What are ADHD rating scales?

Types of ADHD rating scales

Because adults may have different symptoms than children, researchers designed different scales. Clinicians may use one or more scales to help with a diagnosis.

Children's ADHD rating scales

There are a variety of different ADHD rating scales for kids and teens, including:

1. National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale: Commonly used with diagnosing children ages 5 to 12
2. Conners-Wells’ Adolescent Self-Report Scale: Often used with special education placement
3. Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV): Completed with parents and teachers working together
4. Conners Comprehensive Behaviour Rating Scales (CBRS): Used by parents and teachers for kids 6 to 18 or by adults 18 and up
5. Child Behavior Checklist for Ages 6-18 (CBCL): Consists of eight groupings of items reflecting common problems

Adult’s ADHD rating scales

There are a few different ADHD rating scales for adults that have slightly different purposes:

1. Adult ADHD Questionnaire: Self-Report Scale (ASRS-V1.1): Useful for adult self-screening
2. Adult ADHD Clinical Diagnostic Scale (ACDS): For adult ADHD screening
3. Adult ADHD Rating Scale IV With Adult Prompts (ADHD-RS-IV): Helps determine symptom severity
4. Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS): A screening tool that helps measure executive function

Administering an ADHD rating scale

A teacher, parent or clinician can administer an ADHD rating scale or it can be self-administered.

Depending on what you’re using an ADHD rating scale for, you can administer the scale online or in person, formally or informally.  Patients can use the scales before appointments or to understand if they need a mental health professional to review their symptoms.

Anyone can self-administer an ADHD scale, but a clinician may ask about symptoms before screening or testing for ADHD.

Administering an ADHD rating scale generally follows this process:

1. Choosing a scale: Since there are multiple scales, the first step is choosing an appropriate scale for the symptoms and age of the patient.
2. Answering questions: Questions on the scale may ask the patient to rank symptoms, report symptom frequency or describe behavior. Answers may be recorded as a number or on a scale, as ‘yes’ or ‘no’ answers or with a qualifier such as ‘always’ or ‘never.’
3. Determining the score: Reviewing each response, a score is determined, either added together for all questions or recorded individually for each question (for example, counting the number of ‘yes’ answers).
4. Evaluating the score: The score is compared against a scoring key designed for the specific scale. The key will report a result, indicating how likely the patient is to have ADHD.
5. Professional review: If applicable, a clinician or mental health professional reviews the score. The reviewer may decide to refer the patient (for instance, for assessment by a specialist in ADHD or for further testing) or diagnose them with ADHD.

Interpreting the results of an ADHD rating scale

Since ADHD rating scale results typically describe behaviors or symptoms, results can indicate how similar a patient’s answers are with averages for people with ADHD and people without the disorder. A score showing more behavior consistent with ADHD suggests that the patient may benefit from more ADHD screening and possibly an ADHD diagnosis.

On the other hand, low scores usually mean few, if any, behaviors are consistent with ADHD. Many people have one or two behaviors other people might think are ‘quirky’ – like getting distracted now and then or wanting to fidget and move around sometimes – that are neurotypical and aren’t enough to be considered part of ADHD.

A high score on a self-administered test doesn’t necessarily mean you’ll be diagnosed with ADHD, but if you’re concerned about a high score then you should talk with your health care provider. If you are a parent and have a child who received a high score on an ADHD rating scale you administered, consider asking their teacher about behaviors in the classroom and possibilities for ADHD screening from a professional.

Bottom line – don’t worry about a score that indicates ADHD. Only a mental health professional can make an official ADHD diagnosis. Keep in mind that ADHD is also highly treatable and there are many options today that help manage symptoms for both kids and adults.

Common misconceptions about ADHD rating scales

Like ADHD itself, there are few common misconceptions about the rating scales used to diagnose ADHD:

• Can the scale misrepresent certain symptoms?

  Self-reporting and parent or teacher reports may or may not accurately reflect behavior and symptoms. Similarly, bias can happen when the scale is administered by someone who’s hoping for a specific result – for instance, a parent hoping an ADHD diagnosis will mean more help with their child or someone who doesn’t want to believe they have ADHD when they actually do.

  Additionally, behavior that seems neurotypical to one person may seem neurodivergent to another. A mental health clinician can help answer questions about symptoms and navigate the process of ADHD testing.

• Is the ADHD rating scale culturally sensitive?

  ADHD rating scales are tested with various populations, but there may be unintended cultural biases in the development and use of these tests. Different cultures can understand ADHD symptoms and their severity differently in relation to behavior norms and expectations.

  Sometimes, it’s helpful to include multiple perspectives of a patient’s behavior from friends, family, peers and others to get a broader picture of symptoms.

• Are there other conditions the rating scale might not account for?

  Other mental conditions and health issues overlap with ADHD symptoms and can mimic ADHD, which is why it’s a good thing to check in with your health care provider if you suspect ADHD. These other conditions include:

  • Anxiety: With symptoms including stress, fatigue and trouble sleeping, anxiety can look a bit like ADHD.
  • Behavior disorders: Anger, aggression, destruction and breaking the law could stem from something like oppositional defiant disorder (ODD) or conduct disorder (CD).
  • Learning disabilities: Trouble learning, staying organized or paying attention could be a learning difference instead of ADHD.
  • Mood disorder: Depression, difficulty focusing or having fatigue could be caused by a mood disorder. Bipolar disorder and depression are possible conditions.
  • Substance abuse: Illicit drug use can cause symptoms such as memory loss, problems or conflict at school or work and difficulty focusing.

Since these and other conditions share one or more symptoms with ADHD, people using an ADHD rating scale may receive artificially high scores when they actually have a different condition. This is why clinicians need to look at the broader context of patient behavior and interactions when making a diagnosis – it’s important to rule out everything else it could be.

ADHD rating scales in children vs. adults

ADHD symptoms in children and adults can differ in presentation and severity, so it’s important for patients to use an ADHD rating scale designed for the right age group. Children usually need help completing an ADHD screening. For instance, have an adult read the questions and remember examples of symptoms.

Adults can complete self-assessment on their own, although they may also benefit from an outside perspective on their behavior from a trusted friend or family member during the assessment. Adults with ADHD may not know whether or not a symptom reflects ADHD or is also common for neurotypical people.

ADHD rating scales and other assessment tools

As part of the process of diagnosing ADHD, clinicians may use other assessments for conditions that may overlap in symptoms with ADHD, such as anxiety or an autism spectrum disorder. At your appointment, they may use more than one assessment, or use a screening assessment and choose a different assessment that helps them understand your symptoms better.

Using assessments together with interviewing techniques and behavioral observations allows clinicians to gain a better understanding of the full context of symptoms and how these symptoms present.

With a comprehensive approach to diagnosis, clinicians can offer more relevant help for their patients, rule out similar conditions and identify the best treatment options.

Bottom line

An ADHD rating scale is an umbrella term for tools used to help patients, families, educators and clinicians assess and understand the symptoms of ADHD. These tools, also known as assessments, are often used during the process of diagnosing ADHD.

ADHD rating scales are part of the journey towards diagnosing and treating ADHD so patients can have a better quality of life and opportunities to manage their symptoms. They are part of a comprehensive plan to manage and treat ADHD successfully.