2. ADHD Screenings
1. Self-Assessment Screening
| Name of the instrument/test | Test type | Sensitivity (%) | Specificity (%) | Target group/Special features |
|---|---|---|---|---|
| ADHD-E, ADHD screening for adults, including severity assessment compared to normative valuesADHD-RS-IV* Adult; with Adult Prompts, self-report scale, 8 questions, DSM-IV, Spanish version | n = 398, Richarte et al., 20171 | Total ADHD: Cut-off 24: 81.9%; ADHD-C: Cut-off 24, 81.9%; ADHD-I: Cut-off 21: 70.2% | ADHD total: Cut-off 24: 74.7%; ADHD-C: Cut-off 24: 87.3%; ADHD-I: Cut-off 21: 76.1% | ADHD total: Cut-off 24: PVV 50.0%, NPV 93.0%, Kappa 0.78, AUC 89%; ADHD-C: Cut-off 24: PVV 78.6%, NPV 89.4%, Kappa 0.88, AUC 94%; ADHD-I: Cut-off 21: PPV 7.17%, NPV 74.8%, Kappa 0.88, AUC 94%; no gender differences found in the analysis |
| ADHD-SB | n = 88, Rösler et al., 20042 | Cut-off 10: 88%; Cut-off 15: 77%; Cut-off 18: 65% | Cut-off 10: 67%; Cut-off 15: 75%; Cut-off 18: 92% | |
| ASRS-6 (ADHD Self-Report Scale 1.1.) 6 questions | Cut-off 4 for the 0–6 screening: Answer “sometimes,” “often,” or “very often” to 4 or more questions on questions 1–3, and “often” or “very often” to questions 4–6. | ADxS meta-analysis of all available studies on the ASRS-6 1.1. using the 0–6 scoring scale with a cutoff of 4 yields a sensitivity of 53.3% (n = 2,063; all languages, excluding special populations) | Adults, screening, self-report questionnaire, DSM-IV | |
| 0-6 scoring, German version | Cut-off 4, n = 378, Swiss participants, Buchli-Kammermann et al. 20113 | 66.6% | 64.9% | PPV: 84% |
| 0-6 scoring, English version | Cut-off 4, n = 668; Kessler et al. 20074 | 39.1% | 88.3% | . |
| 0-6 scoring, English version | (presumed cutoff of 4), n = 111, college students; Fuller-Killgore et al. 20135 | 21.4% | 95.8% | |
| 0-6 scoring (?), English version | (presumably cutoff 4); n = 154, Kessler et al. 20056; specific questions not listed; cutoff 4 | 68.7% | 99.5% | |
| 0–6 scoring, English version | Cut-off 4, n = 190 college students, Lovett et al., 20217 | 66% | 84% | |
| 0-6 scoring, English version | Cut-off 4, n = 30, Hines et al. 20128 | 92% | 69% | PPV: 48%, NPV: 97% |
| 0-6 scoring, Hebrew version | (presumed cutoff of 4), n = 120, Zohar & Konfortes 20109 | Paper version: 40%; Computer version: 52% | Paper version: 78.4%; Computer version: 73.5% | |
| 0–6 scoring, Korean version | Cut-off 4, n = 209, Heo et al. 201810 | 62.7% | 80.4% | |
| 0-6 scoring, Thai version | Cut-off 4, n = 51 (of 1,500, 1,451 were excluded), Kiatrungrit et al. 201711 | 90.9% | 62.5% | PPV: 40%; NPV: 96% |
| ASRS-6 (ADHD Self-Report Scale 1.1) 6 questions | 0–24 scoring: Each question is scored on a scale of 0 to 4; scores are added together | |||
| 0-24 Scoring, English version | Cut-off: 14 (14 or more points achieved), n = 668, Kessler et al. 20174 | 64.9% | 94.0% | Lundin et al.12 merely report the results of Kessler et al. |
| 0–24 scoring, Swedish (?) version | Cut-off: 14, n = 108, Petterson et al., 201813 | 91.7% | 27.1% | PPV: 61.1%; NPV: 72.2%; Accuracy: 63.0%; AUC: 75.9% |
