The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population

Summary & key facts

The WHO Adult ADHD Self-Report Scale (ASRS) has 18 questions about recent ADHD symptoms, and a shorter six-question screener was tested against blind clinical diagnoses in 154 people from the US National Comorbidity Survey Replication. Each ASRS item was linked to the clinical rating, but agreement varied a lot across items. Overall, the unweighted six-question screener matched clinical diagnoses better than the unweighted full 18-question scale (higher sensitivity, specificity, accuracy, and kappa). The authors say a weighted 18-item version might do better in larger studies, but for now they recommend the unweighted six-question screener for surveys and outreach.

Key facts:

• The ASRS instrument includes 18 questions about recent DSM-IV adult ADHD symptoms; the ASRS screener uses 6 of those 18 questions selected by stepwise logistic regression.
• The validation sample had 154 respondents drawn from the US National Comorbidity Survey Replication, with oversampling of people who reported childhood ADHD and adult persistence.
• Each ASRS symptom score was significantly related to the matching clinical symptom rating, but item-level agreement (Cohen's kappa) ranged from 0.16 to 0.81 across items.
• Summing unweighted dichotomous (yes/no) responses across all 18 ASRS questions was the optimal scoring method to predict clinical syndrome classifications in this analysis.
• Despite that, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS on key measures: sensitivity 68.7% versus 56.3%.
• The six-question screener also had higher specificity (99.5% vs 98.3%), higher total classification accuracy (97.9% vs 96.2%), and a higher kappa (0.76 vs 0.58) than the unweighted 18-question scale.
• The authors note a limitation: clinical calibration in larger samples could show that a weighted 18-question ASRS surpasses the six-question screener, so the current recommendation for preference is provisional and based on these results.

Abstract

Clinical calibration in larger samples might show that a weighted version of the 18-question ASRS outperforms the six-question ASRS screener. Until that time, however, the unweighted screener should be preferred to the full ASRS, both in community surveys and in clinical outreach and case-finding in …

Topics

Attention Deficit Hyperactivity Disorder Functional Brain Connectivity Studies Neural and Behavioral Psychology Studies

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Clinical psychology Cohen's kappa Comorbidity Concordance Developmental psychology Environmental health Internal medicine Kappa Linguistics Logistic regression Mathematics Medicine Philosophy Population Psychiatry Psychology Rating scale Statistics