Adult ADHD Self-Report Scale (ASRS)

Part A contains 6 items that are most predictive of ADHD diagnosis (Kessler et al., 2007). Part B contains 12 additional questions based on DSM criteria that provide additional cues specificity into the patient’s symptoms. The scoring was updated at the suggestion of the authors (Harvard Medical School, 2024) to enhance clinical utility and diagnostic accuracy, moving from a dichotomous scoring system to a more nuanced Likert-based approach.

The ASRS has two subscales that can be used to identify ADHD subtypes (Stanton et al., 2018):

1. Inattentiveness: Measures difficulties with focusing on details, organisation, remembering appointments, making careless mistakes, and concentration.
2. Hyperactivity/Impulsivity (motor and verbal): Assesses two components of hyperactivity/impulsivity. Firstly it measures motor difficulties such as sitting still, staying seated, and ability to relax. It also measures verbal difficulties such as controlling talking, interrupting others, and waiting turns.

ASRS results are presented as Part A, Part B, Total Score and the subscale scores. The primary scoring method is a 5 point Likert scale, from 0 to 4. Older variations of the ASRS use a dichotomous scoring method (0 or 1) which continues to be utilised when calculating the percentage of items endorsed for each sub-type.

Part A scores are most predictive of an ADHD diagnosis (Kessler et al., 2007) and therefore have the most screening and diagnostic utility. However, other aspects of the ASRS can aid in the considerations around applying an ADHD diagnosis based upon overall consistency or differences observed between parts or subscales.

• Criterion Part A (items 1-6. Scores range from 0 to 24)

If the respondent scores 14 or more in Part-A, then the symptom profile of the individual is consistent with a DSM-5-TR ADHD diagnosis in adults (Adler et al., 2006; Kessler et al., 2007). The Part A descriptor provides an indication of whether the respondent meets the DSM criteria, with scores in the high or very high range being considered clinically significant:

• Low: 9 or less
• Mild to Moderate: 10-13
• High: 14-17
• Very High: 18 or more

• Additional Symptoms Part B (items 7-18. Scores range from 0 to 48)

The scores on Part B provide additional information about a broader set of ADHD symptom severity and the impact that inattention or hyperactivity has on their life. A descriptor in the high or very high range (27 or above) is clinically significant:

• Low: 19 or less
• Mild to Moderate: 20-26
• High: 27-32
• Very High: 33 or more

• Total Score (scores range from 0 to 72)

Over and above the key interpretation metrics from Part A and Part B, the total score (sum of part A and B) is converted into a percentile to contextualise responses in comparison to normative data of adults (Adler et al., 2018). For example, a percentile of 90 represents that the respondent scored higher than 90 percent of typical adults in their age range in the community. In most cases, someone with ADHD will score higher than the 79th percentile (raw score of 40). The total score is described as:

• Low: 30 or less
• Mild to Moderate: 31-39
• High: 40-49
• Very High: 50 or more

While Part A contains the items that have been found to be most predictive of ADHD (Kessler et al., 2007), looking at both the Part B score and description (and percentile) can also be informative about diagnosis in cases where the Part A score doesn’t reach the threshold. This scale should always be used in conjunction with a clinical interview to provide additional clinical information important for diagnosis. A WURS-25 could also be useful to retrospectively evaluate the presence and severity of childhood symptoms of ADHD.

ADHD Subscales
Three ADHD subscales are presented according to factors identified by Stanton et al. (2018). Raw scores (as determined by the original ASRS dichotomous scoring method where each score is assigned as either 0 or 1) as well as the percentage of items endorsed are presented, providing more specific information about the focus of difficulties:

1. Inattentiveness subscale (Items 1, 2, 3, 4, 7, 8, 9, 10, 11, range 0 to 9)): measuring an adult’s difficulty in focussing on details, being organised, remembering appointments, making careless mistakes, and concentrating.
2. Hyperactivity/Impulsivity subscale. There are two aspects to this subscale, a motor and a verbal component. Motor (Items 5, 6, 12, 13, 14, range 0 to 5) measures an adult’s difficulty in sitting still, staying seated, and ability to relax. Verbal (Items 15, 16, 17, 18, range 0 to 4) measures an adult’s difficulty in controlling how much they are talking, interrupting others, and waiting their turn.

