{n “title”: “Adult ADHD Self Report Scale”,n “content”: “
Abstract
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The Adult ADHD Self-Report Scale (ASRS v1.1) is an internationally recognized, 18-item psychometric screening instrument developed in conjunction with the World Health Organization (WHO) and the Workgroup on Adult ADHD. Designed to assess attention-deficit/hyperactivity disorder (ADHD) symptoms in adult populations (ages 18 and older), the instrument operationalizes the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), which remain conceptually foundational under DSM-5. The scale comprises two subscales: Inattention (9 items) and Hyperactivity/Impulsivity (9 items). Respondents rate the frequency of behavioral manifestations over the past six months using a 5-point Likert scale ranging from Never (0) to Very Often (4). Psychometric evaluations consistently demonstrate that a subset of six items (designated as Part A) serves as an optimal, highly sensitive screening tool, while the remaining twelve items (Part B) provide essential clinical nuance and dimensional severity profiles. Validation studies across clinical, epidemiological, and community cohorts demonstrate excellent internal consistency (Cronbach’s alpha spanning 0.88 to 0.94), robust test-retest reliability ($r > 0.80$), and remarkable concordance with clinician-administered structured diagnostic interviews, including the Composite International Diagnostic Interview (CIDI) and the Structured Clinical Interview for DSM Disorders (SCID). With high classification sensitivity (68.7%–88.4%) and extraordinary specificity (98.3%–99.5%), the ASRS v1.1 represents a premier benchmark in psychological assessment, cross-cultural psychiatric epidemiology, and routine clinical triage.
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Keywords
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Adult ADHD Self-Report Scale, ASRS v1.1, Attention-Deficit/Hyperactivity Disorder, Psychometrics, Executive Dysfunction, Inattention, Hyperactivity, Impulsivity, WHO Composite International Diagnostic Interview, Diagnostic Screening
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Authors
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The Adult ADHD Self-Report Scale (ASRS v1.1) was developed through a collaborative initiative led by the World Health Organization (WHO) and the Workgroup on Adult ADHD. The primary investigative committee comprised prominent psychiatric epidemiologists, psychometricians, and clinical researchers:
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- Ronald C. Kessler, Ph.D. — Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Principal Investigator and primary epidemiologist for the National Comorbidity Survey Replication).
- Lenard A. Adler, M.D. — Department of Psychiatry and Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
- Russell A. Barkley, Ph.D. — Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA (Emeritus).
- Joseph Biederman, M.D. — Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- C. Keith Conners, Ph.D. — Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Stephen V. Faraone, Ph.D. — Departments of Psychiatry and Neuroscience & Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
- Laurence L. Greenhill, M.D. — New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA.
- Thomas Spencer, M.D. — Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- T. Bedirhan Üstün, M.D. — Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
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Correspondence regarding permissions and epidemiological implementations was centrally coordinated through Professor Ronald C. Kessler at the Department of Health Care Policy, Harvard Medical School.
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Purpose
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The primary purpose of the Adult ADHD Self-Report Scale (ASRS v1.1) is to provide a standardized, psychometrically rigorous, and cost-effective mechanism for identifying adults exhibiting symptoms characteristic of Attention-Deficit/Hyperactivity Disorder. Historically classified as a neurodevelopmental disorder confined to childhood and adolescence, longitudinal tracking demonstrated that ADHD persists into adulthood in approximately 50% to 65% of cases. However, diagnosing adult ADHD presents complex diagnostic challenges due to developmental symptom transformation, compensatory mechanisms, cognitive scaffolding, and elevated psychiatric comorbidity, particularly with major depressive disorder, bipolar disorder, anxiety disorders, and substance use disorders.
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In pediatric populations, hyperactivity typically manifests as observable gross motor excess (e.g., running, climbing, excessive physical movement). In contrast, adults rarely present with overt gross motor hyperactivity; rather, their symptoms undergo internalization, presenting as subjective cognitive restlessness, chronic inner tension, executive dysfunction, pervasive procrastination, organizational paralysis, and verbal impulsivity. Standard DSM criteria, framed originally for pediatric behavioral contexts (such as classroom disruptions), frequently suffered from poor face validity and compromised diagnostic sensitivity when administered to adult cohorts without contextual adaptation.
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To resolve this diagnostic disconnect, the WHO Advisory Committee constructed the ASRS v1.1 to translate each of the 18 DSM symptom criteria into ecologically valid adult behavioral descriptions. The scale fulfills multiple objectives across healthcare environments:
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- Primary Care and Psychiatric Triage: Serving as an efficient preliminary screener to flag patients who require comprehensive neurodevelopmental and psychiatric evaluations, reducing both underdiagnosis and inappropriate stimulant prescription.
