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

About this resource

The ASRS v1.1 was developed by the World Health Organization Composite International Diagnostic Interview group with Ronald Kessler, Lenard Adler and colleagues at Harvard Medical School and New York University. The full Symptom Checklist has 18 questions that correspond to the 18 DSM-IV criteria for ADHD, rated by frequency over the past six months. Part A contains the six questions found to be most predictive of a diagnosis; Part B contains the remaining twelve. Part A on its own is the ASRS v1.1 Screener, and it is the part most often used in primary care and counselling settings.

This resource reproduces the six-question Screener (Part A) in full, because it is made freely available by the WHO and Harvard for clinical use without permission and we are confident of the wording. Part B is described but not reproduced; obtain the full 18-item Symptom Checklist from the official source if you want to use it. The Screener has an unusual scoring rule: rather than adding points, each question has a set of 'shaded' responses, and four or more shaded responses across the six questions indicates symptoms highly consistent with ADHD in adults. Kessler and colleagues (2005) reported that this rule performed well against clinician diagnosis in a general population sample.

In practice the ASRS is a door-opener, not a diagnosis. Adult ADHD requires evidence of symptoms in childhood, impairment in more than one setting, and exclusion of other explanations, none of which a six-question screen can establish. This professional version adds guidance on what to do with a positive screen, on the common overlap with anxiety, depression, sleep disorders and trauma, and on how to explain the result to a client without either dismissing their concern or confirming a diagnosis you have not made.

How to use it

1. Give the Screener when a client raises concerns about attention, organisation or restlessness, or when their history suggests ADHD may be part of the picture. It takes about two minutes.
2. Ask the client to answer each question by choosing the frequency that best describes how they have felt and conducted themself over the past six months.
3. Score using the table in the Scoring section. For questions 1 to 3, a response of Sometimes, Often or Very often counts as a shaded response. For questions 4 to 6, only Often or Very often count. Count the shaded responses.
4. Four or more shaded responses is a positive screen. Explain that this means a fuller assessment is worthwhile, and discuss referral to a physician, psychiatrist or psychologist who assesses adult ADHD. Fewer than four does not rule ADHD out if the history is suggestive.
5. Consider what else could explain the symptoms. Anxiety, depression, poor sleep, substance use and trauma all produce inattention and restlessness, and screening for these alongside the ASRS makes the referral more useful.

References

• Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 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.
• Canadian ADHD Resource Alliance (CADDRA). (2020). Canadian ADHD practice guidelines (4.1 ed.). CADDRA.