Research in Developmental Disabilities 63 (2017) 59–66

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Research in Developmental Disabilities

Psychometric properties of the Japanese version of the Adult

Attention-deficit hyperactivity disorder (ADHD) Self-Report
Scale (ASRS-J) and its short scale in accordance with DSM-5
diagnostic criteria
Toshinobu Takeda a,∗ , Yui Tsuji b , Hiroshi Kurita c
a
Department of Clinical Psychology, Ryukoku University, Kyoto, Japan
b
Graduate School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
c
Zenkoku Ryoiku-Sodan Center, Tokyo, Japan

a r t i c l e i n f o a b s t r a c t

Article history: We developed the Japanese version of the Adult ADHD Self-Report Scale (ASRS-J) and
Received 19 February 2016 report its psychometric properties. The ASRS-J and other questionnaires were administered
Received in revised form 15 February 2017 to 48 adults with ADHD, 46 adults with non-ADHD psychiatric disorders, 96 non-clinical
Accepted 20 February 2017
adults, and 894 university students. ADHD diagnoses were made using the Japanese semi-
Number of reviews completed is 2 structured diagnostic interview for adult ADHD, which is compatible with the DSM-5. The
ASRS-J, its subscales, and the short form, all had Cronbach’s ␣ values of around 0.80. Total
Keywords: scores on the ASRS-J and the ASRS-J-6 were highly correlated with readministration after
Adults a two-week interval. The total and 18 individual item scores in the ASRS-J were signifi-
Attention-deficit hyperactivity disorder
cantly higher in the ADHD group than the other three groups. ASRS-J scores were correlated
(ADHD)
with scores on the Japanese version of Conners’ Adult ADHD Rating Scales-Self Report sub-
Adult ADHD Self-Report Scale (ASRS)
Psychometric properties scales (0.59 ≤ r ≤ 0.77), with one exception. ASRS-J scores were also correlated (albeit more
Screening weakly; r = 0.38) with Beck Depression Inventory-II total scores. Employing optimal cut-offs,
sensitivity, specificity, and positive and negative predictive values of the ASRS-J and ASRS-
J-6 are all above 0.69. The ASRS-J and ASRS-J-6 showed acceptable psychometric properties,
although further study is necessary.
© 2017 Elsevier Ltd. All rights reserved.

What this paper adds?

Other than the original (US) version of the ASRS, no version of the ASRS has uniquely set cut-off scores so far and employed
the cut-off scores of the original US version. It is highly likely that cut-off scores of the scale may vary from country to country
or with its purpose. In order to enhance the clinical utility of the scale, uniquely setting cut-off scores by using the data
collected in the relevant country and in accordance with its purpose is imperative. Thus, in this study, we set cut-offs using
our original data.

∗ Corresponding author at: Department of Clinical Psychology, Ryukoku University, 125-1 Daiku-cho, Oomiya-higashihairu, Shichijyo-dori, Shimogyo-ku,
Kyoto 600-8268, Japan.
E-mail address: t-tak@umin.ac.jp (T. Takeda).

http://dx.doi.org/10.1016/j.ridd.2017.02.011
0891-4222/© 2017 Elsevier Ltd. All rights reserved.
60 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66

