Wender Utah Rating Scale – 25 item version (WURS-25)

The Wender Utah Rating Scale – 25 item version (WURS-25) is a self-report instrument that is designed to retrospectively evaluate the presence and severity of childhood symptoms of ADHD in adults (18+; Ward et al., 1993).

Most of the items in the WURS-25 are not directly tapping into core ADHD symptoms, instead, the items were chosen for their discriminative ability in distinguishing between adults with and without an ADHD diagnosis (Brevik et al., 2020). The WURS-25 has three subscales that provide an indication of the problems experienced by the adult in childhood:

1. Impulsivity & Behavioural problems
2. Inattentiveness & School problems
3. Self Esteem & Negative mood

The WURS-25 is an important adjunct for diagnosis of ADHD in adults given the requirement for childhood onset (American Psychiatric Association, 2013). This scale is useful for screening and diagnosis of ADHD among adults 18+ and can be particularly useful when used in conjunction with the ASRS to provide additional clinical information (Brevik et al., 2020).

It is important to diagnose adults with ADHD given that adult ADHD is associated with negative outcomes, including lower educational achievement, increased rates of incarcerations, unemployment and illicit drug use (Faraone et al., 2015).

Validity and Reliability

The scale originally consisted of 61 items but the long form was reduced to the 25 items that showed the greatest mean difference between patients with ADHD and controls (Ward et al., 1993). The WURS-25 has a high level of internal consistency of 0.94 (Cronbach’s alpha; Kouros et al., 2018) and a higher score on the WURS-25 is associated with poorer performance on objective measures of attention (Mackin et al., 2005).

Brevik et al. (2020) performed a principal component analysis and confirmed a three-factor structure of the WURS as described in previous studies (Caci et al., 2010; Kouros et al., 2018; McCann et al., 2000; Stanton & Watson, 2016):

1. Impulsivity & Behavioural problems (items 5, 6, 8, 10, 12, 13, 14, 15, 16, 19, 20, 21, 22)
2. Inattentiveness & School problems (items 1, 4, 7, 17, 23, 24, 25)
3. Self Esteem & Negative mood (items 2, 3, 9, 11, 18)

The WURS was administered to clinically diagnosed adult ADHD patients (n = 646) and to population controls (n = 908) to calculate percentiles using means and standard deviations (Brevik et al., 2020). The means (and standard deviations) were:

• ADHD diagnosis: Mean = 58.2 (17.9)
• Normative control: Mean = 17.3 (13.9)

Scoring and Interpretation

For the total score of the WURS-25, there is a cut score of 36 (sensitivity and specificity of 96%; Ward et al., 1993) and clients with scores of 36 or above have childhood symptoms that are consistent with adults who have an ADHD diagnosis. Normative and clinical percentiles are presented for the WURS-25 total score based upon administration to clinically diagnosed adult ADHD patients (n = 646) and to population controls (n = 908; Brevik et al., 2020). The means (and standard deviations) were:

• ADHD diagnosis: Mean = 58.2 (17.9)
• Normative control: Mean = 17.3 (13.9)

Raw and average scores are presented for the three subscales of the WURS-25:

1. Impulsivity & Behavioural problems (items 5, 6, 8, 10, 12, 13, 14, 15, 16, 19, 20, 21, 22): a measure of problems with temper, outbursts, anger, and defiance issues as a child. 
2. Inattentiveness & School problems (items 1, 4, 7, 17, 23, 24, 25): a measure of learning problems as a student and prominent issues with inattention as a child. 
3. Self Esteem & Negative mood (items 2, 3, 9, 11, 18): a measure of excessive anxious, worrying, or unhappy moods as a child. 

The average scores for these subscales allows for a comparison between the childhood problem areas given they have differing numbers of questions within each subscale.

Developer

Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. The American Journal of Psychiatry, 150(6), 885–890. https://doi.org/10.1176/ajp.150.6.885 

Reference

Brevik, E. J., Lundervold, A. J., Haavik, J., & Posserud, M.-B. (2020). Validity and accuracy of the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD. Brain and Behavior, 10(6), e01605. https://doi.org/10.1002/brb3.1605

Caci, H. M., Bouchez, J., & Baylé, F. J. (2010). An aid for diagnosing attention-deficit/hyperactivity disorder at adulthood: Psychometric properties of the French versions of two Wender Utah Rating Scales (WURS-25 and WURS-K). Comprehensive Psychiatry, 51, 325–331.

Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., … Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15020.

Kouros, I., Horberg, N., Ekselius, L., & Ramklint, M. (2018). Wender Utah Rating Scale-25 (WURS-25): Psychometric properties and diagnostic accuracy of the Swedish translation. Upsala Journal of Medical Sciences, 123, 230–236.

McCann, B. S., Scheele, L., Ward, N., & Roy-Byrne, P. (2000). Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyper-activity disorder in adults. The Journal of Neuropsychiatry and Clinical Neurosciences, 12(2), 240–24

Stanton, K., & Watson, D. (2016). An examination of the structure and construct validity of the Wender Utah Rating Scale. Journal of Personality Assessment, 98(5), 545–552.

Mackin, R. S., & Horner, M. D. (2005). Relationship of the Wender Utah Rating Scale to objective measures of attention. Comprehensive Psychiatry, 46(6), 468–471. https://doi.org/10.1016/j.comppsych.2005.03.004