The ASRS-5

The Adult ADHD Self-Report Scale for DSM-5 (ASRS-5) is a self-report screening scale for attention deficit hyperactivity disorder (ADHD) in adults. It’s the updated version of the ASRS v1.1.

• Never
• Rarely
• Sometimes
• Often
• Very Often

If you decide to take the test, please consider the Discussion section below.

Scoring

• Scoring range: 0–24
• Threshold score: 14
  • 14↑ you likely have ADHD
  • 14↓ you likely don’t have ADHD

The questions are scored as follows:

• Never – 0
• Rarely – 1
• Sometimes – 2
• Often – 3
• Very often – 4

Note: the original paper on the ASRS-5 indicates there is a weighted scoring, where ‘Never’ is always 0, but the maximum score of the other items varies from 2 to 5 (with a total scoring range still adding up to 0–24);^[2]The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (Ustun et al., 2017) however, Ron Kessler—one of the two authors of the ASRS-5—recommends using unweighted scoring (according to the DSM-IV instead of the DSM-5) instead, as the DSM-5 scoring results in a substantial overestimate of prevalence of ADHD.^[3]DSM-5 scoring of the DSM-IV ASRS screening questions (Kessler, 2023) | Harvard Medical School But just so you know why the scoring deviates from what is stated in the paper.

Validity

Although the ASRS-5 screener can effectively diagnose ADHD in adults, it cannot rule out other medical conditions that may impact the diagnosis of ADHD.

The sensitivity and specificity of the ASRS-5 is as follows:^[4]The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (Ustun et al., 2017)

• Sensitivity (true positive rate) = 91.4%
• Specificity (true negative rate) = 96.0%

Discussion

Dr. Natalie Engelbrecht ND RP:

I love that this test is short. I find the options easily understood. The new ADHD screening scale is short, easily scored, and detects the vast majority of general population cases with high specificity.

Kendall:

As often happens, my mind goes to qualifiers on a few questions. Despite the simple wording, the qualifier conundrum makes them more challenging to answer. Being so brief a test, this didn’t pose the usual back and forth, second-guessing routine. The ASRS-5 is super-quick, simple to score, and for the most part, easily understood.

Eva:

Last year I discovered I likely have ADHD, as ADHD medication has a positive effect on me. Actually, my assessor also suggested it to me when I got diagnosed with autism. I was hoping this test could verify whether indeed I have ADHD; but I scored 13, which is just below the threshold. I think that’s probably fair, as most of my behaviors are probably understood within the autism framework.

Still, I feel the ASRS-5 didn’t give me any clarity. Indeed the test is quick, easy, and I’m sure it’s accurate about what it measures. But considering it’s a short screening test, it will inevitably overlook many aspects of ADHD. For example, impulsivity and low frustration tolerance are not taken into account.

I also have some frustration around questions #4 and #6:

• Is question #4 asking about the tendency to interrupt others, or just the tendency to anticipate what people might say? And is finishing others’ sentences really characteristic of ADHD? None of the people with ADHD that I know have this tendency.
• Question #6 seems to measure support needs based on executive dysfunction, but completely generalizes specific executive function problems. Besides planning, shouldn’t the test include other aspects of executive functions, such as organization and prioritization, time management, and perseverance?

The ASRS-5 seems to be a good short-screening tool. But note that it’s not the most comprehensive measure of ADHD.

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