Do I Have ADHD? A Clinician's Self-Assessment Guide

The Lineage Behind This Guide

The modern clinical framework for ADHD assessment rests on three generations of work. Russell Barkley's behavioral inhibition theory established the cognitive-behavioral substrate of the disorder in the 1980s and 1990s — ADHD as a failure of self-regulation rooted in executive function, not as a deficit of attention narrowly defined. The pharmacoepidemiologic and comorbidity work of Joseph Biederman at Massachusetts General Hospital, Timothy Wilens at Harvard, and Mark Olfson at Columbia translated that framework into population-scale data on prevalence, treatment, comorbidity, and outcomes across the lifespan. The Sultan Lab for Mental Health Informatics at Columbia continues that translation — Sultan, Liu, Hacker, and Olfson (2019, JAMA Network Open, 2:e197850; 440+ citations) established the antipsychotic-before-stimulant prescribing pattern in U.S. youth, and Sultan, Saunders, and Veenstra-VanderWeele (2025, JAMA Psychiatry) characterized the real-world functional outcomes of stimulant treatment. This guide reflects that lineage. The diagnostic logic below is what the field has consolidated, not what a single quiz has captured.

The Gap Stated as Mechanism

Most adults wondering whether they have ADHD have lived for decades with patterns that compensated until the demands of work, relationships, or parenting exposed the underlying executive function load. The compensations are familiar — last-minute panic as a substitute for planning, hyperfocus on novel projects, caffeine as cognitive scaffolding, jobs chosen for stimulation rather than career structure, partners who manage logistics. The compensations work until the load increases. Promotion adds administrative complexity. A child arrives. A parent develops a medical condition. The remote-work transition removes the external structure that a commute and an office had been providing. The compensations fail, and the failure feels new — but the underlying pattern is not new.

The question "Do I have ADHD?" is structurally a question about whether a clinical evaluation is warranted. It is not a question a quiz can answer, because the question is not whether a specific symptom is present in isolation but whether the pattern of symptoms, the developmental history, the functional impairment, and the differential conditions taken together meet the threshold for a clinical diagnosis. That work is what evaluation is for. The self-screen exists to identify when evaluation is warranted — not to substitute for it.

The DSM-5-TR Diagnostic Criteria in Plain Language

The DSM-5-TR (2022) criteria for ADHD are operational. They specify what is required for diagnosis, and they specify what is not. The criteria are structured around two symptom domains — inattentive and hyperactive-impulsive — each with nine specific symptoms. The cut-points and contextual requirements are different for children and adults.

Criterion	What It Requires	Clinical Implication
Inattention symptom count	Six of nine inattentive symptoms in children under 17; five of nine in adolescents 17+ and adults	The adult threshold is lower because symptom expression attenuates with age; functional impairment does not
Hyperactive-impulsive symptom count	Six of nine in children under 17; five of nine in adolescents 17+ and adults	Adult presentation often features mental restlessness, internal driven quality, and impulsive decision-making rather than overt motor hyperactivity
Age of onset	Several inattentive or hyperactive-impulsive symptoms present before age 12	Onset criterion — not all symptoms required by age 12, but the disorder must be developmentally rooted, not acquired in adulthood
Cross-setting persistence	Symptoms present in two or more settings (work, home, school, social, relationships)	Excludes situation-specific presentations driven by a single stressor or environment
Functional impairment	Clear evidence that symptoms reduce or interfere with quality of social, academic, or occupational functioning	Symptoms without impairment do not constitute a disorder — diagnosis requires measurable functional cost
Exclusion	Symptoms not better explained by another mental disorder — psychotic disorder, mood disorder, anxiety, dissociative disorder, personality disorder, substance intoxication or withdrawal	The differential is the clinical work — symptom overlap with other conditions is the rule, not the exception
Presentation specifier	Predominantly inattentive, predominantly hyperactive-impulsive, or combined presentation — based on current symptom profile	Presentation can shift across the lifespan — combined in childhood often becomes inattentive-predominant in adulthood
Severity specifier	Mild, moderate, or severe — based on symptom count beyond threshold and degree of functional impairment	Severity guides treatment intensity and prognostic expectations

These criteria are what a clinician applies in evaluation. The patient supplies the data — current symptoms, childhood history, functional cost, prior workups. The clinician applies the framework, including the differential, and arrives at a diagnosis that is accountable to specific evidence rather than a general impression. The complete pillar treatment of these criteria with examples is at the ADHD Guide and the broader treatment context is at ADHD Pharmacology and Natural Course.

