Adult ADHD Self-Report Scale

The ASRS-v1.1 (Adult ADHD Self-Report Scale, version 1.1) is a brief self-report instrument for screening adults for symptoms of attention-deficit/hyperactivity disorder. It was developed in the early 2000s under the auspices of the World Health Organization, by a workgroup that included Ronald C. Kessler of the Department of Health Care Policy at Harvard Medical School and Lenard A. Adler of New York University, and the validation of its short form was published in 2005. The instrument exists in two related forms: a full 18-item Symptom Checklist, whose items correspond to the eighteen DSM-IV symptom criteria for ADHD, and a 6-item Screener drawn from it. The 6-item Screener is the form in widest use, and it is the form this wiki hosts as a screening instrument.

Development

The scale grew out of the World Health Organization's work, in the early 2000s, on measuring adult ADHD in general-population epidemiology. The WHO World Mental Health Survey Initiative needed a short, self-administered way to identify adults whose symptoms warranted closer assessment, and the workgroup convened for the purpose built and tested the instrument against blinded clinical interviews. Adult ADHD was, at that time, considerably less studied than the childhood form, and a validated brief self-report for adults filled a real gap in both epidemiology and routine practice.

Structure

The full ASRS-v1.1 Symptom Checklist contains eighteen items, one for each of the eighteen ADHD symptom criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): nine covering inattention and nine covering hyperactivity and impulsivity. Each item asks how often the respondent has experienced a particular pattern over the preceding six months, answered on a five-point frequency scale.

The 6-item Screener, sometimes called Part A of the checklist, is a subset of six items selected from the eighteen. The six were identified, during the development work, as the items that best predicted a clinical diagnosis of ADHD, so that a very short instrument could carry most of the screening value of the full checklist.

Scoring and interpretation

The 6-item Screener is scored by a threshold method rather than a simple sum. Each item is answered on the five-point frequency scale, and each item has a defined cut point above which the response is treated as significant. The cut point is not the same for every item, reflecting that some symptom patterns are more discriminating at a lower reported frequency than others. A respondent who reaches the significant threshold on four or more of the six items has screened positive, meaning their reported symptoms are consistent with adult ADHD to a degree that warrants fuller clinical evaluation.

A positive screen is not a diagnosis. The Screener identifies people who should be assessed further; the diagnosis of ADHD remains a clinical judgment that takes in developmental history, age of onset, persistence across settings, functional impairment, and the exclusion of other explanations, none of which a six-item self-report can establish.

Validation

The 2005 Psychological Medicine study validated the 6-item Screener against blinded clinical interviews in a sample drawn from the general population, and found that the short Screener performed at least as well as the full 18-item checklist at identifying ADHD. A 2007 study by Kessler and colleagues examined the Screener's validity in a representative sample of managed-care health-plan members, supporting its use beyond the original epidemiological setting. The ASRS-v1.1 went on to become one of the most widely used adult ADHD screening instruments in both research and routine clinical practice.

Relationship to the DSM-5 update

The ASRS-v1.1 is built on DSM-IV criteria. After the 2013 publication of DSM-5, the same line of work produced an updated six-item screening scale aligned to the DSM-5 conception of adult ADHD, reported by Ustun and colleagues in JAMA Psychiatry in 2017. The instrument hosted on this wiki is the ASRS-v1.1 6-item Screener; the 2017 DSM-5 scale is a separate, later instrument.

Use on this wiki

This wiki hosts the ASRS-v1.1 6-item Screener as a self-administered screening instrument, paired with the AMAAS as its companion. The two play distinct roles. The AMAAS is the wiki's own longer adult-ADHD instrument, and it is experimental and as yet unvalidated; the ASRS-v1.1 Screener is short and externally validated. Pairing them means a person using the wiki's assessment system always has a validated reference instrument alongside the experimental one. The ASRS Screener is reproduced exactly as published: unlike the AMAAS, it is not adapted, reworded, or rescaled, both because it is a fixed validated instrument whose validity depends on being administered as written, and because its licence permits its use only without modification.

Licensing and attribution

The copyright in the ASRS-v1.1 is held by New York University and the President and Fellows of Harvard College. The 6-item Screener is made available without fee for clinical and non-clinical use, including commercial use, and the licence permits the creation of electronic versions, on the conditions that the instrument is not modified and that a required attribution notice is displayed wherever it appears. The attribution notice, shown with the Screener throughout this wiki, reads:

The 6-question Adult Self-Report Scale-Version1.1 (ASRS-V1.1) Screener is a subset of the 18-question Adult ADHD Self-Report Scale-Version1.1 (Adult ASRSV1.1) Symptom Checklist. © New York University and the President and Fellows of Harvard College.

See also

• AMAAS, the wiki's companion adult-ADHD instrument
• Special:MyAssessment, the wiki's self-assessment system