ADHD is commonly screened for in primary care using a short questionnaire called the Adult ADHD Self-Report Scale, or ASRS. While it is quick and easy to use, many people who screen positive on the test do not actually have ADHD, which can lead to unnecessary concern or follow-up.
This study, published in Frontiers in Psychiatry, investigated whether the way the form is designed makes people more likely to screen positive.
The researchers focused on two specific design features of the ASRS. In the standard version, the most important questions are grouped at the top of the form, and certain answer options are shaded to signal which responses count toward a positive screen. The concern was that these visual cues might unintentionally guide people’s answers and inflate positive results.
Nearly 600 adults visiting a family medicine clinic were randomly given one of four versions of the ASRS: the standard version, a version with grouping only, a version with shading only, or a version with neither grouping nor shading. Participants ranged in age from 19 to 65 and represented a mix of educational backgrounds and ethnicities. Some already had an ADHD diagnosis and others suspected they might have undiagnosed ADHD.
About one-third of all participants screened positive for ADHD, which is high for a general primary care population. The key finding was that the design of the form did not meaningfully affect the results. Neither grouping the questions nor shading certain answers made people more or less likely to screen positive. In contrast, people who already had an ADHD diagnosis or believed they might have ADHD were far more likely to screen positive, regardless of which version they received.
The authors found that while the ASRS remains useful as a first step, there is a clear need for better screening approaches that more accurately distinguish who is likely to have ADHD and who is not.
