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

Published online by Cambridge University Press:  21 January 2005

RONALD C. KESSLER
Affiliation:
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
LENARD ADLER
Affiliation:
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
MINNIE AMES
Affiliation:
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
OLGA DEMLER
Affiliation:
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
STEVE FARAONE
Affiliation:
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
EVA HIRIPI
Affiliation:
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
MARY J. HOWES
Affiliation:
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
ROBERT JIN
Affiliation:
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
KRISTINA SECNIK
Affiliation:
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
THOMAS SPENCER
Affiliation:
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
T. BEDIRHAN USTUN
Affiliation:
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
ELLEN E. WALTERS
Affiliation:
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

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.

Type
Research Article
Copyright
© 2004 Cambridge University Press

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