What does a score of 19 on the Wender Utah Rating Scale (WURS) indicate in terms of Attention Deficit Hyperactivity Disorder (ADHD) symptoms?

Understanding a Score of 19 on the Wender Utah Rating Scale (WURS)

A score of 19 on the Wender Utah Rating Scale (WURS) indicates minimal childhood ADHD symptomatology and suggests that the individual would not meet diagnostic criteria for adult ADHD based on childhood history. 1

What is the Wender Utah Rating Scale?

The WURS is a retrospective self-assessment tool used to evaluate childhood ADHD symptoms in adults. It helps clinicians determine if an adult's current attention or behavioral issues may have roots in childhood ADHD. The scale:

• Consists of 25 items where subjects describe their childhood behavior at around age 7
• Uses a scoring system from 0 (few) to 4 (very much)
• Groups items into four clusters: affects/emotional problems, impulsivity/conduct disorders, impulsivity-hyperactivity, and attention difficulties 2

Interpreting a Score of 19

Clinical Significance

• A score of 46 or higher strongly suggests childhood ADHD 2
• A score of 19 falls well below this threshold, indicating minimal childhood ADHD symptomatology 1
• This low score suggests the individual would not meet the childhood symptom criteria required for an adult ADHD diagnosis

Diagnostic Implications

• DSM-5 criteria for ADHD require symptom onset before age 12
• A low WURS score indicates that the person likely did not experience significant ADHD symptoms during childhood
• Without evidence of childhood symptoms, a formal ADHD diagnosis would be difficult to justify 1

Assessment Considerations

Limitations of the WURS

• The WURS relies on retrospective self-reporting, which has inherent limitations
• Test-retest reliability studies show that current ADHD symptoms can influence how people recall their childhood behaviors 3
• Adults with current attention difficulties may have poor recall of childhood experiences

Need for Comprehensive Assessment

• The WURS should be part of a comprehensive assessment that includes:
  • Structured clinical interviews
  • Current symptom rating scales (like the Adult ADHD Self-Rating Scale)
  • Collateral information from multiple sources 1
  • Evaluation of functional impairment in academic, occupational, and social domains

Clinical Approach When WURS Score is Low

Rule Out Alternative Diagnoses

• Consider other conditions that may present with attention difficulties:
  • Anxiety disorders
  • Mood disorders
  • Learning disabilities
  • Sleep disorders
  • Substance use disorders 1

Evaluate Current Symptoms

• Even with a low WURS score, current symptoms should be evaluated against DSM-5 criteria for adult ADHD
• Some cases may develop or become more apparent later in life 1
• Significant current impairment should be addressed, regardless of childhood history

Treatment Considerations

• Stimulant medications are not appropriate for individuals whose symptoms do not meet full DSM-5 criteria for ADHD 4
• Non-ADHD interventions may be considered for specific areas of difficulty:
  • Psychosocial interventions
  • Behavioral strategies for organization and time management
  • Skills training for specific deficits 1

Potential Pitfalls

• Dismissing current symptoms solely based on a low WURS score
• Missing late-onset presentations of attention difficulties
• Failing to identify other conditions that may require treatment
• Overlooking functional impairments that need intervention regardless of diagnosis 1

The WURS score should be interpreted as one piece of information within a comprehensive clinical assessment that considers current symptoms, functional impairment, and alternative explanations for attention difficulties.