- Epidemiological Surveillance: Providing a validated instrument for cross-national prevalence estimations, such as those undertaken by the WHO World Mental Health Survey Initiative.
- Treatment Monitoring and Clinical Trials: Offering a continuous dimensional metric to track therapeutic efficacy, behavioral interventions, and pharmacological response over time.
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Importantly, the ASRS v1.1 is designed not as a definitive standalone diagnostic instrument, but as a systematic first-step screening assessment that must be contextualized by thorough clinical interviews evaluating age-of-onset, developmental chronicity, pervasiveness across settings, and functional impairment.
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Psychological Construct
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The ASRS v1.1 measures the overarching construct of Adult Attention-Deficit/Hyperactivity Disorder, structured hierarchically into two primary psychometric dimensions as delineated by modern diagnostic nomenclature: Inattention and Hyperactivity/Impulsivity.
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1. Inattention Dimension
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The Inattention subscale captures widespread failures in selective, sustained, and executive attention within adult environments. Rather than representing an absolute inability to pay attention, adult inattention reflects an inability to self-regulate attentional allocation, resist cognitive interference, and maintain mental effort during low-stimulation, non-novel tasks. In the ASRS v1.1, this domain is represented across nine items focusing on:
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- Task Execution and Completion Failures: Inability to resolve the final logistical details of projects once the mentally stimulating or challenging portions are accomplished (Item 1).
- Executive Disorganization: Pervasive difficulties in structuring sequences of action, managing workflow, and prioritizing administrative demands (Item 2).
- Prospective Memory Deficits: Failures in cognitive time-tagging, resulting in missed appointments, unfulfilled obligations, and broken commitments (Item 3).
- Task Avoidance and Activation Latency: Severe procrastination or active avoidance when confronted with activities that require sustained executive effort and mental stamina (Item 4).
- Careless Errors and Insufficient Quality Control: Proneness to making oversight errors in occupational or administrative tasks due to lapses in sustained focus during repetitive or mundane tasks (Item 7).
- Vulnerability to Distraction: Inability to filter out ambient auditory or visual environmental stimuli (Item 11), alongside high susceptibility to internal mind-wandering during direct interpersonal communication (Item 9).
- Working Memory Failures: Chronic misplacement of essential items (e.g., keys, wallets, paperwork) required for daily functioning (Item 10).
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2. Hyperactivity/Impulsivity Dimension
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The Hyperactivity/Impulsivity subscale captures the adult behavioral phenotype of physiological restlessness, deficient behavioral inhibition, and impaired impulse control. In adult life, motor restlessness rarely manifests as physical running or climbing; instead, it transmutes into micro-movements, affective dysphoria during enforced idleness, and communicative disinhibition:
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- Peripheral Fidgeting and Somatic Restlessness: Involuntary tapping of hands or feet, squirming in chairs, and inability to maintain physical stillness during seated activities (Item 5 and Item 13).
- Subjective Motor Urgency (“Driven by a Motor”): An enduring, compelling subjective urge to stay constantly occupied, accompanied by rapid behavioral output (Item 6).
- Inappropriate Physical Disengagement: Leaving seats or workstations during professional meetings, lectures, or social settings where seated adherence is expected (Item 12).
- Inability to Modulate Leisure and Relaxation: Severe difficulty unwinding or engaging quietly in leisure pursuits, often experiencing physical relaxation as internally distressing or boring (Item 14).
- Verbal Disinhibition: Chronic hyper-talkativeness, dominating conversations, and speaking excessively in social or professional gatherings (Item 15).
- Impulsive Social Intrusion: Inability to tolerate conversational pauses, leading to finishing other people’s sentences (Item 16), failing to wait one’s turn in structured situations (Item 17), and interrupting or intruding upon others while they are occupied (Item 18).
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Theoretical Framework
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The conceptual architecture of the ASRS v1.1 is grounded in modern neurobiological and cognitive models of executive functioning, most notably Russell A. Barkley’s Unified Theory of Behavioral Inhibition and Executive Functioning, as well as Edmund Sonuga-Barke’s Dual-Pathway Model of ADHD.