| 0-24 Scoring, Spanish version | Cut-off: 12; n = 180, Ramos-Quoriga et al. 200914 | 96.7% | 91.1% | PPV: 91.6%; NPV: 96.5%; Kappa: 0.88; AUC: 94% |
| 0–24 DSM-5 Scoring, Japanese Version | DSM-5, n = 94, Takeda et al., 201715 | Cut-off 14: 69%; Cut-off 15: 67%; Cut-off 16: 57% | Cut-off 14: 80%; Cut-off 15: 84%; Cut-off 16: 87% | PPV Cut-off 14: 75%; Cut-off 15: 82%; Cut-off 16: 82%; NPV: Cut-off 14: 70%; Cut-off 15: 71%; Cut-off 16: 66%; Accuracy: Cut-off 14: 74%; Cut-off 15: 875%; Cut-off 16: 71%; AUC Cut-off 14: 85% |
| ASRS-6 (ADHD Self-Report Scale 1.1) in Special Populations 6 questions, adults, screening, self-report questionnaire, DSM-IV | Cutoff 4 for 0–6 screening: Answer “sometimes,” “often,” or “very often” to 4 or more questions on questions 1–3, and “often” or “very often” to questions 4–6. | |||
| 0–6 scoring, adult patients with depression | Cut-off 4, n = 95, Dunlop et al., 201816 | 55.0% to 60.0%; in particular, ADHD-I not detected | 68.6% to 85.0% | PPV: 21.4% to 78.6% , NPV 65.4% to 92.3% Accuracy 67.5% to 70.0% . |
| 0–6 scoring, inpatient alcohol dependence population, German (?) version | n = 404, Luderer et al., 201917 | Cut-off 4: 64.3% | ||
| 0–6 scoring, adult cocaine-dependent population, English version | n = 102, Dakwar et al. 201218 | Cut-off 4: 60.9% | ||
| 0–6 scoring, substance use disorder population | n = 183, presumably English version in a French-speaking city (Montreal), Chiasson et al. 201219 | Cut-off 4: 100% | Cut-off 4: 81.4% | |
| 0-6 Scoring, substance use disorder population among female prison inmates, Swedish version | n = 56, Konstenius et al. 201520 | Cut-off 4: 100% | Cut-off 4: 66% | PPV: 5Cut-off 4: 5%; NPV: 1Cut-off 4: 00% |
| 0–6 scoring, substance-using population | n = 80, Daigre et al. (2009)21 | Cut-off 3: 93.8%; Cut-off 4: 87.5%; Cut-off 5: 50.0% | Cut-off 3: 54.7%; Cut-off 4: 68.8%; Cut-off 5: 85.9%{ | PPV: Cut-off 3: 34.1%; Cut-off 4: 41.2%; Cut-off 5: 47.1%; NPV: Cut-off 3: 97.2%; Cut-off 4: 95.7%; Cut-off 5: 87.3% |
| 0–6 score, cannabis dependence | Cut-off 4, n = 99, Notzon et al., 202022 | 61% | 86% | |
| 0–6 scoring, substance-use population, mix of inpatients and outpatients | DSM-IV and DSM-5, n = 1,138; van de Glind et al., 201323 | Cut-off 4: 84 to 88% | Cut-off 4: 66 to 67% | Cut-off 4: PPV: 26%; NPV 97% to 98% |
| 0-6 Scoring, substance use disorder patients, Spanish version | n = 280, Pedrero Pérez et al., 200724 | Cut-off 3: 95.7%, Cut-off 4: 78.3% | Cut-off 3: 63.8%, Cut-off 4: 86% | PPV: Cut-off 3: 19.1%, Cut-off 4: 42.6%; NPV: Cut-off 3: 99.4%, Cut-off 4: 97.8% |
| 0-6 scoring, alcoholism | Cut-off 4, n = 379, Reyes et al., 201925 | 79.3% | 70.3% | PPV: 18.1%; NPV: 97.6% |
| 0–6 scoring, adult inpatient substance abuse population, abstinent for 1 week / 3 months | n = 1,064, Adler et al. 200926 | Cut-off 4: PPV: 57.6%; no information on sensitivity or specificity | ||
| ASRS-6 (Jan. 1) | 0-24 scoring, screening, self-report questionnaire, DSM-IV, 6 questions | |||