1. Introduction

Attention deficit hyperactivity disorder (ADHD) is characterised by a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with social, academic, and vocational functioning or development (American
Psychiatric Association [APA], 2013). The high prevalence of ADHD in adults as well as children has been reported across
the world. The prevalence of adult ADHD is estimated to be around 3.4% (range 1.2–7.3%) (Fayyad et al., 2007; Polanczyk,
deLima, Horta, Biederman, & Rohde, 2007). This means that therapies for adult ADHD are in high demand. To implement
an appropriate therapeutic intervention, an accurate diagnosis is vital. However, diagnosing adult ADHD is difficult due
to a high rate of other psychiatric comorbidities, and difficulties associated with recalling childhood symptoms accurately
in adulthood. A semi-structured diagnostic interview is an ideal tool for diagnosing ADHD in adults (Epstein, Johnson, &
Conners, 2000; Kooij, 2010; Spencer et al., 2010). However, this takes a long time to administer by a trained rater. Therefore,
a reliable and valid screening questionnaire is required for professionals to detect possible ADHD in adults.
The Adult ADHD Self-Report Scale-v1.1 (ASRS) Symptom Checklist is one of the most frequently used questionnaires
(Murphy & Adler, 2004). It consists of 18 items (questions) based on the ADHD criteria from the DSM-IV-TR, and measures
the frequency of symptoms on a 5-point Likert scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often). The ASRS
has two subscales: inattention and hyperactivity-impulsivity, each of which contains nine items (Adler et al., 2006; APA,
2000; Kessler et al., 2005; Kessler et al., 2007). The ASRS also has a 6-item short version (ASRS screener), which can screen
adult ADHD with acceptable reliability and validity. The questions in the ASRS are designed to suit an adult, rather than a
child. Its reliability and validity were originally demonstrated in the English version (Kessler et al., 2005; Kessler et al., 2007).
The ASRS has been translated into various languages and their psychometric properties have been studied (Catalano
et al., 2011; Estévez et al., 2014; Kim, Lee, & Joung, 2013; Morin, Tran, & Caci, 2013; Polanczyk et al., 2010; Ramos-Quiroga
et al., 2009; Reyes-Zamorano, García-Vargas, & Palacios-Cruz, 2013; Zohar & Konfortes, 2010). It has been used to estimate
the prevalence of ADHD in general populations (Fayyad et al., 2007; Polanczyk et al., 2010), college students (Garnier-
Dykstra, Pinchevsky, Caldeira, Vincent, & Arria, 2010), and to screen high risk populations including prison inmates (Ginsberg,
Hirvikoski, & Lindefors, 2010), patients with substance abuse problems (Pedrero Pérez & Puerta García, 2007), patients with
mood disorders (Catalano et al., 2011), and adolescents with experiences of sexual abuse (Sonnby, Åslund, Leppert, & Nilsson,
2011).
The DSM-5 (APA, 2013) has now become the gold standard for diagnosing psychiatric disorders. There are critical changes
to how ADHD is diagnosed in the DSM-5 compared to the DSM-IV-TR. Age of onset has changed from 6 to 12, the required
number of symptoms is set at 5 for adult ADHD, and the DSM-5 provides more examples of symptoms. However, there are
few differences in how the symptom descriptions differ themselves between the DSM-IV and DSM-5. Thus, the symptom
descriptions in the ASRS modified for adults from those in the DSM-IV appear to still be relevant. However, to our knowledge,
the utility of the ASRS has not been confirmed in accordance with DSM-5 ADHD criteria.
Additionally, other than the original (US) version of the ASRS, no version of the ASRS has uniquely set cut-off scores so far
and employed the cut-off scores of the original US version. It is highly likely that cut-off scores of the scale may vary from
country to country or with its purpose. In order to increase the clinical utility of the scale, uniquely setting cut-off scores by
using the data collected in the relevant country and in accordance with its purpose is imperative.
In this study, the reliability and validity of the Japanese version of the ASRS (ASRS-J) and its short scale were tested
in a group of adults with ADHD and a group of adults with non-ADHD psychiatric disorders. Semi-structured diagnostic
interviews for adult ADHD were employed that were compatible with the DSM-5 criteria for ADHD. Furthermore, cut-off
scores were set for the ASRS-J and its short scale. The 18 items in the ASRS-J as well as in the original ASRS can be found
online: http://www.hcp.med.harvard.edu/ncs/asrs.php.

2. Method

2.1. Development of the ASRS-J

The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) task force for Translation and Cultural
Adaptation (TCA) has presented Principles of Good Practice on the process of translating a scale written in one language into
a scale in another language (Wild et al., 2005). We followed these guidelines to create the ASRS-J. The first draft was created
through several revisions. Then, it was back-translated into English by professional translators. The back-translated English
version was reviewed by the authors of the original English ASRS according to the Harvard protocol, and was further revised
by the present authors in response to the comments of the original authors. It was then administered to the first author’s
colleagues, students, and patients with ADHD for revising unclear questions to finalise as the ASRS-J. Then the finalised
ASRS-J was proofread. The ASRS-J is a self-report questionnaire consisting of the same 18 items as the ASRS and is printed
on one side of an A4 sheet of paper.
To reduce potential biases, the 18 items were arranged so that inattention items and hyperactive-impulsive items alter-
nate, in the same order as in the DSM-5 ADHD criteria (see the first column in Table 1). Furthermore, in the answer section,
no cells are shaded in grey (used to indicate the clinical threshold of each symptom in the original ASRS).
 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66 61

Table 1
Comparison of ASRS-J and ASRS-J-6 scores among four groups.

