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Module 1 — How to Read an ADHD Screener (and What a Score Can't Tell You)
Before the nine questionnaires: what a screening score actually measures, why sensitivity and specificity pull against each other, what happens to a good screener at real adult ADHD prevalence, and the four validity tiers every instrument here carries.
ADHD Self-Discovery · Part One — Start Here · 13 min read, about 24 min with the workbook
The big idea
Low on capacity today? The whole module in four lines: a screening questionnaire asks how often you have noticed something, over a fixed window of time, and compares your answers to a threshold that was set in somebody else's research sample. It cannot see your brain, it cannot see your childhood, and it cannot rule anything in. Nine questionnaires follow this one, and four of them are tools we built ourselves and label as such. That is the load-bearing part. Everything below is detail.
If you have ever finished an online ADHD quiz, read the phrase 'symptoms consistent with ADHD', and felt vindicated and unconvinced at the same time — keep both feelings. Each of them is responding to something true. The number meant something. It did not mean the thing the results page implied. Ten minutes here, and the nine scores that follow will be worth considerably more to you.
Step 1 — The lesson
A. What the questions can actually see
Open any adult ADHD screener and read the wording rather than the content. The six questions the World Health Organization settled on in 2005 all begin the same way: over the past 6 months, how often do you …1 The answer boxes are never, rarely, sometimes, often, very often. That is the entire apparatus.
So the thing being measured is a frequency estimate, made by you, today, about the last half-year, in categories somebody else chose. Whether you tick "often" or "sometimes" for having trouble getting things in order when a task requires organisation depends on things the questionnaire has no way of seeing. Whether you count the tax return you eventually filed at four in the morning as a success or a disaster. Whether you have spent fifteen years building workarounds so elaborate that the difficulty has been engineered out of sight, which is itself a finding, and one no screener has a box for.
None of that makes the instrument worthless. It makes it a particular kind of object: a structured record of self-reported experience over a stated window. Not a measurement of your brain. Not a count of a deficit. Not a history of your life.
Diagram — A · What the questions can see. Two things a screening questionnaire genuinely establishes, and five it never touches. The blanks are not design faults. They are the reason an assessment takes hours rather than four minutes.
Look at what is missing. Nothing in a screener establishes that anything was present before you turned twelve, which the criteria require. Nothing asks what your partner, your sister or your line manager would say. Nothing rules out the handful of ordinary conditions that produce a near-identical set of answers — a year of broken sleep will do it, so will an untreated anxiety disorder, so will grief, so will a job that was a bad fit from the first week.
A screening questionnaire is doing exactly one job: sorting people into worth a closer look and probably not, on this evidence. It is decent at that job, and has no second job.
B. Nine questionnaires, four kinds of claim
The free-quiz sites never mention this. The questionnaires you meet online are not all the same species. Some have been tested against clinical assessment by independent teams in several countries. Some were written thoughtfully by a clinician last year and have never been tested by anybody. Both can be worth twenty minutes of your evening. They are not making the same claim, and you are owed the difference before you start rather than after.
Every instrument in this course carries a tier, printed above the questions instead of buried in small type underneath them.
Diagram — B · Nine screeners, four kinds of claim. Four tiers, four different sizes of claim. Tier 1 means other people have checked the work. Tier 4 means we wrote it because nothing suitable existed. Both can be useful; only one is evidence.
Tier 1 — validated and published. Built by external researchers, tested against clinical assessment, published in a peer-reviewed journal, and re-tested by other teams in other countries. In this course that means the ASRS v1.1, the BIS-11 and the Clinical Anger Scale.
Tier 2 — published, but the construct is argued over. The questionnaire exists in the literature; what it measures is not a settled category. There is no Tier 2 instrument in this course. We say so rather than leaving a silent gap you might read as an oversight.
Tier 3 — in clinical use for years, never formally normed. Clinicians have organised conversations around it for a long time, and it has earned that place honestly. Nobody has run the validation study. The Copeland checklist and the dyslexia questionnaire sit here.
