The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population.
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.


METHODS
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 kappa 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 kappa (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.
Kessler
Ronald C
RC
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
Adler
Lenard
L
Ames
Minnie
M
Demler
Olga
O
Faraone
Steve
S
Hiripi
Eva
E
Howes
Mary J
MJ
Jin
Robert
R
Secnik
Kristina
K
Spencer
Thomas
T
Ustun
T Bedirhan
TB
Walters
Ellen E
EE
D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology*; D002138:Calibration; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011594:Psychometrics; D012016:Reference Values; D019455:Self Psychology; D014944:World Health Organization