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:
- Generalized anxiety disorder
- Severe depressive episode
- Mania
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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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 ↥
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. ↥
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 ↥
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