Tier 4 — we built it. Four of the nine: the SAAST, the AAMM masking measure, the ADHD-SIM-24 and the RSD-24. Each one exists because a real part of adult life with ADHD had no decent questionnaire attached to it — masking, rejection sensitivity, what a wandering attention does to intimacy. They are written carefully, they are useful, and they have never been normed on anybody. A high score on a Tier 4 tool is a good reason to start a conversation. It is not a finding, and we will not style it as one.
C. Two numbers that pull against each other
Screening accuracy is reported as two figures, and it is worth learning them once. Sensitivity is: of the people who genuinely have the thing, what share does this screen catch. Specificity is: of the people who do not have it, what share does it correctly wave through. Both are percentages, both sound like virtues, and the crucial fact is that you cannot maximise both. The threshold is one line drawn through a spread of scores. Slide it down and you catch more real cases and more false alarms together. Slide it up and you turn away fewer people who are fine and more people who are not. Every threshold in this course was placed deliberately low, because a missed case costs more than a second look.
The same six ASRS questions show how much the answer depends on the room. In the American household survey where they were developed, checked against a blind clinical reappraisal of 154 people, they caught 68.7 per cent of real cases and correctly cleared 99.5 per cent of everyone else, for a total classification accuracy of 97.9 per cent.1 In eight primary-care practices, with 200 adults, the identical six questions caught 92 per cent and cleared only 69 per cent.2 Nothing changed about the instrument. Almost everything changed about who was sitting in front of it.
Now the part that actually decides what your own result is worth, and the part that never appears on a results page.
Diagram — C · If a hundred people screen positive. At a population rate of about 3 in 100, a screen with good-sounding numbers still hands back a set of positives in which most people do not have the condition. The instrument is behaving exactly as designed.
Take a thousand adults. Adult ADHD runs at roughly 3 in 100: a global review of 40 studies across 30 countries estimates persistent adult ADHD at 2.58 per cent3, and twenty nationally representative surveys covering 26,744 people averaged 2.8 per cent.4 So about 30 of your thousand have it, and 970 do not.
Run the primary-care figures across that thousand. Sensitivity of 92 per cent catches about 28 of the 30. Specificity of 69 per cent means 31 in every 100 people without ADHD screen positive anyway — roughly 301 of the 970. You now hold about 329 positive screens, of which 28 are real. Slightly fewer than one in twelve.
That is not a broken instrument, and it is not new. Meehl and Rosen set it out in 1955: a test only earns its place if it does better than the base rate would do on its own, and at a low base rate most positive classifications are wrong however good the test looks.5 The primary-care study reported it directly — a positive predictive value of 0.52 inside its own sample, falling to 0.12 once adjusted to population prevalence.2 A systematic review of every adult ADHD self-report measure with published accuracy data found negative predictive values above 96 per cent across the board, while positive predictive values in clinical samples reached 61 per cent at best and most fell below 20 per cent.6
Two things follow and they lean opposite ways. The first is that a negative screen is the more trustworthy result. Ruling out is the one thing these instruments do reliably, which is why a low score on a single questionnaire is still worth having. The second is that you are not a randomly selected adult. You are here because something has not fitted for years, and that raises your own base rate well above 3 in 100 — which genuinely improves the odds behind a positive screen, and also supplies precisely the confirmation bias that makes a positive feel like proof.
D. Why attention is the hardest thing to ask about
Every self-report instrument leans on the respondent knowing themselves. ADHD screeners lean on something narrower and considerably shakier: the accuracy of your attention about your own attention, and your memory of a decade nobody was taking notes on.
