Adult ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist

Abstract

The Adult ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist was developed by the World Health Organisation (WHO) workgroup as part of the WHO World Mental Health Survey Initiative (Kessler et al., 2005). Its primary function is to provide a valid and brief self-assessment of current Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in adults. The scale consists of 18 items directly mirroring the 18 symptoms defined in the DSM-IV criteria, but deliberately reworded to reflect adult contexts (e.g., using “work” instead of “schoolwork”). Respondents rate symptom frequency over the past six months on a five-point scale.

The ASRS utilizes a frequency count method based on “gray shaded boxes” rather than a total score summation to determine diagnostic likelihood. A count of nine or more endorsed items on the full scale suggests the need for further clinical referral. The instrument also features a 6-item short-form, the ASRS v1.1 Screener (Part A), which has demonstrated strong psychometric properties for rapid screening.

Keywords

ADHD, Adult ADHD Self-Report Scale, ASRS, Screening tool, DSM-IV, Inattention, Hyperactivity, Self-report, WHO, Clinical assessment.

Authors

Ronald C. Kessler, Lenard Adler, Mark Ames, O. Demler, Stephen Faraone, E. V. A. Hiripi, T. B. Ustun, M. J. Howes, J. Biederman, K. Secnik.

Purpose

The fundamental purpose of the ASRS v1.1 Symptom Checklist is to offer a highly efficient and standardized self-report mechanism for identifying the presence and frequency of ADHD symptoms in the general adult population. Developed for large-scale epidemiological studies, such as the WHO World Mental Health (WMH) Survey Initiative, the scale prioritizes ease of administration and scoring.

It is specifically designed as a screening tool to identify adults who exhibit a sufficient number of symptoms to warrant a comprehensive clinical diagnostic interview. Although widely used in clinical and research settings, it is explicitly stated that the ASRS must not be used as the sole basis for making a formal ADHD diagnosis, as it lacks necessary information regarding childhood symptom onset and functional impairment.

Construct

The ASRS measures the subjective frequency of symptomatic behaviors associated with Attention-Deficit/Hyperactivity Disorder, aligning precisely with the 18 symptom criteria detailed in the DSM-IV. The scale captures both core dimensions of the disorder: the Inattention domain and the Hyperactivity-Impulsivity domain.

A key aspect of the ASRS construct is the adaptation of item wording to be ecologically valid for adults. For example, items related to difficulties with sustained effort are framed in the context of “work” or a “boring or difficult project,” making the scale more applicable to adult life challenges. The response mechanism focuses on how often symptoms occurred over the past six months, using a 5-point frequency scale, rather than assessing the severity of the emotional distress or impairment caused by the symptoms.

Validity

The ASRS demonstrates robust validity for its intended use as a screening measure. The initial validation study (Kessler et al., 2005), comparing the scale against structured clinician interviews in a community sample, yielded strong results for classification accuracy. The scale exhibited excellent specificity (98.3%) and excellent total classification accuracy (97.9%), although sensitivity was moderate (56.3%). The associated Kappa value was adequate at 0.58.

Further validation in clinical populations confirmed strong concurrent validity. Adler et al. (2006) reported a high correlation coefficient (0.83) between ASRS scores and scores from a clinician-administered ADHD rating scale. The scale’s face validity is high, as the item wording is appropriate for capturing adult manifestations of the disorder. Its utility has been supported across various contexts, including screening individuals with co-occurring conditions like substance-abuse disorders (Dakwar et al., 2012).

Reliability

Reliability analyses indicate that the ASRS possesses strong internal consistency. For the full 18-item scale, internal consistency was reported to be high (0.84) in a clinical sample of adults with ADHD (Adler et al., 2006).

The 6-item ASRS v1.1 Screener also demonstrates solid psychometric properties. A cross-validation study (Kessler et al., 2007) reported internal consistency coefficients ranging from 0.63 to 0.72. Furthermore, the short-form exhibited acceptable test-retest reliability, ranging from 0.58 to 0.77. Cross-cultural studies of translated versions, such as the Chinese ASRS, consistently report high internal consistency (e.g., 0.83 to 0.91), confirming the stability of the measure across different linguistic groups.

Factor Analysis

The ASRS is structurally based on the two-factor model of ADHD derived from the DSM-IV: Inattention and Hyperactivity/Impulsivity. The scale’s 18 items are divided to assess these two conceptually distinct symptom clusters.