Scores of ASRS-J, two ADHD adults Non-ADHD clinical adults Students Non-clinical adults F (3, 1080)1 Effect size2
subscales, 18 items and
ASRS-J-6 scores
(n = 48) (n = 46) (n = 894) (n = 96)

ASRS-J 42.2 (10.9) 29.7 (12.9) 25.3 (8.8) 21.2 (9.0) 60.92 1.04
Inattention 24.8 (5.7) 16.9 (7.1) 14.6 (5.1) 11.9 (4.8) 66.86 1.22
Hyperactivity-impulsivity 17.4 (6.7) 12.8 (6.9) 10.7a (4.6) 9.3a (4.7) 36.03 0.68
1. Careless mistakes 3.0 (0.9) 2.1 (0.8) 1.9 (0.7) 1.6 (0.7) 36.72 1.09
2. Fidgeting 2.5 (1.2) 1.9 (1.4) 2.0 (1.0) 1.4 (0.9) 20.55 0.53
3. Difficulty keeping 2.6 (1.0) 1.9 (1.1) 1.7 (0.9) 1.4 (0.8) 17.45 0.73
attention
4. Leaves seat 0.9 (1.1) 0.8 (1.2) 0.6b (0.7) 0.5b (0.6) 5.39 0.06
5. Does not listen 2.4 (1.0) 1.7 (1.2) 1.0 (0.8) 0.8 (0.7) 54.03 0.63
6. Feel restless 2.5 (1.1) 1.8 (1.2) 1.4 (0.8) 1.0 (0.8) 41.15 0.56
7. Does not follow through 2.9 (1.0) 2.0 (1.0) 1.7 (0.9) 1.3 (0.8) 35.09 0.93
8. Difficulty relaxing 2.1 (1.3) 1.8 (1.3) 1.0c (1.0) 1.0c (0.9) 31.01 0.22
9. Difficulty organising 2.9 (1.1) 1.7 (1.2) 1.5 (1.0) 1.2 (0.8) 35.3 1.07
10. On the go 2.3 (1.2) 1.5d (1.2) 1.4 (1.0) 1.0d (0.9) 13.42 0.64
11. Avoids effort 2.9 (1.2) 2.2 (1.2) 2.1 (1.0) 1.6 (0.9) 15.13 0.62
12. Talks excessively 1.9 (1.3) 1.4e (1.2) 1.3e (1.0) 1.3e (0.9) 5.97 0.53
13. Loses things 3.0 (1.0) 2.2 (1.0) 1.9 (1.0) 1.5 (0.8) 24.93 0.84
14. Rules conversation 2.4 (1.2) 1.5f (0.9) 1.5f (0.9) 1.4f (0.8) 15.41 0.84
one-sidedly
15. Easily distracted 2.7 (1.1) 2.0 (1.3) 1.7 (1.0) 1.4 (0.8) 18.9 0.65
16. Difficulty waiting turn 1.2 (1.2) 1.1 (1.3) 0.8g (0.9) 0.8g (0.9) 5.67 0.08
17. Forgetful 2.2 (1.2) 1.3h (0.9) 1.2h (0.9) 1.1h (0.7) 27.28 0.91
18. Interrupts others 1.6 (0.9) 1.0i (1.0) 1.0i (0.8) 1.0i (0.7) 8.38 0.62
ASRS-J-6 16.5 (3.8) 10.7j (4.3) 9.6j (3.5) 8.1j (3.2) 67.26 1.43

Note: ASRS-J, The Japanese version of the Adult ADHD Self-Report Scale. The 18 ASRS-J items are arranged with inattention and hyperactive-impulsive
symptom appearing alternatively in descending order.
1
All F values are significant at p < 0.05. Means with the same superscript on the same row do not differ significantly from each other and means that do
not share the same superscript on the same row differ significantly from each other with post hoc comparisons (Tukey’s test) at p < 0.05.
2
Cohen’s d (ADHD vs. Non-ADHD clinical).
Bold characters indicate a large effect size (>0.80). ASRS-J-6, short scale consisting of 6 ASRS-J items with a large effect size.

