Researchers Develop Brief Adult ADHD Rating Scale Using DSM-5 Criteria

Researchers have developed an updated screening scale for diagnosing adults with attention-deficit/hyperactivity disorder (ADHD) that is based on DSM-5 criteria. In a report published yesterday in JAMA Psychiatry, Ronald Kessler, Ph.D., of the Department of Health Care Policy at Harvard Medical School and colleagues described the ability of the six-question screen to detect the majority of adults with ADHD, including among patients who present at specialty clinics.

The team of researchers used a machine-learning algorithm to identify an optimal set of screening questions using the World Health Organization Adult ADHD Self-Report Scale (ASRS) as a guide. The final scale included just six questions, including two that are not directly related to DSM-5 symptoms:

• How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly? (DSM-5 A1c)


• How often do you leave your seat in meetings or other situations in which you are expected to remain seated? (DSM-5 A2b)


• How often do you have difficulty unwinding and relaxing when you have time to yourself? (DSM-5 A2d)


• When you’re in a conversation, how often do you find yourself finishing the sentences of people you are talking to before they finish them themselves? (DSM-5 A2g)


• How often do you put things off until the last minute? (Non-DSM)


• How often to you depend on others to keep your life in order and attend to details? (Non-DSM)

Adults were asked to report how often the symptoms in question occurred over the last six months: never (0), rarely (1), sometimes (2), often (3), and very often (4).

The diagnoses made using the six-question screen were compared with those captured with the ASRS screen, as reflected in two national surveys. The results of the screen were also evaluated in a clinical sample of patients that included a subset who sought evaluations at New York University Langone Medical Center Adult ADHD Program.

When using a cutoff of 14 or higher for the total score, the test identified more than 90% of true ADHD cases in both groups of people, with total accuracy ratings (when including false positives and false negatives) of 67.3% in the general population and 82.8% in the clinical population.   

“The new scale is short, easily scored, can detect nearly all of adult ADHD cases in the general population with high sensitivity and specificity, and also discriminates well among patients presenting for evaluation and specialty treatment,” the authors concluded.

In a related editorial, Judith Rappaport, M.D., of the National Institute of Mental Health and colleagues wrote, “As public awareness of adult ADHD increases, so too does the need for psychometrically robust screening tools both for research and to help identify those most likely to benefit from further expert assessment and treatment.”

To read more about this topic, see the Psychiatric News article “Study Suggests ADHD in Adults May Be Distinct Disorder.”

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