Outcome Measure
Adult ADHD Self-Report Scale
What it measures?
- The ASRS aims to examine Attention Deficit Hyperactivity Disorder (ADHD) symptoms in adults consistent. Questions are consistent with DSM criteria, but have been modified to better reflect focused symptom manifestation in adults and reduce ambiguities. The ASRS is useful for the screening and diagnosis of ADHD in adults, and should be supplemented by clinical interviews to inform diagnosis and treatment.
Who is it for?
The ASRS has been validated for use in adults aged 18 years and older (Adler et al., 2019).
Instrument Quality
- The ASRS is well-established for use in clinical practice and has strong potentials for adoptions into primary care (Adler et al., 2019). Validation studies have found high internal consistency and concurrent validity with existing ADHD rating scales (Adler et al., 2006) and good test-retest reliability (Matza et al., 2011).
Structure
- 18 items
- Items 1-6 - Part A
- Items 7-18 - Part B
- 2-point Likert scale
- Respondents are asked how often (0 = "Never"; 1 = "Very Often") each statement has applied to them over the past 6 months (e.g. "How often do you feel restless or fidgety?")
- Items 1, 2, 3, 9, 12, 16, and 18 yielded a score of 1 for “Sometimes” whereas the remaining 11 items yielded a score of 0
Scoring instructions
Scores from Part A and B are summed to create a total score and transformed into percentiles appropriate to age-related peers (Adler et al., 2019; Kessler et al., 2005)
| Subscale | Item number |
|---|---|
Full-scale (ASRS) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18 |
Part A (ADHD Screener) |
1,2,3,4,5,6 |
Score Interpretation
What higher scores mean?
- Higher scores on Part A suggest an increased number of symptoms associated with Attention Deficit Hyperactivity Disorder (ADHD) and greater likelihood of meeting DSM-IV criteria (Adler et al., 2006; Kessler et al., 2005, 2007) Higher scores on Part B indicate increased symptom count, severity, and functional impact
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 2 | |
| >= | ||
| 1 SD above normative mean | 5.2 | |
| 2 SD above normative mean | 8.4 | |
| Maximum | 18 |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 1.26 | |
| Attention Deficit Hyperactivity Disorder (ADHD) | >=4 | Provisional Diagnosis |
| 1 SD above normative mean | 2.11 | |
| 2 SD above normative mean | 2.96 | |
| Maximum | 6 |
Severity ranges
Normative mean and standard deviation values are derived from Silverstein and colleagues (2018) who examined the test-retest reliability of the ASRS 6-item screener in a primary care sample of adults without ADHD (N = 104). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation.
Provisional diagnosis
* A score at least 4 in Part A has been identified to likely present a symptom profile consistent with an ADHD diagnosis in adults (Adler et al., 2006; Kessler et al., 2005, 2007). * Hines, King & Curry (2012) found this cutoff provided high sensitivity (1.0) and moderate positive predictive power (0.52) for identifying adults with ADHD. Additionally, they found moderate specificity (0.71) and high negative predictive power (1.0), suggesting this measure is unlikely to provide false positives for adults without ADHD.
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 2.79 | Clinical mean and standard deviation values are derived from Adler and colleagues (2018), who examined a US sample with self-reported ADHD (N = 465). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation. |
| Normative | 1.26 | Normative mean and standard deviation values are derived from Silverstein and colleagues (2018) who examined the test-retest reliability of the ASRS 6-item screener in a primary care sample of adults without ADHD (N = 104). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 1.29 | Clinical mean and standard deviation values are derived from Adler and colleagues (2018), who examined a US sample with self-reported ADHD (N = 465). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation. |
| Normative | 0.85 | Normative mean and standard deviation values are derived from Silverstein and colleagues (2018) who examined the test-retest reliability of the ASRS 6-item screener in a primary care sample of adults without ADHD (N = 104). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation. |
Reliability
| Value | Comments |
|---|---|
| 0.78 | * Test-retest reliability (Spearman's Rho) was examined over a 3-week period in a normative sample (N = 104; Silverstein et al., 2018) |
Instrument developers
- Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., ... & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine, 35(2), 245-256.
Refrences
* Adler, L. A., Spencer, T., Faraone, S. V., Kessler, R. C., Howes, M. J., Biederman, J., & Secnik, K. (2006). Validity of pilot Adult ADHD Self-Report Scale (ASRS) to rate adult ADHD symptoms. Annals of Clinical Psychiatry, 18(3), 145-148. * Adler, L. A., Faraone, S. V., Sarocco, P., Atkins, N., & Khachatryan, A. (2019). Establishing US norms for the Adult ADHD Self‐Report Scale (ASRS‐v1. 1) and characterising symptom burden among adults with self‐reported ADHD. International journal of clinical practice, 73(1), e13260. * Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., ... & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine, 35(2), 245-256. * Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self‐Report Scale (ASRS) Screener in a representative sample of health plan members. International journal of methods in psychiatric research, 16(2), 52-65. * Matza, L. S., Van Brunt, D. L., Cates, C., & Murray, L. T. (2011). Test–retest reliability of two patient-report measures for use in adults with ADHD. Journal of Attention Disorders, 15(7), 557-563. * Silverstein, M. J., Alperin, S., Faraone, S. V., Kessler, R. C., & Adler, L. A. (2018). Test–retest reliability of the adult ADHD Self-Report Scale (ASRS) v1. 1 Screener in non-ADHD controls from a primary care physician practice. Family practice, 35(3), 336-341.
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Severity ranges
Normative mean and standard deviation values are derived from Silverstein and colleagues (2018) who examined the test-retest reliability of the ASRS 6-item screener in a primary care sample of adults without ADHD (N = 104). Because the aggregate mean and standard deviation were not reported, we examined the mean score and standard deviation for each of the six items, and then calculated an average—to derive the overall normative mean and normative standard deviation.
Provisional diagnosis
* A score at least 4 in Part A has been identified to likely present a symptom profile consistent with an ADHD diagnosis in adults (Adler et al., 2006; Kessler et al., 2005, 2007). * Hines, King & Curry (2012) found this cutoff provided high sensitivity (1.0) and moderate positive predictive power (0.52) for identifying adults with ADHD. Additionally, they found moderate specificity (0.71) and high negative predictive power (1.0), suggesting this measure is unlikely to provide false positives for adults without ADHD.
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation
Reliability