2.2. Participants

The present study, approved by the ethics committee of the Ryukoku University, had a total of 1084 participants divided
into four groups: (1) ADHD group (48 adults with ADHD, 25 male, mean age = 31.3 ± 9.5 years, age range = 19–53); (2)
non-ADHD clinical group (46 adults with non-ADHD psychiatric disorders, 20 male, mean age = 34.6 ± 11.9 years, age
range = 18–66); (3) non-clinical adult group (96 adults without psychiatric disorders, 37 male, mean age = 37.3 ± 11.0, age
range = 21–65); and (4) student group (894 university students, 475 male, mean age = 20.1 ± 1.4 years, age range = 18–45).
Another 17 (1.5%) participants (all from the student group) who failed to answer at least one question in the ASRS-J were not
included in the four groups. The student group was made up from students in two universities, and the non-clinical adult
group was recruited from several Japanese companies. The ADHD and non-ADHD clinical groups were outpatients at the
clinics where the first author was working. According to DSM-5 criteria, the ADHD group comprised 33 subjects with pre-
dominantly inattentive presentation, 14 with combined presentation, and one with predominantly hyperactive/impulsive
presentation. All of the participants in the ADHD group had an IQ measured on the Japanese version of the Wechsler Adult
Intelligence Scale-III (mean full-scale IQ = 98.6 ± 13.1).
All participants in the ADHD and the non-ADHD clinical groups were administered the Japanese version of the Mini-
International Neuropsychiatric Interview (MINI) (Otsubo et al., 2005) to evaluate psychiatric disorders. Psychiatric disorders
other than those included in the MINI were diagnosed in accordance with the DSM-IV. Autism spectrum disorder (ASD) was
diagnosed for participants who were assessed as having autistic disorder or Asperger’s syndrome or pervasive developmental
disorder not otherwise specified (PDD-NOS) as indicated in DSM-5 ASD criteria (APA, 2013). To aid this diagnostic process,
the Japanese version of the Autism-spectrum Quotient (AQ-J) (Kurita, Koyama, & Osada, 2005) was administered to all
participants in the ADHD group, and if necessary, to those in the non-ADHD clinical group. In this study, comorbidity of
ASD was not regarded as an exclusion criterion for ADHD, in accordance with the DSM-5. The Japanese version of the Beck
Depression Inventory-II (BDI) (Kojima et al., 2002) was administered to all participants in the ADHD group and to 34 in the
non-ADHD clinical group. The Japanese version of the Zung Self-rating Depression Scale (Fukuda & Kobayashi, 1973; Zung,
1965) was administered to 12 participants in the non-ADHD clinical group.
The ADHD group and the non-ADHD clinical group had the following psychiatric disorders other than ADHD (one person
can have more than one disorder): major depressive disorder: 12 (ADHD) and 19 (non-ADHD clinical); dysthymic disorder:
12 and 22; social anxiety disorder: 2 and 3; ASD: 3 and 11; obsessive-compulsive disorder: 2 and 2; posttraumatic stress
62 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66

disorder; 2 and 0; developmental coordination disorder: 1 and 0: tic disorder: 1 and 0; generalised anxiety disorder: 1 and
5; bipolar II disorder: 0 and 2; substance use disorder (alcohol and sedatives): 1 and 2; and dissociative identity disorder: 0
and 1.
The Japanese version of the Conners’ Adult ADHD Rating Scales-Self Report (J-CAARS-S) (Conners, Erhardt, & Sparrow,
1999/2012) was administered to all participants in the ADHD group.