Considering the percentage of items endorsed (as determined by the original ASRS dichotomous scoring method) for each of the subscales can be helpful in determining the ADHD subtype defined in DSM-V-TR: Combined, Hyperactivity-Impulsivity or Inattentive. Note that the DSM-V-TR does not make a distinction between verbal and motor hyperactivity subtypes.

A plot is displayed that shows the client’s Part A score in relation to non-ADHD and ADHD samples (Adler et al., 2018). This plot shows the middle two quartiles (25th to 75th percentiles) as they related to a group of individuals who had been independently assessed as having ADHD, and typical adults without an ADHD diagnosis (the community sample). The cutoff for ADHD is marked at 14, indicating that individuals who score 14 or above show symptoms that are consistent with an ADHD diagnosis.

The ASRS has demonstrated strong psychometric properties in its original validation studies, showing high internal consistency (Cronbach’s alpha = 0.88) and concurrent validity (r = 0.84) (Adler et al., 2006). Using the previous scoring convention, studies reported high sensitivity (1.0) and moderate positive predictive power (0.52), suggesting that the ASRS would rarely miss ADHD in an adult who has ADHD. Moreover, the ASRS showed moderate specificity (.71) and high negative predictive power (1.0), indicating success in not identifying someone with ADHD when they do not have it (Hines, King & Curry, 2012).

Stanton et al. (2018) determined, by using CFA with over 1,000 adult subjects, that the ASRS had three factors:

1. Inattentiveness subscale
2. Motor Hyperactivity/Impulsivity subscale
3. Verbal Hyperactivity/Impulsivity subscale

These factors are used to compute subscale scores. It is noted that the DSM-5-TR specifies two subtypes (Inattentiveness and Hyperactivity/Impulsivity) however analysis of this scale indicates three distinct symptom clusters. For ease of understanding for clinicians, the subscales are presented in a manner that is consistent with the DSM but allows for breaking up the hyperactivity/impulsivity subscale into motor and verbal components.

NovoPsych calculated ASRS percentiles using summed scores and their standard deviations for Part A (items 1-6), Part B (items 7-18), and the Total Score (items 1-18) using the data from Adler et al. (2018). The Adler et al. (2018) sample included 22,397 adults, of whom 465 (2.1%) self-reported a physician diagnosis of ADHD. Compared to those without ADHD (n=21,932; the Community Sample), participants with ADHD were more likely to be male (51.0% vs 45.5%, p=0.02) and younger (mean age 42.0 vs 51.3 years, p<0.001). Of those with ADHD, 174 (37.4%) reported current use of prescription ADHD medication. The ADHD group reported significantly higher rates of psychiatric comorbidities, including depression (58.1% vs 18.0%), anxiety (53.1% vs 16.0%), and sleep difficulties (37.0% vs 14.0%) (all p<0.001). NovoPsych calculations used individual item-level means and standard deviations to determine summed score means (based on likert scoring) and standard deviations for the ADHD group (n = 465) of:

• Part A (M = 16.71, SD = 5.07)
• Part B (M = 32.74, SD = 9.16)
• Total Score (M = 49.45, SD = 13.36)

For the Community Sample (n = 21,932), the values were:

• Part A (M = 10.88, SD = 3.76)
• Part B (M = 21.60, SD = 6.69)
• Total Score (M = 32.48, SD = 9.8).

Although the ASRS was developed for DSM-IV criteria, the core symptoms of adult ADHD in the DSM-IV and DSM-5-TR are essentially the same (Adler et al., 2018) and the only substantive differences in the DSM-5 criteria for ADHD are (Alarachi et al., 2024):

1. A requirement of fewer symptoms among adults than children, and
2. that symptoms must have emerged by age 12 (as opposed to age 7 in DSM-IV)

Therefore, it is appropriate to use the ASRS v1.1 for assessing ADHD with regard to the DSM-5-TR diagnostic criteria.

Supplementary Materials

Further details on the scoring methodology and the calculation of percentiles can be found in the attached article:  

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