The childhood question cannot be answered by a questionnaire. The criteria require several symptoms present before age 12, raised from age 7 in DSM-5 because the older threshold was unworkable for adults; the European consensus statement notes that even 12 lands badly on people whose retrospective recall is poor, which is a large share of the people being assessed.7 When 176 men diagnosed with ADHD as children were re-interviewed a mean of 16.5 years later by interviewers blind to their records, adult recall matched the childhood diagnosis with a sensitivity of 0.78 and a specificity of 0.89 — good agreement. The authors still concluded that once you correct for how uncommon the condition is, roughly three in four retrospectively diagnosed cases would be false positives.8 In a New Zealand birth cohort of 1,037 people followed to age 38, 90 per cent of adults meeting ADHD criteria had no childhood ADHD on record. That finding is still argued over, and it is one good reason a careful assessment asks for school reports rather than trusting anyone's memory.9
The questionnaire depends on the faculty it is asking about. Noticing how often you lose the thread of a conversation requires you to have been tracking the conversations you lost the thread of. When 103 students completed a self-report ADHD questionnaire and were then given a full clinical assessment, the questionnaire agreed with the clinicians 68 per cent of the time — specificity 95 per cent, sensitivity 46 per cent — and the pattern of error was systematic underreporting on both the inattentive and the hyperactive-impulsive clusters.10 Adults with ADHD in that study were not exaggerating. They were playing themselves down.
Other people saw a different film. In a study of 120 adults with ADHD alongside their partners and their parents, the DSM symptom items produced the lowest patient-informant agreement of any part of the assessment, and the authors concluded that adults with ADHD, while still the best informants about themselves, tend to underreport how severe their symptoms are.11 This is why a good clinician asks whether anyone can come with you, and why the European consensus calls a collateral informant — usually a parent or a partner — of great value.7 It is not that you are unreliable. It is that nobody watches themselves from the outside, and ADHD narrows that view further than most.
Diagram — D · One high score, many roads to it. Six questions about focus, restlessness and finishing things will be answered the same way by an exhausted person, a frightened person and a grieving person. Separating those is most of what an assessment is for.
And the answers are not specific to ADHD. Difficulty concentrating, restlessness and unfinished tasks belong to half the psychiatric manual and to several perfectly ordinary weeks. A raised score tells you the pattern is present. It cannot tell you what is producing it, and any clinician who reaches for the prescription pad on the strength of a screener alone is doing it wrong. The systematic review put it plainly: scales alone cannot diagnose ADHD, and people who screen positive need a more rigorous evaluation.6
So a positive screen means look closer. It is a reason to book something, to write things down, to ask someone who has known you for twenty years an awkward question. It is not a case closed, and the number cannot be made to say more by staring at it.
INSIDE THE INSTRUMENT
SCREENING METHODOLOGY — how to read every score in this course
Where it came from
Modern screening arithmetic dates to Meehl and Rosen's 1955 paper in Psychological Bulletin, which showed that the clinical value of any sign, pattern or cutting score depends on the antecedent probability of the condition in the population being tested, and that at low base rates a rule which simply predicts the majority class can outperform a good test.5
What it is made of
Four numbers, two of which are properties of the instrument and two of which are not. Sensitivity and specificity are conditional on true status and are reasonably stable within a given population. Positive and negative predictive value are conditional on the test result, and they move with prevalence. The reader wants the third number and is nearly always given the first two.
How well it performs
For orientation, the best-evidenced instrument in this course: the six-item ASRS v1.1 screener returned sensitivity 68.7 per cent, specificity 99.5 per cent and total classification accuracy 97.9 per cent against blind clinical reappraisal in the US National Comorbidity Survey Replication.1 In 200 primary-care patients across eight practices the same six items returned sensitivity 0.92 and specificity 0.69, with a positive predictive value of 0.48 rising to 0.52 on adjusted analysis, and 0.12 when adjusted to population prevalence; negative predictive value was 0.97.2 Across the wider literature, negative predictive values exceeded 96 per cent for every measure with published data, while positive predictive values reached 61 per cent at best and mostly fell below 20 per cent.6
Where it was validated
The populations carry the numbers. The ASRS development sample was a general-population household survey with a 154-person clinical reappraisal subsample.1 The primary-care figures come from 200 consecutive adult patients in eight practices.2 Prevalence anchors: 2.58 per cent for persistent adult ADHD and 6.76 per cent for symptomatic adult ADHD in a 40-study global meta-analysis3, and 2.8 per cent across twenty WHO World Mental Health surveys of 26,744 respondents.4 Four of the nine instruments in this course have no validation sample at all, and their modules say so on the page.
