For almost 50 years, ADHD rating scales have been used to help screen, evaluate, and monitor the symptoms of attention deficit hyperactivity disorder (ADHD) in children and adults. Rating scales are considered essential for ADHD diagnosis in children. Many different types of scales are available. Ideally, you or one of the following people will complete the forms:
- your child
Scales can help:
- your doctor make an evaluation or diagnosis
- monitor you or your child’s progress
- you see the bigger picture about behavior
Scales don’t give:
- a complete diagnosis of ADHD
- an objective perspective on behavior
- sufficient evidence when used alone
A typical rating scale will have 18 to 90 questions about the frequency of ADHD-related behaviors. Questions are based on the definition of ADHD provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some examples of these behaviors include:
- having difficulty focusing, organizing, and paying attention
- having difficulty staying still
- having difficulty being patient
- being unable to wait your turn
- interrupting others
- having difficulty following through on instructions or tasks
Behaviors like squirming or inattention are common in healthy children, so scales usually ask about behaviors over the last six months. Because scales are subjective, it’s best to have more than one person fill them out. Remember that these ADHD rating scales aren’t an official diagnosis. But they do help doctors provide one.
What’s in a typical ADHD rating scale?
ADHD rating scales are available for children, teenagers, and adults. Questionnaires can take anywhere from 5 to 20 minutes to complete. You can find them online for free or sold for up to $140. While anyone can fill out a rating scale, only your doctor can provide an accurate diagnosis of ADHD.
Common ADHD rating scales for children include the:
- Child Behavior Checklist (CBCL), which is for children ages 6 to 18
- Conners-Wells’ Adolescent Self-Report Scale, which is for teenagers
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), which is for children ages 6 to 18
- National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, which is for children ages 6 to 12
- Conners Comprehensive Behavior Rating Scale (CBRS), which is for children ages 6 to 18
Some forms may separate questions based on sex. Boys and girls with ADHD tend to display different behaviors like being hyper versus being shy, respectively.
Forms for adults include the:
- Adult ADHD Self-Report Scale (ASRS v1.1)
- Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2
- Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults
- ADHD Rating Scale-IV (ADHD-RS-IV)
Typical questions and scoring system
A question may probe the extent of excessive talking or fidgeting to gauge hyperactivity. Questions regarding impulsivity may ask about interrupting. Rating these behaviors can help measure inattention, hyperactivity, and impulsiveness. Some rating scales like the SNAP-IV will also ask about classroom performance. Overall, the tests are designed to look for strong evidence of ADHD behaviors.
Some survey questions will include rating how often the person:
- avoids assignments or has trouble wrapping up details of a project
- is distracted by other things or people
- has trouble remembering appointments or obligations
For children, it will rate how often they act on the go. For adults, it will rate how much difficulty they have unwinding or relaxing.
The adult rating scale may also include checklists, prompts, and questions about clinical history.
Rating scales will ask you to score behaviors, typically on a point scale of 0-3 or 4. Usually, 0 means never, and 3 or 4 means very often and the higher the score, the more severe the symptom.
Each test has a different way of adding up the scores to determine the likelihood of ADHD. Some say that you need six counted behaviors to indicate ADHD while others ask you to add up scores. Read on to see how some common tests determine their results.
Checklists for adults and children
For children, there’s the CBCL. This checklist screens emotional, behavioral, and social problems. It covers many conditions from autism to depression. The has a shortened checklist for signs or symptoms of ADHD.
If someone shows six or more symptoms of inattention or hyperactivity and impulsivity, they may have ADHD. Those symptoms must be considered inappropriate for the age and have been present for more than six months. If your child has scored 6 or more, bring the list to a doctor. Be sure to have another parent, teacher, or caregiver fill out the checklist too.
Adults have the ASRS v1.1 symptoms checklist, which has 18 questions. The scoring is based on frequency. Instructions ask that you consider work, family, and other social settings when filling out the survey.
the Vanderbilt ADHD Diagnostic Rating Scale
Many healthcare professionals use the to help diagnose ADHD. The scale is meant for children ages 6 to 12, but people in other age groups can use it, if applicable. Different forms are available for parents and teachers. Both forms screen for symptoms of ADHD and inattention. The parent assessment scale has a separate section for conduct disorder, or antisocial behavior while the teacher assessment scale has an extra section on learning disabilities.
There must be six counted behaviors with a score of 2 or 3 out of the nine questions for inattention or hyperactivity to meet DSM-5’s criteria for ADHD. For the performance questions, there must be a score of 4 of higher on two questions, or a score of 5 on one question, for the results to indicate ADHD.
If you’re using this test to track symptoms, add all of the numbers from the responses and then divide it by the number of responses. Compare the numbers from each assessment to monitor improvement.
Scoring the Conners CBRS
The Conners CBRS is for assessing children ages 6 to 18. It’s specially formatted to help determine if:
- the student qualifies for inclusion or exclusion in special education
- the treatment or intervention is effective
- ADHD is a concern
- response to the treatment is positive
- what treatment plans may work best
Separate forms are available for parents, teachers, and the child. The short version is 25 questions and can take 5 minutes to an hour to complete. The long version is used for ADHD evaluation and monitoring progress over time. Scores above 60 indicate ADHD. Your doctor will also convert those scores into percentile scores for comparison.
the SNAP-IV Rating Scale
The SNAP-IV rating scale contains nine questions regarding inattention and nine regarding hyperactivity and impulsivity. For each item, or behavior, you note the frequency from not at all to very much. These responses are ranked on a scale of 0 to 3. Once you add up the scores for each section, you divide the number by 9 to determine an average.
On the Snap-IV scale, teachers can rate a child who scores above as inattentive. For parents, the figure is . A score on the hyperactive and impulsive questions of for teachers and for parents indicates a need for further investigation for ADHD.
What happens next?
ADHD may last for the rest of your child’s life, although most people report that symptoms improve as they age. The condition is manageable, however. Standard ADHD treatments involve one or more of the following:
People with ADHD often take stimulant drugs like Adderall or Ritalin to balance the chemicals in their brain. Your doctor should ask if you have any heart conditions or a family history of heart conditions before prescribing any medication. Ask your doctor about any potential side effects.
For non-drug related treatments, suggests developing a management plan that:
- includes behavioral therapy, education, or coaching
- is based on the individual and their needs
- has goals and can be monitored
- involves family, friends, and healthcare professionals
Many healthcare professionals use ADHD rating scales to help form a diagnosis. Since rating scales are subjective, it’s best to have people from different settings like a teacher or a doctor fill out the tests too. Bring your rating scale to a healthcare professional for a proper diagnosis if the scores indicate the likelihood of ADHD.