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The ASRS v1.1 (Adult ADHD Self-Report Scale) is a six-question adult ADHD screener developed through the WHO World Mental Health initiative and published by Kessler and colleagues in 2005. Primary care, psychiatry, and telehealth teams use it at intake and to track treatment. It screens; it never diagnoses. This page covers how to document ASRS results defensibly, with a fictional sample note.
Patient self-report, scored and interpreted by the clinician; Canadian practice adds an observer version when feasible
Primary care and psychiatry, ADHD assessment services, telehealth platforms, payers reviewing stimulant requests, accommodation evaluators
A result line plus interpretation in the note · six-question screener takes about 2 to 5 minutes
Self-report screening scale (six items; Part B of the full checklist adds 12 interview probes)
Adult ADHD intake screening, pre-assessment triage, treatment-response tracking, observer corroboration in Canadian workflows
The six-question v1.1 screener is free to use; the 18-item checklist and ASRS-5 require permission; no law requires an ASRS
The World Health Organization Adult ADHD Self-Report Scale version 1.1 is a screening instrument published by Kessler and colleagues in Psychological Medicine in 2005, developed through the WHO World Mental Health survey initiative. The full Symptom Checklist has 18 questions mapping to the adult ADHD symptom set; the six most predictive form Part A, the validated screener, and the remaining 12 form Part B, which supplies interview probes and no score. The authoritative copies live on Harvard Medical School's National Comorbidity Survey site, with copyright held by New York University and the President and Fellows of Harvard College and permissions routed through the NYU team. Harvard's stated position is that use of the six-question v1.1 screener is "free and does not require any formal permission or approval," with a citation, the copyright notice, and an unaltered form expected; the 18-question checklist and the newer ASRS-5 each require a permission request. Free to use is not public domain.
The documentation problem is version control, because three scoring systems now coexist. The original v1.1 rule counts how many of the six Part A responses reach their item-specific thresholds, with four or more a positive screen; the thresholds differ by item, so it is wrong to describe the rule as four answers of Often or Very Often. A second, continuous method sums the six frequency responses to a 0 to 24 total with 14 or higher positive and four probability strata, drawn from the 2007 health-plan validation and endorsed as an alternative scoring in a Harvard update dated February 28, 2024. The ASRS-5, published in 2017 for DSM-5, is a different six-item instrument with machine-learned unequal weights, a corrected range of 0 to 25, and a threshold of 14 or higher. All three are screens. None is a severity scale, and none makes the diagnosis: that belongs to the full evaluation documented in an ADHD evaluation report, with normed instruments like the CAARS-2 playing their own distinct role.
Primary care and psychiatry use the ASRS at adult intake and as a longitudinal symptom measure, and the United States is the jurisdiction where its paper trail matters most while having the least national guidance: as of August 2026 there is still no released US adult ADHD clinical practice guideline (the first, from APSARD, is anticipated for distribution in 2027), so American clinicians document against DSM-5-TR criteria, payer policies, and clinical convention. Canadian practice follows the CADDRA workflow, which pairs the patient ASRS with an observer version when feasible, a functional-impairment measure, and a diagnostic interview, and states plainly that the toolkit alone cannot make the diagnosis. Australian practice sits on the 2022 AADPA guideline, which prohibits diagnosis from rating scales alone, layered over fast-moving state stimulant-authority reforms. Telehealth platforms lean on the ASRS heavily, which is exactly where screening-quality problems concentrate, and accommodation evaluators encounter it inside multi-method documentation standards that reject internet checklists on their own. Prescribing decisions and their monitoring live in the medication management note; youth assessment uses age-specific tools covered on the Conners 4 page.
No statute prescribes an ASRS note format, and no US, Canadian, or Australian law requires an ASRS, positive or otherwise, before diagnosing ADHD or prescribing a stimulant. What survives review is a record that treats the screen as one data source and shows the reasoning around it. Each element below carries the pitfall that most often undermines it.
Instrument identity and scoring method. Record the exact instrument (v1.1 Part A alone, Part A plus Part B, or ASRS-5), the language, the reporter (patient, observer, or other), the administration context, and which scoring system produced the number. Pitfall: "ASRS 14" with nothing else. Three scoring systems share 14 as a meaningful boundary: it could be a v1.1 continuous total at threshold, an ASRS-5 weighted total at threshold, or a miscomputed count, and the three are not interchangeable.
The result, stated precisely. For the original v1.1 rule, chart how many of the six Part A responses reached their item-specific thresholds and whether the screen was positive, for example "5 of 6 responses reached their item-specific screening thresholds; positive screen." That preserves the result without reproducing the scoring grid. Any continuous 0 to 24 total is identified separately, with its strata treated as probability regions rather than severity grades. Pitfall: rebranding screen counts or strata as mild, moderate, or severe ADHD; no ASRS number grades severity, and no minimal clinically important difference has been established.
