Scoring the Adult Self-Report Scale (ASRS)-v1.1
The Adult ADHD Self-Report Scale (ASRS)-v1.1 is scored by counting the number of "often" or "very often" responses in Part A (the first 6 questions), with a positive screen indicated by 4 or more such responses. 1
Part A (Screening Section)
- The ASRS-v1.1 consists of 18 total questions, but Part A contains the critical 6-question screening items 1
- When a patient checks "often" or "very often" for 4 or more of these 6 questions, the screen is considered positive and warrants further investigation 1, 2
- These 6 screening questions were selected through stepwise logistic regression to optimize concordance with clinical diagnosis 2
- The 6-question screener has demonstrated better performance than the full 18-question version with higher sensitivity (68.7% vs. 56.3%), specificity (99.5% vs. 98.3%), and overall classification accuracy (97.9% vs. 96.2%) 2
Full Scale (Part A and Part B)
- The complete ASRS-v1.1 contains 18 questions that correspond to the DSM criteria for ADHD 1
- If the patient screens positive on Part A, they should complete Part B (remaining 12 questions) to further elucidate their symptoms 1
- The full scale can be divided into two subscales: inattention and hyperactivity/impulsivity 3, 4
- Factor analysis confirms this two-factor structure that accounts for approximately 67.7% of the variance 3
Expanded Version Scoring
- Expanded versions of the ASRS include additional items assessing executive function deficits and emotional dyscontrol 4, 5
- For the expanded 31-item ASRS, scores of 70-82 suggest a high likelihood of adult ADHD 5
- For the expanded AISRS (clinician-rated version), scores of 23-26 on the 18-item version suggest a high likelihood of adult ADHD 5
Clinical Application
- After a positive screen, further diagnostic assessment is needed to determine if the patient meets full diagnostic criteria for ADHD 1
- Consider having someone who knows the patient well (e.g., parent, spouse) complete the ASRS with the patient in mind to gain additional perspective 1
- A functional impairment scale such as the Weiss Functional Impairment Rating Scale-Self (WFIRS-S) can provide additional information about ADHD-specific impairment 1
- The ASRS has demonstrated good reliability when administered in different formats (telephone interview vs. paper version) with a correlation of 0.66 6
- Self-reports on the ASRS correlate well with collateral reports (correlation = 0.47) and with measures of executive functioning (correlation = 0.63) and everyday cognitive failures (correlation = 0.74) 6
Common Pitfalls and Caveats
- Relying solely on the ASRS for diagnosis without considering functional impairment can lead to misdiagnosis 1
- The ASRS is a screening tool, not a diagnostic instrument; positive screens require follow-up clinical evaluation 1, 2
- In populations with substance use disorders, the ASRS has shown acceptable validity with 87.5% sensitivity and 68.6% specificity using a cut-off of 4 3
- Comorbid conditions like depression or anxiety may influence symptom reporting and should be considered in interpretation 1, 4
- Adults with ADHD are more likely to present with inattentive symptoms, which may affect the pattern of positive responses on the scale 1