What it cannot do
It cannot establish onset. DSM-5 requires several symptoms before age 12, and no self-report instrument tests that. Retrospective recall of childhood ADHD achieved kappa 0.67 against childhood records in a 16.5-year prospective follow-up, yet the same authors calculated that at population prevalence about three-quarters of retrospectively identified cases would be false positives.8
It cannot cross settings. Cross-situational presence is a criterion; a single respondent answering alone cannot supply it. Patient-informant agreement is weakest precisely on the DSM symptom items, and adults with ADHD underreport severity relative to partners and parents.11
It cannot discriminate. The item content is transdiagnostic. Sleep debt, mood disorder, anxiety, trauma, thyroid disease and ordinary overload generate the same responses, and differential diagnosis is not something a total score performs.
It cannot survive a change of setting unaltered. Operating characteristics are properties of an instrument-in-a-population, not of an instrument. The 68.7 per cent and 92 per cent sensitivities above are the same six questions in two different rooms.1,2
What a clinician does with it
Uses it to decide who gets the hour, not what the hour concludes. The European consensus statement is explicit that diagnosis rests on a careful, systematic assessment of a lifetime history of symptoms and impairment, with collateral information wherever it can be obtained.7 The self-report literature reaches the same place from the other direction: clinicians cannot rely on scales alone and must undertake a more rigorous evaluation of anyone who screens positive.6 A screening score belongs in the referral letter as a reason for the appointment, never in the formulation as evidence for the conclusion.
Validity tier: none — this module scores no instrument. Worth being straight about the tier scheme itself: it is a New Path editorial convention rather than a published standard, which by its own definitions makes it a Tier 4 object. We use it because labelling is better than silence, and where a questionnaire could sit in two tiers we put it in the lower one.
Diagram — E · Where the screen actually sits. Nine screening scores are the wide end. Everything below them narrows, and each narrowing adds something a questionnaire cannot: another person's account, a childhood record, a differential, a decision.
STRENGTHS LENS
You have been running an investigation on yourself for years, and you got the method roughly right.
Noticing a pattern, testing it against several years of evidence, resisting the first explanation, then going looking for better instruments — that sequence is what careful clinical reasoning looks like. Most people never do it about themselves. Reading the methodology page before taking the questionnaires is not overthinking; it is the same instinct that got you this far, pointed at the right target.
One thing to prepare for. Adults identified later in life describe relief first, and then a much less comfortable stretch — confusion, anger, grief for the version of things that might have been — before anything settles into something usable.12 If a score lands hard, that is not a sign you got it wrong. It is the ordinary shape of finding a word for something old.
F. What helps
Five habits that will make the next nine modules more useful and a good deal less destabilising.
1. Answer for the last six months, not the last six days.
Most of these questionnaires name a window, and the ASRS names six months. ADHD traits swing hard with sleep, stress and deadlines, so a bad fortnight and a well-managed fortnight will produce different totals from the same person. Answer as yourself on an ordinary Tuesday. If you cannot find an ordinary Tuesday in the last six months, write that down, because it matters more than the score.
2. Ask one person who has watched you.
Informant accounts are the single thing self-report cannot supply, and adults with ADHD reliably rate themselves as less affected than the people who live with them do. Pick someone who has known you for years and ask something concrete: do I interrupt more than most people, do I lose the thread when you are talking, what do you notice that I do not. Write their exact words down, not your summary of them.
3. Go and find the childhood evidence before you need it.
The criteria ask for several symptoms before age 12, and this is the piece assessments most often stall on. School reports, old exercise books, a parent's memory of parents' evenings, the teacher comment that has annoyed you for thirty years. Photograph anything you find and keep it in one place. It takes an afternoon and it can save a wasted appointment.
