Best Self-Report Scale for Retrospective Childhood ADHD Symptoms in Adults
The Wender Utah Rating Scale (WURS) is the best self-report instrument for adults to retrospectively assess their childhood ADHD symptoms, as it is specifically designed to capture childhood behaviors at age 7 and demonstrates superior discriminatory properties compared to other scales. 1, 2
Primary Recommendation: The Wender Utah Rating Scale
The WURS is specifically designed for retrospective childhood symptom assessment, asking adults to describe their own childhood behavior when they were 7 years old using 25 items rated from 0 (not at all) to 4 (very much) 3, 4
The WURS demonstrates the highest diagnostic accuracy among available scales, with an area under the curve (AUC) of 0.956 in discriminating adults with ADHD from controls 2
A WURS score of 46 or more strongly suggests a diagnosis of ADHD during childhood 3
The scale captures four critical symptom clusters: affects and emotional problems, impulsivity and conduct disorders, impulsivity-hyperactivity, and difficulties in attention 3
Why WURS Outperforms Other Scales
The WURS has better discriminatory properties than the Adult ADHD Self-Report Scale (ASRS) specifically because of its wider symptom range and retrospective childhood frame of symptoms 2
The full WURS (61 items) is more successful at distinguishing ADHD from other psychiatric conditions (depression, anxiety) than the abbreviated WURS-25, with an AUC of 0.995 versus psychiatric controls 5
The WURS captures emotional dysregulation symptoms that are critical to understanding ADHD but not fully represented in DSM-based scales 5
Critical Clinical Caveat: The Reliability Problem
Adults with ADHD are notoriously poor self-reporters and often underestimate the severity of their symptoms, making collateral information from family members or others who knew the adult in childhood essential 1, 6
Current ADHD symptom severity substantially influences retrospective WURS scores—adults with more severe current symptoms tend to report more severe childhood symptoms, which may represent recall bias 6
Test-retest reliability shows that while 60% of adults with ADHD report consistent severity levels over time, WURS scores are positively associated with current ADHD symptoms at both time points 6
Recommended Assessment Algorithm
Administer the WURS-25 as the primary retrospective childhood symptom scale to the adult patient 1, 2
Obtain collateral information using the Wender Parent's Rating Scale from parents to establish symptom onset before age 12, which is a DSM-5 diagnostic requirement 1
Supplement with the Conners' Adult ADHD Rating Scale-Observer Report (CAARS-O) completed by a spouse, parent, or close friend who knows the adult well 1
Cross-validate with current symptom assessment using the ASRS to evaluate present-day ADHD symptoms, recognizing that current severity may bias retrospective reports 1, 6
Alternative Validated Options
The Brown Attention-Deficit Disorder Scale for Adults can be used as an alternative and has demonstrated strong predictive validity for clinical diagnosis, though it focuses more on current executive function deficits than retrospective childhood symptoms 1, 4
The ASRS has an AUC of 0.904 and performs well as a screening tool, but it assesses current symptoms rather than childhood retrospective symptoms 2
Common Pitfalls to Avoid
Never rely solely on self-report WURS scores without obtaining collateral information from family members—this is the single most important clinical error to avoid given the poor self-reporting accuracy of adults with ADHD 1, 6
Do not use the WURS in isolation; it must be combined with clinical interview, current symptom assessment, and documentation of functional impairment in multiple settings to meet diagnostic criteria 1
Be aware that comorbid mood disorders (depression) and the presence of dyslexia are positively associated with higher WURS scores, potentially inflating retrospective symptom reports 6
Recognize that the WURS captures a broader symptom range including emotional dysregulation beyond DSM-5 criteria, which improves discrimination from other psychiatric conditions but means scores should be interpreted in full clinical context 5