| 0-24 Scoring, substance use population, Turkish version | n = 190, Evren et al. 201627 | Cut-off 10: 75% | Cut-off 10: 79% | PPV: Cut-off 10: 46%; NPV: Cut-off 10: 93% |
| 0-24 scoring, inpatient alcohol dependence population, German (?) version | n = 404, Luderer et al., 201917 | Cut-off 14: 57.1%; Cut-off 11: 88.1% | Cut-off 11: 61.2% | |
| 0-24 score, outpatient alcohol dependence population | Cut-off 14, n = 355, Daigre et al., 201528 | 86.7% | 66.1% | |
| 0-24 score, population of alcohol-dependent individuals post-detoxification, Spanish (?) version | Cut-off 14, n = 297, Roncero et al., 201929 | 83.3% | 66.1% | PPV 32.3%, NPV 95.4% |
| ASRS-5; Optimal RiskSLIM DSM-5 ASRS Screening Scale (ASRS Update 2017 for DSM-5), 6 questions | 0–24 scoring; screening, self-report questionnaire, adults | |||
| German version of the | ; screening; self-report questionnaire; 6 questions; 0–24 scoring; n = 262; Ballmann et al., 202230 | Cut-off 14: 95.6% | Cut-off 14: 72.3% | |
| 0-24 Scoring, English versiong | n = 337, Ustun et al. 201731 | Cut-off 13: 92.6%; Cut-off 14: 91.4%; Cut-off 15: 87.0%; Cut-off 16: 84.1%; Cut-off 17: 79.3% | Cut-off 13: 63% / 84.4% Cut-off 14: 74% / 96%; Cut-off 15: 81.1% / 97.6%; Cut-off 16: 86.6% / 99%; Cut-off 17: 92.9% / 99.5% | ; Cut-offs 13 through 17: AUC: 78.0% to 94.0%; Cut-off 13 to 17: PPV: 34.9% to 93.6% |
| 0-24 Scoring, French versiong | n = 484, Baggio et al., 202032 | Cut-off 10: 95.8%; Cut-off 11: 92.8%; Cut-off 12: 89.4%; Cut-off 13: 84.3%; Cut-off 14: 78.0%; Cut-off 15: 69.1% | Cut-off 10: 71.8%; Cut-off 11: 79.0%; Cut-off 12: 85.5%; Cut-off 13: 91.9%; Cut-off 14: 94.0%; Cut-off 15: 95.6% | |
| 0-24 Scoring, Turkish version | n = 136, Genc et al., 202133 | Cut-off 9: 85.2%; Cut-off 10: 85.1% | Cut-off 9: 89.7%; Cut-off 10: 89.5% | AUC: Cut-off 9: 91.6%; Cut-off 10: 91.3%; PPV: Cut-off 10: 90.5%; NPV: Cut-off 10: 83.6%; |
| Adolescents, 0–24 scoring, English version | n = 564, Somma et al. 202134 | Cut-off of 12 recommended | Cut-off of 12: AUC: 84.3% | |
| ASRS-18 (ADHD Self-Report Scale 1.1) 18 questions | Screening, self-report questionnaire, DSM-IV; adults | |||
| 0–18 scoring, cutoff 9, English version, adults | n = 154, Kessler et al. 200535 | 56.3% | 98.3% | Each question was assigned one point; it was not reported when a question was considered met |
| 0-36 scoring, cutoff 8, English version, adults | n = 154, Kessler et al. 200535 | 55.9% | 96.5% | Each question was worth up to two points; it was not reported when a question was considered met |
| 0-72 Scoring, Norwegian version | n = 1,554, Brevik et al. 202036 | Cut-off 16: 98%, Cut-off 21: 95%, Cut-off 27: 90%, Cut-off 30: 88%, Cut-off 35: 80%, Cut-off 36: 79%, Cut-off 42: 64% Cut-off 49: 45% | Cut-off 16: 22%, Cut-off 21: 45%, Cut-off 71: 90%, Cut-off 30: 80%, Cut-off 35: 88%, Cut-off 36: 90%, Cut-off 42: 95%, Cut-off 49: 98% | , Cut-off 35: AUC 90.4%36 |
| 0-72 scoring, Swedish version, Adults | n = 111, Olofsdotter et al. 202337 | Cut-off 24: 91% | Cut-off 24: 35% | |