The development of Part A (the 6-item screener) was based on identifying the most predictive items for clinical diagnosis, regardless of their specific factor loading (Inattention or Hyperactivity), thus optimizing the short form for maximum screening efficacy rather than strict factor representation. This approach prioritizes predictive accuracy over a pure two-factor structure for rapid identification purposes.

Instrument

Test Type: Self-report Symptom Checklist / Screening Tool

Format: 18 items administered using a 5-point Likert-type frequency scale (0 “never,” 1 “rarely,” 2 “sometimes,” 3 “often,” and 4 “very often”).

Language Available: Available in at least 10 languages, including Chinese (Mandarin), Dutch, German, Japanese, Portuguese, Russian, and Spanish. Cross-cultural validation exists for several translated versions.

Population Group: General and Clinical populations, including individuals with co-morbid disorders (e.g., substance use disorders).

Age Group: Adults (18+ years) and Adolescents (13-17 years), following subsequent validation studies.

Population Details: Developed and initially validated in the US using a community-based sample, with further validation in clinical samples of individuals diagnosed with ADHD.

Test Methodology: The scale assesses the frequency of symptoms over the past six months. Scoring is determined by counting the number of items endorsed that fall into pre-specified “gray shaded boxes.” A count of 9 or more endorsed items on the full scale, or 4 or more on the 6-item screener (Part A), is the recommended threshold for clinical referral.

Keywords

Psychometrics, Screening, WHO, Adult psychiatry, Inattention, Hyperactivity-Impulsivity, Test-retest reliability, Concurrent validity, Clinical research, Self-assessment.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The ASRS v1.1 Symptom Checklist is free for public use, including clinical and research applications. The core scale development and initial validation studies were published in 2005 (Kessler et al.) and 2006 (Adler et al.). The original PDF can be downloaded here: https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf.

Reference’s

Adler, L. A., Spencer, T., Faraone, S. V., Kessler, R. C., Howes, M. J., Biederman, J., & Secnik, K. (2006). Validity of pilot Adult ADHD Self-Report Scale (ASRS) to rate adult ADHD symptoms. Annals of Clinical Psychiatry, 18(3), 145-148.

Dakwar, E., Mahony, M. A., Pavlicova, M., Glass, M. A., Brooks, M. D., Mariani, J. J., … & Levin, F. R. (2012). The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders. The Journal of clinical psychiatry, 73(11), e1372.

Herrmann, M. J., Saathoff, C., Schreppel, T. J., Ehlis, A. C., Scheuerpflug, P., Pauli, P., & Fallgatter, A. J. (2009). The effect of ADHD symptoms on performance monitoring in a non-clinical population. Psychiatry research, 169(2), 144-148.

Hines, J. L., King, T. S., & Curry, W. J. (2012). The adult ADHD self-report scale for screening for adult attention deficit–hyperactivity disorder (ADHD). The Journal of the American Board of Family Medicine, 25(6), 847-853.

Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., … & Ustun, T. B. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine, 35(02), 245-256.

Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self‐Report Scale (ASRS) Screener in a representative sample of health plan members. International journal of methods in psychiatric research, 16(2), 52-65.

Kim, J. H., Lee, E. H., & Joung, Y. S. (2013). The WHO Adult ADHD Self-Report Scale: reliability and validity of the Korean version. Psychiatry investigation, 10(1), 41-46.

Reuter, M., Kirsch, P., & Hennig, J. (2006). Inferring candidate genes for attention deficit hyperactivity disorder (ADHD) assessed by the World Health Organization Adult ADHD Self-Report Scale (ASRS). Journal of neural transmission, 113(7), 929-938.

Yeh, C. B., Gau, S. S. F., Kessler, R. C., & Wu, Y. Y. (2008). Psychometric properties of the Chinese version of the adult ADHD Self‐report Scale. International journal of methods in psychiatric research, 17(1), 45-54.

Items of the Adult ADHD Self Report Scale (ASRS) v1.1. Symptom Checklist

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

The original source content did not provide the explicit text of the 18 items. It only described their nature and adult-specific wording changes, such as replacing references to “play” and “schoolwork” with “work” and “boring or difficult project.” The 18 items cover the full range of Inattention and Hyperactivity-Impulsivity symptoms corresponding to the DSM-IV criteria.