Using the Adult ADHD Self-Report Scale (ASRS) in Therapy or Treatment Planning

The Adult ADHD Self-Report Scale (ASRS) is an 18-item checklist made by the World Health Organization (WHO) along with ADHD experts, psychiatrists, and researchers to check for ADHD symptoms in adults, since ADHD looks different in adults than in kids. The questions follow DSM-IV criteria but use adult-focused language that shows how symptoms might pop up in adult situations.

There are two versions: the full ASRS v1.1 Symptom Checklist with 18 items and a shorter ASRS v1.1 Screener with just 6 items. The Screener has the six questions that best predict ADHD and works as a quick assessment to find people who might need more evaluation.

Following the publication of DSM-5 in 2013, researchers developed an updated screening tool called the ASRS-5. Unlike the original 18-item version, the ASRS-5 is a streamlined instrument with just 6 items total, carefully selected to align with DSM-5 criteria. These six questions were identified through rigorous research as the most predictive of an ADHD diagnosis under the DSM-5 framework. The ASRS-5 maintains the same frequency-based response format as the original but focuses only on the most discriminating symptoms.

Unlike many other psychological tests, the ASRS is free and takes only about five to ten minutes to finish, making it really practical in busy clinical settings.

Why the Adult ADHD Self-Report Scale is Used

The ASRS serves several important purposes in clinical work:

First, it helps screen adults who might have ADHD but never got diagnosed. Research shows adult ADHD affects about 4% of U.S. adults but remains hugely underdiagnosed. Many adults struggle for years without knowing why.

Second, it gives structure to clinical interviews. The specific questions help clinicians gather relevant info about attention, hyperactivity, and impulsivity in an organized way.

Third, it helps tell ADHD symptoms apart from other conditions. The pattern of answers can help distinguish ADHD from anxiety, depression, or other problems with similar complaints.

Fourth, the scale can track treatment progress. By giving the ASRS before and after treatment, clinicians can see how symptoms change over time.

Take Maria, a 35-year-old accountant who always struggled with deadlines and staying organized. She often misses appointments, loses important papers, and can’t focus in meetings. She first came to therapy for anxiety, but her therapist gave her the ASRS, which showed signs of ADHD. This led to proper treatment that greatly improved her work and reduced her anxiety.

Who Should Use the Adult ADHD Self-Report Scale?

The ASRS is especially useful for several types of healthcare providers:

Primary care doctors often see adults first when they have attention or organization problems. Since these doctors may not have much training in ADHD assessment, the ASRS gives them a structured, quick screening method. When clients score high, doctors can refer them to mental health specialists.

Mental health specialists—like psychologists, psychiatrists, and therapists—can use the ASRS as part of a full evaluation. The scale adds to clinical interviews and helps plan treatment.

Neuropsychologists might use the ASRS alongside cognitive tests to better understand a client’s executive functioning challenges.

College counseling centers can use the ASRS to screen students having academic troubles, as ADHD often becomes more obvious when young adults face the increased demands of college without the structure they had from parents or high school.

For example, a family doctor noticed several clients complained of chronic disorganization, relationship problems, and career issues despite seeming motivated. By using routine ASRS screening, he found several cases of previously undiagnosed adult ADHD. These clients reported big life improvements after getting proper treatment.

How the Adult ADHD Self-Report Scale is Structured

The ASRS v1.1 Symptom Checklist has 18 questions that match the DSM-IV criteria for ADHD. These questions come in two parts:

Part A has six questions research found most predictive of ADHD. These make up the shorter ASRS Screener and focus on key symptoms like trouble finishing projects, difficulty organizing tasks, problems remembering appointments, putting off challenging tasks, fidgeting, and feeling driven by a motor.

Part B has the other twelve questions, which give more info about symptom patterns. These questions cover things like making careless mistakes, keeping attention during boring tasks, concentrating on conversations, misplacing items, getting distracted by outside stuff, leaving seats in meetings, feeling restless, having trouble relaxing, talking too much, finishing others’ sentences, having difficulty waiting turns, and interrupting others.

People rate each symptom on a five-point frequency scale: Never, Rarely, Sometimes, Often, and Very Often. This frequency approach helps capture the ongoing, persistent nature of ADHD symptoms.

The questions use language that makes sense to adults. Instead of just asking about “fidgeting” (which might seem childish), the scale asks, “How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?” This translates the symptom into adult experiences.

Scoring the Adult ADHD Self-Report Scale

Scoring the ASRS involves both numbers and patterns:

For the ASRS Screener (Part A), scoring is simple: if four or more answers fall into the darkly shaded boxes, the person’s symptoms match ADHD and need more investigation. The darkly shaded boxes usually mean “Sometimes,” “Often,” or “Very Often” answers, though this varies by question.

For the full Symptom Checklist, Part B doesn’t have a simple number cutoff. Instead, clinicians should pay special attention to answers in the darkly shaded boxes, which show symptom frequency levels matching ADHD. These answers provide extra info and can lead to more clinical discussion.

Beyond just counting frequencies, clinicians should look at the pattern of symptoms across inattentive and hyperactive-impulsive areas. Some adults might mostly show inattentive symptoms, others mainly hyperactive-impulsive symptoms, while many show both.

Look at James, a 42-year-old marketing executive. His ASRS showed five shaded boxes in Part A, suggesting likely ADHD. Looking deeper at his pattern, his therapist noticed his symptoms were mostly in the inattentive area, with few hyperactive symptoms. This pattern helped guide treatment toward strategies specifically for attention and organization rather than hyperactivity management.