The clinical meaning, kept modest. A positive screen supports proceeding to a comprehensive assessment and is not independently diagnostic; a negative screen lowers probability but does not exclude the diagnosis, since the six-item sensitivity was 68.7% in the original validation. Pitfall: "ASRS positive, ADHD confirmed." The screen cannot establish onset, pervasiveness, impairment, or the differential.
Childhood-onset evidence. Document that relevant difficulties were present before age 12: school records or report-card comments, childhood evaluations, parent or sibling accounts, repeated concrete historical examples, and the limits of each. Pitfall: "patient reports lifelong ADHD" standing alone. State what the patient recalls and what corroborates it, or does not.
Cross-setting impairment. Record examples from at least two important settings and separate symptoms from functional consequences, including impairment concealed by heavy compensation. Pitfall: a symptom list with no functional analysis; frequent distractibility without clinically significant impairment does not meet criteria.
Collateral, and what was unavailable. Name the records and informants reviewed, whether the informant knew the patient in childhood, material agreements and disagreements, and what could not be obtained and why. Pitfall: treating missing collateral as either disqualifying or ignorable. It lowers or qualifies confidence and shifts weight to other longitudinal evidence; document that reasoning.
Differential and comorbidity. Record the plausible alternatives considered: depression, anxiety, bipolar spectrum, trauma, substance use, sleep disorders and restriction, learning disorders, and medical contributors. The false-positive data make this the load-bearing element: in a major-depression sample the v1.1 positive predictive value was 21.4%, and in treatment-seeking substance-use patients it was 0.26. Pitfall: reading the famous 99.5% specificity, a community-sample figure, as if it applied in comorbid clinical populations.
Diagnostic status, validity, and the next step. Use an explicit status (screen positive, assessment pending; provisionally diagnosed; criteria met; not established; deferred pending records or sleep and mood stabilization) and document any external incentive or inconsistency neutrally and behaviorally. Pitfall: character labels. "Drug-seeking" and "malingering" are conclusions the ASRS cannot support; it has no embedded validity scale, and simulation studies show the symptom profile is easy to produce. Chart the facts, the missing data, and how they limit confidence.
ASRS DOCUMENTATION BLOCK Date: [ ] Setting: [ ] Reporter: [patient / observer] Instrument: [v1.1 Part A / Part A + B / ASRS-5] Language: [ ] Scoring method: [item-threshold count / 0-24 sum / ASRS-5 weighted] Result: [count or total + positive/negative at stated threshold] Interpretation: [screen result only; not independently diagnostic] Childhood onset (<12): [records, informants, examples + limits] Cross-setting impairment: [setting 1] [setting 2] [functional consequences, compensation] Collateral: [reviewed / attempted / unavailable + why + effect on confidence] Differential considered: [mood, anxiety, sleep, substance, learning, medical + evidence for/against] Validity considerations: [incentives, inconsistencies, stated neutrally] Status: [screen positive, assessment pending / provisional / criteria met / not established / deferred] Next step: [structured interview, records, informant, follow-up] Clinician signature / credentials: Date:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with element-by-element pitfalls and a pre-sign checklist; the DOCX is the blank documentation block, ready to adapt. Neither reproduces the scale itself.
Scenario: a positive intake screen documented as a screen, with the developmental, cross-setting, collateral, and differential evidence recorded alongside it and the diagnosis left to the structured assessment. All details are fictional.
Patient: D.K., 34 · Setting: Outpatient psychiatry, intake · Clinician: A. Reyes, PMHNP · Note date: 08/12/2026
Screening: Patient completed the English ASRS v1.1 Symptom Checklist today, self-report, referring to the past six months. Part A: 5 of 6 responses reached their item-specific screening thresholds; positive screen, original scoring method. Part B was reviewed as interview probes only; no Part B score exists. Result interpreted as supporting further assessment, not as a diagnosis.
History: Longstanding difficulty organizing multistep work, completing administrative tasks, and tracking nonroutine obligations, with impairment at work (missed filing deadlines documented in two performance reviews) and at home (unpaid bills, abandoned projects). Recalls similar problems from elementary school; report cards brought today reference incomplete assignments and needing redirection. Older sister, contacted with consent, independently describes chronic childhood disorganization. Generalized anxiety disorder is active and worsens concentration under deadlines, but the attentional pattern reportedly predates it. Sleep averages seven hours; no current mood episode, psychosis, or substance use disorder identified on screening.