| 0-72 Scoring, Swedish version, Adolescents | n = 111, Olofsdotter et al. 202337 | Cut-off 30: 81% | Cut-off 30: 50% | |
| 0-72 scoring, Korean version, adults | n = 209, Heo et al. 201810 | Cut-off 32: 70.6% | Cut-off 32: 80.4% | |
| 0-72 scoring, cutoff 37, English version, adults | n = 154, Kessler et al. 200535 | 57.2% | 96.5% | Each question was scored up to four points; it was not reported when a question was considered met |
| 0–72 Scoring (?) Hebrew version, Adults | Cut-off unknown, n = 72, Zohar & Konfortes 201038 | Paper version: 65%; Computer version: 73.9% | Paper version: 68%; Computer version: 62.7% | |
| 0-72 Scoring, Japanese version | DSM-5, n = 94, Takeda et al., 201715 | Cut-off 35: 71%; Cut-off 36: 71%; Cut-off 37: 69% | Cut-off 35: 74%; Cut-off 36: 74%; Cut-off 37: 76% | PPV Cut-off 35: 73%; Cut-off 36: 73%; Cut-off 37: 75%; NPV: Cut-off 35: 89%; Cut-off 36: 89%; Cut-off 37: 70%; Accuracy: Cut-off 35: 72%; Cut-off 36: 72%; Cut-off 37: 72%; AUC Cut-off 35: 77% |
| 0-72 Scoring, Italian version, Adolescents | Somma et al. 201939 | Cut-off 31: 78% | Cut-off 31: 71% | |
| 0-72 Scoring, Swedish version, Adolescents | n = 111, Olofsdotter et al. 202337 | Cut-off 30: 81% | Cut-off 30: 50% | |
| 0-72 Scoring, Italian version, adolescent girls | Olofsdotter et al. 202337 | Cut-off 43: 56%, Cut-off 44: 52% | Cut-off 43: 90%, Cut-off 44: 93% | |
| 0-72 Scoring, Italian version, adolescent boys | Olofsdotter et al. 202337 | Cut-off 38: 56%, Cut-off 45: 17% | Cut-off 38: 90%, Cut-off 45: 93% | |
| ASRS-18 (ADHD Self-Report Scale 1.1) Addiction populations 18 questions | ||||
| 0-72 Scoring, Turkish version in a substance use population | Cut-off 30: 81%27 | Cut-off 30: 75%27 | PPV: Cut-off 30: 43%; NPV: Cut-off 30: 94%27 | |
| 0-72 Scoring, Substance-use disorder population among female prison inmates, Swedish version | n = 56, Konstenius et al. 201520 | approx. 100% | 45% | PPV: 42% |
| ASRS for Adolescents | Screening, Adolescents, Self-Report Questionnaire, DSM-IV, 6 or 18 questions | |||
| ASRS-A 1.1. (Adolescent ADHD Self-Report Scale) 18 questions | 0–18 scoring, cutoff 9, n = 134, Sonnby et al. 201540 | 79% | 60% | |
| ASRS-A-S 1.1. (Adolescent ADHD Self-Report Scale Screener) 6 questions | 0–6 scoring, cutoff 4, n = 134, Sonnby et al. 201540 | 74% | 60% | |
| CAARS-S-SR Conners Scales of Attention and Behavior for Adults – Self-Report, Screening Version, English (?) version | Cut-off 65, Taylor et al., 201141 | 82% | 87% | PPV: 87%; NPV: 83% |
| CAARS-S-SR in a population with alcohol dependence, German (?) version | n = 404, Luderer et al., 201917 | Cut-off 60: 88.1 | ||
| CAARS-S-SR combination, Cut-off 60 OR ASRS-6 0–24 Cut-off 11, in a population with alcohol dependence, German (?) version | n = 404, Luderer et al., 201917 | 100% | 78.1% | PPV: 54.9% |
- ADHD Screening for Adults (ADHD-E) (including severity of symptoms compared to normative values)
- ASRS 1.1.
- WHO ADHD Screening42
- 6-Item Brief Screening
- 18-Item Long Screening
- For sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), see the table under 1.
