Lenard Adler, MD ADHD in AdultsUstun et al. (2017) recently published an updated version of the adult ADHD screener which is validated for DSM-5: the ASRS v1.1 Screener: DSM-5. The prior DSM-IV version of the screener was established using two populations: a community-based sample from the National Co-Morbidity Survey (NCS-R) and a sample of individuals from a health care plan.

The first step was to recalibrate the new screener using these same two samples, but applying updated DSM-5 criteria; symptoms included not only core symptoms of inattention (IA) and hyperactivity-impulsivity (HI) as defined in DSM, but additional co-traveling symptoms of executive dysfunction (eg: deficits in organization, planning, working memory) or emotional dysregulation (eg: over emotionality, changeable mood).

The symptoms of executive dysfunction have been shown to carry a high symptom burden and in many ways drive the symptom presentation when present in a recent factor analysis (Adler et al. 2017). The selection and weighting of the symptoms was selected by SLIM artificial intelligence – six items were selected: four were from DSM classic symptoms of IA and HI, but two were symptoms of executive dysfunction beyond those defined in the DSM. The process was again repeated and validated in a new sample of referred individuals for ADHD evaluations and controls from primary care practices from the NYU School of Medicine as second validation. The screener is again self-report and rated on a frequency basis of 0-4 (never to very often), with a cut-off score of > = 14 indicating a positive screen. The weighting of items in the screener is not evenly distributed and the scoring algorithm will shortly be available through an educational program on this website.

The ASRS v1.1 Sceener: DSM-5 has a high degree of sensitivity and specificity (first sample: 91.4%; 96.0%, respectively; second NYU sample: 91.9%, 74.0%, respectively). Given the high sensitivity and specificity, the new screener can be a highly effective tool for clinicians to identify individuals at risk for adult ADHD who merit further evaluation and a full diagnostic evaluation.

REFERENCES
Adler LA, Faraone SV, Spencer TJ, Berglund P, Alperin S, Kessler RC. The structure of adult ADHD. Int J Methods Psychiatr Res. 2017 Mar;26(1). doi: 10.1002/mpr.1555. Epub 2017 Feb 17.

Ustun B, Adler LA, Rudin C, Faraone SV, Spencer TJ, Berglund P, Gruber MJ, Kessler RC. The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA Psychiatry. 2017 May 1;74(5):520-526. doi: 10.1001/jamapsychiatry.2017.0298.

Lenard A. Adler, MD

About Lenard A. Adler, MD

Dr. Adler is Professor, Department of Psychiatry, and Department of Child and Adolescent Psychiatry, as well as the Director of the Adult ADHD Program at NYU Langone Medical Center in Manhattan, New York. He is a member of APSARD, the American Professional Society of ADHD and Related Disorders, and is on the Advisory Board of ADHD in Adults.com