Assessment: Positive ASRS v1.1 screen with corroborated childhood onset and cross-setting impairment; anxiety remains a relevant comorbidity and possible contributor. ADHD is not diagnosed today: status is screen positive, structured assessment pending.
Plan: Structured DSM-5 adult ADHD interview next visit; remaining school records requested; functional impairment and cardiovascular history to be assessed before any medication discussion. Baseline ASRS retained for treatment-response comparison using the same version and scoring method.
This sample is fictional and for educational purposes. It does not describe a real patient or record; the details are invented to show documentation structure and are not clinical guidance.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsUnited States: the striking fact is what does not exist. There is still no released national adult ADHD clinical practice guideline; APSARD's first-ever US adult guideline was in external review during 2026 with distribution anticipated in 2027 (CONVENTION in progress), leaving DSM-5-TR criteria, the AAFP's multi-visit clinical approach, and payer policy as the operative anchors. Stimulants are Schedule II under the federal schedules (LAW), which governs prescribing and recordkeeping without naming any rating scale. The telemedicine pathway that allows remote stimulant initiation without a prior in-person examination is the fourth temporary extension of COVID-era flexibilities, scheduled to end December 31, 2026, with the special-registration framework still a proposal (LAW, dated). State PDMP checks are their own layer of law and vary: some states require consultation before any Schedule II prescription while others mandate checks only for opioid and benzodiazepine classes, so the PDMP entry is charted separately from the diagnostic reasoning. Payer policy is where scale requirements actually live: Missouri Medicaid's adult form names an Adult ADHD Self-Report scale outright, while most reviewed policies require a documented DSM-5 diagnosis supported by generic standardized rating scales (PAYER POLICY, not law). For accommodations, ETS documentation guidelines require multi-method evaluation and state that no single measure suffices; internet checklists are explicitly insufficient (CONVENTION under the ADA framework).
Canada and Australia supply the guidelines the US lacks. CADDRA's 4.1 guideline and eToolkit (CONVENTION) embed the ASRS in a workflow with an observer version when feasible, childhood-informant material where possible, a functional-impairment measure, medical and substance review, and the explicit statement that the toolkit alone cannot make the diagnosis; no Canadian federal rule requires an ASRS. Australia's 2022 AADPA guideline (CONVENTION, NHMRC approval window running to July 2027) requires comprehensive assessment, bars diagnosis from rating scales or observation alone, and expects evidence across settings and reporters. The binding Australian layer is state and territory Schedule 8 stimulant-authority law, which was reformed jurisdiction by jurisdiction through 2025 and 2026: New South Wales opened trained-GP continuation prescribing in September 2025 with GP-led diagnosis expanding through 2026, South Australia opened a trained-GP pathway in February 2026, Queensland and Tasmania broadened GP roles, and the ACT created standing approvals in February 2026 whose GP instrument is a continuation, not initiation, authority (LAW, dated per jurisdiction). None of those laws requires ASRS completion; they regulate prescriber class, authorities, monitoring systems, and co-management.
On rights and fidelity: Harvard's distribution page states that use of the six-question v1.1 screener is "free and does not require any formal permission or approval," asking for the 2005 citation, the New York University and Harvard copyright notice, and an unaltered instrument; the 18-question Symptom Checklist and the ASRS-5 each require permission routed through the NYU team, and third-party online versions prove nothing about authorization. The steward lists 20 translations while its background memo notes that no cultural validations of those translations have been conducted, so the chart should name the language used. BastionGPT is not affiliated with the instrument authors, WHO, Harvard, or NYU. This page describes the instrument in original prose and reproduces no item text, response grid, or scoring materials.
The numbers behind these errors are setting-dependent in a way most pages hide. The famous 99.5% specificity comes from the 2005 community validation; in adults with major depression the v1.1 positive predictive value was 21.4%, in treatment-seeking substance-use patients it was 0.26, and in two non-treatment-seeking population samples 17% to 26% screened positive, several times the plausible adult prevalence. Simulation studies add that undergraduates can produce convincing ADHD self-report profiles with or without coaching, and the ASRS has no embedded validity scale. The BastionGPT Clinical Advisory Board sees the same errors most often in ASRS documentation reviews:
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That further assessment is warranted, and nothing more. Under the original v1.1 rule, a screen is positive when four or more of the six Part A responses reach their item-specific thresholds (the threshold differs by item, so it is not simply four answers of Often or Very Often). The screen cannot establish childhood onset, cross-setting impairment, functional interference, or the differential, all of which the diagnosis requires. A negative screen is not an exclusion either: the six-item sensitivity was 68.7% in the original validation, so roughly three in ten true cases screen negative, and a strong developmental and collateral history justifies continuing the assessment.
