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1. A.D.H.D SURVEY FORM
Personal details
NAME: __________________________ AGE: ____________ GENDER: MALE/ FEMALE
Please spare a fewminutesof your time to answer some questionsabout A.D.H.D disease.
The informationyou provide,includingyour name and age, for thissurvey will remain
confidential andwill be usedsolelyfor research purposes only.
1. Is the full abbreviationof A.D.H.D, AttentionDeficitHyperactive Disorder?
 Yes
 No
2. Are there any differencesbetweenA.D.H.DandAttentionDeficit Disorder?
 Yes
 No
3. What disorderisA.D.H.D?
 Psychiatric/Mental disorder
 Physical disorder
4. Is A.D.H.Dgenetic?
 Yes
 No
5. Is A.D.H.Dinfectious?
 Yes
 No
6. How manytypesof A.D.H.Ddiseases are there?
 1
 2
 3
7. Who can be diagnosedA.D.H.D.?
 Children
 Adults
 ElementarySchool Kids
 All of the above

2. 8. Is A.D.H.Ddifferentingirlsfromguys?
 Yes
 No
9. What are the symptomsof A.D.H.D?
 Inattention
 Impulsiveness
 Hyperactive
 All of the above
10. Do childrenandadultshave the similarA.D.H.D.symptoms?
 Yes
 No
11. Whendo the symptomsforA.D.H.Dnormallyoccur?
 Childhood
 Oldage
 Adulthood
 All of the above
12. What are the causes of A.D.H.D?
 Brain injury
 Environmentexposure
 Premature deliver
 All of the above
13. How does A.D.H.Daffectthe suffererof thisdisorder?
 Low-self-esteem
 Developmentof addictivedisorders(e.g.drugs)
 Social Anxiety
 All of the above
14. Is there anycure forA.D.H.D?
 Yes
 No
15. Is A.D.H.Dcausedby badparenting?
 Yes
 No