What does a Wender Utah score of 19 indicate regarding Attention Deficit Hyperactivity Disorder (ADHD) symptoms and treatment?

Interpretation of Wender Utah Score of 19

A Wender Utah score of 19 indicates that the individual does not meet the threshold for adult ADHD diagnosis, as this score falls well below the established cutoff score of 46 that would suggest childhood ADHD symptoms.

Understanding the Wender Utah Rating Scale

The Wender Utah Rating Scale (WURS) is a retrospective assessment tool used to evaluate childhood ADHD symptoms in adults. This self-report measure helps clinicians determine if an adult's current symptoms may be related to childhood ADHD. Key points about the scale:

• The 25-item version of the WURS uses a cutoff score of 46 to identify potential childhood ADHD 1
• A score of 19 falls significantly below this threshold, suggesting minimal childhood ADHD symptomatology
• The scale has demonstrated good psychometric properties with high internal consistency (alpha=0.91) and test-retest reliability (r=0.68-0.9) 2, 3

Clinical Significance of a Score of 19

A score of 19 on the WURS has the following implications:

• Negative for childhood ADHD symptoms: The score is well below the established cutoff of 46 that correctly identified 86% of patients with ADHD in validation studies 1
• High specificity: Research shows that scores below the cutoff correctly identified 99% of normal subjects without ADHD 1
• Low likelihood of ADHD diagnosis: This score suggests that the individual would not meet diagnostic criteria for ADHD according to DSM-5 standards

Diagnostic Considerations

When evaluating a low WURS score of 19:

1. Rule out alternative diagnoses: Current symptoms resembling ADHD may be due to other conditions such as:

   • Anxiety disorders
   • Mood disorders (depression)
   • Learning disabilities
   • Sleep disorders
   • Substance use disorders 4

2. Consider current symptoms separately: Even with a low WURS score, current symptoms should be evaluated against DSM-5 criteria for adult ADHD, as some cases may develop or become more apparent later in life 4

3. Evaluate functional impairment: Regardless of WURS score, assess current functioning in academic, occupational, and social domains 4

Treatment Implications

Given a WURS score of 19:

• Medication not indicated: Stimulant medications are not appropriate for individuals whose symptoms do not meet DSM-5 criteria for ADHD 4
• Consider non-ADHD interventions: If the individual is experiencing attention or executive function difficulties despite the low WURS score, consider:
  • Evaluation for other conditions that may explain symptoms
  • Psychosocial interventions targeting specific areas of difficulty
  • Behavioral strategies for organization and time management 5

Common Pitfalls to Avoid

1. Over-reliance on a single measure: The WURS should be part of a comprehensive assessment that includes:

   • Structured clinical interviews
   • Current symptom rating scales
   • Collateral information from multiple sources 4

2. Ignoring comorbidities: Low WURS scores may mask other conditions that require treatment 4

3. Dismissing current symptoms: Even with a negative childhood history (low WURS), significant current impairment should be addressed 4

4. Missing late-onset presentations: Some individuals may develop significant ADHD symptoms later in life despite minimal childhood manifestations 4

Conclusion

A Wender Utah score of 19 strongly suggests the absence of significant childhood ADHD symptoms and indicates that the individual would not meet diagnostic criteria for adult ADHD based on childhood history. Any current attention or executive function difficulties should be evaluated for alternative explanations and addressed with appropriate non-ADHD interventions.