4. Read the tier before you read the number.
Every module in this course prints its instrument's tier above the questions. Four of the nine are Tier 4 tools we built ourselves, and a high score on one of those is a prompt rather than a result. Knowing which kind of object you are holding is the difference between useful information and a bad evening.
5. Write down what you actually want to be different.
A diagnosis is not made of scores; it is made of history, cross-setting evidence and impairment. The last of those is the part only you can describe. Name three specific things — the unopened post, the third job in four years, the friendships that go quiet — and take those with you. They will carry more weight than any total.
Step 2 — Your workbook
Your answers save to this device only — we cannot see a word of what you write. This module has no screener of its own. Instead it sets up how you are going to use the nine that follow: your real question, your ordinary six months, the person who could speak for the outside view, and the childhood evidence worth finding before anyone asks for it.
The question you actually came here with
One or two sentences, in the words you would use out loud rather than the clinical version. This is the thing every score should be measured against.
Fields: What I am really asking; How long I have been wondering: Weeks / Months / A few years / Most of my adult life / Since childhood
Your ordinary six months
Section F, item 1. The screeners ask about a window, usually the last six months. Deciding now what an ordinary period looks like stops a bad fortnight from writing your answers for you.
Fields: What the last six months have actually contained; Were the last six months typical for me: Fairly typical / Harder than usual / Easier than usual / Nothing about them was typical
The person who has watched you
Section F, item 2. Self-report cannot supply an outside view, and adults with ADHD tend to rate themselves as less affected than the people around them do.
Fields: Who I would ask; Their exact words, not my summary of them; Tick: They have known me since before I was twelve
Evidence from before you were twelve
Section F, item 3. The criteria ask for several symptoms before age 12, and this is where assessments most often stall. Tick what you can actually lay hands on.
Fields: Tick: School reports or old report cards; Tick: A parent or older sibling who remembers; Tick: Exercise books, letters home, photographs; Tick: A referral, an assessment or a note from the time; The comment from childhood I have never forgotten
What else is on the list
Section D. Six questions about focus and restlessness get the same answers from an exhausted person, a frightened person and a grieving person. Naming the alternatives is what a good assessment does anyway.
Fields: Tick: Long-term broken or insufficient sleep; Tick: Anxiety that predates the attention problems; Tick: Depression, now or in the last two years; Tick: Bereavement, trauma or a major upheaval; Tick: A physical cause nobody has checked - thyroid, iron, pain, menopause; What else has been true of the last two years
What you want to be different
Section F, item 5. Impairment is the part only you can describe, and it carries more weight in an appointment than any total.
Fields: Three specific things it currently costs me; What I would want to be true in a year
Your score log
Come back and add to this as you go. Read together, weeks later, nine scores say something no single score can.
Fields: Instrument, tier, score, date; The sentence I am watching out for
Appendix — Research companion
Peer-reviewed research
4. Fayyad J, Sampson NA, Hwang I, et al (2017). The descriptive epidemiology of DSM-IV adult ADHD in the World Health Organization World Mental Health Surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9(1), 47-65. DOI 10.1007/s12402-016-0208-3. View the paper Twenty nationally or regionally representative surveys with 26,744 respondents, interview-administered. Adult ADHD prevalence averaged 2.8 per cent, higher in high-income countries at 3.6 per cent than in low and lower-middle-income countries at 1.4 per cent, with persistence from childhood in 57.0 per cent of childhood cases and low treatment seeking everywhere. Limitation: DSM-IV criteria and lay-administered interviews, so the absolute rate is best read as an anchor for base-rate reasoning rather than a current diagnostic estimate.
