Adult ADHD-RS-IV* with Adult Prompts

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Patricia Franklin
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1 Adult ADHD-RS-IV* with Adult Prompts The ADHD-RS-IV with Adult Prompts is an 8-item scale based on the DSM-IV-TR criteria for ADHD that provides a rating of the severity of symptoms. The adult prompts serve as a guide to explore more fully the extent and severity of ADHD symptoms and create a framework to ascertain impairment. The first 9 items assess inattentive symptoms and the last 9 items assess hyperactive-impulsive symptoms. Scoring is based on a 4-point Likert-type severity scale: = none, = mild, 2 = moderate, 3 = severe. Clinicians should score the highest score that is generated for the prompts for each item. Example: If one prompt generates a 2 and all others are a, by convention, the rating for that item is still a 2 Significant symptoms in clinical trials are generally considered at least a 2 moderate. Moderate Severe 2 3 Moderate Severe 2 3. Carelessness Do you make a lot of mistakes (in school or work)? Is this because you re careless? Do you rush through work or activities? Do you have trouble with detailed work? Do you not check your work? Do people complain that you re careless? Are you messy or sloppy? Is your desk or workspace so messy that you have difficulty finding things? 2. Difficulty sustaining attention in activities Do you have trouble paying attention when watching movies, reading, or attending lectures? Or on fun activities such as sports or board games? Is it hard for you to keep your mind on school or work? Do you have unusual trouble staying focused on boring or repetitive tasks? Does it take a lot longer than it should to complete tasks because you can t keep your mind on the task? Is it even harder for you than some others you know? Do you have trouble remembering what you read and do you need to re-read the same passage several times? 3. Doesn t listen Do people (spouse, boss, colleagues, friends) complain that you don t seem to listen or respond (or daydream) when spoken to or when asked to do tasks? A lot? Do people have to repeat directions? Do you find that you miss the key parts of conversations because of drifting off in your own thoughts? Does it 4. No follow through Do you have trouble finishing things (such as work or chores)? Do you often leave things half done and start another project? Do you need consequences (such as deadlines) to finish? Do you have trouble following instructions (especially complex, multistep instructions that have to be done in a certain order with different steps)? Do you need to write down instructions, otherwise you will forget them? Can t organize Do you have trouble organizing tasks into ordered steps? Is it hard prioritizing work and chores? Do you need others to plan for you? Do you have trouble with time management? Does it Does difficulty in planning lead to procrastination and putting off tasks until the last moment possible? 6. Avoids/dislikes tasks requiring sustained mental effort Do you avoid tasks (work, chores, reading, board games) that are challenging or lengthy because it s hard to stay focused on these things for a long time? Do you have to force yourself to do these tasks? How hard is it? Do you procrastinate and put off tasks until the last moment possible? 7. Loses important items Do you lose things (eg, important work papers, keys, wallet, coats, etc)? A lot? More than others? Are you constantly looking for important items? Do you get into trouble for this (at work or at home)? Do you need to put items (eg, glasses, wallet, keys) in the same place each time, otherwise you will lose them? 8. Easily distractible Are you ever very easily distracted by events around you such as noise (conversation, TV, radio), movement, or clutter? Do you need relative isolation to get work done? Can almost anything get your mind off of what you are doing, such as work, chores, or if you re talking to someone? Is it hard to get back to a task once you stop? 9. Forgetful in daily activities Do you forget a lot of things in your daily routine? Like what? Chores? Work? Appointments or obligations? Do you forget to bring things to work, such as work materials or assignments due that day? Do you need to write regular reminders to yourself to do most activities or tasks, otherwise you will forget?

2 Adult ADHD-RS-IV* with Adult Prompts Moderate Severe Moderate Severe. Squirms and fidgets Can you sit still or are you always moving your hands or feet, or fidgeting in your chair? Do you tap your pencil or your feet? A lot? Do people notice? Do you regularly play with your hair or clothing? Do you consciously resist fidgeting or squirming?. Can t stay seated Do you have trouble staying in your seat? At work? In class? At home (eg, watching TV, eating dinner)? In church or temple? Do you choose to walk around rather than sit? Do you have to force yourself to remain seated? Is it difficult for you to sit through a long meeting or lecture? Do you try to avoid going to functions that require you to sit still for long periods of time? Talks excessively Do you talk a lot? All the time? More than other people? Do people complain about your talking? Is it a problem? Are you often louder than the people you are talking to? 6. Blurts out answers Do you give answers to questions before someone finishes asking? Do you say things before it is your turn? Do you say things that don t fit into the conversation? Do you do things without thinking? A lot? 7. Can t wait for turn Is it hard for you to wait your turn (in conversation, in lines, while driving)? Are you frequently frustrated with delays? Does it Do you put a great deal of effort into planning to not be in situations where you might have to wait? Runs/climbs excessively Are you physically restless? Do you feel restless inside? A lot? Do you feel more agitated when you cannot exercise on an almost daily basis? 3. Can t play/work quietly Do you have a hard time playing/working quietly? During leisure activity (nonstructured times or on your own such as reading a book, listening to music, playing a board game), are you agitated or dysphoric? Do you always need to be busy after work or while on vacation? Intrudes/interrupts others Do you talk when others are talking, without waiting until you are acknowledged? Do you butt into others conversations before being invited? Do you interrupt others activities? Is it hard for you to wait to get your point across in conversations or at meetings? On the go, driven by a motor Is it hard for you to slow down? Do you feel like you (often) have a lot of energy and that you always have to be moving, are always on the go? Do you feel like you re driven by a motor? Do you feel unable to relax? 2 3 *From ADHD Rating Scale-IV: Checklists, Norms and Clinical Interpretation. Reprinted with permission of The Guilford Press: New York. I998 George J. DuPaul, Thomas J. Power, Arthur A. Anastopoulos and Robert Reid. This scale may not be reproduced in any form without written permission of The Guilford Press. Prompts developed by Lenard Adler, MD, Thomas Spencer, MD, and Joseph Biederman, MD. 23 New York University and Massachusetts General Hospital. All rights reserved. DO NOT REPRODUCE WITHOUT WRITTEN PERMISSION OF MASSACHUSETTS GENERAL HOSPITAL OR NEW YORK UNIVERSITY. THERE ARE NO WARRANTIES REGARDING THIS ATTENTION DEFICIT HYPERACTIVITY DISORDER RATING SCALE IV AND ADULT PROMPTS ( SCALE ), EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION, IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, AND ALL OTHER REPRESENTATIONS OR WARRANTIES OF ANY KIND ARE HEREBY DISCLAIMED. New York University and the Massachusetts General Hospital shall neither exercise control over nor interfere with the physician-patient relationship of users of this Scale and shall not be responsible for any use made of this Scale, including any medical decisions regarding the care and treatment of patients using the Scale. S4785 7/6

