Clinical practice · August 17, 2026 · 5 min read
Screening Adults for ADHD with the ASRS-6: Shaded Boxes, Not Sums
How the ASRS 6-item screener actually scores (it isn't a simple total), what a positive screen means, and the assessment that must follow.
Adult ADHD referrals have surged, and the WHO's ASRS-6 is the standard first gate. It's also the most commonly mis-scored screener in practice, because it doesn't sum.
How it actually scores
Six items, rated Never to Very Often over six months. Each item has a shaded-box threshold: items 1-3 count when rated Sometimes or higher; items 4-6 count when rated Often or higher. Four or more items in the shaded range = positive screen. No total score exists.
What a positive screen is, and isn't
Positive means "symptoms highly consistent with adult ADHD, proceed to full evaluation." It is emphatically not a diagnosis: that requires developmental history (symptoms before age 12), impairment across settings, collateral report where possible, and, the part screeners can't do, differential thinking. Anxiety, depression, sleep disorders, and trauma all produce concentration complaints that light up the ASRS.
Using it well in a therapy practice
- Screen when the story suggests it (lifelong patterns, not two months of pandemic-brain).
- Pair with PHQ-9/GAD-7 the same week; comorbidity is the rule and sequencing treatment matters.
- If positive, refer for or conduct structured diagnostic assessment per your scope; document the screen, the referral, and the interim plan.
Scope reminder
In most provinces, communicating an ADHD diagnosis belongs to specific professions (psychologists, physicians, NPs). Screening, supporting, and referring is squarely within broader scopes; the diagnosis conversation may not be.
PsychApp scores the ASRS-6 with the correct shaded-box logic automatically (no hand-counting), flags positives, and files the result with trend history. See the ADHD tools.
Frequently asked questions
What is a positive ASRS-6 score?
Four or more of the six items rated in their shaded ranges (Sometimes+ for items 1-3, Often+ for items 4-6). There is no meaningful total score — the instrument counts threshold items.