The ASRS v1.1 — What It Is, What It Tells You, What It Does Not

The Adult ADHD Self-Report Scale version 1.1 (ASRS) is the World Health Organization screening instrument developed in collaboration with the U.S. National Comorbidity Survey replication. It was established by Kessler, Adler, Ames, Demler, Faraone, Hiripi, Howes, Jin, Secnik, Spencer, Ustun, and Walters in their foundational paper — Kessler et al. (2005, Psychological Medicine, 35:245-256). The ASRS is 18 items mapped to the DSM symptom set, but the validated screening core is the six-item Part A.

The Part A six items are weighted because of differential performance during validation — four items have higher discriminative power and are scored if the response falls in the shaded threshold range, regardless of whether the response is "sometimes," "often," or "very often." Endorsement of four or more of the six items places the screen in the positive range.

The performance characteristics of ASRS Part A against a structured clinical interview as the gold standard are specific. Sensitivity is 68.7%. Specificity is 99.5%. Concordance with the clinical interview is 97.9%. These numbers are favorable for a six-item screen. They do not make the ASRS a diagnostic instrument — they make it a calibrated front door to evaluation.

The complete treatment of the ASRS alongside the parallel pediatric instruments is at ADHD Assessment Tools — Vanderbilt, Conners, SNAP, ASRS. The current site self-screen for adults is at the ADHD quiz. A positive ASRS-style result is the signal to seek evaluation. It is not the diagnosis itself, and the evaluation that follows is not optional if the goal is treatment.

The Vanderbilt and SNAP-IV — For Children

The pediatric assessment landscape is parallel but distinct. The NICHQ Vanderbilt Assessment Scales — developed under the American Academy of Pediatrics National Initiative for Children's Healthcare Quality — are the most widely used multi-informant pediatric ADHD screens in U.S. primary care. The Vanderbilt has a parent version and a teacher version. Both versions are necessary because DSM requires symptoms across two or more settings, and the teacher version captures the school-based observations a parent cannot provide directly.

The SNAP-IV — Swanson, Nolan, and Pelham — is the parallel research-grade rating scale used in the landmark Multimodal Treatment of ADHD (MTA) study and in much of the subsequent ADHD treatment literature. The SNAP-IV is symptom-mapped to DSM and has parent, teacher, and self-report versions for older children.

The Conners rating scales provide a third widely used pediatric option with strong psychometric properties and broader behavioral coverage beyond ADHD-specific symptoms. The full comparative treatment of these instruments — what each measures, what the cut-points are, and how to interpret discordance between parent and teacher reports — is at ADHD Assessment Tools. For children, no single self-report is sufficient — multi-informant assessment is the standard. The pediatric-specific consultation pathway is at Ask Dr. Sultan — ADHD in Children.

Online ADHD Tests — What They Actually Do

The distinction between sensitivity and positive predictive value is the core statistical issue with population-level screening. Sensitivity is the probability that the test is positive given the disease is present. Specificity is the probability that the test is negative given the disease is absent. Positive predictive value (PPV) is the probability that the disease is present given a positive test — and PPV depends on prevalence in the population being tested.

Adult ADHD prevalence in the U.S. general population is 4.4% — established by Kessler, Adler, Barkley, Biederman, Conners, Demler, Faraone, Greenhill, Howes, Secnik, Spencer, Ustun, Walters, and Zaslavsky (2006, American Journal of Psychiatry, 163:716-723). With that base rate:

