Adult ADHD Self-Report Scale

Abstract

The Adult ADHD Self Report Scale (ASRS v1.1) is a widely used, brief self-report screening instrument designed to identify symptoms consistent with Attention-Deficit/Hyperactivity Disorder (ADHD) in adult populations. Developed by the World Health Organization (WHO) in collaboration with researchers from Harvard Medical School, the ASRS v1.1 is based on the diagnostic criteria outlined in the DSM-IV. It consists of 18 items that measure the two primary domains of ADHD: inattention and hyperactivity/impulsivity. The scale is highly valued in clinical settings and research for its efficiency and strong psychometric properties, serving as an effective preliminary step before a full clinical diagnostic interview.

Keywords

ADHD, Adult ADHD, ASRS, Self-Report, Screening Tool, Psychometrics, Inattention, Hyperactivity, Impulsivity, WHO

Authors

World Health Organization (WHO), Ronald Kessler (for subsequent development and distribution), Harvard Medical School

Purpose

The primary purpose of the ASRS v1.1 is to serve as a rapid, standardized screening instrument for detecting the presence and severity of ADHD symptoms in adults aged 18 and older. It is specifically designed to overcome the challenge of identifying persistent, clinically significant ADHD symptoms that began in childhood but continue to affect functioning in adulthood.

The scale aids general practitioners and mental health professionals in deciding whether a full diagnostic assessment, often requiring a structured clinical interview, is warranted. The six items comprising Part A of the scale are often used as a preliminary screening mechanism due to their high predictive power.

Construct

The ASRS v1.1 measures the core psychological construct of Attention-Deficit/Hyperactivity Disorder (ADHD) as defined by major psychiatric classification systems (e.g., DSM-IV, later adapted for DSM-5 context). The 18 items are structured to assess behaviors related to two distinct symptom clusters:

• Inattention: Difficulties with organization, task completion, sustained focus, memory, and managing distractions.
• Hyperactivity/Impulsivity: Excessive motor activity, restlessness, difficulty relaxing, excessive talking, impatience, and interrupting others.

The scale operationalizes these constructs by asking respondents about the frequency of specific symptomatic behaviors over the previous six months, providing a quantitative measure of symptom burden.

Validity

The ASRS v1.1 demonstrates robust validity, particularly in its screening capacity. It was developed based on the structure of the WHO’s Composite International Diagnostic Interview (CIDI), ensuring strong content validity aligned with established diagnostic criteria. Studies have consistently shown that the scale possesses high sensitivity (ability to correctly identify those with ADHD) and acceptable specificity (ability to correctly identify those without ADHD) when compared against gold-standard clinical diagnostic assessments.

The initial six-item screening version (Part A) is highly predictive, contributing significantly to criterion validity. Furthermore, the scale exhibits good concurrent validity, correlating positively with other established measures of adult ADHD severity and related constructs like executive dysfunction.

Reliability

The reliability of the ASRS v1.1 is generally regarded as strong. Internal consistency, measured typically using Cronbach’s alpha, is high across both the total scale and its subscales (Inattention and Hyperactivity/Impulsivity), indicating that the items within each domain are measuring the same underlying construct reliably. Test-retest reliability is also strong, suggesting that results remain stable over short periods, provided the individual’s clinical status does not change significantly.

Factor Analysis

Factor analysis of the ASRS v1.1 typically supports a two-factor model, corresponding to the established dimensions of Inattention and Hyperactivity/Impulsivity, which aligns with the structure of ADHD as conceptualized in the DSM. While the scale is administered as a single 18-item instrument, the underlying factor structure confirms that the items successfully differentiate between these two core symptom clusters in the adult population. This structural validity confirms its utility in assessing the distinct presentations of ADHD.

Instrument

Test Type: Self-report screening questionnaire

Format: 18 items scored on a 5-point Likert scale (Never, Rarely, Sometimes, Often, Very Often)

Language Available: English (standard version); widely translated into numerous languages for international use.

Population Group: Clinical and General Population

Age Group: Adults (18 years and older)

Population Details: Originally validated using large population samples, including those participating in the WHO World Mental Health Survey Initiative.

Test Methodology: Respondents rate how often they experience specific behaviors related to ADHD symptoms over the past six months. A scoring algorithm based on the frequency responses to the first six items (Part A) determines the likelihood of an ADHD diagnosis, prompting a recommendation for further evaluation.

Keywords

DSM-IV, CIDI, Clinical Assessment, Screening Instrument, Behavioral Assessment, Executive Function, Composite International Diagnostic Interview

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: [email protected] (For permissions related to Ronald Kessler/Harvard Medical School)

Correspondence Address: Professor Ronald Kessler, PhD, Department of Health Care Policy, Harvard Medical School.

Permissions & Fee and Test Year

The ASRS v1.1 was released in 2003. The instrument is based on the Composite International Diagnostic Interview (CIDI) developed by the World Health Organization (WHO) in 2001. All rights are reserved by the WHO. Requests for permission to reproduce or translate the instrument, whether for sale or noncommercial distribution, must be directed to Professor Ronald Kessler, PhD, at Harvard Medical School. The instrument is widely accessible online for clinical and research use, often without charge for non-commercial purposes. Further information about the instrument can be found at the official source: http://www.hcp.med.harvard.edu/ncs/asrs.php.

Reference’s

1. Schweitzer JB‚ et al. Med Clin North Am. 2001;85(3):10-11‚ 757-777.
2. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. 1998.
3. Biederman J‚ et al. Am J Psychiatry.1993;150:1792-1798.
4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders‚ Fourth Edition‚ Text Revision. Washington‚ DC‚ American Psychiatric Association. 2000: 85-93.

Items of the Adult ADHD Self Report Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Response Options: Never, Rarely, Sometimes, Often, Very Often

Part A

1. How often do you have trouble wrapping up the final details of a project‚ once the challenging parts have been done?
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
3. How often do you have problems remembering appointments or obligations?
4. When you have a task that requires a lot of thought‚ how often do you avoid or delay getting started?
5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
6. How often do you feel overly active and compelled to do things‚ like you were driven by a motor?

Part B

7. How often do you make careless mistakes when you have to work on a boring or difficult project?
8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
9. How often do you have difficulty concentrating on what people say to you‚ even when they are speaking to you directly?
10. How often do you misplace or have difficulty finding things at home or at work?
11. How often are you distracted by activity or noise around you?
12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
13. How often do you feel restless or fidgety?
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
15. How often do you find yourself talking too much when you are in social situations?
16. When you’re in a conversation‚ how often do you find yourself finishing the sentences of the people you are talking to‚ before they can finish them themselves?
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
18. How often do you interrupt others when they are busy?