What is the Adult ADHD Self‑Report Scale (ASRS) rating scale and how is it scored?

Adult ADHD Self-Report Scale (ASRS)

What is the ASRS?

The Adult ADHD Self-Report Scale (ASRS) is an 18-question self-administered screening tool developed by the World Health Organization that assesses the frequency of recent DSM-IV Criterion A symptoms of adult ADHD, with a validated 6-question short screener (ASRS-V1.1) that demonstrates superior performance for clinical screening. 1

Structure and Components

• The full ASRS contains 18 questions corresponding to the 18 DSM-IV symptoms of ADHD, asking respondents to rate the frequency of each symptom on a 5-point scale 1
• The ASRS-V1.1 screener consists of 6 questions selected through stepwise logistic regression to optimize concordance with clinical diagnosis 1
• An expanded 31-item version includes additional items assessing executive function deficits and emotional dyscontrol beyond core ADHD symptoms 2
• The scale can be completed rapidly, taking an average of 54.3 seconds (range 22-252 seconds) to administer 3

Scoring Methods

Six-Question ASRS-V1.1 Screener (Preferred)

The 6-question screener uses unweighted dichotomous scoring (summing yes/no responses) and outperforms the full 18-question version in clinical accuracy. 1

• The screener demonstrates sensitivity of 68.7% to 100%, specificity of 71% to 99.5%, and negative predictive value of 1.0 1, 3
• A four-category scoring version shows strong concordance with clinician diagnoses, with an area under the ROC curve of 0.90 4
• The screener should be preferred over the full ASRS for both community surveys and clinical case-finding until weighted versions are validated 1

Full 18-Question ASRS

• Optimal scoring involves summing unweighted dichotomous responses across all 18 questions 1
• Individual symptom items show variable concordance with clinical ratings (Cohen's kappa range 0.16-0.81) 1
• The full scale demonstrates high internal consistency (Cronbach's alpha 0.88-0.89) and strong intraclass correlation with clinician-administered ratings (ICC 0.84) 5
• Individual item agreement with clinician ratings ranges from 43% to 72%, with all items showing significant kappa coefficients 5

Expanded 31-Item ASRS

• For the expanded version including executive function and emotional dyscontrol items, a cutoff score of 70-82 suggests high likelihood of adult ADHD 2
• Scores below 70 in ADHD control samples represent the 95th percentile cutoff 2
• This version shows high validity for assessing both core DSM symptoms and associated executive/emotional symptoms 2

Clinical Context and Utility

Structured rating scales like the ASRS are useful adjuncts in the comprehensive psychiatric evaluation required to diagnose adult ADHD, which must include particular focus on core ADHD symptoms starting in childhood. 6

• The ASRS serves as an effective screening tool to guide further evaluation for ADHD in primary care settings, given its ease of use, short administration time, high sensitivity, and moderate specificity 3
• Because adults with ADHD often have poor insight and underestimate symptom severity, collateral information from a spouse, parent, or friend should supplement self-report measures 6
• The scale demonstrates high test-retest reliability (Pearson correlations 0.58-0.77) and internal consistency (0.63-0.72) across administrations 4

Important Caveats

• The ASRS is a screening tool, not a diagnostic instrument—positive screens require comprehensive clinical evaluation including medical history, physical examination, and assessment for conditions that may masquerade as ADHD (bipolar disorder, depression, personality disorders, learning disabilities, narcolepsy, borderline intellectual functioning) 6
• Current symptomatology, rather than formal diagnosis alone, better predicts psychosocial impairment and quality of life outcomes 7
• The DSM-5 version (ASRS-5) uses a cutoff score of 14 on a simple additive scale, identifying approximately 6.0-6.5% prevalence in population samples, though some measurement challenges exist including disordered response categories and gender-related differential item functioning 8