Screen Performance	Result at 4.4% Adult Prevalence	What This Means
Sensitivity 90%, Specificity 80%	PPV = 17.2%	Fewer than one in five positive results corresponds to true ADHD — high false-positive rate
Sensitivity 80%, Specificity 90%	PPV = 26.9%	Roughly one in four positives is a true case — improved by raising specificity, not sensitivity
ASRS Part A — 68.7% sensitivity, 99.5% specificity	PPV = 86.3%	High specificity is what gives the ASRS clinical utility — most positives are true cases at population base rate
Self-selecting population (e.g., adults seeking ADHD evaluation, ~30% prevalence)	PPV substantially higher across all screens	The act of seeking a quiz raises pre-test probability — screens perform better in the enriched population than in the general one

The implication is direct. A non-validated online ADHD test answers a different question than the ASRS. Non-validated quizzes are not calibrated against a structured clinical interview and have unknown sensitivity and specificity. The ASRS is the validated instrument, and even the ASRS is a screen — its purpose is to enrich the pre-test probability for the clinical evaluation that follows. The instrument is not the diagnosis. The instrument identifies who should be evaluated, and the evaluation answers the diagnostic question.

What a Positive Self-Screen Actually Means

A positive ASRS or a positive non-validated online ADHD test means one thing — the signal is strong enough to warrant clinical evaluation. The next step is a structured psychiatric evaluation. The structured evaluation accomplishes what the screen cannot: it applies the full DSM-5-TR criteria with developmental history and functional impairment evidence, it runs the differential against the conditions that produce overlapping symptoms, and it identifies the comorbidities that change treatment selection and sequence.

Self-recognition is clinically useful — it is the reason most adults present for evaluation, and it is what motivates persistence through a process that requires time and cost. Self-recognition is not diagnosis. The diagnostic threshold exists for a reason — to distinguish ADHD from the other conditions that produce similar functional impairment, and to identify what specifically needs to be treated. Treating presumed ADHD when the actual driver is severe sleep apnea, untreated depression, or unrecognized C-PTSD produces partial or no response and delays the correct intervention. The evaluation prevents that.

What an Evaluation Actually Involves

A psychiatric ADHD evaluation in an adult is a 60-90 minute structured clinical assessment. The pediatric version is longer — 90-120 minutes — because of the multi-informant requirement. The components are operational, not optional.

Developmental history. The clinician traces the symptom trajectory from earliest childhood forward. The questions cover early elementary school attention and behavior, middle school academic performance and organizational pattern, high school study habits and time management, college or work transitions, and current adult functioning. Report cards and any childhood psychoeducational testing are diagnostically informative if available. Parents or older siblings as collateral informants are valuable when available and willing.

DSM symptom assessment. The clinician walks through each of the nine inattentive and nine hyperactive-impulsive symptoms, asking for specific recent examples — not whether the patient identifies with a description, but whether the symptom is present in defined operational terms. Rating scales — ASRS, Conners Adult ADHD Rating Scale, or equivalent — are administered and scored.

Functional impairment specifics. Generalities are insufficient. The clinician documents specific costs — missed work deadlines and the consequences, financial difficulties traceable to disorganization or impulsivity, relationship strain with specific examples, safety events (driving incidents, accidents), academic underperformance relative to ability.

Comorbidity screening. Anxiety disorders, major depressive disorder, persistent depressive disorder, bipolar spectrum disorders, post-traumatic stress disorder, sleep disorders (especially obstructive sleep apnea and delayed sleep phase), substance use disorders, learning disorders, thyroid dysfunction, and trauma history are all assessed. The complete picture is at ADHD Comorbidity and Differential Diagnosis.

Differential diagnosis. The clinician systematically considers what else could produce the presenting symptom picture. The differential is the clinical work.

Functional baseline and treatment plan. A diagnosis without a plan is incomplete. The evaluation closes with a clear diagnostic statement, treatment recommendations, and a follow-up structure.

What Evaluation Does Not Require

Several diagnostic additions are sometimes proposed or marketed for ADHD evaluation but are not required for diagnosis in routine cases. State each clearly.

