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2. Screenings for ADHD

2. Screenings for ADHD

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 of severity compared to norm valuesADHD-RS-IV* Adult; with Adult Promptsself-report scale, 8 questions, SM-IV, panic version n = 398, Richarte et al, 20171 ADHD total: 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: PVV 7.17 % %, NPV 74.8 % %, kappa 0.88, AUC 94 %, no gender differences found in evaluation
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 0-6 screening: 4 or more questions reach sometimes, often or very often for questions 1-3, often or very often for questions 4 to 6. Adults, screening, self-report questionnaire, DSM-IV
0-6 scoring, German version Cut-off 4, n = 378, Swiss subjects, 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 presumably cut-off 4, n = 111, college students; Fuller-Killgore et al. 20135 21.4 % 95.8 %
0-6 scoring (?), English version presumably cut-off 4; n = 154, Kessler et al. 20056; specific questions not mentioned; cut-off 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 presumably cut-off 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 (1,451 of 1,500 were not included), 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 receives 0 to 4 points, points are added up
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 al12 only reproduce the result 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 Scoring DSM 5, 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: 4 or more questions reach sometimes, often or very often for questions 1-3, often or very often for questions 4 to 6.
0-6 Scoring, adult depressed patients Cut-off 4, n = 95, Dunlop et al, 201816 55.0% to 60.0%; especially ADHD-I not recognized 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 dependence population, English version n = 102, Dakwar et al. 201218 Cut-off 4: 60.9 %
0-6 Scoring, addiction population n = 183, presumably English version in French-speaking city (Montreal), Chiasson et al. 201219 Cut-off 4: 100 % Cut-off 4: 81.4 %
0-6 Scoring, addiction 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 use 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 Scoring, cannabis addiction Cut-off 4, n = 99, Notzon et al, 202022 61 % 86 %
0-6 Scoring, substance use population, mixture 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 addiction 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 misuse population, abstinent for 1 week / 3 months n = 1,064, Adler et al. 200926 Cut-off 4: PPV: 57.6 %; no statement on sensitivity or specificity
ASRS-6 (1.1.) 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 scoring, outpatient alcohol dependence population Cut-off 14, n = 355, Daigre et al., 201528 86.7 % 66.1 %
0-24 scoring, alcohol dependence population after withdrawal, 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 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-off 13 to 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 12 recommended Cut-off 12: AUC: 84.3 %
ASRS-18 (ADHD Self-Report Scale 1.1) 18 questions Screening, self-report questionnaire, DSM-IV; adults
0-18 scoring, cut-off 9, English version, adults n = 154, Kessler et al. 200535 56.3 % 98.3 % Each question received one point; not reported when a question was fulfilled
0-36 scoring, cut-off 8, English version, adults n = 154, Kessler et al. 200535 55.9 % 96.5 % Each question received up to two points; not reported when a question was fulfilled
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, cut-off 37, English version, adults n = 154, Kessler et al. 200535 57.2 % 96.5 % Each question received up to four points; not reported when a question was fulfilled
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 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, Addiction 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, cut-off 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, cut-off 4, n = 134, Sonnby et al. 201540 74 % 60 %
CAARS-S-SR Conners Scales of Attention and Behavior for Adults - Self-Assessment, Screening Version, English (?) Version Cut-off 65, Taylor et al., 201141 82 % 87 % PPV: 87 %; NPV: 83 %
CAARS-S-SR in alcohol dependence population, German (?) version n = 404, Luderer et al, 201917 Cut-off 60: 88.1
Combination CAARS-S-SR, cut-off 60 OR ASRS-6 0-24 Cut-off 11, in alcohol dependence population, German (?) version n = 404, Luderer et al, 201917 100% 78.1% PPV: 54.9%
  • ADHD screening for adults (ADHD-E) (including severity of severity compared to standard values)
  • ASRS 1.1.
    • ADHD screening by the WHO42
    • 6-item short screening
    • 18-item long screening
    • For sensitivity, specificity. Positive predictive value (PPV) and negative predictive value (NPV), see the table under 1.
    • The ASRS 1.1 rating scales have a very limited diagnostic value37
    • The high negative predictive value is typical for a (non-diagnostic) screening instrument that must not overlook any possible case, with a low positive predictive value, meaning that more than every second person with a positive ASRS is not diagnosed with ADHD
      • Average time to complete less than 1 minute
    • A different evaluation method resulted in significantly improved values43
      • Quantitative assessment between 0 and 24 points with a threshold value of 12 points:
      • Sensitivity: 96.7 %
      • Specificity: 91.1 %
      • Positive prediction value: 91.6 %
      • Negative prediction value: 96.5 %
      • Kappa index: 0.88
      • AUC: 0.94
  • Provisional Diagnostic Instrument 4; PDI-4
    • short self-report questionnaire for adults for various disorders
    • ADHD:
      • Sensitivity:
        • 82 %44
        • 79 % (compared to CAARS-S at cut-off 28)45
      • Specificity:
        • 73 %44
        • 87 % (compared to CAARS-S at cut-off 28)45
    • Generalized anxiety disorder
      • Sensitivity:
        • 83 %44
        • 64 % (compared to HADS-A at cut-off 14)45
      • Specificity:
        • 75 %44
        • 92 % (compared to HADS-A at cut-off 14)45
    • Severe depressive episode
      • Sensitivity:
        • 80 %44
        • 69 % (compared to PHQ-9 at cut-off 12)45
      • Specificity:
        • 80 %44
        • 90 % (compared to PHQ-9 at cut-off 12)45
    • Mania
      • Sensitivity:
        • 83 %44
        • 52 % (compared to MDQ at cut-off 7)45
      • Specificity:
        • 82 %44
        • 86 % (compared to MDQ at cut-off 7)46

