Interpretation and Follow‑up of Positive ASRS‑v1.1 Screens

Scoring Criteria

Mark responses of “sometimes,” “often,” or “very often” as positive for items 1‑3 on the ASRS‑v1.1 Part A, as defined in the original validation study. 1

Self‑report alone is insufficient for ADHD assessment because adults with ADHD typically lack insight into symptom severity. 2
The ASRS cannot reliably differentiate ADHD from other conditions with overlapping symptoms (e.g., bipolar disorder, depression, anxiety, learning disabilities, narcolepsy, substance‑use disorders). 2

Obtain a detailed psychiatric and medical history that documents core ADHD symptoms beginning in childhood (before age 7, per DSM‑IV criteria). 2
Collect collateral information from a spouse, parent, or significant other to verify symptom presence and severity. 2
Document moderate‑to‑severe functional impairment in at least two settings (e.g., occupational/academic, social, family). [1][2]
Perform a medical history, physical examination, and screening laboratory tests to exclude medical conditions that can mimic ADHD. 2
Consider a urine drug screen because of the high comorbidity between ADHD and substance‑use disorders. 2

Do not omit collateral informant interviews; self‑report systematically underestimates functional impairment. 2

Structured rating scales such as the ASRS are valuable adjuncts in the comprehensive psychiatric assessment required to diagnose adult ADHD, emphasizing the need to evaluate core ADHD symptoms that began in childhood. 3, 4

Because adults with ADHD frequently have limited insight and tend to underestimate symptom severity, information from a spouse, parent, or close friend should be obtained to supplement self‑report responses. 3, 4

The ASRS functions solely as a screening instrument; a positive screen must be followed by a full clinical evaluation—including medical history, physical examination, and assessment for conditions that can mimic ADHD (e.g., bipolar disorder, depression, personality disorders, learning disabilities, narcolepsy, borderline intellectual functioning). 3, 4