Brain scans. Structural MRI, functional MRI, SPECT, and PET have research utility for understanding ADHD-related brain differences at the group level. None of them has clinical diagnostic accuracy at the individual level — the brain differences associated with ADHD overlap substantially with neurotypical variation and with other conditions. The detailed treatment is at ADHD Brain Subtypes 2026. Brain scans are not part of standard ADHD evaluation and do not establish or refute the diagnosis.
Quantitative EEG (qEEG). Marketed in some commercial settings as an objective ADHD diagnostic. Independent validation does not support its use as a stand-alone diagnostic tool. It is not part of standard evaluation.
Genetic testing. ADHD is highly heritable — 70-80% by twin studies — but the genetic architecture is polygenic with hundreds of small-effect variants. No genetic test diagnoses ADHD. The detailed treatment is at ADHD Genetics and Heritability. Genetic testing is appropriate when ADHD presents with intellectual disability, dysmorphic features, or autism spectrum disorder, but not for typical adult ADHD evaluation.
Comprehensive neuropsychological testing for typical presentations. A 6-10 hour neuropsychological battery costs $2,500-$5,000 and is not required for routine adult ADHD diagnosis. It is appropriate when the clinical question is learning disorder, intellectual disability, or differential between ADHD and a primary neurocognitive condition — those are different clinical questions than "Does this adult have ADHD?"

Each of these additions inflates evaluation cost without adding diagnostic accuracy for the typical presentation. The accurate evaluation is the clinical one done by a trained psychiatrist applying DSM-5-TR criteria with full developmental history, rating scales, functional documentation, and differential diagnosis.

Differential Diagnosis — What Looks Like ADHD But Is Not

The differential is the clinical work. Each of the conditions below produces symptom signatures that overlap with ADHD — inattention, executive dysfunction, fatigue, irritability, low frustration tolerance, working memory failures. Each has its own evidence-based treatment that does not match ADHD treatment. Misidentification produces partial response, no response, or harm.

Obstructive sleep apnea. Untreated OSA produces daytime inattention, executive dysfunction, irritability, and concentration failure that is indistinguishable from inattentive-presentation ADHD on symptom report. CPAP treatment of OSA resolves the symptoms. The differential treatment is at ADHD vs. Sleep Apnea. Screening question — does the patient or partner report loud snoring, witnessed apneas, or non-restorative sleep — is part of every adult ADHD evaluation.
Trauma and C-PTSD. Complex post-traumatic stress disorder produces hypervigilance, dissociation, executive dysfunction, sleep disruption, and concentration failure. The pattern overlaps with ADHD in surface presentation but the underlying mechanism is different, and the treatment is different. The detailed differential is at ADHD vs. C-PTSD.
Perimenopause and menopause. Estrogen decline produces cognitive symptoms — brain fog, working memory failure, executive dysfunction — that frequently bring women in their 40s and 50s to ADHD evaluation. The hormonal contribution is real, and ADHD that was compensated for decades can decompensate in perimenopause. The differential and the overlap are at ADHD in Perimenopause and Menopause.
Thyroid dysfunction. Hypothyroidism and hyperthyroidism both produce cognitive symptoms. TSH is part of every adult ADHD workup.
Major depressive disorder. Concentration difficulty is a DSM criterion for major depression. Depression can mimic inattentive ADHD, and ADHD elevates lifetime risk of depression. Sequence of treatment matters.
Generalized anxiety disorder. Worry-driven cognitive load produces working memory failures and concentration difficulty. Anxiety and ADHD co-occur frequently; treating one improves the other but does not substitute for treating both when both are present.
Substance use disorders. Stimulant misuse, cannabis use, and alcohol use all produce cognitive and attentional symptoms. The bidirectional relationship between ADHD and substance use is real — treating ADHD reduces substance use risk, and active substance use complicates ADHD diagnosis.
Learning disorder. Specific learning disorders — dyslexia, dyscalculia, learning disorder with impairment in written expression — produce academic underperformance and frustration that can be mistaken for ADHD. The two co-occur frequently. Differentiation matters because accommodations and treatments differ.

The differential is what separates a clinical evaluation from a quiz. Treating presumed ADHD when the driver is one of the conditions above produces partial response, no response, or harm — and delays the correct intervention.

Special Populations

The "Do I have ADHD?" question presents differently in identifiable subgroups. The pattern recognition matters because the screening tools and the differential weight differently.

