How to screen all your patients for Adult ADHD

This page was last reviewed and updated on October 13, 2022.

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If you see patients with depression, anxiety, etc, you can be sure that you are missing the underlying or additional diagnosis of ADHD in some of them. Don’t believe me? Try this screening on every single one of your patients for one week, then send me an email to tell me how wrong I was. 🙂

The important point is that EVERY patient we see, especially those with mood or anxiety disorders, should be screened for ADHD. The word “screening” refers to briefly evaluating patients who are not known to or even specifically suspected of having the disorder. If a patient comes in specifically for suspected ADHD, that is not screening. That is not what this page is about. Those patients don’t require screening since they are already suspected of maybe having ADHD. They require a good history and a full evaluation. But, it is not practicable to do a full ADHD evaluation on every patient we see. 

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Use the Adult ADHD Self-Report Scale (ASRS)

The simplest way to screen patients for adult ADHD is to have every patient fill out the Adult ADHD Symptom Rating Scale (ASRS; Kessler et al., 2005). The scale is available for download and use at no cost at any of the links below. Several links are provided in case one of them stops working in the future. 

https://www.adhdawarenessmonth.org/wp-content/uploads/psych_adhd_checklist.pdf

https://www.hcp.med.harvard.edu/ncs/asrs.php

https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf

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Alternatively, the ASRS can be completed online at the following link:

https://tests.add.org/

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Tips on using the ASRS

1. An “abnormal” rating on any of the items is indicated on the scale by the fact that those boxes have a grey background. 

2. The first 6 items have greater value for screening even though the scale has 18 items (Kessler et al., 2007). So, the 6-item scale can be sufficient for screening if you would rather keep it as brief as possible. But I just have my patients complete the full 18-item version because I would rather err on the side of identifying a patient as having possible ADHD.

2.  If a patient scores 4 or more out of the first 6 items in the abnormal range, it is highly suggestive of ADHD and a full clinical evaluation is indicated. But my personal recommendation is that if any items are scored in the abnormal range (grey area), we should ask more about that symptom.

2. Unfortunately, the scale does not have a very high sensitivity. Even if the patient screens negative, it does not rule out ADHD. So, it is not ideal, but at least it is better than not doing any screening. If we get a history in childhood or adulthood that could be suggestive of ADHD, we should go ahead and ask about the symptoms of ADHD even if the ASRS score did not suggest possible ADHD. To repeat: the purpose of the scale is to help alert us to possible ADHD. It does NOT help to rule out ADHD. I hope that is not too confusing.

3. In my opinion, it is crucial, when using the Adult ASRS scale to screen a patient presenting with depression, anxiety, etc, to ask the patient to answer the questions for their “lifetime,” i.e., “before the depression (or anxiety).” This is because when a patient is significantly depressed, of course, he/she will have symptoms that suggest ADHD.

4. Using the Adult ASRS scale in every single patient, as part of the initial evaluation packet, will tremendously improve the detection of Adult ADHD. But, patients who screen positive on the ASRS still need to be evaluated for ADHD by taking a specific history of ADHD.

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Please see below for links to all the articles on this website that are related to ADHD and its treatment.

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Related Pages

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References

Adler LA, Faraone SV, Sarocco P, Atkins N, Khachatryan A. Establishing US norms for the Adult ADHD Self-Report Scale (ASRS-v1.1) and characterising symptom burden among adults with self-reported ADHD. Int J Clin Pract. 2019 Jan;73(1):e13260. doi: 10.1111/ijcp.13260. Epub 2018 Sep 21. PMID: 30239073; PMCID: PMC6585602.

Anbarasan D, Kitchin M, Adler LA. Screening for Adult ADHD. Curr Psychiatry Rep. 2020 Oct 23;22(12):72. doi: 10.1007/s11920-020-01194-9. PMID: 33095375.

Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01600. doi: 10.4088/PCC.13r01600. Epub 2014 Jun 12. PMID: 25317367; PMCID: PMC4195639.

Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005 Feb;35(2):245-56. doi: 10.1017/s0033291704002892. PMID: 15841682.

Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res. 2007;16(2):52-65. doi: 10.1002/mpr.208. PMID: 17623385; PMCID: PMC2044504.

Ustun B, Adler LA, Rudin C, Faraone SV, Spencer TJ, Berglund P, Gruber MJ, Kessler RC. The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA Psychiatry. 2017 May 1;74(5):520-527. doi: 10.1001/jamapsychiatry.2017.0298. Erratum in: JAMA Psychiatry. 2017 Dec 1;74(12):1279. Erratum in: JAMA Psychiatry. 2019 Nov 1;76(11):1213. PMID: 28384801; PMCID: PMC5470397.

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