medications with known cognitive side effects (for example, some antihistamines, anticholinergics, or anticonvulsants)
A recent start, stop, or dose change
Withdrawal or between-use effects

Life load

Load is not a diagnosis, but it changes how much attention anyone has left over.

Caregiving load
Work overload or constant interruptions
Financial strain
Grief or a major loss
Relationship conflict
Safety concerns at home
Heavy notification or screen load
Step 4 of 8

Differential prompts

Other explanations for the same complaints, and conditions that often travel alongside attention difficulties. More than one can be true at once.

Co-occurrence is common. “Likely co-occurring” means it may be present as well as, not instead of, an attention difficulty. Mark it that way rather than forcing an either-or.

Depression

Look for: Concentration that drops along with low mood, loss of interest, slowed thinking, or changes in sleep and appetite.

Ask: “Was attention noticeably better before, or between, the low stretches?”

Why it matters: Concentration complaints are common in depressive episodes and often ease as mood lifts.

Anxiety

Look for: Worry or tension that takes up mental bandwidth; attention that is better when the person is calm.

Ask: “When you can’t focus, what is your mind doing instead?”

Why it matters: Avoidance driven by fear of getting it wrong can look like procrastination.

Trauma and PTSD

Look for: Hypervigilance, intrusive memories, a strong startle, zoning out or dissociation, and an onset after a traumatic event or period.

Ask: “Did the focus problems start or get worse after something hard happened?”

Why it matters: Check current safety before going deeper, and pace the questions.

Bipolar spectrum

Look for: Distinct stretches with much less need for sleep, unusual energy, racing thoughts, fast speech, or risky choices that differ from the person’s usual self.

Ask: “Have there been runs of days when you slept far less than usual and didn’t feel tired?”

Why it matters: Episodic versus lifelong is the key contrast. Family history of mood disorders matters, and so does any medication conversation the prescriber has.

Substance effects

Look for: Attention that shifts with use, intoxication, withdrawal, or the day after.

Ask: “What is focus like on days you don’t use?”

Why it matters: Regular alcohol or cannabis use can blur the picture. Any change in use where withdrawal is a risk should be planned with medical input.

Sleep disorders

Look for: Snoring, witnessed pauses, unrefreshing sleep, chronic short sleep, or a body clock that runs late.

Ask: “How rested do you feel on a day off after a full night in bed?”

Why it matters: Sleepiness and distractibility overlap. Primary care or sleep medicine can sort out which is which.

Learning differences

Look for: Difficulty concentrated in reading, writing, or math, with attention closer to typical in other kinds of work.

Ask: “Is it hard to focus on everything, or mainly on certain kinds of tasks?”

Why it matters: Academic history and work samples help; clarifying this usually needs formal testing by a qualified assessor.

Autism

Look for: Lifelong differences in social communication, a strong need for predictability, sensory sensitivity, intense focused interests, and exhaustion after masking.

Ask: “Is focus hard everywhere, or mostly when things are loud, unpredictable, or socially demanding?”

Why it matters: Autism and attention difficulties can occur together; one does not rule out the other.

Cognitive or neurological

Look for: New onset in mid or later life, memory loss beyond everyday forgetting, word-finding trouble, changes other people notice, head injury, or new neurological symptoms.

Ask: “Is this different from how your mind has worked for most of your life?”

Why it matters: New cognitive change calls for medical and possibly neurological evaluation before an attention explanation is settled on.

Step 5 of 8

Collateral

Other people and records often fill in the childhood history and the cross-setting picture that self-report alone can miss.

Sources

Get written authorization before contacting anyone or requesting records.

Partner or spouse
Parent, sibling, or someone who knew them as a child
School records or report cards
Work feedback or performance reviews
Records from earlier treatment
Earlier psychological or neuropsychological evaluation reports
Primary care records or recent labs
Step 6 of 8

Screening instruments to consider

Names and official sources only. No items are reproduced here; get each instrument from its publisher and follow its terms.

Screens are not diagnoses. A high attention score can come from depression, anxiety, trauma, or sleep loss, so read results alongside the rule-outs. Confirm that an instrument is within your scope of practice and your setting’s policies, and check the publisher’s current licensing and training terms before using it.

ASRS v1.1 (Adult ADHD Self-Report Scale)

Self-report of current adult attention and hyperactivity symptoms. There is a short screener and a longer symptom checklist.

WHO ASRS validation paper: Kessler et al. (2005), Psychological Medicine, doi.org/10.1017/S0033291704002892. The official form is distributed by Harvard Medical School's National Comorbidity Survey (hcp.med.harvard.edu, which was returning errors on Oct 26, 2026). Use the official form unaltered and check its current permission terms.

DIVA-5 (Diagnostic Interview for ADHD in adults)

A structured clinician interview covering childhood and adult symptoms and impairment.

DIVA Foundation: divacenter.eu. The foundation does not allow changes or adaptations without its written approval, and it lists training options.

