Date:_____________ ID:__________

Adult Concentration Inventory (ACI)

INSTRUCTIONS: Please circle how much you feel each sentence is true for you in the past six months.

Not at all Sometimes Often Very Often

1 I am slow at doing things. 0 1 2 3

2 My mind feels like it is in a fog. 0 1 2 3
3 I stare off into space. 0 1 2 3
4 I feel sleepy or drowsy during the day. 0 1 2 3

5 I daydream. 0 1 2 3

6 I lose my train of thought. 0 1 2 3

7 I am not very active. 0 1 2 3

8 I get lost in my own thoughts. 0 1 2 3

9 I get tired easily. 0 1 2 3

10 I forget what I was going to say. 0 1 2 3

11 I feel confused. 0 1 2 3

12 I am not motivated to do things. 0 1 2 3

13 I zone out or space out. 0 1 2 3

14 My mind gets mixed up. 0 1 2 3

15 My thinking seems slow or slowed down. 0 1 2 3

I have a hard time putting my thoughts
16 0 1 2 3
into words.

How much difficulty do these behaviors cause in your…

No Minimal Some Moderate Severe Not
Difficulty Difficulty Difficulty Difficulty Difficulty Applicable
17 Work or job. 0 1 2 3 4 n/a
18 Schooling or educational activities. 0 1 2 3 4 n/a
19 Relationships with friends. 0 1 2 3 4 n/a
20 Relationships with romantic partners. 0 1 2 3 4 n/a

21 Parenting. 0 1 2 3 4 n/a

22 Organization of daily life. 0 1 2 3 4 n/a

Daily self-care (e.g., bathing/hygiene,
23 0 1 2 3 4 n/a
exercise, eating).
24 Ability to get a good night’s sleep. 0 1 2 3 4 n/a

Becker, S. P., Burns, G. L., & Willcutt, E. G. (2015). Adult Concentration Inventory (ACI). Cincinnati, OH: Author.