What does a score of 21 on the Adult Self-Report Scale (ASRS) indicate?

Interpretation of a Score of 21 on the Adult ADHD Self-Report Scale (ASRS)

A score of 21 on the Adult ADHD Self-Report Scale (ASRS) indicates a high likelihood of ADHD and warrants further comprehensive evaluation for formal diagnosis. 1

Understanding the ASRS Score

The Adult ADHD Self-Report Scale (ASRS) is a validated screening tool for adult ADHD with the following interpretation framework:

• The ASRS is a widely used screening instrument with high sensitivity (100%) and moderate specificity (71%) 2
• A score of 21 falls above established thresholds that suggest probable ADHD:
  • Scores ≥ 70 on the expanded 31-item version or ≥ 23 on the 18-item version indicate high likelihood of ADHD 3
  • The standard 18-item version considers scores in this range to be strongly suggestive of ADHD symptoms requiring further evaluation

Next Steps in Evaluation

A positive ASRS screening requires additional assessment steps:

1. Complete diagnostic interview:

   • Structured clinical interview focusing on DSM-5 criteria
   • Assessment of symptom onset before age 12 (not the previous age 7 requirement)
   • Verification of symptoms persisting for at least 6 months
   • Confirmation of symptoms occurring in 2+ settings (work, home, social)

2. Collateral information gathering:

   • Obtain reports from multiple sources (family members, partners, close friends)
   • Review academic/work history for evidence of functional impairment
   • This step is crucial as self-report alone is insufficient for diagnosis 1

3. Rule out alternative explanations:

   • Medical conditions that may mimic ADHD symptoms
   • Other psychiatric disorders, particularly depression and anxiety
   • Substance use or medication effects
   • Environmental factors causing attention problems

Diagnostic Considerations

For formal ADHD diagnosis, the following criteria must be met:

• For adults (17+ years): At least 5 symptoms from either the inattention or hyperactivity-impulsivity categories 1
• Symptom presentations:
  • Predominantly Inattentive Presentation
  • Predominantly Hyperactive-Impulsive Presentation
  • Combined Presentation

Important Clinical Caveats

• False positives are common: The ASRS has a positive predictive value of only 52%, meaning nearly half of positive screens are not true ADHD 2
• Depression can inflate scores: MDD patients frequently endorse ADHD symptoms on the ASRS, requiring careful differential diagnosis 4
• Negative screens are reliable: The ASRS has a negative predictive value of 100%, meaning a negative screen strongly suggests absence of ADHD 4, 2
• Functional impairment is essential: Symptoms alone without evidence of impairment do not constitute ADHD 1

Impact on Quality of Life and Functioning

Untreated ADHD significantly impacts quality of life and functioning in multiple domains:

• Academic/occupational difficulties
• Relationship problems
• Financial management issues
• Higher rates of accidents and injuries
• Increased risk of substance use disorders
• Difficulties with parenting (particularly relevant in perinatal settings) 5

Adults with ADHD often display difficulties managing their home environment, keeping track of appointments, and may experience greater distress in demanding life situations such as pregnancy and parenthood 5.

Key Recommendation

The positive ASRS score of 21 should trigger a comprehensive ADHD evaluation by a qualified mental health professional to confirm diagnosis and develop an appropriate treatment plan to improve quality of life and functioning.