They are different instruments with different arithmetic, and a third scoring system sits between them. The v1.1 original rule counts qualifying Part A responses, 0 to 6, with four or more positive. The v1.1 continuous method sums the six frequency responses to 0 to 24, with 14 or higher positive and four probability strata; a Harvard scoring update dated February 28, 2024 endorsed it as an alternative. The ASRS-5, published in 2017 for DSM-5, uses a different item set with machine-learned unequal weights, a corrected range of 0 to 25 (one response can contribute six points, per the 2019 correction), and a threshold of 14 or higher, and it requires its own permission. The totals are never comparable across systems, which is why the chart names the version and method every time.
The six-question v1.1 screener, yes: Harvard's distribution page states its use is "free and does not require any formal permission or approval," with three conditions worth honoring in an EHR build: cite the 2005 article, retain the New York University and Harvard copyright notice, and do not alter the response options or scoring. That is free use, not public domain. The 18-question Symptom Checklist and the ASRS-5 each require a permission request routed through the NYU team, and a third-party version circulating online proves nothing about authorization. The steward prefers links to its current copies so scoring updates are not stranded in stale reproductions, and its own memo notes the 20 listed translations have had no cultural validations, so name the language used.
Not as a severity scale. The screen count is case-finding arithmetic, and the 0 to 24 strata (low negative, high negative, low positive, high positive) are probability regions from a health-plan calibration whose meaning shifts with population prevalence; none of it was validated as mild, moderate, or severe ADHD. For treatment tracking, re-administration is a reasonable convention (Canadian guidance recommends documenting change with scales meaningful to the patient) if the version, scoring method, language, reporter, and recall period are held constant and the score is paired with functional outcomes. No broadly accepted minimal clinically important difference exists; a 2026 analysis found none of 11 randomized trials had reported one. Direction of change is documentable; a point difference is not itself proof of response.
Because positive predictive value depends on the population, and the ASRS asks about experiences many conditions produce. The 99.5% specificity came from the 2005 community validation design. In adults with major depression, the positive predictive value was 21.4%; in treatment-seeking substance-use patients it was 0.26; in a university sample 37% screened positive while 7.9% received a diagnosis; and in two general-population samples 17% to 26% screened positive, several times any plausible prevalence. Depression, anxiety, sleep restriction, and substance effects all generate attentional complaints the form cannot distinguish. The documentation consequence: a positive screen in a comorbid patient is the beginning of the differential, not the end of it.
No law in the US, Canada, or Australia requires one. Stimulant law regulates other things: federal Schedule II controls, state PDMP checks, telemedicine rules (the current US flexibility runs through December 31, 2026), and, in Australia, state Schedule 8 authority schemes that specify prescriber class and permits rather than any rating scale. Where a scale requirement exists, it is payer or organizational policy: Missouri Medicaid's adult prior-authorization form names an Adult ADHD Self-Report scale, while most policies ask generically for standardized rating scales supporting a DSM-5 diagnosis. Chart the diagnostic reasoning for the clinical record and the specific payer's requirement when one applies, and never present a payer rule as a legal mandate.
The attempts, the reason, the substitutes, and the effect on confidence. Parents may be deceased or estranged and school records destroyed; that is not a diagnostic exclusion. Document what was sought and why it was unavailable; use substitute longitudinal evidence such as siblings, partners, old evaluations, employment history, and repeated concrete historical examples; compare the account with the current functional pattern; and state plainly how the missing corroboration qualifies the conclusion. What fails review is silence: a note that neither sought collateral nor acknowledged its absence, or one that invents reassurance the record does not contain.
The symptom profile is easy to produce: simulation studies found undergraduates could feign ADHD on self-report scales whether or not they were coached, and the ASRS contains no embedded validity scale to detect it. That justifies multimethod assessment, not suspicion of every patient. Chart behavior and evidence rather than character: the external incentive when one exists (a licensing exam, an accommodation deadline), the specific inconsistencies (an abrupt reported onset against clean contemporaneous records), what data are missing, and how those facts limit confidence. Where formal symptom- or performance-validity testing is used, name the measure and its result, and remember that a noncredible result limits interpretation without proving intent.
Yes. Give it the facts (instrument and version, scoring method, result, childhood-onset evidence, settings and impairment, collateral status, differential, any incentives) and it drafts the full screening entry: precise result phrasing without the scoring grid, modest interpretation, corroboration point by point, neutral validity language, and an explicit status with next steps, ready for your review. It can also check a finished note for a bare "ASRS positive," a missing method, strata charted as severity, or a diagnosis resting on the screen alone. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The instrument facts and compliance claims on this page trace to these sources, last verified August 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.