Women diagnosed late. Adult women, particularly those diagnosed in their 30s, 40s, and 50s, are the fastest-growing demographic in ADHD diagnosis. The childhood presentation was often inattentive without overt hyperactivity, did not produce classroom disruption, and went unrecognized. The detailed treatment is at ADHD in Women, ADHD in Women — Diagnosis, and Ask Dr. Sultan — ADHD in Women.

The gifted-kid masking pattern. Adults who tested into gifted programs and coasted through high school on raw cognitive horsepower frequently decompensate in college or in early career when the demands exceed what raw intelligence compensates for. The masking and the unmasking are at ADHD Masking and Unmasking.

High-achievers compensating until structure fails. Adults in structured high-performance environments — surgery, law, finance, military — frequently maintain function until a structural change removes the external scaffolding. The pattern is structural compensation followed by exposure when the structure changes.

Post-college decompensation. The transition from college — which provides structured schedules, syllabi, and clear evaluation cycles — to early career, which does not, exposes executive function gaps that academic settings had compensated for. The post-college years (ages 22-28) are a common diagnostic window.

The parent diagnosed alongside the child. A child's ADHD diagnosis frequently prompts a parent's recognition of their own undiagnosed ADHD. The genetic transmission rate — 40-50% per child if one parent is affected — makes this unsurprising. The detailed treatment is at ADHD Genetics and Heritability and the adult diagnostic pathway is at Adult ADHD Diagnosis.

Action Framework — From Suspicion to Evaluation

The operational sequence from self-recognition to evaluation is straightforward. Each step has a defined output.

Step	Action	Output	Timing & Cost
1	Complete a validated self-screen — the ASRS Part A six-item screen or equivalent	Positive or negative screen result; if positive, proceed to step 2	5-10 minutes; free
2	Document specific functional impairment — concrete examples in work, finances, relationships, safety	A written list of specific examples to bring to evaluation	1-2 hours; free
3	Gather developmental history sources — report cards, parental account, childhood records	Childhood corroborative data for the evaluating clinician	1-2 weeks; free
4	Rule out medical confounds with primary care — TSH, sleep evaluation, CBC, basic chemistry	Medical confound workup complete before psychiatric evaluation	2-4 weeks; covered by most insurance
5	Schedule psychiatric evaluation with a clinician experienced in adult ADHD	60-90 minute structured evaluation; diagnostic statement and treatment plan	2-6 weeks to schedule; $400-$1,200 self-pay, often reimbursable
6	If diagnosed, begin treatment per plan — medication, behavioral therapy, coaching, lifestyle	Treatment initiation; titration over 4-12 weeks	Ongoing; coverage varies
7	Follow-up structured monitoring — symptom rating scales, functional outcomes, side effects	Sustained treatment optimization	Monthly initially; then quarterly

The sequence is what evaluation looks like done well. The full guide to the consultation pathway is at ADHD Psychiatrist NYC, and the broader question-and-answer set is at Ask Dr. Sultan — ADHD, Ask Dr. Sultan — ADHD Medications, and the ADHD FAQ. The downstream stakes — what happens when ADHD goes untreated across decades — are at ADHD Untreated Adverse Outcomes and ADHD and Life Expectancy.

Frequently Asked Questions

How accurate are online ADHD tests?

Under controlled validation conditions, the WHO Adult ADHD Self-Report Scale (ASRS v1.1) Part A achieves sensitivity of 68.7% and specificity of 99.5% against a structured clinical interview — established by Kessler et al. (2005, Psychological Medicine, 35:245-256). Most non-validated quizzes online have not been studied that way and perform worse. At a population base rate of 4-5% adult ADHD, even a screen with 90% sensitivity and 80% specificity produces a positive predictive value below 20% — fewer than one in five positive results corresponds to true ADHD. A positive online result is a signal to seek evaluation. It is not a diagnosis.

Can I diagnose myself with ADHD?

No. DSM-5-TR diagnosis requires symptom-count criteria, onset of several symptoms before age 12, persistence across two or more settings, functional impairment in occupational or social functioning, and a differential diagnosis that rules out conditions producing overlapping symptoms — sleep apnea, trauma, perimenopause, thyroid dysfunction, depression, anxiety, substance use, and learning disorder. Self-recognition of pattern is clinically useful and is the reason most adults present for evaluation. The diagnosis itself requires a clinician.

