Attention deficit hyperactivity disorder (ADHD) is not only a problem for children—young people with ADHD often grow up to become adults with ADHD, leading to negative implications for education, occupation, marital outcomes, and of course, health (see London & Landes, 2021). The Adult ADHD Self-Report Scale (ASRS-v1.1) is a symptom checklist designed to help healthcare providers measure symptoms consistent with attentional difficulties. The ASRS is available now in CBS Health so that customers can easily measure adult ADHD alongside our cognitive function tasks and other mental health questionnaires. Healthcare experts in a wide variety of disciplines will benefit from the ability to better understand a patient’s mental health and demonstrate the impacts of treatment.
What is the ASRS?
The ASRS is a symptom checklist with eighteen questions based on the ADHD diagnosis guidelines established in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was developed by a World Health Organization work group to be appropriate both for research and as a screener at an individual level. The ASRS consists of two parts. Part A contains six questions found to be most predictive of symptoms consistent with ADHD, best used as a screening instrument. Part B contains the remaining twelve items, which provide additional information about patient symptoms for following up or discussing with patients.
The ASRS consists of two parts. Part A contains six questions found to be most predictive of symptoms consistent with ADHD, best used as a screening instrument. Part B contains the remaining twelve items, which provide additional information about patient symptoms for following up or discussing with patients.
Part A of the ASRS is scored to determine if the results are indicative of symptoms consistent with adult ADHD. Both parts have a shaded area in the raw responses shown in the CBS Health report. Responses in the shaded area contribute to the score in Part A, where four or more responses in this area indicates symptoms consistent with ADHD. In Part B, responses in the shaded area are where clinicians are encouraged to pay closer attention and take action as needed.
Reliability and validity are strong when using Part A of the ASRS as a screening tool. Kessler et al. (2007) found high internal consistency, test-retest reliability, and concordance with clinician diagnoses in a sample of U.S. health plan subscribers. The questionnaire’s strong psychometric properties and brevity make it an appropriate and convenient tool in many clinical settings.
Note that the ASRS is only a screening scale, not a diagnostic test. A trained clinician must follow up with patients who screen positive. See Kessler et al. (2005) for more information on the creation of and recommended usage for the ASRS.
How is ADHD related to cognition?
Cognitive assessments, like those included in CBS Health, are important tools to assist in the treatment of ADHD. Baseline cognition scores can complement ADHD tools like the ASRS, verifying self-reported symptoms with objective data, providing additional details on the specific cognitive domains affected, or ruling out broader cognitive impairment. As treatment progresses, many providers will administer cognitive assessments alongside self-report questionnaires in order to verify that treatments are having the desired effects or adjust them as needed.
Cognition has been directly linked with ADHD in scientific literature. Cognitive areas such as attention, executive functions, learning, and processing speed demonstrate subtle impairments in adults with ADHD (Woods, Lovejoy, & Ball, 2002). Response inhibition (measured by Stroop type tasks like Double Trouble; Lansbergen, Kenemans, & van Engeland, 2007) is of particular interest in ADHD studies, and is often impaired in individuals diagnosed with the condition.
While these high-level links between cognition and ADHD can illuminate the nature of the disorder, for individual people with ADHD, the link with core cognitive functions depend on a number of variables, such as the clinical profile of the patient’s symptoms, comorbid disorders, and even the timing of the cognitive assessment. For example, some patients with ADHD may perform better on a shorter version of the same test of cognition, or the same test administered earlier in a sequence. ADHD has also been described as heterogeneous, with multiple causes and effects under the same label (see Luo et al., 2019). For these reasons, it is essential to gain as much patient information as possible, including both the self-reported information from the ASRS and objective cognitive data from CBS Health cognitive assessments.
Which healthcare providers should measure adult ADHD with the ASRS?
Measuring ADHD symptoms is not exclusively for healthcare providers focusing directly on ADHD treatment. Attentional difficulties that arise or persist into adulthood are associated with a wide range of negative outcomes, such as depression, anxiety, substance abuse, learning disabilities, and career difficulties (Uchida et al., 2015). In fact, seeking treatment specifically for ADHD is rare, and many patients initially seek treatment for related difficulties before exploring attentional symptoms (Fayyad et al., 2017). Therefore, practitioners such as psychiatrists, clinical psychologists, neurologists, addiction specialists, and occupational therapists may find value in measuring adult ADHD in order to better explain and treat comorbid disorders.
CBS Health includes objective cognitive assessments as well as other common mental health assessments, such as the GAD-7 to measure anxiety symptoms, the PHQ-9 to measure depression symptoms, and the RPQ to measure the effects of concussion. Treating mental and physical health may have positive effects on more than one type of symptom. By measuring various outcomes over time, healthcare providers and their patients will better understand the full impact of their work, and demonstrate the impact to patients with tangible reports. Long-term post-treatment monitoring of cognitive and mental health also assists in identifying any changes that could become a concern, justifying the need for reinitiating or continuing treatment.
Delivering a digital version of the ASRS in CBS Health
Including the ASRS in a CBS Health protocol is simple. It can be sent on its own, or as part of a series of cognitive tasks and other health questionnaires. When creating a protocol within CBS Health, click the Questionnaires section, then check off the Adult ADHD Self-Report Scale (ASRS). You can include additional questionnaires or a set of cognitive tasks within the protocol for a seamless patient experience that can be completed in one integrated flow.
For detailed instructions on administering questionnaires within CBS Health, please see our previous blog post on administering a computerized PHQ-9.
The version of the ASRS included in CBS Health has all the advantages of computerized assessments. The questionnaire can be administered instantly with just a few clicks, and requires no special training. It can also be added to a CBS Health schedule, allowing you to automatically send this assessment (as well as any others of your choosing) via email on a cadence that you define. The results are scored instantly, and if a patient completes the questionnaire more than once, results are added to the patient’s report to track changes in response to treatments or to monitor for variations over time. For the patient, completing the ASRS only takes five minutes and can be initiated from any location with one click—no registration or login required. With minimal effort, both healthcare provider and patient benefit from the valuable information provided by a standardized ADHD scale.
Need more computerized health questionnaires or symptom checklists?
If there are any questionnaires you are administering in pen-and-paper form today that you would like to have available within CBS Health instead—or if you have other feedback or comments for the CBS team—please do not hesitate to let us know by commenting on this blog post or contacting us directly by email. We are always happy to hear from you.
Thanks, as always,
— The Cambridge Brain Sciences Team