PHQ-9

Self-report of depressive symptom severity.

phqscreeners.com

GAD-7

Self-report of anxiety symptom severity.

phqscreeners.com

PC-PTSD-5

A brief trauma and PTSD screen designed for primary care.

National Center for PTSD (U.S. VA): ptsd.va.gov

PCL-5

A longer self-report of PTSD symptoms.

National Center for PTSD (U.S. VA): ptsd.va.gov

MDQ (Mood Disorder Questionnaire)

A screen for lifetime bipolar-spectrum symptoms.

Published with Hirschfeld et al. (2000), American Journal of Psychiatry; see the references.

AUDIT

A screen for hazardous and harmful alcohol use.

World Health Organization manual (2nd ed., 2001): who.int

Epworth Sleepiness Scale

Self-report of daytime sleepiness.

Official site: epworthsleepinessscale.com. The site states that a license is required, with fees for some users.

STOP-Bang

A brief screen for obstructive sleep apnea risk, mostly used in medical settings.

Chung et al. (2008), Anesthesiology; see the references. A positive screen points to primary care or sleep medicine.

AQ-10 (adult)

A brief screen for autistic traits.

Autism Research Centre, University of Cambridge: autismresearchcentre.com. The centre states its tests are not diagnostic and sets terms of use.

MoCA (Montreal Cognitive Assessment)

A brief screen for cognitive impairment.

Official site: mocacognition.com. The site states that training is required to give the paper version.

For drug use beyond alcohol, use the screen your setting already relies on.

Step 7 of 8

Referral and next steps

Where the next piece of information should come from.

When to refer for formal psychological testing (by a qualified assessor)

Formal testing can clarify a picture an interview cannot. Select any reasons that apply; they carry into the summary.

Medical and other referrals to consider
For you
Step 8 of 8

Summary

A worksheet built from your answers: considerations to explore, rule-outs still open, and next steps. It is not a diagnosis.

Go deeper: clinician toolkits

Want this walkthrough as a printable workbook with treatment pathways? Mason’s own product; Therapist Front Page earns from these sales.

Clinician toolkit29-page PDF$29

The Attention Differential

A 29-page printable workbook for adult inattention: intake map, rule-outs, a ten-way differential grid, a formulation page, and ten treatment pathways with sources.

See what’s inside
Clinician toolkits

All clinician toolkits

One printable workbook per differential question, each taken from intake to a treatment plan. More topics are in development.

Browse the toolkits

Diagnostic criteria

This walkthrough deliberately does not restate diagnostic criteria. For the criteria themselves, use the DSM-5-TR (American Psychiatric Association) or ICD-11 code 6A05 and the WHO’s clinical descriptions and diagnostic requirements (CDDR). For assessment practice, see NICE NG87, the updated European consensus on adult ADHD, and the CADDRA guidelines listed below.

References

Guidelines, manuals, and the original papers for each instrument named above.

  1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). doi.org/10.1176/appi.books.9780890425787
  2. World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 6A05 Attention deficit hyperactivity disorder. icd.who.int
  3. World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. who.int/publications/b/68103
  4. National Institute for Health and Care Excellence. (2018, updated 2019). Attention deficit hyperactivity disorder: diagnosis and management (NICE guideline NG87). nice.org.uk/guidance/ng87
  5. Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., et al. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34. doi.org/10.1016/j.eurpsy.2018.11.001
  6. Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., et al. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818. doi.org/10.1016/j.neubiorev.2021.01.022
  7. Canadian ADHD Resource Alliance (CADDRA). (2020). Canadian ADHD Practice Guidelines (4.1 ed.). caddra.ca
  8. Kessler, R. C., Adler, L., Ames, M., Demler, O., et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256. doi.org/10.1017/S0033291704002892
  9. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. doi.org/10.1046/j.1525-1497.2001.016009606.x
  10. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. doi.org/10.1001/archinte.166.10.1092
  11. Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., et al. (2016). The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206-1211. doi.org/10.1007/s11606-016-3703-5
  12. Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498. doi.org/10.1002/jts.22059
  13. Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., Calabrese, J. R., et al. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875. doi.org/10.1176/appi.ajp.157.11.1873
  14. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test. Guidelines for use in primary care (2nd ed.). World Health Organization. who.int
  15. Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep, 14(6), 540-545. doi.org/10.1093/sleep/14.6.540
  16. Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., et al. (2008). STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812-821. doi.org/10.1097/ALN.0b013e31816d83e4
  17. Allison, C., Auyeung, B., & Baron-Cohen, S. (2012). Toward brief “red flags” for autism screening: the Short Autism Spectrum Quotient and the Short Quantitative Checklist in 1,000 cases and 3,000 controls. Journal of the American Academy of Child & Adolescent Psychiatry, 51(2), 202-212.e7. doi.org/10.1016/j.jaac.2011.11.003
  18. Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. doi.org/10.1111/j.1532-5415.2005.53221.x

For licensed clinicians and supervised associates. Not a diagnostic instrument. Not a substitute for clinical judgment or formal assessment. Nothing entered here is sent or saved.

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