The findings of a study of adults with attention-deficit/hyperactivity disorder (ADHD) published in Brain and Behavior have demonstrated the validity and diagnostic accuracy of the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS).
In this study, researchers sought to investigate the psychometric properties of the ASRS and WURS in a well-characterized sample of adult ADHD patients and population controls. They also compared the usefulness of these tools to improve the clinical diagnosis of ADHD.
The ASRS, the official screening instrument of the World Health Organization, was developed as a brief screening instrument to identify potential ADHD symptoms, including inattention, hyperactivity, and impulsivity. The severity of the symptoms are graded on a 5-point Likert scale (total range, 0–72). The 25-item version of the WURS evaluates childhood symptoms by asking the participants to retrospectively recall the frequency and severity of ADHD symptoms and related problems in childhood. The severity of the symptoms are reported on a 5-point Likert scale (total range, 0–100).
In total, 1554 participants (n=646 adult patients with ADHD; mean age, 34.0±10.3 years; 48.5% women and n=908 controls; mean age, 29.4±7.8 years; 59.9% women) were included as part of the ADHD in Norwegian Adults project launched in 2004. The ASRS and WURS were administered to both groups. The researchers performed principal component analyses (PCA) and calculated receiver operating curves (ROC), including area under the curve (AUC) for the full ASRS and WURS, as well as for the PCA generated factors and the ASRS short screener.
The total WURS and ASRS sum scores were strongly correlated (full sample: r = .78, P <.001; ADHD group: r = .36, P <.001; controls: r = .70, P < .001). The discriminative ability of the ASRS and WURS revealed an AUC of 0.904 (95% CI: 0.888–0.921) for the ASRS and 0.956 (95% CI: 0.946–0.965) for the WURS. The short screen ASRS revealed an AUC of 0.903 (95%CI: 0.886–0.920). Combining the 2 scales gave an AUC of 0.964 (95% CI: 0.955–0.973).
The researchers generated a 2-factor solution for the ASRS in the full sample, explaining 62.2% of the variance. The first factor included items reflecting inattention, while the second factor included hyperactivity and impulsivity. The researchers also generated a 3-factor solution for the WURS items in the full sample, explaining 69.2% of the variance. The first factor included items reflecting aggressiveness and social problems, the second factor comprised learning and attention problems, and the third factor involved dysthymia.
Limitations of the study include possible memory biases and lack of recall due to retrospective self-report, as well as uncertainty about whether the adult participants would have obtained a childhood diagnosis of ADHD.
Overall, retrospective childhood symptoms of aggressiveness and social problems, which feature on the WURS, are reliable predictors of an adult diagnosis of ADHD. The study authors concluded that the findings provide evidence that emotional regulation problems constitute a large part of ADHD symptomatology in childhood.
“Both the WURS and the ASRS had excellent screening and psychometric properties, with somewhat stronger properties for the WURS,” the researchers concluded, also noting that the short screen and full version of the ASRS performed equally well. They recommended using both assessments jointly in determining adult ADHD.
Brevik EJ, Lundervold AJ, Haavik J. Validity and accuracy of the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD (published online April 13, 2020). Brain Behav. doi:10.1002/brb3.1605.