Is an Adult ADHD Self-Report Scale (ASRS) score of 21 indicative of Attention Deficit Hyperactivity Disorder (ADHD)?

Interpreting an ASRS Score of 21 for ADHD Diagnosis

A score of 21 on the Adult ADHD Self-Report Scale (ASRS) is highly indicative of ADHD and warrants further clinical evaluation to confirm the diagnosis. 1

Understanding ASRS Scoring and Interpretation

The ASRS is a validated screening tool for adult ADHD with different scoring methods:

• The ASRS-V1.1 Screener consists of 6 questions and serves as an initial screening tool
• The full ASRS Symptom Checklist contains 18 items that align with DSM diagnostic criteria
• Research shows that using a quantitative scoring approach (0-24 points) with a cutoff of 12 points yields excellent psychometric properties:
  • Sensitivity: 96.7%
  • Specificity: 91.1%
  • Positive predictive value: 91.6%
  • Negative predictive value: 96.5% 2

With a score of 21, which exceeds this validated cutoff, there is a high probability of ADHD.

Clinical Significance of the Score

A score of 21 on the ASRS suggests:

• The presence of multiple ADHD symptoms at clinically significant levels
• Potential functional impairment in daily activities
• The need for comprehensive clinical assessment 3

Next Steps After a Positive Screen

1. Complete diagnostic evaluation:

   • Confirm symptoms have been present for at least 6 months
   • Verify symptoms cause significant impairment in at least two major settings (social, academic, or occupational)
   • Ensure some symptoms were present before age 12
   • Rule out alternative explanations for symptoms 4

2. Determine ADHD presentation type:

   • Predominantly inattentive: ≥5 symptoms of inattention, <5 symptoms of hyperactivity-impulsivity
   • Predominantly hyperactive-impulsive: ≥5 symptoms of hyperactivity-impulsivity, <5 symptoms of inattention
   • Combined type: ≥5 symptoms of both inattention AND hyperactivity-impulsivity 4

3. Assess functional impairment:

   • Use validated tools like the Weiss Functional Impairment Rating Scale-Self (WFIRS-S)
   • Evaluate impact on home management, work performance, social relationships, and daily responsibilities 4

4. Gather collateral information:

   • Obtain reports from someone who knows the patient well (parent, spouse)
   • Research shows moderate congruency (correlation = .47) between self and collateral reports 5

Common Pitfalls to Avoid

• Relying solely on the ASRS score: While highly sensitive, the ASRS is a screening tool, not a diagnostic instrument
• Overlooking comorbidities: Adults with ADHD frequently have comorbid conditions like anxiety, depression, or substance use disorders that may complicate the clinical picture
• Neglecting functional impairment: Diagnosis requires evidence that symptoms significantly impact daily functioning
• Missing developmental history: Confirming that some symptoms were present before age 12 is essential for diagnosis 6

Conclusion for Clinical Practice

The ASRS takes approximately 54.3 seconds to complete and has high sensitivity (1.0) and moderate specificity (0.71) 1. With a score of 21, which is well above established cutoffs, this patient very likely has ADHD and should receive a comprehensive evaluation to confirm the diagnosis and determine the most appropriate treatment approach.