2. External assessment 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; better for girls than for boys
ASRS-AP-S 1.1 (Parent of 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

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  11. Kiatrungrit K, Putthisri S, Hongsanguansri S, Wisajan P, Jullagate S (2017): Validity and Reliability of Adult ADHD Self-Report Scale Thai Version (ASRS-V1.1 TH). Shanghai Arch Psychiatry. 2017 Aug 25;29(4):218-227. doi: 10.11919/j.issn.1002-0829.217021. PMID: 28955141; PMCID: PMC5608994. n = 51

  12. Lundin A, Kosidou K, Dalman C (2019): Testing the Discriminant and Convergent Validity of the World Health Organization Six-Item Adult ADHD Self-Report Scale Screener Using the Stockholm Public Health Cohort. J Atten Disord. 2019 Aug;23(10):1170-1177. doi: 10.1177/1087054717735381. PMID: 29073818. n = 86.653

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  15. Takeda T, Tsuji Y, Kurita H (2017): Psychometric properties of the Japanese version of the Adult Attention-deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS-J) and its short scale in accordance with DSM-5 diagnostic criteria. Res Dev Disabil. 2017 Apr;63:59-66. doi: 10.1016/j.ridd.2017.02.011. PMID: 28260624.

  16. 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

  17. Luderer M, Kaplan-Wickel N, Richter A, Reinhard I, Kiefer F, Weber T (2019): Screening for adult attention-deficit/hyperactivity disorder in alcohol dependent patients: Underreporting of ADHD symptoms in self-report scales. Drug Alcohol Depend. 2019 Feb 1;195:52-58. doi: 10.1016/j.drugalcdep.2018.11.020. PMID: 30583265. n = 404

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  19. Chiasson JP, Stavro K, Rizkallah É, Lapierre L, Dussault M, Legault L, Potvin S (2012): Questioning the specificity of ASRS-v1.1 to accurately detect ADHD in substance abusing populations. J Atten Disord. 2012 Nov;16(8):661-3. doi: 10.1177/1087054711425768. PMID: 22049481. n = 183

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  21. 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

  22. Notzon DP, Pavlicova M, Glass A, Mariani JJ, Mahony AL, Brooks DJ, Levin FR (2020): ADHD Is Highly Prevalent in Patients Seeking Treatment for Cannabis Use Disorders. J Atten Disord. 2020 Sep;24(11):1487-1492. doi: 10.1177/1087054716640109. PMID: 27033880; PMCID: PMC5568505.

  23. van de Glind G, van den Brink W, Koeter MW, Carpentier PJ, van Emmerik-van Oortmerssen K, Kaye S, Skutle A, Bu ET, Franck J, Konstenius M, Moggi F, Dom G, Verspreet S, Demetrovics Z, Kapitány-Fövény M, Fatséas M, Auriacombe M, Schillinger A, Seitz A, Johnson B, Faraone SV, Ramos-Quiroga JA, Casas M, Allsop S, Carruthers S, Barta C, Schoevers RA; IASP Research Group; Levin FR (2013): Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug Alcohol Depend. 2013 Oct 1;132(3):587-96. doi: 10.1016/j.drugalcdep.2013.04.010. PMID: 23660242; PMCID: PMC4083506. n = 1.138

  24. Pedrero Pérez EJ, Puerta García C (2007): El ASRS v.1.1. como instrumento de cribado del trastorno por déficit de atención e hiperactividad en adultos tratados por conductas adictivas: propiedades psicométricas y prevalencia estimada [ASRS v.1.1., a tool for attention-deficit/hyperactivity disorder screening in adults treated for addictive behaviors: psychometric properties and estimated prevalence]. Adicciones. 2007;19(4):393-407. Spanish. PMID: 18173102.

  25. Reyes MM, Schneekloth TD, Hitschfeld MJ, Geske JR, Atkinson DL, Karpyak VM (2019): The Clinical Utility of ASRS-v1.1 for Identifying ADHD in Alcoholics Using PRISM as the Reference Standard. J Atten Disord. 2019 Aug;23(10):1119-1125. doi: 10.1177/1087054716646450. PMID: 27138328.

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