2.3. Clinical Diagnosis of ADHD

At the clinics, the first author administered the Assessment System for Individuals with ADHD (ASIA), a Japanese semi-
structured diagnostic interview for adult ADHD (Takeda, Tsuji, Uwatoko, & Kurita, 2015). The ASIA ADHD criterion A, which
corresponds to the DSM-5 ADHD criterion A, comprises 144 original questions that probe nine inattention symptoms and
nine hyperactivity-impulsivity symptoms (each inattention or hyperactivity-impulsivity symptom has four questions on
both childhood and adulthood, totalling eight). The 144 questions are evaluated on a 3-point frequency scale. The ASIA
ADHD criteria B to E, corresponding to DSM-5 ADHD criteria B to E, are evaluated on a 2-point scale. The ASIA ADHD criteria
showed acceptable reliability and validity in 36 adults with ADHD and 24 adults without ADHD. Administration of the ASIA
was discontinued in the non-ADHD clinical group if a participant had fewer than four symptoms across the inattention
and hyperactivity-impulsivity domains (i.e. if the minimum criteria for ADHD according to the ASIA had not been reached
(Takeda et al., 2015)).

2.4. Procedure

2.4.1. Psychometric properties of the ASRS-J

We evaluated the internal consistency reliability (Cronbach’s ˛) of the ASRS-J based on data across all four groups, totalling
1084 participants. We evaluated the test–retest reliability of the ASRS-J based on data from 65 participants (16 adults with
ADHD, 3 adults with a non-ADHD psychiatric disorder and 46 university students), who completed the ASRS-J twice with a
2-week interval, by examining whether the two ratings were correlated or significantly different.
We tested the discriminant validity of the ASRS-J by examining whether its scores were significantly higher in the ADHD
group than the other three groups by using an analysis of variance (ANOVA) with post hoc comparisons (Tukey’s test). We
tested the concurrent validity of the ASRS-J by examining whether its scores were significantly correlated with J-CAARS-S
scores. We also examined divergent validity by examining whether a correlation between ASRS-J and BDI scores was smaller
than a correlation between ASRS-J and J-CAARS-S scores.
By using the receiver operating characteristic (ROC) curve procedure, we determined the most appropriate ADHD cut-off,
and corresponding sensitivity, specificity, and predictive values of the ASRS-J.

2.4.2. Short scale and its psychometric properties

Based on the ASRS-J data, we devised a short scale of the ASRS-J. The candidate items for a short scale were selected in
two different ways: (1) items were identified as explanatory variables for ADHD diagnosis from the ASRS-J items in forward
stepwise logistic regression, as was done in the original ASRS (Kessler et al., 2005), and (2) items with a large effect size on
ADHD diagnosis were considered.
We evaluated internal consistency reliability, test–retest reliability, concurrent, discriminant and divergent validity, and
sensitivity, specificity and predictive values of the short scale in the same way as the ASRS-J full scale.

2.5. Data analysis

Data analyses were conducted in IBM SPSS statistics 22 for Windows, with the threshold for statistical significance set at
p < 0.05 (two-tailed test).

3. Results

3.1. ASRS-J

3.1.1. Reliability
Internal consistency reliability (˛) of the ASRS-J total, inattentive, and hyperactive-impulsive scores were 0.89, 0.85, and
0.78, respectively, across all of the 1084 participants.
As for test–retest reliability in the 65 participants, ASRS-J total score at the first time point was significantly correlated with
total score at the second time point (r = 0.85, p = 0.000), and did not differ significantly between the first (mean = 30.2 ± 12.7)
and second (mean = 30.5 ± 12.3) ratings (df = 64, paired t = 0.42, p = 0.68).

3.1.2. Validity
As shown in Table 1, the ADHD group scored significantly higher than the other three groups in terms of total score,
subscale scores, and on each of the 18 individual items. There were no significant gender differences across groups. The
 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66 63

Table 2
Cut-offs of ASRS-J-6 based on 48 ADHD adults and 46 non-ADHD clinical adults.

