The ASRS v1.1 is the adult ADHD self-report scale developed with the World Health Organization. Its first six questions, Part A, screen adults for ADHD: four or more answers in the shaded boxes is a positive screen. See how to score it, what a positive screen means and what comes next, and record the result with the free template.
ASRS v1.1 result template
FreeASRS v1.1 SCREEN Date: [Date] Patient: [Name or ID, age] Completed by: [Patient on paper, patient online, or items read aloud word for word; interpreter if used] Reason for screening: [Concentration or organization concerns, referral question, or routine screening] Form used: [6-question screener only, or the full 18-item checklist] PART A SCREEN Answers in the shaded range: [Number of the 6 Part A answers in the shaded boxes] Shaded items: [Which of items 1 to 6] Screen result: [Positive at 4 or more of 6, or negative at 0 to 3] Sum score, if used: [Part A total 0 to 24, cutoff 14; say which method the service uses] PART B Part B notes: [Shaded answers among items 7 to 18, the symptom areas they point to, and examples the patient gave] COLLATERAL AND CONTEXT Collateral information: [Who was asked, with consent, and what they said about childhood and daily life now] Childhood evidence: [School reports or other records, or none available] Other explanations: [Mood, anxiety, sleep, substance use, medicines, medical causes; other screening scores] NEXT STEP Decision: [Full adult ADHD assessment, treat another condition first and repeat the screen, or no further action] Referral: [To whom, and what was sent] Repeat screen: [Date, or the change that would prompt it] Clinician: [Name, credentials]
Use it for
Adults 18 and over answer on the official form, on paper or online, about the past six months. Part A takes about two minutes.
Avoid: Asking the questions from memory or in your own words. The screen was validated on the published wording.
Count how many of the six answers fall in the shaded boxes. Four or more is a positive screen.
Avoid: Adding the answers up as points and then applying the 4 of 6 cutoff to the total. The two methods use different numbers.
Part B’s 12 items aren’t scored for the screen. They show which symptoms are present and where to probe.
Avoid: Adding Part B to Part A for a bigger total. Only Part A decides the screen.
A positive screen means current symptoms are highly consistent with adult ADHD. A full assessment decides whether it is ADHD.
Avoid: Starting a stimulant on the screen result.
Fewer than four shaded answers makes adult ADHD less likely, but the screener misses about one in three adults who have it.
Each one follows the recording template. Use them to judge how much to write.
University student health clinic, first visit about falling behind, completed on paper before the appointment
Answers in the shaded range: 5 of 6, items 1 to 4 and 6. Screen positive. Sum score not used.
8 of 12 answers in the shaded range, mostly inattention, with some restlessness and few impulsive answers. Her examples: lab keys and notebooks lost most weeks, experiments finished but write-ups left for weeks, and leaving seminars to walk the hallway.
27-year-old graduate student in the third year of a chemistry PhD. Two thesis chapter deadlines missed this year, raised in writing by her supervisor. Her mother, by phone with consent, recalls teachers from grade 3 calling her “a daydreamer” who rarely finished homework; she has kept the report cards. PHQ-9 6. GAD-7 7. Sleeps about 7 hours. Alcohol 3 drinks a week, cannabis rarely, 4 coffees a day. No spells of high mood or little need for sleep. No head injury.
Positive screen with a childhood history worth exploring. Referred for a full adult ADHD assessment with the campus psychiatry service; she will bring her report cards. No medication started from the screen. In the meantime, a weekly written plan with her supervisor and shorter interim deadlines. Follow-up in 4 weeks.
Family practice, visit for low mood and poor concentration, completed on paper in the room
Answers in the shaded range: 4 of 6, items 1 to 4. Screen positive, at the cutoff.
3 of 12 answers in the shaded range, all inattention. No hyperactive or impulsive answers shaded.
