Developed by the World Health Organization (WHO) Workgroup on Adult ADHD. A screening instrument; not a stand-alone diagnostic tool.
Instructions to the patient
Rate yourself on each of the criteria below using the five-point frequency scale. Mark the option that best describes how you have felt and conducted yourself over the past 6 months. Complete both Part A and Part B and return the form to your healthcare professional for review.
Symptom checklist (18 items)
Shaded cells indicate the response thresholds that count as a positive endorsement when scoring (per Kessler et al., 2005). The shading is a visual scoring aid; the patient should answer every item honestly without trying to read into it.
Awaiting responses
Complete all six Part A items to compute the screen result.
Note on Part B: Per the official WHO scoring instructions, no total score or diagnostic likelihood is computed for the 12 Part B items. They surface additional symptom information for clinical probing. The two domain counts above tally items endorsed at "Often" or "Very Often" across all 18 questions, which is the DSM-5 symptom criterion threshold (≥5 in either cluster meets the symptom-criterion in adults).
How to score this instrument
Part A : the validated six-question screener
Each Part A item has a specific response threshold below which the answer does not count toward the screen. Thresholds were derived empirically by Kessler and colleagues (Psychological Medicine, 2005) and reflect the response levels most predictive of an adult ADHD diagnosis in general-population samples.
Item
Symptom
Counts when answer is
DSM-IV domain
1
Trouble wrapping up the final details of a project
Sometimes / Often / Very Often
Inattention
2
Difficulty getting things in order
Sometimes / Often / Very Often
Inattention
3
Problems remembering appointments or obligations
Sometimes / Often / Very Often
Inattention
4
Avoiding or delaying tasks requiring sustained thought
Often / Very Often
Inattention
5
Fidgeting or squirming when seated for a long time
Often / Very Often
Hyperactivity-Impulsivity
6
Feeling overly active, "driven by a motor"
Often / Very Often
Hyperactivity-Impulsivity
Official WHO scoring rule (verbatim): "Score Part A. If four or more marks appear in the darkly shaded boxes within Part A then the patient has symptoms highly consistent with ADHD in adults and further investigation is warranted." The 6-item screener has high sensitivity and specificity for adult ADHD in the general population (Kessler 2005: sensitivity 68.7%, specificity 99.5%, PPV 87.5%, total classification accuracy 97.9% in the validation sample).
Part B : the twelve supplementary items
Part B does not produce a total score or diagnostic likelihood. Its purpose is to surface additional symptom information for the clinical interview and to map the symptom profile onto DSM criteria. Per DSM-IV / DSM-5, an item is considered to meet the symptom criterion when answered "Often" or "Very Often". Use Part B to:
Identify additional symptoms endorsed at clinically significant frequency ("Often" or "Very Often").
Examine the distribution across the two DSM symptom clusters (inattention vs. hyperactivity-impulsivity), shown in the score panel above. The pattern guides presentation classification (Predominantly Inattentive, Predominantly Hyperactive-Impulsive, or Combined).
Probe items where frequency understates severity (for example, leaving meetings, blurting out, interrupting). Corroborate with the patient's narrative and, where available, collateral history.
Symptom domain mapping (DSM-IV / DSM-5)
Inattention (9 items)
Hyperactivity-Impulsivity (9 items)
Q1 Fails to finish tasks once started (DSM-IV In #4)
Q2 Difficulty organising tasks and activities (In #5)
Q3 Forgetful in daily activities (In #9)
Q4 Avoids tasks requiring sustained mental effort (In #6)
Q7 Careless mistakes; lack of attention to detail (In #1)
Q8 Difficulty sustaining attention (In #2)
Q9 Does not seem to listen when spoken to (In #3)
Q10 Loses or misplaces things (In #7)
Q11 Easily distracted by external stimuli (In #8)
Q5 Fidgets with hands or feet (DSM-IV HI #1)
Q6 "On the go" / driven by a motor (HI #5)
Q12 Leaves seat when remaining seated is expected (HI #2)
Q16 Blurts out / finishes others' sentences (HI #7)
Q17 Difficulty awaiting turn (HI #8)
Q18 Interrupts or intrudes on others (HI #9)
DSM-5 diagnostic threshold (clinical reference, separate from the screener):
Adults aged 17 and older require 5 or more symptoms in either domain (versus 6+ for children), present for at least 6 months, with several symptoms present before age 12, evidence of clinically significant impairment in two or more settings (work/school, home, social), and the symptoms not better explained by another mental disorder.
Beyond the score : impairment, history, and differential
A positive ASRS screen is necessary but not sufficient for diagnosis. Three clinical dimensions must be assessed before concluding:
Impairment. Review each endorsed symptom for impact in work or school, social relationships, and family settings. Frequency typically correlates with severity, but always confirm functional impact directly. Ask the patient how each symptom has affected their ability to work, manage home life, or maintain relationships.
Childhood history. Look for early-appearing, long-standing problems with attention or self-control. Adults with ADHD need not have been formally diagnosed in childhood, but some significant symptoms must have been present before age 12. Probe school reports, behavioural patterns, and parental observations.
Differential diagnosis. Mood disorders, anxiety disorders, sleep disorders, substance use, thyroid disease, and trauma-related conditions can mimic or coexist with ADHD symptoms. Screen for these before concluding. Comorbidity is the rule rather than the exception in adult ADHD.
Clinical notes & observations
The Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was developed in conjunction with the World Health Organization (WHO) and the Workgroup on Adult ADHD: Lenard Adler, MD (Associate Professor of Psychiatry and Neurology, NYU Medical School); Ronald C. Kessler, PhD (Professor, Department of Health Care Policy, Harvard Medical School); Thomas Spencer, MD (Associate Professor of Psychiatry, Harvard Medical School). The 18 items map directly to the DSM-IV-TR symptom criteria for ADHD. The instrument is in the public domain and may be used without permission.
Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256.
Adler LA, Spencer T, Faraone SV, et al. Validity of pilot Adult ADHD Self-Report Scale (ASRS) to rate adult ADHD symptoms. Ann Clin Psychiatry. 2006;18(3):145-148.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: APA Publishing; 2013.
Schweitzer JB, Cummins TK, Kant CA. Attention-deficit/hyperactivity disorder. Med Clin North Am. 2001;85(3):757-777.
Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. New York: Guilford Press; 1998.