Scale (score range) Cut-off Sensitivity Specificity PPV NPV TCA AUC

ASRS-J (0-72) 35 0.71 0.74 0.73 0.89 0.72 0.77

36 0.71 0.74 0.73 0.89 0.72
37 0.69 0.76 0.75 0.70 0.72

ASRS-J-6 (0-24) 14 0.69 0.80 0.75 0.70 0.74 0.85

15 0.67 0.84 0.82 0.71 0.75
16 0.56 0.87 0.82 0.66 0.71

Note: ASRS-J, The Japanese version of the Adult ADHD Self-Report Scale; ASRS-J-6, 6-item short scale of ASRS-J; PPV, positive predictive value; NPV, negative
predictive value; TCA, total classification accuracy; AUC, area under the receiver operator characteristic curve.
Bold characters indicate relevant cut-offs and corresponding sensitivity, specificity, and predictive values.

ADHD group scored significantly higher than the non-ADHD clinical, student, and non-clinical adult groups on total score,
the two inattention subscales, and all of the 18 items.
ASRS-J total scores showed acceptable correlation with the J-CAARS-J subscale scores of A through H (except for D),
where: A: inattention/memory (n = 55, r = 0.59, p = 0.00); B: hyperactivity/restlessness (n = 55, r = 0.68, p = 0.00), C: impulsiv-
ity/emotional lability (n = 55, r = 0.63, p = 0.00), D: problem with self-concept (n = 55, r = 0.38, p = 0.02), E: DSM-IV inattentive
symptoms (n = 55, r = 0.75, p = 0.00), F: DSM-IV hyperactive-impulsive symptoms (n = 55, r = 0.71, p = 0.00), G: DSM-IV total
ADHD symptoms (n = 55, r = 0.77, p = 0.00), and H: ADHD index (n = 55, r = 0.69, p = 0.00).
The ASRS-J total score showed a significant but small correlation with BDI total score (n = 102, r = 0.38, p = 0.000).

3.2. Short scale

Four ASRS-J items (1, 8, 9, and 14) were identified as explanatory variables for ADHD diagnosis via forward stepwise
logistic regression (Hosmer–Lemeshow [Chi square = 5.93, df = 8, p = 0.66]; Cox–Snell R2 = 0.39; Nagelkerke R2 = 0.53). As
shown in Table 1, however, six (1, 7, 9, 13, 14, and 17) of the 18 items that showed a significantly higher score in the ADHD
group than the non-ADHD clinical group had a large effect size (i.e. Cohen’s d > 0.80). We selected these 6 items for the short
scale of the ASRS-J, ASRS-J-6, because it had a higher AUC (area under the receiver operator characteristic curve) than a short
scale based on the former 4 items and it included at least one hyperactive-impulsive symptom (item 14).
The ASRS-J-6 had a Cronbach’s ˛ of 0.83 for the 1084 participants. The ASRS-J-6 total score was significantly correlated
between the first and second ratings (r = 0.84, p = 0.00) with an interval of 2 weeks and did not differ significantly between
the first (11.6 ± 4.4) and second ratings (11.2 ± 4.2) (df = 64, t = 1.28, p = 0.21) in the 65 participants.
As shown in the last row in Table 1, the ADHD group scored significantly higher on the ASRS-J-6 than the other three
groups. There were again no significant differences in gender across the four groups.
The ASRS-J-6 score showed acceptable correlation with the J-CAARS-J subscale scores of A through H except for D,
where A: inattention/memory (n = 55, r = 0.67, p = 0.00), B: hyperactivity/restlessness (n = 55, r = 0.55, p = 0.00), C: impulsiv-
ity/emotional lability (n = 55, r = 0.53, p = 0.00), D: problem with self-concept (n = 55, r = 0.37, p = 0.02), E: DSM-IV inattentive
symptoms (n = 55, r = 0.83, p = 0.00), F: DSM-IV hyperactive-impulsive symptoms (n = 55, r = 0.56, p = 0.00), G: DSM-IV total
ADHD symptoms, n = 55, r = 0.73, p = 0.00, and H: ADHD index (n = 55, r = 0.63, p = 0.00).
The ASRS-J-6 score showed a significant but small correlation with total BDI score (n = 102, r = 0.34, p = 0.000).

