Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients
Open accessAbstract
Background To detect attention deficit hyperactivity disorder (ADHD) in treatment seeking substance use disorders (SUD) patients, a valid screening instrument is needed.Objectives To test the performance of the Adult ADHD Self-Report Scale V 1.1(ASRS) for adult ADHD in an international sample of treatment seeking SUD patients for DSM-IV-TR; for the proposed DSM-5 criteria; in different subpopulations, at intake and 1-2 weeks after intake; using different scoring algorithms; and different externalizing disorders as external criterion (including adult ADHD, bipolar disorder, antisocial and borderline personality disorder).Methods In 1138 treatment seeking SUD subjects, ASRS performance was determined using diagnoses based on Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as gold standard.Results The prevalence of adult ADHD was 13.0% (95% CI: 11.0-15.0%). The overall positive predictive value (PPV) of the ASRS was 0.26 (95% CI: 0.22-0.30), the negative predictive value (NPV) was 0.97 (95% CI: 0.96-0.98). The sensitivity (0.84, 95% CI: 0.76-0.88) and specificity (0.66, 95% CI: 0.63-0.69) measured at admission were similar to the sensitivity (0.88, 95% CI: 0.83-0.93) and specificity (0.67, 95% CI: 0.64-0.70) measured 2 weeks after admission. Sensitivity was similar, but specificity was significantly better in patients with alcohol compared to (illicit) drugs as the primary substance of abuse (0.76 vs. 0.56). ASRS was not a good screener for externalizing disorders other than ADHD.Conclusions The ASRS is a sensitive screener for identifying possible ADHD cases with very few missed cases among those screening negative in this population.
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The Adult ADHD Self-Report Scale (ASRS) and its short forms provide efficient identification of probable cases and demonstrate strong specificity and reliability (~0.90 Cronbach's alpha).
“The Adult ADHD Self-Report Scale (ASRS) and its short forms provide efficient identification of probable cases and demonstrate strong specificity and reliability (~0.90 Cronbach’s alpha) [31,118].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [31]
The Methods (§2.3, page unavailable) identify the six-item ASRS as a screening form, and the Discussion (§4, page unavailable) calls it useful for identifying potential ADHD in treatment-seeking substance use disorder patients. But the Discussion describes specificity in that population as moderate (66%), not strong. The Introduction (§1.2.1, page unavailable) reports high internal consistency from earlier work, but this paper does not give a Cronbach’s alpha of approximately 0.90. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe ASRS has moderate sensitivity (~69%), meaning that negative screening results should not exclude diagnosis in clinically suspected cases.
“However, their moderate sensitivity (~69%) means that negative screening results should not exclude diagnosis in clinically suspected cases.”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [31]
The Results (section 3.2) report 84% sensitivity at admission, not approximately 69%. The Discussion warns that assessing only ASRS-positive patients would miss some ADHD cases, which supports not treating a negative screen as an absolute exclusion. It does not specifically address clinically suspected cases, and it describes a negative result as making ADHD very unlikely in this treatment-seeking substance-use population. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThere was acceptable sensitivity but not specificity in studies of substance use disorders and incarcerated women.
“There was acceptable sensitivity but not specificity in studies of substance use disorders (Daigre Blanco et al., 2009; Van de Glind et al., 2013) and incarcerated women (Konstenius et al., 2015).”
From The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (2023) · cites this paper as Van de Glind et al., 2013
The Results (section 3.2; page not available) report good sensitivity for treatment-seeking patients with substance use disorders and lower specificity, particularly for drug use disorders. But the Discussion calls overall specificity moderate, not unacceptable, and reports better specificity for alcohol use disorders. The incarcerated-women finding is attributed to a different citation in the sentence, not to this paper. (LLM, conf=0.83)
Experimental — accuracy not yet measured
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References 58 · Cited by 189
Research works printed but not linked: 2
- Pérez Pedrero EJ Puerta García C ASRS v.1.1., a tool for attention-deficit/hyperactivity disorder screening in adults treated for addictive behaviors: psychometric properties and estimated prevalence Adicciones 2007 19 393 407 18173102
- Van de Glind G Konstenius M Levin FR Koeter MWJ Van Emmerik-van Oortmerssen K Carpentier PJ Kaye S Degenhardt L Skutle A Franck J Bu ET Moggi F Dom G Verspreet S Demetrovics Z Kapitány-Fövény M Fatseas M Auriacombe M Schillinger A Johnson B Faraone SV Ramos-Quiroga JA Casas M Allsop S Carruthers S Schoevers RA Wallhed S Barta C Alleman P IASP Research Group Van den Brink W Variability in Prevalence Rates of adult ADHD in treatment seeking SUD patients; results from an international multi-center study, submitted for publication PMC4133781 24156882
- Authors
- van de Glind, G., van den Brink, W., Koeter, M. W. J., Carpentier, P.-J., van Emmerik-van Oortmerssen, K., Kaye, S., Skutle, A., Bu, E.-T. H., Franck, J., Konstenius, M., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitány-Fövény, M., Fatséas, M., Auriacombe, M., Schillinger, A., Seitz, A., Johnson, B., Faraone, S. V., Ramos-Quiroga, J. A., Casas, M., Allsop, S., Carruthers, S., Barta, C., Schoevers, R. A., & Levin, F. R.
- Affiliations
- Amsterdam Institute for Addiction Research (NL)
- Reinier van Arkel (NL)
- UNSW Sydney (AU)
- Karolinska Institutet (SE)
- University of Fribourg (CH)
- University of Antwerp (BE)
- Eötvös Loránd University (HU)
- Université de Bordeaux (FR)
- Østfold Hospital Trust (NO)
- University Hospital of Bern (CH)
- SUNY Upstate Medical University (US)
- Universitat Autònoma de Barcelona (ES)
- Curtin University (AU)
- Semmelweis University (HU)
- University Medical Center Groningen (NL)
- New York State Psychiatric Institute (US)
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 132
- Issue
- 3
- Pages
- 587-596
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC4083506
- OpenAlex
- W2024182137
- Cited by
- 189
- References
- 58
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 13 · 2023: 19 · 2022: 22 · 2021: 15 · 2020: 23 · 2019: 10 · 2018: 5 · 2017: 13 · 2016: 12 · 2015: 7 · 2014: 13 · 2013: 4
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- BORIS (University Library Bern) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Eli Lilly and Company
- GW Pharmaceuticals
- Noaber Foundation
- National Institutes of Health
- National Institute on Drug Abuse (K24DA029647)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- Adult ADHD Self-Report Scale, adult ADHD, ADHD screening, substance use disorders, treatment-seeking patients, screening validity, sensitivity and specificity, positive predictive value, negative predictive value, alcoholism, illicit drug use, externalizing disorders, bipolar disorder, antisocial personality disorder, borderline personality disorder
- MeSH terms
- Adolescent, Adult, Aged, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Treatment Outcome, Substance-Related Disorders, Young Adult, Self Report
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