Should I just ask my primary care doctor?

Primary care is a reasonable first point of contact and is sufficient for screening, ruling out medical confounds — thyroid, anemia, sleep — and starting first-line treatment in uncomplicated cases. Adult ADHD with comorbid anxiety, depression, sleep disorder, substance use, prior treatment failure, or diagnostic ambiguity is better served by a psychiatrist who has done several hundred adult ADHD evaluations. The presenting question is rarely whether ADHD is present in isolation. It is what the full clinical picture is and what the sequence of treatment should be.

What if I do not remember my childhood symptoms?

DSM-5-TR requires onset of several symptoms before age 12, not a complete recall of childhood. Useful corroborating sources include report cards — teacher comments about attention, organization, and disruptive behavior are diagnostically informative — parents or older siblings who can describe early patterns, and records of childhood psychoeducational testing. In adults whose parents are unavailable and whose records do not exist, the clinician relies on the patient's best reconstruction combined with patterns documented in adolescence and early adulthood. Absence of perfect childhood data does not preclude diagnosis.

What if the evaluation says I do not have ADHD?

That outcome is clinically informative. A negative evaluation does not invalidate the experience of impaired attention, executive function, or motivation — it redirects the clinical workup. The differential diagnosis for those symptoms includes sleep apnea, depression, generalized anxiety disorder, post-traumatic stress disorder, thyroid dysfunction, perimenopause, anemia, substance use, and learning disorder. Each has its own evidence-based treatment. A negative ADHD evaluation done well is the first step in identifying what is actually driving the impairment.

How much does an ADHD evaluation cost?

A psychiatric ADHD evaluation conducted in 60-90 minutes by a board-certified psychiatrist ranges from $400-$1,200 in most U.S. markets depending on geography, sub-specialty training, and whether the evaluation includes formal rating scales and collateral interviews. Some insurance plans cover diagnostic evaluation; out-of-network reimbursement at 50-70% of fee is common with PPO plans. Comprehensive neuropsychological testing — a 6-10 hour battery costing $2,500-$5,000 — is not required for routine adult ADHD diagnosis. It is appropriate when learning disorder, intellectual disability, or differential between ADHD and a primary neurocognitive condition is the clinical question.

Primary References

DSM-5-TR ADHD criteria: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: American Psychiatric Association Publishing; 2022.

ASRS validation: Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine. 2005;35:245-256. PubMed PMID 15841682

Adult ADHD prevalence: Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry. 2006;163:716-723.

AAP Clinical Practice Guideline: Wolraich ML, Hagan JF, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144:e20192528.

Sultan Lab anchor papers: Sultan RS, Liu SM, Hacker KA, Olfson M. Antipsychotic treatment among youths with attention-deficit/hyperactivity disorder. JAMA Network Open. 2019;2:e197850. PubMed PMID 31339547 · Sultan RS, Saunders M, Veenstra-VanderWeele J. Real-world functional outcomes of stimulant treatment in adults with ADHD. JAMA Psychiatry. 2025.

Additional reading: ADHD Guide | Dr. Sultan's Publications | PubMed: Sultan RS

Work With Dr. Sultan

Dr. Ryan S. Sultan, MD evaluates and treats ADHD across the lifespan — children, adolescents, and adults — at Integrative Psych in Chelsea, Manhattan. Consultations cover initial diagnostic evaluation, second opinions on complex cases (ADHD with anxiety, depression, autism, substance use, or treatment resistance), medication optimization, and ongoing care.

What sets Dr. Sultan's practice apart: Double board certification in Adult Psychiatry and Child & Adolescent Psychiatry. Active NIH NIDA-funded ADHD research at Columbia. 440+ research citations. Director of the Sultan Lab for Mental Health Informatics. Author of the 2019 JAMA Network Open study that changed how youth ADHD is prescribed, and the 2025 JAMA Psychiatry analysis of real-world treatment outcomes.

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Do I Have ADHD? A Clinician's Self-Assessment Guide and What to Do With Your Answer