6. Harrison AG, Edwards MJ (2023). The ability of self-report methods to accurately diagnose attention deficit hyperactivity disorder: a systematic review. Journal of Attention Disorders, 27(12), 1343-1359. DOI 10.1177/10870547231177470. View the paper Systematic review of the 20 published studies or manuals that report sensitivity and specificity for adult ADHD self-report measures. Negative predictive values exceeded 96 per cent across the board, while positive predictive values in clinical samples reached 61 per cent at best and most fell below 20 per cent; the authors conclude that clinicians cannot rely on scales alone and must evaluate anyone who screens positive more rigorously. Limitation: heterogeneous samples and reference standards, so the range is indicative rather than a pooled estimate.
2. Hines JL, King TS, Curry WJ (2012). The Adult ADHD Self-Report Scale for screening for adult attention deficit-hyperactivity disorder (ADHD). Journal of the American Board of Family Medicine, 25(6), 847-853. DOI 10.3122/jabfm.2012.06.120065. View the paper 200 adults across eight primary care practices completed the ASRS-V1.1. Sensitivity was 0.92, specificity 0.69, positive predictive value 0.48 and negative predictive value 0.97; on adjusted analysis sensitivity was 1.0, specificity 0.71 and positive predictive value 0.52, which fell to 0.12 once adjusted to a population prevalence of 4.4 per cent. Limitation: a single-site family medicine study with only 55 participants completing both screening instruments, so the confidence intervals around these figures are wide.
1. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005). The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256. DOI 10.1017/S0033291704002892. View the paper Development of the ASRS from the WHO Composite International Diagnostic Interview, with a blind clinical reappraisal subsample of 154 respondents from the US National Comorbidity Survey Replication. The six-question screener outperformed the full 18-question scale, with sensitivity 68.7 per cent, specificity 99.5 per cent and total classification accuracy 97.9 per cent. Limitation: a general-population household sample with oversampling of people reporting childhood ADHD, so these operating characteristics do not transfer to clinical or self-selected settings.
11. Kooij JJS, Boonstra AM, Swinkels SHN, Bekker EM, de Noord I, Buitelaar JK (2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders, 11(4), 445-458. DOI 10.1177/1087054707299367. View the paper 120 adults with ADHD, together with their partners and their parents, completed the ADHD Rating Scale, the Conners' Adult ADHD Rating Scales and the Brown Attention-Deficit Disorder Scale alongside a structured diagnostic interview. The DSM-IV symptom factors produced lower patient-informant agreement than the other factors, and the authors concluded that adults with ADHD are the best informants about their own symptoms but tend to underreport their severity. Limitation: a clinically referred Dutch sample already diagnosed with ADHD, so it describes agreement within known cases rather than screening accuracy.
8. Mannuzza S, Klein RG, Klein DF, Bessler A, Shrout P (2002). Accuracy of adult recall of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 159(11), 1882-1888. DOI 10.1176/appi.ajp.159.11.1882. View the paper 176 men diagnosed with ADHD in childhood and 168 comparison men were re-interviewed a mean of 16.5 years later by interviewers blind to childhood status. Adult recall identified 78 per cent of those who had had childhood ADHD with an 11 per cent false positive rate, kappa 0.67, but the authors calculated that once adjusted for population prevalence about three of four retrospectively diagnosed cases would be false positives. Limitation: an all-male, clinic-referred cohort assessed under DSM-II and DSM-III era criteria, so the recall estimates may not hold for women or for adults identified later in life.
10. Manor I, Vurembrandt N, Rozen S, Gevah D, Weizman A, Zalsman G (2012). Low self-awareness of ADHD in adults using a self-report screening questionnaire. European Psychiatry, 27(5), 314-320. DOI 10.1016/j.eurpsy.2010.08.013. View the paper 103 students, 79 with ADHD and 24 controls, completed a self-report screening questionnaire and then a full clinical ADHD assessment. Overall classification agreement with the clinicians was 68 per cent, with specificity 95 per cent but sensitivity only 46 per cent, and symptoms were under-reported on both the inattentive and hyperactive-impulsive clusters; area under the curve was 0.90 for inattention and 0.75 for hyperactivity-impulsivity. Limitation: a small student sample in one country, and one non-standard questionnaire rather than a widely used screener.
