Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that persists into adult life in up to 60% of cases. It is characterized by deficits in the cognitive areas of attention, hyperactivity and impulsivity, which leads to purposeless or unfocused hyperkinetic movement or activity, inability to execute complex tasks, and significant impairment in relationships, social interactions and occupational success.
The prevalence of this disorder is higher in adults with substance abuse, up to 46%, which means it is much more common here than in the general population. At the same time, this subset of adult ADHD patients have a worse outcome and tend to relapse more often than those without substance abuse. For this reason, screening all patients who abuse substances would be a sensible step, but is often not carried out because of the time-consuming nature of the screening.
Inside the adult ADHD brain
Adult ADHD Self-Report Scale (ASRS)
Screening for this disorder has been done using a tool called the Adult ADHD Self-Report Scale (ASRS), which was developed by the World Health Organization (WHO) to assess ADHD in individuals who are at least 18 years old. It is used for community screening or for individual screening on demand. It is a screening test rather than a diagnostic test and therefore identifies patients for further clinical assessment. A positive screening result is defined by the test materials.
The ASRS Screener has 6 items that were found to have the highest predictive value for ADHD. These questions echo DSM-IV criteria for adult ADHD. These include questions, which explore the individual’s ability to plan and execute organized projects, including beginning them, cleaning up the finer points, remaining still when in a situation that demands quiet sitting, and keeping appointments. These are included in part A of the ASRS Symptom Checklist, while part B includes 12 more questions for greater elucidation of the patient’s symptoms.
The test is available in a number of languages, but the material has not been changed irrespective of the country of use, which means that the translated forms have not been checked for cross-cultural validity. However, the tool is widely available for individual use without prior permission being necessary.
Advantages of the ASRS
Screening is important to pick up the maximum number of cases of ADHD in the adult population. It is inexpensive, easy to use, and takes only 5 minutes, while it can be assessed by a professional in a few seconds. This can be used as the first step to identify those who are to be tested further using the Conner’s Adult ADHD Diagnostic Interview for DSM-IV (CAADID), which takes about an hour. However, this two-step process will lead to missing some patients who are not picked up by the ASRS.
The ASRS is useful to provide estimates of prevalence of and the factors that correlate with ADHD in the community, currently pegged at around 1-6%. However, the expected probability of clinically diagnosed ADHD for each value on the screening tool has not been calibrated using international data. Thus, the present calibration is based on a US sample.
The ASRS has been used to help confirm the presence of adult ADHD in applicants for disability services, for instance, based on self-report. This is possible because studies have shown that adults can self-report their ADHD symptoms to a degree of reliability that is replicable by other tests and by using informant reports.