49-year-old man, logistics manager, separated in the spring. Low mood, waking at 4 a.m., and poor focus for about 7 months; he has made mistakes on delivery schedules. Concentration was fine until this year. His sister says he was organized and did well at school. PHQ-9 17, item 9 at 0. Insomnia Severity Index 18. Up to 3 beers most nights to get to sleep. TSH normal last month.
The attention problems began with the depression and poor sleep, with no sign of them in childhood, so those come first. Started sertraline 50 mg daily; referred for CBT for insomnia; advised cutting back alcohol and keeping a fixed wake time. Crisis line 988, call or text, discussed. PHQ-9 in 4 weeks. Repeat the ASRS in 3 months, once mood and sleep have improved; if attention problems remain then, reassess for other causes, ADHD among them.
A positive Part A shows current symptoms. It doesn’t show they began in childhood, or that depression, anxiety, or poor sleep isn’t causing them.
The shaded boxes don’t start at the same answer on every item. Count them on the official form.
Part B adds detail about which symptoms are present. Only Part A decides whether the screen is positive.
The 4 of 6 count, the 0 to 24 sum, and the ASRS-5 each have their own cutoff. Record which one you used.
Depression, anxiety, and poor sleep all push answers into the shaded range. Record them next to the result, and repeat the screen once they’re treated.
Vero Scribe records the ASRS result in your template from the visit, with the patient’s consent, or from your dictation: the Part A count, the screen result, what collateral sources said, and the next step. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Count how many of the six Part A answers fall in the shaded boxes on the official form. Four or more is a positive screen; 0 to 3 is negative. The shading starts at a different answer for some items, so count from the form. Part B isn’t scored for the screen.
It means current symptoms are highly consistent with adult ADHD, and a full assessment should follow. It isn’t a diagnosis. That needs a clinical interview showing symptoms before age 12, in two or more settings, with impairment, and not better explained by something else, such as depression or poor sleep.
A second way to score Part A, described in Harvard’s 2024 scoring update. Each answer scores 0 to 4, from never to very often, for a total of 0 to 24, and 14 or more is positive. Totals of 0 to 9 are low negative, 10 to 13 high negative, 14 to 17 low positive, and 18 to 24 high positive. It was found more robust for research; many clinics still use the 4 of 6 count.
The ASRS v1.1 was written for DSM-IV and is the version most clinics use. The ASRS-5, published in 2017, is a separate six-question screener written for DSM-5. Its items carry different weights, its total runs from 0 to 24, and 14 or more is the usual positive cutoff. It needs permission to use, through NYU’s licensing site.
In the 2005 validation study, Part A classified 98% of adults correctly: it picked up 69% of those with ADHD and correctly screened out 99.5% of those without it. So a negative screen can miss ADHD. In clinics, results vary more, partly because depression, anxiety, and poor sleep also raise the count.
Anyone in the care team can hand it out, and patients fill it in themselves: in the waiting room, online, or before a visit. A clinician reads the result, and the diagnosis comes from a full assessment by a clinician trained to diagnose ADHD, such as a psychiatrist, psychologist, or physician.
The six-question screener is free to use and needs no formal permission: cite the 2005 paper, keep the copyright notice, and don’t alter the form. Download it, with its translations, from Harvard’s National Comorbidity Survey site. The full 18-question checklist and the ASRS-5 need permission through NYU’s licensing site. The recording template on this page is free to copy or download.
Eleven items on memory, attention, and executive function: a cognitive screen scored 0 to 30, with cutoffs set by schooling.
Three-word recall and a clock drawing in about 3 minutes: a dementia screen scored 0 to 5, positive at 0 to 2.
Memory, attention, language, visuospatial and executive skills, and orientation in about 10 minutes: scored 0 to 30, normal at 26 or more.
The full assessment after a positive screen: childhood history, settings, impairment, and other causes.
For testing that brings rating scales, interviews, and cognitive tests into one report.
What a diagnosis needs beyond the screen: onset, settings, and impairment.
Assessments, follow-ups, and letters, drafted from the visit for your review.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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