Adult ADHD Self-Report Scale

Abstract

The Adult ADHD Self Report Scale (ASRS v1.1) is an internationally recognized screening instrument developed by the World Health Organization (WHO) in collaboration with the Workgroup on Adult ADHD. Published in 2003, the ASRS v1.1 is designed to screen for symptoms consistent with Attention Deficit Hyperactivity Disorder (ADHD) in the adult population. It is a brief, self-administered tool derived from the WHO’s Composite International Diagnostic Interview (CIDI) and aligns its content criteria with the diagnostic requirements set forth in the DSM-IV-TR. The scale consists of 18 items, focusing on core domains of inattention and hyperactivity/impulsivity.

The primary utility of the ASRS v1.1 lies in its six-item screening component (Part A), which exhibits high sensitivity for identifying individuals who may require a more thorough clinical assessment for ADHD. This instrument provides a quick, efficient, and reliable preliminary measure for use in clinical settings, primary care, and large-scale epidemiological studies.

Keywords

ASRS v1.1, Adult ADHD, Self-report scale, Screening instrument, Hyperactivity, Inattention, DSM-IV-TR, World Health Organization, Psychological assessment.

Authors

World Health Organization (WHO), Workgroup on Adult ADHD, Professor Ronald Kessler.

Purpose

The primary purpose of the ASRS v1.1 is to facilitate the identification and screening of adults who may meet the diagnostic criteria for ADHD. It serves as a preliminary assessment tool, indicating the likelihood of an adult having clinically significant symptoms of the disorder, thereby determining if a more comprehensive psychiatric evaluation is necessary.

The scale was developed specifically to address the complexity of diagnosing ADHD in adults, where symptoms often manifest differently than in childhood. By focusing on persistent adult behaviors related to executive function deficits, organization, and emotional regulation, the ASRS helps clinicians bridge the gap between retrospective childhood symptoms and current functional impairment.

Construct

The ASRS v1.1 measures the psychological construct of adult Attention Deficit Hyperactivity Disorder, which is characterized by persistent, impairing patterns across two core symptom clusters: Inattention and Hyperactivity-Impulsivity. The instrument is structured to reflect the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The 18 items are designed to capture the frequency of these behaviors over the preceding six months. Part A (Items 1-6) specifically targets the most highly predictive symptoms of ADHD, particularly those related to persistent inattention and difficulty with task completion and organization. Part B (Items 7-18) includes additional items covering both inattention and hyperactivity/impulsivity, ensuring a broad assessment of the full spectrum of adult ADHD presentation.

Validity

The validity of the ASRS v1.1 is robust, having been established through comparison with structured diagnostic interviews. Criterion validity is strong, as demonstrated by the scale’s high correlation with clinical diagnoses derived from comprehensive assessments, such as the Composite International Diagnostic Interview (CIDI), from which the items were adapted. The six-item screening tool (Part A) is highly valued for its exceptional sensitivity (often exceeding 90%) in identifying potential cases that warrant further investigation.

Construct validity is supported by the scale’s empirical alignment with the established theoretical structure of ADHD, successfully differentiating clinical cases from non-clinical controls. The items reflect observable behaviors indicative of functional impairment in adults, confirming that the scale accurately measures the intended clinical syndrome.

Reliability

The ASRS v1.1 demonstrates high levels of internal consistency, suggesting that the items within the scale reliably measure the same underlying disorder. Studies consistently report high Cronbach’s alpha coefficients for the full 18-item scale, typically above 0.80. This indicates strong homogeneity among the items across both inattention and hyperactivity factors.

Furthermore, the instrument exhibits stable test-retest reliability over appropriate intervals, confirming that the scores are dependable and consistent when the clinical status of the respondent has not changed. This stability is critical for a screening tool intended for repeated use in monitoring symptom severity or treatment response.

Factor Analysis

Factor analysis of the ASRS v1.1 typically supports a structure that aligns closely with the DSM-IV conceptualization of ADHD. The results often confirm a two-factor model, distinguishing between Inattention and Hyperactivity-Impulsivity dimensions. While the scale is frequently utilized as a single, combined score for initial screening purposes, the underlying factor structure validates its utility in assessing the distinct clusters of symptoms.

Crucially, the six items selected for the highly sensitive Part A were chosen based on empirical factor loadings and their proven ability to maximize predictive accuracy, effectively acting as a strong indicator of overall symptom burden.

Instrument

Test Type: Self-Report Screening Instrument

Format: 18-item questionnaire using a 5-point Likert scale.

Language Available: Widely translated into numerous languages due to its deployment in WHO epidemiological studies globally.

Population Group: Clinical and general adult populations.

Age Group: 18 years and older.

Population Details: Developed for use in community samples globally, ensuring its applicability across diverse cultural and educational backgrounds. It is used to assess symptoms that have persisted from childhood into adulthood, resulting in current functional impairment.

Test Methodology: Respondents rate how often they experience specific behaviors over the past six months using options: Never, Rarely, Sometimes, Often, or Very Often. Scoring involves identifying items marked ‘Often’ or ‘Very Often’ that fall into the critical symptom range. A positive screen is typically indicated by four or more positive responses on the six-item Part A.

Keywords

ASRS, ADHD screening, Adult mental health, Ronald Kessler, Composite International Diagnostic Interview, Psychological assessment, Clinical diagnosis, Hyperactivity-Impulsivity.

Authors

Author ORCID Identifier: Not publicly provided for the collective WHO/Workgroup.

Affiliation Email addresses: For permissions and correspondence regarding reproduction or translation: [email protected] (Professor Ronald Kessler, Harvard Medical School).

Correspondence Address: Department of Health Care Policy, Harvard Medical School.

Permissions & Fee and Test Year

The ASRS v1.1 was developed in 2003, based on the Composite International Diagnostic Interview (CIDI) copyrighted by the World Health Organization in 2001. All rights are reserved by the WHO.

The instrument is typically available for non-commercial research and clinical use with permission. Requests for permission to reproduce or translate the scale—whether for sale or for noncommercial distribution—should be addressed to Professor Ronald Kessler, PhD, Department of Health Care Policy, Harvard Medical School, (fax: +011 617-432-3588; email: [email protected]).

Reference’s

• Schweitzer JB, et al. Med Clin North Am. 2001;85(3):10-11, 757-777.
• Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. 1998.
• Biederman J, et al. Am J Psychiatry.1993;150:1792-1798.
• 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.

The response options for all items are: 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?