A Self-Reflection Worksheet

This worksheet is not a diagnostic tool. It is designed to help you notice patterns that you can discuss with your therapist or healthcare provider.

Part 1: What's Bringing Me Here?

What symptoms made you begin wondering about ADHD or anxiety?

Part 2: When I Can't Focus...

Think about the last few times you had trouble concentrating.

What usually happens first?

☐ I begin worrying.

☐ I get distracted by other thoughts.

☐ I feel overwhelmed.

☐ I don't know where to start.

☐ I lose interest.

☐ I become afraid I'll do it wrong.

☐ Something else:

My thoughts usually sound like:

Anxiety

☐ What if I fail?

☐ What if I forget?

☐ What if people judge me?

☐ I need to get this perfect.

☐ I can't stop worrying.

OR

ADHD

☐ Oh! I just remembered something else.

☐ I'll do this after one more thing.

☐ Wait...what was I doing?

☐ My brain jumped somewhere else.

☐ I know what I need to do, I just can't get started.

Part 3: My Procrastination

When I put things off, it's usually because...

(Check all that apply.)

Fear-Based

☐ I'm afraid I'll mess it up.

☐ I don't know enough.

☐ I don't want to disappoint someone.

☐ It feels overwhelming.

☐ I keep waiting until I feel "ready."

Executive Function-Based

☐ I genuinely forget.

☐ I lose track of time.

☐ I don't know where to begin.

☐ I get distracted.

☐ Another task grabs my attention.

☐ I underestimate how long it will take.

Part 4: My Thoughts

When my mind is busy, it usually looks like...

Mostly Anxiety

☐ Replaying conversations

☐ Worrying about the future

☐ Thinking of worst-case scenarios

☐ Trying to prevent mistakes

☐ Constant planning

Mostly ADHD

☐ Random ideas

☐ Songs

☐ Memories

☐ New projects

☐ Multiple thoughts at once

☐ My mind changes subjects quickly

Part 5: My Daily Life

Rate how often these happen.                             Never           Sometimes          Often           Very Often

I lose things.                                                                ☐                        ☐                      ☐                       ☐

I miss deadlines.                                                         ☐                        ☐                      ☐                       ☐

I avoid things because I'm anxious                          ☐                        ☐                      ☐                       ☐

I feel overwhelmed by simple tasks                        ☐                        ☐                      ☐                       ☐

I interrupt people                                                       ☐                        ☐                      ☐                       ☐

I replay conversations                                               ☐                        ☐                      ☐                       ☐

I forget appointments                                               ☐                        ☐                      ☐                       ☐

I constantly worry                                                      ☐                        ☐                      ☐                       ☐

I start projects but don't finish them                      ☐                        ☐                      ☐                       ☐

I feel restless inside                                                   ☐                        ☐                      ☐                       ☐

Part 6: Looking Back

Thinking about childhood...

Were these experiences present before age 12?

☐ Frequently forgot things

☐ Daydreamed often

☐ Couldn't sit still

☐ Easily distracted

☐ Constantly worried

☐ Needed lots of reassurance

☐ Perfectionistic

☐ Frequently lost belongings

☐ Teachers said I wasn't working up to my potential

☐ None of these

Part 7: Which Fits Me Better?

When I make mistakes...

☐ I mostly feel embarrassed or ashamed.

☐ I usually didn't notice until later.

☐ Both.

When I have a deadline...

☐ I worry about it for days.

☐ I forget until the last minute.

☐ Both.

When I have free time...

☐ I worry about everything I should be doing.

☐ I accidentally spend hours doing something else.

☐ Both.

When someone gives me instructions...

☐ I worry I'll misunderstand.

☐ I forget part of what they said.

☐ Both.

Part 8: Strengths

Sometimes our greatest strengths provide important clues.

I tend to be...

☐ Creative

☐ Highly empathetic

☐ Curious

☐ Detail-oriented

☐ Great under pressure

☐ Good at solving problems

☐ Deep thinker

☐ Passionate about my interests

☐ Organized

☐ Compassionate

Other strengths:

Reflection

After completing this worksheet...

What patterns do you notice?

What surprised you?

What questions do you still have?

Remember

Many people experience symptoms of both ADHD and anxiety, and one can influence the other. This worksheet isn't meant to provide a diagnosis. Instead, it's a way to organize your observations and start a meaningful conversation with a qualified mental health professional.

Next Steps

If these patterns have been affecting your work, relationships, school, or daily life, consider seeking a comprehensive evaluation. Understanding why you're struggling is often the first step toward finding strategies that truly fit how your brain works.