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

Interpreting 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

Understanding the WURS Score in Context

The Wender Utah Rating Scale is a retrospective assessment tool used to evaluate childhood ADHD symptoms in adults. It helps clinicians determine if current attention difficulties may have roots in childhood ADHD. When interpreting WURS scores:

• A score of 19 is considered low and indicates minimal childhood ADHD symptoms
• For comparison, a score of 46 or higher strongly suggests a diagnosis of childhood hyperactivity disorder 2
• Low scores suggest the absence of significant ADHD symptoms during childhood

Clinical Implications of a Low WURS Score

Despite a low WURS score of 19, it's important to consider:

1. Current symptoms assessment is still necessary

   • The American Academy of Child and Adolescent Psychiatry recommends evaluating current symptoms separately, even with a low WURS score 1
   • Some ADHD cases may develop or become more apparent later in life
   • Current symptoms should be evaluated against DSM-5 criteria for adult ADHD

2. Differential diagnosis considerations

   • A low WURS score may indicate that current attention difficulties stem from conditions other than ADHD
   • Alternative diagnoses to consider include:
     • Anxiety disorders
     • Mood disorders
     • Learning disabilities
     • Sleep disorders
     • Substance use disorders 1

Assessment Approach When WURS Score is 19

When a patient presents with a WURS score of 19 but has attention-related complaints:

• Conduct a comprehensive assessment including:

  • Structured clinical interviews
  • Current symptom rating scales (such as the Adult Self-Report Scale or Brown's ADD Scale)
  • Collateral information from multiple sources
  • Evaluation of functional impairment in academic, occupational, and social domains 1

• Consider using additional validated tools:

  • The Adult Self-Report Scale (ASRS) correlates well with Brown's ADD Scale and can provide better understanding of current attention difficulties 2
  • The Brown Attention Deficit Disorders Scale (ADD) assesses symptoms beyond the DSM-IV inattention criteria 2

Important Caveats and Pitfalls

• Avoid dismissing current symptoms solely based on WURS score

  • Current functional impairment should be addressed regardless of childhood history 1
  • Missing late-onset presentations can lead to inadequate diagnosis and treatment

• Consider test-retest reliability issues

  • Research shows that WURS scores can be influenced by current ADHD symptom severity 3
  • Adults with more severe current ADHD symptoms may retrospectively report more childhood symptoms

• Be aware of comorbidities

  • Low WURS scores may mask other conditions that require treatment
  • Research indicates that WURS scores are associated with objective measures of attention, particularly those involving executive function, response speed, and visuomotor coordination 4

• Recognize potential cultural and demographic influences

  • Validation studies of the WURS have been conducted in different populations, which may affect interpretation 5

Remember that while a score of 19 on the WURS suggests minimal childhood ADHD symptomatology, a comprehensive evaluation of current symptoms and functioning is essential for appropriate clinical decision-making.