Psychological Medicine



The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population


RONALD C. KESSLER a1c1, LENARD ADLER a1, MINNIE AMES a1, OLGA DEMLER a1, STEVE FARAONE a1, EVA HIRIPI a1, MARY J. HOWES a1, ROBERT JIN a1, KRISTINA SECNIK a1, THOMAS SPENCER a1, T. BEDIRHAN USTUN a1 and ELLEN E. WALTERS a1
a1 Department of Health Care Policy, Harvard Medical School; Departments of Psychiatry and Neurology, New York University School of Medicine; Department of Psychiatry, Massachusetts General Hospital; Eli Lilly and Company, Global Health Outcomes; Global Burden of Disease Unit, World Health Organization

Article author query
kessler rc   [PubMed][Google Scholar] 
adler l   [PubMed][Google Scholar] 
ames m   [PubMed][Google Scholar] 
demler o   [PubMed][Google Scholar] 
faraone s   [PubMed][Google Scholar] 
hiripi e   [PubMed][Google Scholar] 
howes mj   [PubMed][Google Scholar] 
jin r   [PubMed][Google Scholar] 
secnik k   [PubMed][Google Scholar] 
spencer t   [PubMed][Google Scholar] 
ustun tb   [PubMed][Google Scholar] 
walters ee   [PubMed][Google Scholar] 

Abstract

Background. A self-report screening scale of adult attention-deficit/hyperactivity disorder (ADHD), the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed in conjunction with revision of the WHO Composite International Diagnostic Interview (CIDI). The current report presents data on concordance of the ASRS and of a short-form ASRS screener with blind clinical diagnoses in a community sample.

Method. The ASRS includes 18 questions about frequency of recent DSM-IV Criterion A symptoms of adult ADHD. The ASRS screener consists of six out of these 18 questions that were selected based on stepwise logistic regression to optimize concordance with the clinical classification. ASRS responses were compared to blind clinical ratings of DSM-IV adult ADHD in a sample of 154 respondents who previously participated in the US National Comorbidity Survey Replication (NCS-R), oversampling those who reported childhood ADHD and adult persistence.

Results. Each ASRS symptom measure was significantly related to the comparable clinical symptom rating, but varied substantially in concordance (Cohen's κ in the range 0·16–0·81). Optimal scoring to predict clinical syndrome classifications was to sum unweighted dichotomous responses across all 18 ASRS questions. However, because of the wide variation in symptom-level concordance, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS in sensitivity (68·7% v. 56·3%), specificity (99·5% v. 98·3%), total classification accuracy (97·9% v. 96·2%), and κ (0·76 v. 0·58).

Conclusions. 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 initiatives.


Correspondence:
c1 Dr R. C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: kessler@hcp.med.harvard.edu)


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