3 Adult ADHD Self-Report Scale (ASRS-v.) Symptom Checklist Instructions The questions on the back page are designed to stimulate dialogue between you and your patients and to help confirm if they may be suffering from the symptoms of attention-deficit/hyperactivity disorder (ADHD). Description: The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR criteria. Six of the eighteen questions were found to be the most predictive of symptoms consistent with ADHD. These six questions are the basis for the ASRS v. Screener and are also Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions. Instructions: Symptoms. Ask the patient to complete both Part A and Part B of the Symptom Checklist by marking an X in the box that most closely represents the frequency of occurrence of each of the symptoms. 2. Score Part A. If four or more marks appear in the darkly shaded boxes within Part A then the patient has symptoms highly consistent with ADHD in adults and further investigation is warranted. 3. The frequency scores on Part B provide additional cues and can serve as further probes into the patient s symptoms. Pay particular attention to marks appearing in the dark shaded boxes. The frequency-based response is more sensitive with certain questions. No total score or diagnostic likelihood is utilized for the twelve questions. It has been found that the six questions in Part A are the most predictive of the disorder and are best for use as a screening instrument. Impairments. Review the entire Symptom Checklist with your patients and evaluate the level of impairment associated with the symptom. 2. Consider work/school, social and family settings. 3. Symptom frequency is often associated with symptom severity, therefore the Symptom Checklist may also aid in the assessment of impairments. If your patients have frequent symptoms, you may want to ask them to describe how these problems have affected the ability to work, take care of things at home, or get along with other people such as their spouse/significant other. History. Assess the presence of these symptoms or similar symptoms in childhood. Adults who have ADHD need not have been formally diagnosed in childhood. In evaluating a patient s history, look for evidence of early-appearing and long-standing problems with attention or self-control. Some significant symptoms should have been present in childhood, but full symptomology is not necessary.

4 Adult ADHD Self-Report Scale (ASRS-v.) Symptom Checklist Patient Name Today s Date Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your healthcare professional to discuss during today s appointment. Never Rarely Sometimes Often Very Often. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? 2. How often do you have difficulty getting things in order when you have to do a task that requires organization? 3. How often do you have problems remembering appointments or obligations? 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started? 5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? 6. How often do you feel overly active and compelled to do things, like you were driven by a motor? Part A 7. How often do you make careless mistakes when you have to work on a boring or difficult project? 8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work? 9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?. How often do you misplace or have difficulty finding things at home or at work?. How often are you distracted by activity or noise around you? 2. How often do you leave your seat in meetings or other situations in which you are expected to remain seated? 3. How often do you feel restless or fidgety? 4. How often do you have difficulty unwinding and relaxing when you have time to yourself? 5. How often do you find yourself talking too much when you are in social situations? 6. When you re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves? 7. How often do you have difficulty waiting your turn in situations when turn taking is required? 8. How often do you interrupt others when they are busy? Part B

5 The Value of Screening for Adults With ADHD Research suggests that the symptoms of ADHD can persist into adulthood, having a significant impact on the relationships, careers, and even the personal safety of your patients who may suffer from it. -4 Because this disorder is often misunderstood, many people who have it do not receive appropriate treatment and, as a result, may never reach their full potential. Part of the problem is that it can be difficult to diagnose, particularly in adults. The Adult ADHD Self-Report Scale (ASRS-v.) Symptom Checklist was developed in conjunction with the World Health Organization (WHO), and the Workgroup on Adult ADHD that included the following team of psychiatrists and researchers: Lenard Adler, MD Associate Professor of Psychiatry and Neurology New York University Medical School Ronald C. Kessler, PhD Professor, Department of Health Care Policy Harvard Medical School Thomas Spencer, MD Associate Professor of Psychiatry Harvard Medical School As a healthcare professional, you can use the ASRS v. as a tool to help screen for ADHD in adult patients. Insights gained through this screening may suggest the need for a more in-depth clinician interview. The questions in the ASRS v. are consistent with DSM-IV criteria and address the manifestations of ADHD symptoms in adults. Content of the questionnaire also reflects the importance that DSM-IV places on symptoms, impairments, and history for a correct diagnosis. 4 The checklist takes about 5 minutes to complete and can provide information that is critical to supplement the diagnostic process. References:. Schweitzer JB, et al. Med Clin North Am. 2;85(3):-, Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed Biederman J, et al. Am J Psychiatry.993;5: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association. 2:

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