The Adult ADHD Self-Report Scale (ASRS) is a short questionnaire developed by the World Health Organization to screen for ADHD in adults. It asks about the frequency of common ADHD-related behaviors over the past six months. The ASRS can help identify symptom patterns worth exploring with a clinician, but a positive screen is not the same as a diagnosis.
What is the ASRS?
The ASRS is a self-report checklist that measures how often you experience behaviors linked to adult ADHD. It comes in two parts: a six-question screener (Part A) and twelve additional symptom questions (Part B), totaling 18 items that map onto the DSM criteria for ADHD [1].
Each question asks you to rate how frequently a specific behavior has occurred over the past six months, using a five-point scale from "never" to "very often." The behaviors cover both inattention (difficulty finishing tasks, trouble with details, losing things) and hyperactivity-impulsivity (fidgeting, interrupting, feeling driven to be on the go).
Part A is the most widely used version in clinical and research settings. It was designed to be completed in under two minutes, making it practical for primary care offices, workplace wellness programs, and community surveys. Part B provides additional symptom detail but is not required for the initial screen.
The ASRS is freely available and has been translated into multiple languages. The US National Institute on Drug Abuse hosts a downloadable version for clinical and research use (NIDA Data Share) [7].
How does the ASRS work?
The ASRS Part A covers six items that best predict clinical ADHD, making it a quick initial screen.
The ASRS works by comparing your self-reported symptom frequency against scoring thresholds that were calibrated using clinical diagnostic interviews. For Part A, responses are scored against a shaded cutoff on each question. If four or more of the six items fall in the shaded range, the screen is considered positive, meaning further evaluation is warranted.
The scoring is intentionally simple. Each item has its own threshold rather than a single summed score, because the six Part A questions were selected through statistical modeling to maximize the screener's ability to distinguish people with ADHD from those without it [1].
A positive screen means your pattern of responses looks similar to patterns seen in people who were later confirmed to have ADHD through clinical interview. It does not mean you have ADHD. A negative screen means your responses fell below the threshold, but it does not rule ADHD out entirely, especially if symptoms are being masked or compensated for.
What to do with your results
| ASRS result | What it suggests | Recommended next step |
|---|---|---|
| Positive screen (4+ items in shaded range) | Symptom pattern is consistent with possible ADHD | Schedule a clinical evaluation for a thorough assessment |
| Negative screen (fewer than 4 items) | Symptom pattern is below the screening threshold | If concerns persist, discuss them with a clinician anyway |
| Borderline (3 items in shaded range) | Pattern is close to the threshold | Consider a full evaluation, especially if daily functioning is affected |
If you are curious about where you stand, you can try a free ADHD screening questionnaire to get a sense of your symptom patterns before booking a clinical appointment.
Who developed the ASRS?
The ASRS was developed by the World Health Organization in collaboration with a team of ADHD researchers led by Ronald Kessler at Harvard Medical School. The original validation study, published in 2005, tested the screener against blind clinical diagnoses in a community sample drawn from the US National Comorbidity Survey Replication [1].
The research team started with 18 questions covering all DSM-IV ADHD symptom criteria, then used stepwise logistic regression to identify the six questions that best predicted clinical ADHD diagnoses. Those six became the Part A screener.
In 2017, a revised version was developed to align with DSM-5 criteria, which broadened the age-of-onset requirement and lowered the adult symptom threshold from six to five symptoms. This updated screener used a machine-learning algorithm to select the optimal six questions and their scoring weights for DSM-5 (Ustun et al., 2017) [2].
How accurate is the ASRS?
The ASRS screener's accuracy depends on the population being tested and the version used. In the DSM-5 validation study, the six-question screener showed 91.4% sensitivity and 96.0% specificity when applied to weighted general population data, with an area under the curve of 0.94 (Ustun et al., 2017) [2].
