What rating scales or surveys should be used to monitor an adult's response to ADHD medication?

Monitoring Adult ADHD Medication Response with Rating Scales

Use the Adult ADHD Self-Report Scale (ASRS) as your primary monitoring tool for tracking medication response in adults with ADHD, obtaining both patient self-report and collateral informant ratings at baseline and follow-up visits. 1

Primary Monitoring Tool: ASRS

The ASRS demonstrates strong validity for monitoring treatment response in clinically-referred adults already on stable stimulant doses, with a robust correlation (rs = .65) between patient self-reports and clinician assessments. 2

Administer the full 18-item ASRS Symptom Checklist at each medication adjustment visit, not just the 6-item screener, to capture comprehensive symptom changes across both inattentive and hyperactive-impulsive domains. 1, 3

Practical Implementation

• Baseline assessment: Have patients complete the 18-item ASRS before initiating medication to establish a symptom severity baseline. 4
• Follow-up monitoring: Re-administer the ASRS at each dose titration visit (typically weekly during titration, then monthly during maintenance). 1
• Score interpretation: The ASRS shows high internal consistency (Cronbach's alpha 0.88) and excellent agreement with clinician-rated scales (ICC 0.84), making it reliable for detecting medication-induced symptom changes. 4

Essential Collateral Input

Always obtain collateral informant ratings using the ASRS completed by a spouse, parent, or close contact, because adults with ADHD consistently underestimate their symptom severity and functional impairment. 5, 6

• The Conners' Adult ADHD Rating Scale-Observer Report (CAARS-O) serves as the gold-standard collateral tool when available. 6
• Collateral ASRS reports show moderate correlation with self-reports (r = .47) but capture different contextual information critical for comprehensive assessment. 6, 3

Functional Impairment Tracking

Supplement symptom ratings with the Weiss Functional Impairment Rating Scale-Self (WFIRS-S) to measure real-world functional changes in domains like work performance, home management, and social relationships—outcomes that matter more than symptom counts alone. 5

The ASRS correlates strongly with executive functioning deficits (r = .63) and everyday cognitive failures (r = .74), confirming it captures functionally meaningful impairment. 3

Monitoring Schedule Algorithm

1. Titration phase: Obtain ASRS self-report weekly at each dose adjustment, plus collateral report every 2-4 weeks. 1
2. Maintenance phase: Re-administer ASRS monthly for the first 3 months, then quarterly once stable. 1
3. Dose optimization: Continue titration until ASRS scores show ≥30% reduction from baseline or patient reaches maximum tolerated dose. 1

Critical Monitoring Pitfalls to Avoid

• Never rely solely on patient self-report without collateral input, as adults with ADHD lack insight into their symptom severity. 5, 6
• Do not use the 6-item ASRS screener alone for monitoring—it was designed for initial case-finding, not treatment tracking; use the full 18-item version. 1, 7
• Recognize that positive ASRS screens in patients with comorbid depression require careful interpretation, as depressive symptoms inflate ASRS scores (specificity only 68.6% in MDD populations). 8
• Avoid assuming symptom improvement equals functional recovery—always pair ASRS symptom tracking with functional impairment measures like the WFIRS-S. 5

Time Efficiency

The ASRS takes an average of 54 seconds to complete, making it feasible for routine clinical use without adding significant visit time. 7