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Barkley’s Executive Function and Behavioral Inhibition Model
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Barkley posits that the fundamental neurobehavioral defect in ADHD is not an attention deficit per se, but an underlying disruption in behavioral inhibition. Behavioral inhibition encompasses three interlocked processes: (1) inhibiting an initial prepotent response, (2) interrupting an ongoing response that is proving ineffective, and (3) protecting the delay period and self-directed executive actions from interference (interference control). Under this theoretical framing, intact behavioral inhibition serves as the vital foundation that allows four central executive functions to operate effectively:
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- Non-Verbal Working Memory: Holding sensory and behavioral representations in mind over temporal delays to guide future behavior. Impairments explain why adults with ADHD misplace items (ASRS Item 10) and forget obligations (Item 3).
- Internalization of Speech (Verbal Working Memory): The developmental shift from external verbal guidance to covert, internal self-talk that facilitates self-directed rule adherence, reflection, and task persistence. Impairments lead to conversational intrusion (Item 16) and excessive vocal output (Item 15).
- Self-Regulation of Affect, Motivation, and Arousal: The capacity to generate intrinsic motivation to sustain effort in the absence of immediate extrinsic reinforcement. In adults, this manifests as chronic procrastination on complex tasks (Item 4) and an inability to wind down or modulate arousal levels (Item 14).
- Reconstitution (Analysis and Synthesis): The cognitive ability to deconstruct observed behaviors and synthesize novel, goal-directed behavioral sequences. Disruption results in severe disorganization and logistical failure during the completion phases of projects (Items 1 and 2).
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The Dual-Pathway Neurocognitive Model
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The dual-pathway model proposed by Sonuga-Barke suggests that ADHD originates through two dissociable neurobiological pathways: a cognitive/executive pathway mediated by fronto-striatal and fronto-parietal dopaminergic circuits, and a motivational/reward-processing pathway mediated by the meso-limbic dopamine system. While executive dysregulation drives inattention and disorganization, reward-processing abnormalities cause delay aversion—a profound affective intolerance of temporal delays and low-stimulation tasks. In the ASRS v1.1, delay aversion is directly captured by items measuring the active avoidance of mentally taxing tasks (Item 4), careless mistakes during boring routines (Item 7), and interpersonal impatience (Item 17).
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Furthermore, modern cognitive neuroscience confirms that ADHD in adulthood involves disruptions in default mode network (DMN) regulation. Normally, the DMN attenuates during cognitively demanding tasks as the Central Executive Network (CEN) activates. In individuals with adult ADHD, insufficient DMN suppression allows intrusive task-unrelated thoughts and external distractions to break focus, directly operationalizing the phenomena captured in ASRS Items 8, 9, and 11.
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Validity
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The ASRS v1.1 has undergone rigorous international psychometric validation across clinical, general community, and occupational samples, establishing robust construct, criterion, convergent, and discriminant validity.
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1. Criterion and Diagnostic Validity
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In the foundational validation study conducted by Kessler et al. (2005) utilizing data from the National Comorbidity Survey Replication (NCS-R), the 18-item ASRS was calibrated against blinded clinical diagnoses derived from the clinician-administered Structured Clinical Interview for DSM-IV (SCID). Stepwise logistic regression and receiver operating characteristic (ROC) curve analyses revealed that a 6-item subset (designated as Part A) outperformed the full 18-item scale in classification accuracy.
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The area under the ROC curve (AUC) for the 6-item Part A screener reached 0.89 to 0.94 across general population and clinical samples. When scored using the recommended dichotomous threshold (where $\\ge 4$ positive items signify a positive screen), the ASRS Part A demonstrated:
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- Sensitivity: 68.7% in general community samples, increasing to 88.4% in psychiatric outpatient cohorts.
- Specificity: 98.3% to 99.5%, demonstrating an exceptionally low false-positive rate.
- Total Classification Accuracy: 97.9% concordance with comprehensive clinical psychiatric diagnoses.
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2. Convergent and Divergent Validity
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Convergent validity has been evaluated by correlating ASRS scores with established clinical ADHD scales. The ASRS total and subscale scores correlate strongly ($r = 0.76$ to $0.84$) with the Conners’ Adult ADHD Rating Scales (CAARS), the Barkley Adult ADHD Rating Scale (BAARS-IV), and the Wender Utah Rating Scale (WURS) retrospectively assessing childhood symptoms ($r = 0.61$ to $0.72$).
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Discriminant validity has been confirmed through differential correlation with mood and anxiety inventories. While ASRS scores show modest correlations with the Beck Depression Inventory (BDI; $r = 0.32$ to $0.41$) and the Beck Anxiety Inventory (BAI; $r = 0.28$ to $0.36$)—reflecting real-world clinical comorbidity—exploratory factor analyses confirm that ASRS items load onto distinct neurodevelopmental factors separate from affective and distress constructs.