"Operating characteristics were excellent at the diagnostic threshold in the weighted data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%)." Ustun et al., 2017 [2]
Those numbers look strong, but context matters. Sensitivity tells you how well the screener catches true cases (91.4% means it correctly flagged about 9 in 10 people who actually had ADHD). Specificity tells you how well it correctly identifies people without ADHD (96.0% means only about 4 in 100 non-ADHD adults screened positive).
The catch is positive predictive value (PPV), which depends heavily on how common ADHD is in the group being screened. In the general population, where ADHD prevalence is estimated around 2.5 to 8.2%, even a highly specific screener will produce a meaningful number of false positives. A 2021 study by Chamberlain and colleagues found that the ASRS indicated probable ADHD in 26.0% of a UK sample and 17.3% of a US sample, far exceeding expected prevalence, with an estimated PPV of only about 11.5% (Chamberlain et al., 2021) [3].
This does not mean the ASRS is broken. It means a screening tool is designed to cast a wide net. Missing a true case (a false negative) is considered worse than flagging someone who turns out not to have ADHD (a false positive), because the consequence of a positive screen is simply "get evaluated further."
What is the difference between screening and diagnosis?
A screener like the ASRS flags possible ADHD, but only a full clinical evaluation can confirm a diagnosis.
A screener like the ASRS identifies people whose symptom patterns are worth investigating further. A diagnosis requires a thorough clinical evaluation that the ASRS cannot replace. This distinction is the single most important thing to understand about any self-report ADHD tool.
A full adult ADHD evaluation typically includes:
- Clinical interview: A structured conversation about current symptoms, how they affect work, relationships, and daily life
- Developmental history: Evidence that attention or impulsivity problems were present in childhood, even if they were not recognized at the time
- Differential diagnosis: Ruling out conditions that can look like ADHD, including anxiety, depression, sleep disorders, and thyroid problems
- Collateral information: Input from a partner, family member, or someone who has observed your behavior over time
- Functional impairment assessment: Confirming that symptoms cause real difficulty in at least two settings
The American Academy of Family Physicians recommends that ADHD evaluation typically requires at least two clinical visits to allow for a thorough assessment, including symptom corroboration and screening for comorbid conditions (AAFP) [6].
The DSM-5 diagnostic criteria require five or more symptoms of inattention or hyperactivity-impulsivity that have persisted for at least six months, are present in two or more settings, and cause clinically significant impairment. The ASRS can flag the symptom count, but it cannot assess persistence, pervasiveness, or impairment on its own.
How is the ASRS used in clinical practice?
Clinicians use the ASRS in several ways. In primary care, it often serves as a first-pass filter: a patient who screens positive gets referred for a specialist evaluation. In psychiatric and psychology practices, the ASRS may be one of several tools used during intake to guide the clinical interview.
The ASRS has also been validated for use in specific populations. A study of 1,138 adults seeking treatment for substance use disorders found that the ASRS had a sensitivity of 0.84 and a specificity of 0.66 in that group, confirming its usefulness as a sensitive screener even in populations with high rates of overlapping conditions (van de Glind et al., 2013) [5].
A large US normative study of over 22,000 adults established population-level score benchmarks and found that adults with self-reported ADHD diagnoses scored significantly higher on all 18 ASRS items compared to those without ADHD. The same study noted that ADHD was associated with substantially higher rates of depression (58.1% vs. 18.0%), anxiety (53.1% vs. 16.0%), and sleep difficulties (37.0% vs. 14.0%) (Adler et al., 2019) [4].
Questions to bring to your clinician after screening
If your ASRS results suggest elevated symptoms, these questions can help you get more out of your first appointment:
- "Could my symptoms be explained by something other than ADHD?" This opens the door for differential diagnosis.
- "What does a full evaluation involve, and how long does it take?" Sets expectations for the process.
- "Should I bring someone who knows me well to a follow-up visit?" Collateral information strengthens the evaluation.
- "How do you distinguish ADHD from anxiety or depression?" Especially useful if you have been treated for either condition before.
- "What happens if the evaluation confirms ADHD?" Helps you understand treatment options before committing.
How does the ASRS compare to other screening tools?