5. Meehl PE, Rosen A (1955). Antecedent probability and the efficiency of psychometric signs, patterns, or cutting scores. Psychological Bulletin, 52(3), 194-216. DOI 10.1037/h0048070. View the paper The founding methodological paper on base rates in clinical assessment. It shows that the usefulness of any psychometric sign, pattern or cutting score depends on the antecedent probability of the condition in the population being tested, and that when that probability is low a rule which simply predicts the majority class can classify more accurately than an apparently good test. Limitation: a theoretical paper from 1955 with no clinical sample of its own, and it predates the modern vocabulary of sensitivity, specificity and predictive value.
9. Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al (2015). Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. American Journal of Psychiatry, 172(10), 967-977. DOI 10.1176/appi.ajp.2015.14101266. View the paper The Dunedin birth cohort of 1,037 people born in 1972-73, followed to age 38 with 95 per cent retention. Three per cent met DSM-5 criteria for adult ADHD at 38, and 90 per cent of those adult cases had no childhood ADHD history, while only 3 of 61 childhood cases still met criteria as adults. Limitation: a single New Zealand cohort, and the adult-onset interpretation is actively contested, with critics arguing that substance use, comorbidity and measurement thresholds explain much of the discontinuity.
3. Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I (2021). The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis. Journal of Global Health, 11, 04009. DOI 10.7189/jogh.11.04009. View the paper Systematic review and meta-analysis of 40 articles from 30 countries, covering 107,282 people for persistent adult ADHD and 50,098 for symptomatic adult ADHD. Estimated prevalence was 2.58 per cent for persistent adult ADHD and 6.76 per cent for symptomatic adult ADHD, equating to 139.84 million and 366.33 million adults worldwide in 2020; pooled unadjusted figures were higher, at 4.61 per cent and 8.83 per cent. Limitation: heterogeneous case definitions and instruments across studies, and very few data from low-income countries.
Clinical frameworks and position statements
7. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balazs J, et al (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34. DOI 10.1016/j.eurpsy.2018.11.001. View the source Consensus statement of the European Network Adult ADHD, drafted by 63 authors across 25 countries. It states that diagnosis rests on a careful and systematic assessment of a lifetime history of symptoms and impairment, records the DSM-5 changes from symptoms and impairment by age 7 to several symptoms before age 12 and from six symptoms to five for people over 17, cautions that the age-of-onset criterion may disadvantage adults with poor retrospective recall, and describes a collateral informant such as a parent or partner as of great value. Limitation: an expert consensus document rather than a systematic review, and European practice does not map exactly onto other health systems.
Lived experience
12. Young S, Bramham J, Gray K, Rose E (2008). The experience of receiving a diagnosis and treatment of ADHD in adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. Journal of Attention Disorders, 11(4), 493-503. DOI 10.1177/1087054707305172. View the source Semi-structured interviews with eight adults diagnosed with ADHD at a tertiary service, analysed using interpretative phenomenological analysis. Participants described reviewing the past and feeling different from others, the emotional impact of the diagnosis, and consideration of the future; the authors proposed a six-stage sequence of relief and elation, confusion and emotional turmoil, anger, sadness and grief, anxiety, and accommodation and acceptance. Limitation: eight participants at a single specialist clinic, all of whom had been referred and medicated, so it does not describe the experience of self-identification without assessment.
Peer-reviewed = checked by independent experts before publication. Clinical model = an established professional framework, not a single study.
Up next
Module 2 - ASRS v1.1 — The WHO's Six-Question Adult ADHD Screener
All modules in ADHD Self-Discovery
A number is a starting point, not an answer. This course was built by clinicians who are part of the New Path family of therapy centers. Working out whether a raised ADHD screening score is attention, exhaustion, anxiety or some combination of all three is the sort of question that goes considerably faster with someone alongside you. Therapy for clients in California, coaching worldwide, all by telehealth. A conversation costs nothing and there is no pressure. Saving this for later counts too. Talk with the New Path team