- What You Should Know
- What to Expect
- What You Can Do

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Life with ADHD presents unique challenges — the first of which is understanding the impact and implications of living with ADHD for you, your family and your future. Knowing what to expect, and what your options are, is an important first step toward a successful life with ADHD. To start you on that path, Shire has compiled the ADHDefined Series, a collection of informative booklets covering ADHD across various ages and aspects of daily life including:

Choose from the following (You may download all 3):

	ADHD in adults—A guide to ADHD in adults and its treatment
	ADHD roadmap to success—A 4-step guide to help your child succeed
	Your child’s classroom rights—A guide to the educational rights of children with ADHD

You’ll also receive ongoing ADHD information from Shire, including information about treatment options.

All personal information you provide will be kept completely private and will not be used or distributed to anyone for any purpose other than what is explained here. View our full privacy policy.

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*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State:	State AK - Alaska AL - Alabama AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming
*ZIP Code:
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*Email :
*Date of birth of the person with ADHD:	MM January February March April May June July August September October November December DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
*Gender of the person with ADHD:	Gender Male Female

*1. Have you or your child been diagnosed with ADHD by a healthcare professional? Yes No

*2. Have you or your child ever taken prescription medication for ADHD? Yes No

*3. Are you or your child currently taking prescription medication for ADHD? Yes No

*4. Which of the following prescription medications are you or your child currently taking for ADHD? Adderall XR® Amphetamine (short-acting) Concerta® Daytrana™ Focalin® XR Guanfacine or Clonidine Metadate™ CD Methylphenidate (short-acting) Ritalin® Ritalin LA® Strattera® Vyvanse™ Wellbutrin® Other None *5. Which of the following other prescription medications are you or your child currently taking for ADHD? Adderall XR® Amphetamine (short-acting) Concerta® Daytrana™ Focalin® XR Guanfacine or Clonidine Metadate™ CD Methylphenidate (short-acting) Ritalin® Ritalin LA® Strattera® Vyvanse™ Wellbutrin® Other None *6. How long have you or your child been taking this prescription medication? Less than 4 months Between 4 months and 1 year Longer than 1 year Unsure *7. How satisfied are you with your or your child’s current treatment for ADHD? Very satisfied Satisfied Somewhat dissatisfied Dissatisfied Please rate the following statements by selecting one of the opinions beneath each statement. 8. Previously, I or my child tried medications for ADHD, but stopped because they weren’t worth the trouble. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree 9.  I do not believe in administering medication for ADHD to myself or my child every day. It’s better to take a break on the weekends. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree 10. I am likely to ask my physician about new treatments for ADHD in the next 3 months. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

Please rate the following statements by selecting one of the opinions beneath each statement. 3. I am likely to ask my physician about new treatments for ADHD in the next 3 months. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Please rate the following statements by selecting one of the opinions beneath each statement. 4. Previously, I or my child tried medications for ADHD, but stopped because they weren’t worth the trouble. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree 5. I do not believe in administering medication for ADHD to myself or my child every day. It’s better to take a break on the weekends. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree 6. I am likely to ask my physician about new ADHD/ADD treatments in the next 3 months. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

Adderall XR® is a registered trademark of Shire LLC. Daytrana™ is a trademark of Shire Pharmaceuticals Ireland Limited. Vyvanse™ is a trademark of Shire LLC. All other product names are the trademarks of their respective companies.