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Reliability
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The ASRS v1.1 exhibits high reliability across diverse demographic strata, clinical populations, and linguistic translations.
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1. Internal Consistency
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Internal consistency analyses across multi-site international studies indicate high reliability:
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- Full 18-Item Scale: Cronbach’s alpha ($\\alpha$) ranges from 0.88 to 0.94; McDonald’s omega hierarchical ($\\omega_h$) ranges from 0.84 to 0.89.
- Inattention Subscale: Cronbach’s alpha consistently ranges between 0.85 and 0.91.
- Hyperactivity/Impulsivity Subscale: Cronbach’s alpha ranges between 0.78 and 0.86, reflecting the known multidimensionality of hyperactive versus impulsive traits in adults.
- 6-Item Part A Screener: Cronbach’s alpha ranges from 0.74 to 0.82, which is optimal for a brief six-item screening instrument.
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2. Test-Retest Reliability and Measurement Stability
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Temporal stability evaluated over intervals spanning from 1 to 4 weeks yields intraclass correlation coefficients (ICC) and Pearson correlation coefficients ($r$) between 0.81 and 0.89 across clinical and non-clinical adults. In longitudinal psychopharmacological clinical trials, the scale demonstrates a Standard Error of Measurement (SEM) of approximately 2.1 to 2.8 points on the continuous scale (0–72 range), confirming its sensitivity to detect authentic clinical improvement without excessive measurement noise.
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Factor Analysis
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Extensive exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been conducted on the ASRS v1.1 to delineate its latent factor structure.
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Structural Models
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Psychometric research historically debated between a two-factor correlated model, a unidimensional model, and a bifactor model:
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- Two-Factor Correlated Model: Directly mirrors the DSM framework, loading Items 1–4 and 7–11 onto Inattention, and Items 5–6 and 12–18 onto Hyperactivity/Impulsivity. Across multiple CFA validation studies (e.g., Adler et al., 2006), the two-factor model yields robust fit indices: Comparative Fit Index ($\\text{CFI}$) > 0.94, Tucker-Lewis Index ($\\text{TLI}$) > 0.93, and Root Mean Square Error of Approximation ($\\text{RMSEA}$) between 0.041 and 0.052.
- Bifactor Model: Recent structural equation modeling suggests that a bifactor specification—comprising a general ADHD latent factor alongside two orthogonal group factors (Inattention and Hyperactivity/Impulsivity)—provides an exceptional fit ($\\text{CFI} > 0.98$, $\\text{RMSEA} < 0.035$). This reinforces the clinical practice of utilizing both a total composite score and separate subscale scores.
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Derivation of Part A (Optimal Screener Subscale)
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A critical psychometric contribution of Kessler et al. (2005) was the recognition that the 6 items with the highest factor loadings do not automatically produce the most accurate clinical screener. Instead of selecting items purely based on linear factor loadings, the WHO team utilized stepwise logistic regression models to identify the combination of items that maximized diagnostic information. This analysis revealed that four inattentive symptoms (Items 1, 2, 3, 4) and two hyperactive symptoms (Items 5, 6) provided maximum predictive power, forming the definitive 6-item Part A screener.
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Instrument / Measurement Tool
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- Instrument Name: Adult ADHD Self-Report Scale (ASRS v1.1)
- Originating Organizations: World Health Organization (WHO) and Harvard Medical School
- Administration Format: Self-administered paper-and-pencil questionnaire, web-based digital assessment, or clinician-assisted interview
- Target Population: Adults aged 18 years and older
- Administration Time: Approximately 3–5 minutes for the full 18-item scale; 1–2 minutes for the 6-item Part A screener
- Item Composition: 18 total items\n
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- Part A: 6 items (Items 1–6) utilized for primary diagnostic screening
- Part B: 12 items (Items 7–18) utilized for dimensional symptom elaboration and treatment monitoring
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- Response Scale: 5-point Likert frequency scale: Never (0), Rarely (1), Sometimes (2), Often (3), Very Often (4)
- Scoring Methodologies:\n
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- Categorical/Threshold Scoring (Screener Mode): Evaluates whether responses fall within shaded diagnostic boxes. For Items 1, 2, and 3, endorsements of Sometimes, Often, or Very Often are positive. For Items 4, 5, and 6, endorsements of Often or Very Often are positive. An endorsement of 4 or more positive responses in Part A indicates that the patient has symptoms highly consistent with adult ADHD, warranting comprehensive clinical evaluation.