How to Administer the ASRS

Giving the ASRS effectively involves several key steps:

1. Introduce the scale to the client, explaining it helps identify attention and organization difficulties many adults have. Stress that this is a screening tool, not a final diagnosis.
2. Ask the client to complete both Part A and Part B, marking the box that best shows how often each symptom happened over the past six months.
3. After they finish, review the answers with the client, especially those in the shaded boxes. This review can bring out valuable clinical info beyond the raw scores.
4. Discuss how the symptoms affect the client’s functioning in different areas: work/school, home life, and social relationships. For example, if a client often marks “difficulty getting things in order,” ask for specific examples of how this affects their job or home organization.
5. Check symptom history, particularly signs of childhood symptoms. While adults with ADHD didn’t need a formal childhood diagnosis, some significant attention or self-control difficulties should have been present early in life. Ask about school experiences, teacher comments on report cards, or consistent troubles with homework or organization as a child.
6. Based on the ASRS results and follow-up talk, decide if a more complete ADHD assessment is needed.

For best results, stay curious and non-judgmental. Many adults with ADHD feel shame about their difficulties, often having been called “lazy,” “unmotivated,” or “not trying hard enough.” Approaching the assessment with empathy helps clients share their experiences openly.

Limitations of the ASRS

While the ASRS is valuable, therapists should know about several limitations:

1. Like any self-report measure, answers depend on the client’s self-awareness and honesty. Some people might over-report symptoms due to distress or wanting a diagnosis, while others might under-report due to coping strategies, shame, or limited insight into their behaviors.
2. Symptom overlap with other conditions can make interpretation tricky. Depression, anxiety, substance use, and certain personality disorders may cause concentration difficulties that look like ADHD symptoms. The ASRS alone can’t tell these apart.
3. Cultural factors might affect symptom reporting and interpretation. Behaviors considered problematic in some cultural contexts might be viewed differently in others. Also, language barriers may affect understanding of scale items.
4. The ASRS was based on DSM-IV criteria. In this case, a newer version based on the DSM-5 is now available, and the differences in diagnosis should be taken into account.
5. Research on the ASRS’s validity with special populations (like those with intellectual disabilities or certain neurological conditions) is limited.

For these reasons, the ASRS should never be the only basis for diagnosis. It should be one part of a comprehensive assessment that includes a clinical interview, developmental history, information from others who know the client well, and consideration of other explanations for symptoms.

Using ASRS Results in Therapy or Treatment Planning

ASRS results can really inform therapeutic interventions and treatment planning.

Symptoms identified through the ASRS can help prioritize treatment goals. Clients with mostly inattentive symptoms might benefit most from cognitive-behavioral strategies and environmental changes, while those with significant hyperactivity might also need physical outlet planning and impulse control techniques.

Giving the ASRS again periodically can track treatment progress. Decreases in symptom frequency can confirm interventions are working, while persistent difficulties might suggest a need to adjust the approach.

Note-taking and record-keeping based on ASRS findings can support both clinician and client. Documenting symptom patterns and therapeutic goals aligned with ASRS responses can enhance continuity of care, especially when working in multidisciplinary teams or over long periods. For clients, keeping track of strategies that match their ASRS profile helps reinforce progress and fosters self-awareness. Clinicians might also use structured session notes tied to ASRS domains (e.g., organization, attention, impulsivity) to monitor and reflect on clinical focus areas across sessions.

For example, Tasha, a 29-year-old graduate student, completed the ASRS during her first therapy session. Her results showed big difficulties with starting tasks, maintaining attention during boring activities, and remembering appointments. Her therapist used this info to develop a treatment plan that included:

1. Setting up a special planner system with visual cues and reminders
2. Body doubling techniques for starting difficult assignments
3. Breaking reading assignments into smaller chunks with movement breaks
4. Exploring medication options with her doctor

Three months later, Tasha reported big improvements in academic performance and less anxiety about her capabilities.

In conclusion, the Adult ADHD Self-Report Scale (ASRS) isn’t just a screening tool—it can be a turning point. When used thoughtfully and in the right context, it helps shine a light on patterns that many adults have lived with for years without having a name for them. For therapists, it offers a powerful entry point into deeper conversations and targeted support. And for adults navigating the challenges of undiagnosed ADHD, the ASRS can be the moment everything starts to make sense—the beginning of a journey toward clarity, self-compassion, and strategies that truly work for them.

Resources

Adler, L. A., Spencer, T., Faraone, S. V., Kessler, R. C., Howes, M. J., Biederman, J., & Secnik, K. (2006). Validity of Pilot Adult ADHD Self- Report Scale (ASRS) to Rate Adult ADHD Symptoms. Annals of Clinical Psychiatry, 18(3), 145–148. https://doi.org/10.3109/10401230600801077

Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine, 35(2), 245–256. https://doi.org/10.1017/s0033291704002892

National Institute of Mental Health. (n.d.). Attention-deficit/hyperactivity disorder (ADHD). U.S. Department of Health and Human Services. Retrieved April 24, 2025, from https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd

Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B. S. G., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E., & MTA Cooperative Group (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of child psychology and psychiatry, and allied disciplines, 58(6), 655–662. https://doi.org/10.1111/jcpp.12620

Ustun, B., Adler, L. A., Rudin, C., Faraone, S. V., Spencer, T. J., Berglund, P., Gruber, M. J., & Kessler, R. C. (2017). The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA psychiatry, 74(5), 520–527. https://doi.org/10.1001/jamapsychiatry.2017.0298