- The rating scales in ASRS 1.1 have fairly limited diagnostic value.37
- The high negative predictive value is typical of a screening tool (not intended for diagnostic purposes) that must not miss any potential cases, while at the same time having a low positive predictive value, meaning that more than half of those with a positive ASRS score do not receive an ADHD diagnosis
- On average, it takes less than 1 minute to complete
- A different analysis method yielded significantly better results43
- Quantitative assessment on a scale of 0 to 24 points, with a cutoff score of 12 points:
- Sensitivity: 96.7%
- Specificity: 91.1%
- Positive predictive value: 91.6%
- Negative predictive value: 96.5%
- Kappa index: 0.88
- AUC: 0.94
- Provisional Diagnostic Instrument 4; PDI-4
- A short self-report questionnaire for adults covering various disorders
- ADHD:
- Generalized Anxiety Disorder
- Severe depressive episode
- Mania
2. Third-Party Evaluation Screening
| Name of the instrument/test | Test type | Sensitivity (%) | Specificity (%) | Target group/Special features |
|---|---|---|---|---|
| ASRS-AP-S 1.1. (Parent of Adolescent ADHD Self-Report Scale), 6 questions | Screening, self-report questionnaire, DSM-IV, 6 questions, Sjölander et al., 201647 | 80% | 74% | Adolescents; Short questionnaire for their parents; performs better for girls than for boys |
| ASRS-AP-S 1.1. (Parent of the Adolescent ADHD Self-Report Scale), 6 questions | Screening, self-report questionnaire, DSM-IV, 6 questions, n = 134, Sonnby et al. 201540 | 79% | 60% | |
| ASRS-AP-18 1.1. (Parent of Adolescent ADHD Self-Report Scale), 18 questions | Screening, self-report questionnaire, DSM-IV, 18 questions | 78%47 | 75%47 | Adolescents; Short questionnaire for their parents; better for girls than for boys |
| CASQ (Conners Abbreviated Symptom Questionnaire) (meta-analysis, k = 11)48 | Questionnaire | 83% | 84% | Children and adolescents; questionnaire for parents |
| CTRS/CPRS (Conners’ Teacher/Parent Rating Scales)49 | Questionnaire | 83.5% | 35.7% | Children; high sensitivity, low specificity |
| CTRS-R (Conners Teacher Rating Scale-Revised) (meta-analysis, k = 11)48 | Questionnaire | 72% | 84% | Children and adolescents; questionnaire for teachers |
| CBCL-AP Scale (Child Behavior Checklist-Attention Problem)(meta-analysis, k = 14)48 | Questionnaire | 77% | 73% | Children and adolescents |
| CRS-R (Conners Parent Rating Scale-Revised) (meta-analysis, k = 11)48 | Questionnaire | 75% | 85% | Children and adolescents; questionnaire for parents |
3. Screenings for ASD
(The first tentative steps toward collecting data.)
One screening tool for ASD is the Social Communication Questionnaire (SCQ). The German version is called the Fragebogen zur Sozialen Kommunikation (FSK).50 The SCQ was developed in 2003 based on the ADI-R and consists of 40 yes/no questions for parents or caregivers.
The originally recommended threshold of 15 was used as a screening value, not to rule out ASA if the result was below that threshold.51
Screening should always be only the first step toward a more comprehensive diagnostic evaluation and should not be misused as a substitute for a complete diagnostic evaluation.
Subsequent studies identified lower SCQ cut-off scores for certain population groups:52
- 10 for people aged 1 to 25
- 11 for preschool-aged children
The SCQ has been criticized for showing insufficiently significant agreement with the results of a comprehensive diagnosis.5354 It is considered most suitable as a screening tool for young children, which was the purpose for which it was originally developed.
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Dunlop BW, Wu R, Helms K (2018): Performance of the Adult ADHD Self-Report Scale-v1.1 in Adults with Major Depressive Disorder. Behav Sci (Basel). 2018 Mar 29;8(4):37. doi: 10.3390/bs8040037. PMID: 29596328; PMCID: PMC5946096. n = 95 ↥
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Daigre Blanco C, Ramos-Quiroga JA, Valero S, Bosch R, Roncero C, Gonzalvo B, Nogueira M (2009): Adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist in patients with substance use disorders. Actas Esp Psiquiatr. 2009 Nov-Dec;37(6):299-305. PMID: 20066581. n = 80 ↥
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