3.3. Cut-offs

Table 2 shows the most appropriate cut-off, two other possible cut-offs and the corresponding sensitivity, specificity, and
predictive values of the ASRS-J and the ASRS-J-6 based on 48 ADHD and 46 non-ADHD clinical controls. The best cut-offs for
differentiating between patients with ADHD and non-ADHD clinical controls on the ASRS-J and ASRS-J-6 were 36 and 15,
respectively, in view of the necessary balance between sensitivity and specificity.

4. Discussion

Internal consistency reliability (Cronbach’s ˛) of the ASRS-J, ASRS-J subscales, and the ASRS-J-6 were all satisfactory
(around 0.80). The ASRS-J and the ASRS-J-6 also showed satisfactory test-retest reliability, as indicated by significant r-
values of 0.85 and 0.79, respectively, with no significant difference in scores between the first and second ratings. The values
obtained here are fairly comparable with those in five previous studies (Kessler et al., 2007; Kim et al., 2013; Pedrero Pérez
& Puerta García, 2007; Yeh, Gau, Kessler, & Wu, 2008; Zohar & Konfortes, 2010), as shown in Table 3.
The total score, two subscale scores and all of the 18 item scores on the ASRS-J were significantly higher in the ADHD
group than the other three non-ADHD groups, demonstrating discriminant validity.
ASRS-J total score was acceptably and significantly correlated with all of the J-CAARS-J subscale scores (r = 0.59–0.77)
except for subscale D, Self-Concept (r = 0.38). It was only weakly correlated with BDI score (r = 0.38), presumably because
64 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66

Table 3
Psychometric properties of 6-item short scale and 18-item full scale in six language versions of Adult ADHD Self-Report Scale (ASRS).

ASRS versions (Author, year of publication)

Original US version Spanish (Pedrero Chinese (Yeh et al., Hebrew (Zohar & Korean (Kim et al., Japanese (This
(Kessler et al., Pérez & Puerta 2008) Konfortes, 2010) 2013) study)
2005a , Kessler García, 2007)
et al., 2007b )

Number and 154 adults (60 280 persons with 4329 (1031 soldiers 120 college 205 persons (no 1084 (48 ADHD, 46
characteristics ADHD and 94 substance-related and 3298 college students (20 ADHD diagnosis of ADHD non-ADHD clinical
of subjects controls)a 668 disorders (23 [8.2%] students: no and 100 healty or non-ADHD) controls, 96
adults (a were estimated to diagnosis of ADHD controls)c non-clinical adults,
representative have ADHD) or non-ADHD) 894 university
sample of large colleges (n = 3298) students)
health care plan
members)b
Used scale: S S (IA-d, e, i, f, HI- a, S (the same as –/F S (the same as –/F S (IA-a, d, e, g, i,
(short scale, 6 e)/F Kessler’s)/F Kessler’s)/F HI-g)/F
items)/F
(18-item full
scale)
Psychometric properties
Internal 0.70 (668)b /– 0.68 (280)/– –/0.89 (3298) –/0.89 (55) –/0.89 (205) 0.76/0.89 (1084)
consistency, ␣
(n)
Test–retest 0.67 (668)b /– 0.74 (60)/– –/0.85 (4329) –/0.89 (55) –/0.88 (41) 0.79/0.85 (65)
reliability, r (n)
Cut-off 4 (0–6)d /37 (0–72)e d
4 (0–6) /– –/– d
4 (0–6) /51 (0–72) –/– 15 (0–24)/36
(range) (n) (60 ADHD vs. 90 (20 ADHD vs. 100 (0–72) (48 ADHD
controls)a controls) vs. 46 non-ADHD
clinical controls)
Sensitivity 0.39/0.57 –/– –/– 0.40/0.65 –/– 0.67/0.71
Specificity 0.88/0.97 –/– –/– 0.78/0.68 –/– 0.84/0.74

Note: IA, inattention; HI, hyperactive-impulsive (IA-a = IA symptom a in DSM-5 ADHD diagnostic criteria).
a
Kessler et al’s 2005 study.
b
Kessler et al’s 2007 study.
c
The paper and pencil (but not computer) version was used as was done in the other studies.
d
The sum of 6 item scores on a 2-point scale (0–1).
e
The sum of 18 item scores on a 5-point scale (0–4) is cited to compare with the other studies.
– = not reported.

