Symptoms and frequency of Adult ADHD.
Measured Factor Detail
The ASRS v1.1 screener consists of psychometric items that best predict ADHD in adults. Patients are asked to rate theirselves on each criteria using a scale that includes never, rarely, sometimes, often or very often. Scores ≥4 indicate high possibility for Adult ADHD. Scores <4 indicate less possibility for Adult ADHD. Subjects with Scores ≥4 may need further evaluation for adult ADH.
Primary Care Physician
Measured Factor High Impact
- Critical High: ≥4
- Normal: <4
- Normal Adult Male: <4
- Normal Adult Female: <4
- Normal Geriatric Male: <4
- Normal Geriatric Female: <4
Key limitation of this test is that the ASRS screener and clinical interviews are based on self-reports. Contrary to adult ADHD, childhood ADHD is diagnosed on the basis of parent and teacher reports who are in good positions to observe the child's behavior. Adult ADHD diagnosis is limited due to limited extent to which other people are able to observe their behaviors and the availability of reliable informants that depend on the respondent’s marital status, occupational status, and social networks.
Study Validation 1
The WHO Adult ADHD Self-Report Scale (ASRS) screener is a short scale made of 6 questions that can be self-administered and has shown good sensitivity, accuracy and specificity in other studies. This study aimed to assess the validity of this screening test in subscribers to a large health plan in the United States. The sample population was composed of 668 patients who were administered the ASRS screener three times, in order to also assess the test’s retest reliability. Internal consistency reliability of the continuous ASRS Screener was from 0.63 to 0.72. The test-retest reliability using Pearson correlations was from 0.58 to 0.77.
Due to the fact that the ASRS Screener items were selected using a stepwise logistic regression, a better way to evaluate the utility of this test is by considering its concordance with clinical diagnoses. Concordance of the ASRS with clinician diagnosed adult ADHD was found to be strong with an area under the receiver operating characteristic curve of .90, and there were good brevity and ability to discriminate between cases and non-cases.
Study Additional 1
Attention deficit hyperactivity disorder (ADHD) is a common comorbid disorder among patients with mood disorders, such as Major Depressive Disorder (MDD). However, diagnosis of ADHD in this patient population is difficult due to the number of overlapping symptoms that exist between the two. An article published in 2018 looked at two studies and their results to assess the utility of the ADHD Self-Report Scale version 1.1 (ASRS-v1.1) as a tool for diagnosis of ADHD in patients with MDD.
The ASRS-v1.1 was administered to 55 healthy controls and to 40 adults who had a confirmed psychiatric diagnosis of MDD. Patients with MDD scored significantly higher on all 18 items of the ASRS-v1.1 with a p < 0.00278. Overall participants with MDD endorsed many of the ASRS items at a higher frequency than participants with no MDD. Fourteen of the 40 participants with MDD screened positive on the ASRS with a score ≥ 4, indicating a positive result for ADHD. The prevalence of full criteria ADHD, as per the Diagnostic and Statistical Manual of Mental Disorders or DSM, was 12.5% among the depressed sample. The ASRS demonstrated a fair sensitivity (60%) and specificity (68.6%), indicating that the ASRS-v1.1 may have some utility as a quick screening test for ruling out comorbid ADHD in patients with MDD.
Study Additional 2
A study completed in 2013 aimed test the validity and usefulness of the Adult ADHD Self Report scale to detect attention deficit hyperactivity disorder (ADHD) in patients with treatment seeking substance use disorder (SUD). Individuals with substance use disorder represent a substantial proportion of the global population and these are usually associated with adverse outcomes, including ADHD. Surveys indicate an average prevalence of 3-4% adult ADHD in SUD populations.
This study looked at the usefulness of the 6-item version of the World Health Organization ASRS symptom checklist as a screening tool. There was a total of 1138 subjects who completed all parts of the study that included two stages, separated by approximately 14 days. Stage 1 included questions about demographics, substance use and the ASRS. Stage 2 included a second administration of the ASRS and a thorough examination to establish the presence of SUD, ADHD, antisocial personality disorder (APD), borderline personality disorder (BPD), major depression (MD), and bipolar disorder (BD) diagnoses.
The prevalence of adult ADHD in the study was 13%. At stage 1 there were 3.4% false negatives and 28.3% true positives. At stage 2 there were 2.5% false negatives and 28.3% false positives. The sensitivity and specificity of the test was similar at both stages with 0.84 sensitivity and 0.66 specificity at stage 1 and 0.88 sensitivity and 0.67 specificity at stage 2. In general, the ASRS was not a good screener for externalizing disorders other than adult ADHD. This suggests than important clinical variables are not likely to impact the utility of this screening tool in this patient population.
Study Additional 3
The test-retest reliability of the Adult Attention deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS) v1.1 screener in adults without ADHD was examined in non-ADHD subjects from a primary care physician practice. A total of 104 subjects tested negative for ADHD using the ASRS v1.1 screener in a primary care physician waiting room were re-tested over the phone using the same ASRS v1.1 screener. Screener scores from the waiting room were significantly correlated with those over the phone, with Spearman correlation's rho of 0.78 and p value < 0.0001. The McNemar-Bowker tests showed no significant differences for ASRS Screener total score and IA items; however, the H-I items were higher for ASRS scores from the waiting room versus those over the phone. The study concluded that ASRS v1.1 Screener has high test-retest reliability in subjects without ADHD.