The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5
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Importance: Recognition that adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria. Objectives: To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening. Design, Setting, and Participants: Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016. Main Outcomes and Measures: The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS. Results: Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5/Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%). Conclusions and Relevance: The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
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The introduction of DSM-V might lead to a further increase in adult ADHD prevalence by raising the age-of-onset from seven to 12 years and switching diagnostic emphasis from clinically significant impairments to more lenient symptoms.
“while the introduction of DSM-V might lead to a further increase by bringing a rise of age-of-onset from seven years to 12 years and switching the diagnostic emphasis from clinically significant impairments to more lenient symptoms [6,30].”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [30]
The Introduction (page unavailable) says DSM-5 criteria should increase adult ADHD prevalence because they require fewer symptoms and allow a later age of onset. The ASRS Screening Scale Item Pool section (page unavailable) specifies an onset threshold of age 12, but it also says the diagnoses required clinically significant ADHD-related impairment. The paper therefore does not support the claimed switch away from an impairment requirement. (LLM, conf=0.88)
Experimental — accuracy not yet measuredStudies of the ASRS-5 found acceptable sensitivity but not specificity in individuals with bipolar disorder and/or borderline personality disorder and other clinical groups.
“Studies of the ASRS-5 found acceptable sensitivity but not specificity in individuals with bipolar disorder and/or borderline personality disorder (Baggio et al., 2021) and other clinical groups (Ustun et al., 2017).”
From The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (2023) · cites this paper as Ustun et al., 2017
Other studies of the ASRS-5 have found both specificity and sensitivity levels above 80% in non-clinical controls.
“Other studies of the DSM-5 version of the ASRS, the ASRS-5, have found both specificity and sensitivity levels above 80% in non-clinical controls (Baggio et al., 2021; Ustun et al., 2017).”
From The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (2023) · cites this paper as Ustun et al., 2017
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- Authors
- Ustun, B., Adler, L. A., Rudin, C., Faraone, S. V., Spencer, T. J., Berglund, P., Gruber, M. J., & Kessler, R. C.
- Affiliations
- Massachusetts Institute of Technology (US)
- NYU Langone Health (US)
- Duke University (US)
- SUNY Upstate Medical University (US)
- Harvard University (US)
- University of Michigan (US)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 74
- Issue
- 5
- Pages
- 520
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5470397
- OpenAlex
- W2604231045
- Cited by
- 423
- References
- 9
- Citations by year
- 2026: 50 · 2025: 60 · 2024: 57 · 2023: 57 · 2022: 33 · 2021: 71 · 2020: 43 · 2019: 20 · 2018: 21 · 2017: 9 · 2016: 1 · 2012: 1
- FWCI
- 20.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Pan American Health Organization
- National Institute of Mental Health
- Fogarty International Center
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- adult ADHD, ADHD screening, DSM-5 diagnostic criteria, machine learning, screening accuracy, sensitivity and specificity, primary care, managed care
- MeSH terms
- Machine Learning, Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Psychiatric Status Rating Scales, Psychometrics, Sensitivity and Specificity, World Health Organization, Reproducibility of Results, Diagnostic and Statistical Manual of Mental Disorders, Young Adult, Self Report
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