both of these measurements (i.e., J-CAARS-J subscale D and BDI) are pertinent to concepts different from ADHD. Thus, these
results show that the ASRS-J has convergent and divergent validity.
Moreover, the ASRS-J is considered to have content validity, because it was created from the ASRS through a successful
back translation according to the ISPOR-TCA guidelines (Wild et al., 2005).
Employing optimal cut-offs, the sensitivity, specificity, and positive and negative predictive value of the ASRS-J and ASRS-
J-6 were all 0.69 or above, and seem acceptable. In the original US study (Kessler et al., 2005) various methods to ascertain the
optimal cut-off score were applied. When a simple summation of the 18 item scores on a 5-point scale (0–4) was employed,
as we did in this study, its optimal cut-off was 37, corresponding sensitivity was 0.57 and specificity was 0.95. The original
US study’s cut-off was set for use in the general population, whereas our cut-offs for the ASRS-J (36) and ASRS-J-6 (15) have
been set for use in clinical settings. Thus, higher sensitivity (0.71, 0.67) and lower specificity (0.74, 0.84) in the ASRS-J and
ASRS-J-6, respectively, than in the original ASRS can be justified when considering the purpose of use.
Unlike the Spanish and Hebrew ASRS short versions, which employed the same items as the original US 6-item ASRS
screener, items in the ASRS-J-6 are different from those in the US 6-item ASRS screener, except for three inattention symp-
toms, d: “does not follow through”, e: “difficulty organizing”, and i: “forgetful”, as shown in Table 3. The ASRS-J-6 has 5
inattentive items while the US 6-item screener has 4 inattentive items. Using a representative population-based sample of
3574 30-year-old individuals, Vitola et al. (2016) showed that the adult ADHD phenotype was constituted mainly by inat-
tentive symptoms and furthermore, inattentive symptoms were the symptoms most associated with impairment. Thus, the
bias towards inattentive items in ASRS-J-6 could be legitimate. Also, this difference may have resulted from methodological
differences in extracting items for the short versions, and the relatively small number of participants with ADHD in this
study: further research is needed.
It is well understood that various psychiatric conditions can mimic ADHD symptoms (Kumar, Faden, & Steer, 2011;
Stein, 2008). This study may corroborate this view, since the non-ADHD clinical group showed an intermediate level of
ADHD symptom scores between the ADHD group and the other two non-ADHD groups. However, follow-up studies of
individuals with ADHD into their mid-twenties have revealed that ADHD symptoms decrease with age (Mannuzza, Klein,
Bessler, Malloy, & LaPadula, 1993; Weiss, Hechtman, Milroy, & Perlman, 1985). Non-clinical level ADHD symptoms may also
 T. Takeda et al. / Research in Developmental Disabilities 63 (2017) 59–66 65

decrease with age, since the student group showed a higher level of ADHD symptoms than the non-clinical adult group in
our cross-sectional study.
This study had several limitations. First, the small sample sizes, especially of the ADHD and non-ADHD clinical groups,
might hamper generalisation of the results of this study. Second, since the cut-offs of the ASRS-J and ASRS-J-6 were set for
clinical use, they should not be applied to a community sample. A further study is needed in this respect to set a relevant
cut-off that can be used in identifying possible ADHD students or adults in the general population. Third, although ADHD was
diagnosed in accordance with the DSM-5, non-ADHD psychiatric disorders were diagnosed in accordance with the DSM-IV,
because systematic diagnostic interviews for those psychiatric disorders offered in the DSM-5 are not yet available in Japan.
However, we note that this does not seem to have had any impact on the results of our study.

5. Conclusion

The ASRS-J and ASRS-J-6 showed acceptable psychometric properties (i.e. internal consistency and test–retest reliability;
concurrent, discriminant and content validity; sensitivity, specificity, and positive and negative predictive values at relevant
cut-offs), although further investigation is necessary.

Acknowledgements

This study was supported in part by the Grants-in-Aid for Scientific Research (C) (No. 70596460) from the Japan Society
for the Promotion of Science. The authors thank the 1101 participants for their participation in this study.

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