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6-Question Screening Tool Introduced for Diagnosing Adult ADHD

The brief diagnostic tool, designed to better reflect symptoms of ADHD in adults, was recently developed by a World Health Organization advisory group.




May 2, 2017

Researchers affiliated with the World Health Organization (WHO) say they have developed a simple scale that can reliably diagnose ADHD in most adults — using just six straightforward questions.

The new tool, known as the Adult ADHD Self-Report Scale (ASRS), was outlined in an article published April 5 in JAMA Psychiatry. It was designed by a WHO advisory board, along with two additional psychiatrists, based on three different samples: one from the National Comorbidity Survey, a national face-to-face survey; one from a sample being treated at NYU Langone Medical Center; and a third from a large telephone-based survey of the users of a particular healthcare plan. Researchers used data from the samples — approximately half of whom had been diagnosed previously with ADHD — to create an algorithm of ADHD diagnosis in adults, based on the answers to the following six questions:

  1. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
  2. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
  3. How often do you have difficulty unwinding and relaxing when you have time to yourself?
  4. When you’re in a conversation, how often do you find yourself finishing the sentence of the people you are talking to before they can finish it themselves?
  5. How often do you put things off until the last minute?
  6. How often do you depend on others to keep your life in order and attend to details?

Each question can be answered with “never,” “rarely,” “sometimes,” “often,” or “very often,” and is graded on a 24-point scale. According to the researchers, it accurately predicted adult ADHD in their sample population approximately 80 percent of the time.

Recent studies suggest that while as many as 4.4 percent of adults in the U.S. have been diagnosed with ADHD, most people with the disorder never seek a diagnosis or treatment — meaning the true rate of adult ADHD may be much higher. And since most diagnostic tools are based on children’s symptoms or on the now-outdated DSM-IV, experts say, they may not be able to accurately diagnose ADHD in most adults, who show significantly different symptoms than do children with ADHD.

The new tool aims to change that, its creators say, by allowing primary care doctors to accurately diagnose ADHD in their adult patients much more quickly than they once could. But its simple format raises questions about the current diagnostic principles for adult ADHD, which may be overly complex or too reliant on childhood symptoms, the researchers say.

“Such findings raise the issue of whether current criteria, designed with children in mind, can adequately capture the expression of ADHD in adulthood,” wrote Philip Shaw, Ph.D., in an accompanying editorial. “These fascinating findings will not only stimulate further research but could also result in less insistence on a childhood history of symptoms, perhaps even further increasing diagnostic rates.”

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