Does the Format of the Adult ADHD Self-Report Scale Impact the Results

Does the Format of the Adult ADHD Self-Report Scale Impact the Results: a Randomized Controlled Trial

The World Health Organization Adult ADHD Self-Report Scale v1.1 (ASRS) is frequently used in family medicine clinics to screen for ADHD. Numerous studies have found the ASRS has a low positive predictive value. Compounding this concern is the format of the ASRS. Specifically, the answers on the ASRS that lead to screen positive results are shaded in gray and grouped together, which may make it easy for patients to discern which responses should be selected for a positive screen.

Study Overview

• Status: Completed
• Conditions: Attention Deficit Hyperactivity Disorder
• Intervention / Treatment: Other: Altered ASRS format, without shading and with grouping; Other: Altered ASRS format, with shading and without grouping; Other: Altered ASRS format, without shading and without grouping

Detailed Description

The ASRS is used widely to screen for ADHD in adults. It has 18 questions, with response options "never," "rarely," "sometimes," "often," and "very often." The 6 questions considered most predictive of ADHD are grouped together in Part A and questions that are meant to provide additional cues are grouped together in Part B. The options that are considered a positive response vary between questions; for some questions the option is at least "sometimes," while for others it is at least "often." The positive response options are shaded on the ASRS. A person is considered to have a positive screen if 4 of the 6 questions in Part A are positive.

The objective of this trial is to determine if the shading and grouping on the ASRS impacts screening results. This trial has a 2x2 factorial design set in a family medicine clinic(s). When a patients check in for an appointment, clinic staff will offer them a survey that includes 1) demographic questions and 2) 1 of the 4 versions of the ASRS, the version they receive is randomized (with programming). Most patients will take approximately 5 minutes to complete the survey prior to them seeing the family physician.

• Study Type: Interventional
• Enrollment (Actual): 587
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada
      • Shifa Medical Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 19 - 65 years old
• Patients who are registering for their appointment at the family medicine clinic
• Patients who are expected to be in the reception area for ≥5 minutes before going to a clinic room

Exclusion Criteria:

• Any patients who do not have the capacity to complete the form (e.g., cognitive impairment, unable to read English, unable to use a computer)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ASRS without shading and with grouping; These participants will receive the ASRS form that does not have shading for the screen positive response options and has the questions grouped (ie, the headings "Part A" and "Part B" will remain on the form).	Other: Altered ASRS format, without shading and with grouping; Participants will be asked to complete the ASRS form without shading and with grouping.
Experimental: ASRS with shading and without grouping; These participants will receive the ASRS form that has the screen positive response options shaded and has the questions ungrouped (ie, the headings "Part A" and "Part B" are removed).	Other: Altered ASRS format, with shading and without grouping; Participants will be asked to complete the ASRS form with shading and without grouping.
Experimental: ASRS without shading and without grouping; These participants will receive the ASRS form that does not have shading for the screen positive response options and has the questions ungrouped (ie, the headings "Part A" and "Part B" are removed).	Other: Altered ASRS format, without shading and without grouping; Participants will be asked to complete the ASRS form without shading and without grouping.
No Intervention: Standard ASRS: with shading and with grouping; These participants will receive the standard ASRS form. This form has the positive response options for each question shaded and has the questions grouped (ie, the headings "Part A" and "Part B" will remain on the form).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Screen positive rate	Poisson regression to determine the relative risk of a screen positive among the different versions of the form. We will include the following covariates: shading, grouping, shading x grouping, suspect ADHD without diagnosis, ADHD diagnosis, sex, and age.	Through study completion, estimated to be 2 months

Collaborators and Investigators

• Sponsor: University of Alberta
• Investigators: Principal Investigator: Roni Kraut, University of Alberta

Publications and helpful links

General Publications

• Kraut RY, Ono C, Garrison S, Kamal O, Doroshuk ML, Vandermeer B, Amanna G, Babenko O. Does the format of the adult ADHD self-report scale influence screen-positive rates? A randomized controlled trial in primary care. Front Psychiatry. 2026 Jan 2;16:1646293. doi: 10.3389/fpsyt.2025.1646293. eCollection 2025.

Study record dates

Study Major Dates

• Study Start (Actual): July 29, 2024
• Primary Completion (Actual): October 31, 2024
• Study Completion (Actual): October 31, 2024

Study Registration Dates

• First Submitted: July 26, 2024
• First Submitted That Met QC Criteria: July 30, 2024
• First Posted (Actual): July 31, 2024

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Attention Deficit and Disruptive Behavior Disorders; Attention Deficit Disorder with Hyperactivity
• Other Study ID Numbers: Pro00144202

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No