ASRS v1.1 Scoring · Adult ADHD Self-Report Scale

The ASRS (Adult ADHD Self-Report Scale) is an 18-item self-report questionnaire that screens adults for ADHD by rating how often recent DSM Criterion A symptoms occur; its 6-item Part A is the screener ^[1].

Foundational context

The ASRS was developed to address the need for a brief, accurate adult ADHD screener that could be used in both clinical and general population settings. Prior to its creation, most ADHD measures were designed for children or required lengthy clinician administration.

The ASRS v1.1 was developed with the World Health Organization alongside the revised Composite International Diagnostic Interview, and was validated against blind clinical diagnoses in 154 respondents from the US National Comorbidity Survey Replication ^[1], demonstrating strong performance as a short screener.

Part A (the 6-item screener) includes items with the highest predictive power for identifying potential ADHD cases. Part B offers a fuller view of symptom frequency but is not used for diagnostic cutoffs. Together, they provide an accessible, structured approach to detecting potential ADHD symptoms in adults who may not have been identified earlier in life.

What does the ASRS measure?

The ASRS evaluates symptom frequency across core ADHD domains, reflecting DSM-IV/DSM-5-TR criteria for adult presentations. It focuses on the real-world expression of symptoms in daily functioning, including both attentional and hyperactive-impulsive patterns.

The ASRS measures:

• Inattention: difficulty sustaining focus, disorganization, forgetfulness, task avoidance
• Hyperactivity: restlessness, trouble sitting still, excessive activity
• Impulsivity: interrupting, difficulty waiting, acting without thinking
• Task initiation and completion: starting tasks, following through on responsibilities
• Executive functioning challenges: planning, prioritizing, and working memory issues

These domains help clinicians understand whether symptom patterns align with common adult ADHD profiles, without implying diagnostic determination.

How do you give the ASRS?

• Self-administered in paper or digital formats
• Designed for quick completion with minimal burden
• Works well in primary care, psychiatry, psychology, and workplace evaluations
• Should be administered when the individual is calm and able to reflect on typical functioning
• For individuals with literacy challenges, clinician-supported administration may be appropriate

Documenting ASRS results in clinical notes: The ASRS Part A score and symptom endorsement count belong in the Objective section of the note. The SOAP notes guide has templates and examples.

How do you score and interpret the ASRS?

1. The adult rates how often each of the 18 symptoms has occurred recently. Six of them form Part A, the screener; the other 12 form Part B ^[1].
2. Score Part A: count how many of the 6 Part A answers fall in the shaded (elevated-frequency) range on the form.
3. A count of 4 or more is a positive screen: the person is likely to meet criteria for ADHD on further evaluation. It is a trigger for a full clinical assessment, not a diagnosis.
4. Read a negative screen with care. In the original validation, Part A had 68.7% sensitivity and 99.5% specificity against blind clinical diagnoses ^[1], so about 1 in 3 adults with ADHD may screen negative.
5. Review Part B for detail. It has no separate cutoff; higher-frequency answers show more persistent ADHD-like patterns and guide interview follow-up.

Global Considerations:

• Self-report may be influenced by mood, stress, insight, or coping mechanisms.
• ADHD symptoms must cause functional impairment to meet diagnostic criteria, the ASRS does not assess impairment directly.
• Elevated scores warrant contextual evaluation through interview, collateral information, and functional assessment.

Psychometric properties

Reliability

• Part A screener internal consistency 0.63–0.72 and test–retest reliability 0.58–0.77 in 668 health plan subscribers ^[2]
• High test–retest reliability of the screener in adults without ADHD in primary care (Spearman's rho = 0.78; ICC = 0.75) ^[3]

Validity

• Part A demonstrates moderate sensitivity (68.7%) and excellent specificity (99.5%) for ADHD screening, outperforming the unweighted 18-item ASRS (56.3% and 98.3%) ^[1]
• Area under the ROC curve of 0.90 against clinician diagnoses in a health plan sample ^[2]
• Strong convergent validity with clinician-administered ADHD assessments
• Distinguishes well between adults with ADHD and non-ADHD controls
• Factor analyses support its structure across attention and hyperactive-impulsive domains

The screener was validated against blind clinical DSM-IV ratings in a community sample ^[1], contributing to its widespread adoption.

Limitations

• Screening tool only, not diagnostic
• Self-report bias may influence results
• Does not assess age-of-onset criteria or functional impairment (required for diagnosis)
• Not validated for severe cognitive impairment or unstable psychiatric states
• Cultural and linguistic adaptation may affect validity across populations

ASRS vs other ADHD screening tools

Choosing the right ADHD assessment depends on your clinical setting and diagnostic needs. Here's how the ASRS compares to other ADHD measures.

ASRS vs CAARS: brief screener vs full assessment

The ASRS suits high-volume screening in primary care or at intake: Part A (6 questions) gives rapid triage with very high specificity ^[1].

Use the CAARS when you need detailed symptom profiling across subscales or a fuller diagnostic evaluation. Many clinics screen with the ASRS, then follow positive screens with the CAARS.

When to use the ASRS: fast screening, large caseloads, primary care, a brief self-report screen, or an initial intake assessment.

ASRS vs WURS: current vs childhood symptoms

The ASRS screens for current adult ADHD symptoms, while the WURS-25 asks about childhood symptom history, which DSM-5-TR requires for an ADHD diagnosis. In full evaluations, use both: the ASRS for current symptoms, the WURS for early onset.

The WURS relies on retrospective recall, which can be unreliable; corroboration from childhood records or family is recommended.

When to use both: a complete ADHD diagnosis documents both current symptoms (ASRS) and childhood onset (WURS or clinical interview). The ASRS alone is enough for screening and symptom monitoring.

ASRS-6 (Part A only) vs the full 18-item ASRS

Part A alone (ASRS-6) is enough for screening in high-volume settings: its 99.5% specificity means very few false positives, and in the original study it outperformed the unweighted 18-item ASRS ^[1].

Use the full 18-item ASRS when you need a detailed symptom breakdown for treatment planning, or to monitor response to ADHD medication.

Workflow: use the ASRS-6 (Part A) for initial screening in primary care. If positive, give the full ASRS and a clinical interview to confirm the diagnosis.