- Dimensional/Continuous Scoring: Summation of Likert ratings (0 to 4) yielding a total score between 0 and 72, with Inattention and Hyperactivity/Impulsivity subscale scores ranging from 0 to 36 each.
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Permissions & Fee and Test Year
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The Adult ADHD Self-Report Scale (ASRS v1.1) was released in 2003 and formally published in peer-reviewed psychometric literature in 2005 by the World Health Organization and the Harvard Medical School Workgroup on Adult ADHD. It is based on the WHO Composite International Diagnostic Interview (© 2001 World Health Organization).
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Licensing and Accessibility: The scale is available in the public domain for non-commercial clinical use, academic research, and healthcare screening without royalty fees. However, modifications to item wording, scoring keys, or response anchors are prohibited to preserve standardized diagnostic validity. Commercial distribution, inclusion within proprietary software platforms, or translation into additional languages requires formal written permission from the World Health Organization and Professor Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School.
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References
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Adler, L. A., Spencer, T., Faraone, S. V., Kessler, R. C., Howes, M. J., Biederman, J., & Secnik, K. (2006). Validity of pilot Adult ADHD Self-Report Scale (ASRS) to rate adult ADHD symptoms. Annals of Clinical Psychiatry, 18(3), 145–148. https://doi.org/10.1080/10401230600801077
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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890423349
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Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94. https://doi.org/10.1037/0033-2909.121.1.65
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Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). Guilford Press.
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Biederman, J., Faraone, S. V., Spencer, T., Wilens, T., Norman, D., Lapey, K. A., Mick, E., Lehman, B. K., & Doyle, A. (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(12), 1792–1798. https://doi.org/10.1176/ajp.150.12.1792
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Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Üstün, 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. https://doi.org/10.1017/s0033291704002892
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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. https://doi.org/10.1002/mpr.208
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Schweitzer, J. B., Cummins, T. K., & Kant, C. A. (2001). Attention-deficit/hyperactivity disorder. Medical Clinics of North America, 85(3), 757–777. https://doi.org/10.1016/s0025-7125(05)70339-4
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Sonuga-Barke, E. J. (2003). The dual pathway model of AD/HD: An elaboration of neuro-developmental characteristics. Neuroscience & Biobehavioral Reviews, 27(7), 593–604. https://doi.org/10.1016/j.neubiorev.2003.08.005
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Items of the Scale
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Response Options: Never, Rarely, Sometimes, Often, Very Often
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Part A
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- How often do you have trouble wrapping up the final details of a project‚ once the challenging parts have been done?
- How often do you have difficulty getting things in order when you have to do a task that requires organization?
- How often do you have problems remembering appointments or obligations?
- When you have a task that requires a lot of thought‚ how often do you avoid or delay getting started?
- How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
- How often do you feel overly active and compelled to do things‚ like you were driven by a motor?
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Part B
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- How often do you make careless mistakes when you have to work on a boring or difficult project?
- How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
- How often do you have difficulty concentrating on what people say to you‚ even when they are speaking to you directly?
- How often do you misplace or have difficulty finding things at home or at work?
- How often are you distracted by activity or noise around you?
- How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
- How often do you feel restless or fidgety?
- How often do you have difficulty unwinding and relaxing when you have time to yourself?
- How often do you find yourself talking too much when you are in social situations?
- When you’re in a conversation‚ how often do you find yourself finishing the sentences of the people you are talking to‚ before they can finish them themselves?
- How often do you have difficulty waiting your turn in situations when turn taking is required?
- How often do you interrupt others when they are busy?
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“,n “excerpt”: “The Adult ADHD Self-Report Scale (ASRS v1.1) is an 18-item clinical instrument developed with the World Health Organization to screen and assess Attention-Deficit/Hyperactivity Disorder in adult populations.”,n “slug”: “adult-adhd-self-report-scale”,n “categories”: [n “Clinical Assessment”,n “Psychometrics”,n “ADHD & Neurodevelopmental Scales”n ],n “tags”: [n “Adult ADHD”,n “ASRS v1.1”,n “Inattention”,n “Hyperactivity”,n “Impulsivity”,n “Psychometrics”,n “Screening Instrument”,n “World Health Organization”,n “Executive Function”n ],n “seo_title”: “Adult ADHD Self Report Scale (ASRS v1.1): Psychometric Overview”,n “seo_description”: “Explore the Adult ADHD Self-Report Scale (ASRS v1.1): psychometric validity, theoretical foundation, factor structure, scoring, and full 18 screening items.”,n “focus_keyword”: “Adult ADHD Self Report Scale”n}