The ASRS is the most widely used adult ADHD screener, but it is not the only one. Different tools measure different things, and clinicians sometimes use more than one.
| Tool | What it measures | Format | Best used for |
|---|---|---|---|
| ASRS (v1.1 or DSM-5) | Symptom frequency over the past 6 months | 6-item screener or 18-item checklist | Initial screening in primary care, research, and self-assessment |
| Conners Adult ADHD Rating Scales (CAARS) | ADHD symptoms plus related problems (emotional lability, self-concept) | 66 or 26 items, self-report and observer versions | Detailed symptom profiling during clinical evaluation |
| Weiss Functional Impairment Rating Scale (WFIRS) | Functional impact across domains (work, school, social, self-concept, risk) | 69 items | Measuring how ADHD affects daily life, tracking treatment response |
| ADHD Rating Scale IV (ADHD-RS-IV) | DSM symptom frequency with adult-specific prompts | 18 items, clinician-administered or self-report | Structured symptom assessment during diagnostic evaluation |
The ASRS is strongest as a quick, accessible first step. The Conners and WFIRS provide deeper information that is more useful once a clinician is already investigating ADHD. The AAFP recommends using rating scales alongside clinical interview and collateral information rather than relying on any single tool (AAFP) [6].
If you want to explore your own symptom patterns before scheduling an appointment, you can take our online ADHD self-assessment as a practical starting point.
Infographic: key points about adhd asrs scale.
Each screening tool measures different aspects of ADHD, from core symptoms to functional impairment.
Frequently asked questions
Is the ASRS the same as an ADHD diagnosis?
No. The ASRS is a screening tool that flags symptom patterns consistent with ADHD, but it cannot confirm or rule out a diagnosis. A positive screen means your responses look similar to those of people with clinically confirmed ADHD, and further evaluation is recommended. A full diagnosis requires a clinical interview, developmental history, and assessment of functional impairment (AAFP) [6].
How many questions are on the ASRS?
The full ASRS contains 18 questions covering all DSM ADHD symptom criteria. The Part A screener uses six of those questions, selected because they best distinguish ADHD from non-ADHD in general population samples (Kessler et al., 2005) [1]. Most people encounter the six-question version first.
Can I take the ASRS online?
Yes. The ASRS is freely available and many websites offer digital versions. The US National Institute on Drug Abuse hosts a downloadable copy (NIDA Data Share) [7]. You can also complete a similar ADHD screening questionnaire on this site.
What does a positive ASRS screen mean?
A positive screen means four or more of the six Part A items fell in the shaded scoring range, suggesting your symptom pattern is worth investigating further. It does not mean you have ADHD. In general population samples, the ASRS can overestimate ADHD prevalence considerably (Chamberlain et al., 2021) [3], which is why clinical follow-up is essential.
What if my ASRS screen is negative but I still think I have ADHD?
A negative screen does not rule out ADHD. Some adults, particularly women and those who have developed strong compensatory strategies, may score below the threshold despite having clinically significant symptoms. If your concerns persist, discuss them with a clinician who can conduct a thorough evaluation.
Is there a newer version of the ASRS for DSM-5?
Yes. In 2017, researchers published an updated six-question screener calibrated to DSM-5 criteria, which broadened the age-of-onset requirement and lowered the adult symptom threshold. The DSM-5 version showed 91.4% sensitivity and 96.0% specificity in weighted population data (Ustun et al., 2017) [2].
Can the ASRS distinguish ADHD from anxiety or depression?
Not reliably on its own. Symptoms like difficulty concentrating, restlessness, and trouble finishing tasks appear in ADHD, anxiety, and depression. The ASRS measures symptom frequency but does not assess the underlying cause. A clinician uses the clinical interview and differential diagnosis process to sort out which condition, or combination of conditions, best explains the pattern.
Should I bring my ASRS results to my doctor?
Yes. Completed screening results give your clinician a structured starting point for conversation. They show which specific symptoms you are experiencing and how frequently, which can make the first appointment more productive. Bring the completed form along with notes about when symptoms started and how they affect your daily life.
