Can ADHD really be diagnosed with a simple 18-question test? We ask the experts

 There are now 2.6 million people in the UK with ADHD – and diagnoses are on the rise. Looking at 18 years of anonymised NHS patient records, researchers at University College London noted a 20-fold increase in the diagnosis of ADHD in adult men, and 15-fold in women. Meanwhile, demand for a diagnosis has soared by more than 400 per cent since the pandemic, according to figures from the ADHD Foundation.

As those looking for an ADHD diagnosis face a wait as long as eight years on the NHS, the two-minute Adult ADHD Self-Report Scale (ASRS), which asks individuals to answer 18 questions themselves, has become widely used.

But when Oxford University made the decision to use it to grant extra exam time to almost all students who got a positive result, it called to question the efficacy of the quick test. The students underwent a 90-minute assessment by an unqualified expert after the initial screening but still, it opened a heated discussion about whether the ASRS test was fit for purpose.

There are two main concerns surrounding this test: One being that the ease at which people are accessing it is contributing to the fact that doctors are being inundated with diagnosis requests from people who believe they have ADHD. And secondly, if people know that a positive result on the ASRS test could lead to extra time in exams, or to being eligible for benefits, then there could be incentives to answer a certain way.

What exactly is the ASRS test?

Written in 2005, the self-reporting test was devised by the World Health Organisation (WHO) and experts from Harvard Medical School. It is generally used as an initial screening for ADHD and is widely used by the NHS and private clinicians. The test is only meant to be used as an initial screening and to assess whether a further assessment by a specialist clinician is necessary.

“It was designed to screen for what we call ADHD traits. The main purpose is to flag those patients to primary care providers like GPs, who might want to refer them to secondary care where a more thorough assessment can be done. It’s not meant to be used alone for a diagnosis,” says  Dr Alessio Bellato, clinical psychologist and lecturer in neurodiversity and mental health at the University of Southampton.

With no blood test or objective criteria, ADHD is tricky to diagnose – and sometimes open to abuse. “ADHD is a constellation of behaviours, but there’s no specific gene or signal in the brain that we know about, so we have to rely on observations,” says Dr Bellato. “The presence of symptoms alone is not enough for a clinical diagnosis; they must have negative consequences that are clinically impactful in everyday life, like maybe the person can’t hold down a job or perform at university.”

Ideally, a diagnosis should include extensive clinical interviews and evidence of impairment across more than one area of life, according to NICE (National Institute for Health and Care Excellence). So what’s the theory behind this two-minute test for ADHD and is there still a place for it?

Concerns over diagnosing ADHD with a two-minute test

Dr Bellato believes the ASRS test, provided it’s used correctly, is a useful tool for initial screening and referrals. “As of today, it’s the best screening tool we have – it’s supported by the WHO and designed and developed by researchers from reputable institutions. We have to be realistic about the time GPs have, and ADHD assessment is not their job,” he says.

But it isn’t perfect. Since ADHD is being widely talked about amongst friends and on social media, most people now understand what boxes to tick on the test, and in some older versions of the test, the answers with the highest scores are also obvious because they’re shaded grey.

Dr Marios Adamou is a consultant psychiatrist with the adult ADHD and Autism Service, South West Yorkshire Partnership Foundation Trust. He’s concerned that too many people are referred by GPs for an assessment after completing the test and are adding to already lengthy waiting lists.