Adult ADHD Self-Report Scale

The Adult ADHD Self-Report Scale (ASRS) Symptom Checklist is a self-

reported questionnaire used to assist in the diagnosis of adult ADHD. ADHD is a neurological
disorder that can present itself in adolescence and adulthood. Some individuals can outgrow ADHD
but around 30% will continue to have ADHD throughout their adulthood.[1] Adults with ADHD may
experience difficulties in relation to cognitive, academic, occupational, social and economic
situations.[1]
The PhenX Toolkit uses ASRS as its adult protocol for Attention-Deficit/Hyperactivity Disorder
Symptoms.[2]

Background
ADHD is a neurological disorder that can present itself in adolescence and adulthood. Some
individuals can outgrow ADHD but around 30% will continue to have ADHD throughout their
adulthood.[1] Adults with ADHD may experience difficulties in relation to cognitive, academic,
occupational, social and economic situations.[3]
ADHD has no single cause but can be genetically inherited in many cases, and roughly 76% of
those diagnosed inherited it from their parent(s). For the remaining percentage of individuals, 14-
15%, ADHD may have been caused due to their environment, such as trauma in the womb or during
birth.[1] Changes in the genes that influence the neurochemicals serotonin, dopamine,
and norepinephrine levels can cause them to be overactive or under active, possibly playing a role in
the development of an individual with ADHD.[4] It has also been shown that activity in the frontal
lobe is decreased in an individual with ADHD compared to an individual without ADHD. [1] The Adult
ADHD Self-Reporting Scale was created to estimate the pervasiveness of an adult with ADHD in an
easy self survey.[5]
The ASRS was developed in conjunction with the World Health Organization (WHO), and the
Workgroup on Adult ADHD which included researchers from New York University Medical
School and Harvard Medical School. The ASRS has eighteen questions, which are consistent with
the DSM-IV[6] criteria and address ADHD symptoms in adults. The six question ASRS Screener was
later developed as a subset of the WHO's eighteen question ASRS. At least one study has found
that the six question ASRS Screener outperformed the eighteen question ASRS in diagnosing
ADHD in the general population.[7]
ASRS has been adapted to other languages including Spanish and Chinese.[8][9] Conducted research
proved that the scale is a valid and useful tool for the screening of adult ADHD.[10] The ASRS was
externally validated on approximately 60 adult patients, and showed high internal consistency and
high concurrent validity with the physician-administered ADHD rating system.[10]

Development and History

Self rating scales are generally useful tools because they create a way to collect a large, accurate
amount of data in an organized, quick, and cost effective way.[11] The diagnostic criteria originally
designed for determining whether an individual was experiencing ADHD symptoms was designed for
children.[12] This criteria has been criticized for being too limiting for adults and the symptoms that can
sometimes present themselves in adults with ADHD such as procrastination, poor motivation and
time management difficulties.[12]
Scoring
Each question can be answered on a five item Likert scale, based on a scale of frequency ranging
from "Never" to "Very Often". Answers are scored as either positive or negative and the threshold is
different for individual questions. Answers of "Never" and "Rarely" are always scored negative,
answers of "Often and Very Often" are always scored positive, and answers of "Sometimes" are
scored positively in only seven of the eighteen questions. Four or more positive answers in Part A is
indicative of ADHD symptoms.
The Adult Attention-Deficit/Hyperactivity Disorder Self-Reporting Rating Scale (ASRS) is composed
of 18 questions, and uses a scale that ranges from 0-4 based on the individuals mark in either the
"never, rarely, sometimes, often, very often" column for a possible total score of 72. Each column is
used to describe the severity of the individuals symptoms based on the question asked. The
participant is asked to make a mark within one column for each question that best describes their
answer.[13] The questions are split up into 2 separate parts; Part A consists of questions 1-6 and Part
B consists of questions 7-18. If four or more answers are scored “positive” then a high consistency of
ADHD is indicated and further follow up with a licensed clinician is necessary.[13] Positive scores in
Part B can be further identifying cues of the individuals symptoms.[13]

Uses/Applications
The Adult ADHD Self Report Scale is used to test the probability of adults, (18 years and older),
having ADHD(4). The ADHD Self-Reporting Scale for adults is also used to determine if someone
with a substance use disorder has a comorbid disorder of ADHD.[13]

Reliability/Validity
There have been studies done to test the validity and reliability of the ASRS by comparing results of
participants that were diagnosed with childhood ADHD, after completing the self reporting on their
own and then were subsequently tested with a clinician. There was high correlation between the
grouped symptoms (hyperactivity/impulsiveness and inattentiveness) when comparing the
administration results of the tests.[10] After an experiment with 60 adults whom completed the self
rating scale and whose results were compared to their ratings with an administered ADHD rating
scale, the results showed that the self rating scale has a high internal reliability and also validity.[10]

Limitations
The Adult ADHD Self-Report Scale is only applicable for adults with diagnosed or undiagnosed
ADHD. A positive screening is not a proper diagnosis, but an indication that the adult should seek a
healthcare professional for further analysis.[11] Although the 6 question ASRS screener can be
effective in diagnosing ADHD in adults and can be completed quickly, it can not rule out other
medical conditions that could be impacting the diagnosis of ADHD.[12] Some symptoms of ADHD do
contain some overlap with other mental disorders that are not tested for within the ASRS.[14] Other
limitations such as paying attention to possible comorbid conditions and history of the individual,
(such as substance abuse issues), need to be considered when comparing their results to the scale.
Keeping in mind that the symptoms must be ongoing, these symptoms can not be considered
indicators of ADHD if they’ve only been present for the past few months or even years.[1]