Wender Utah ADHD Rating Scale

WURS explained

This is a scale used in the diagnosis of attention deficit hyperactivity disorder based on behaviour and feelings experienced during childhood.

The self-report questionnaire consists of 61-items, 25 of which are highly relevant items for ADHD (thus used in the scale for ADHD) and can help link childhood symptoms with patterns of behaviour in adulthood.

The scale is however limited by the capacity of the patient to recall memories from childhood.

Each of the questions in the retrospective scale has 4 answer choices, awarded points from 0 to 4:

■ Not at all or slightly (0 points);

■ Mildly (1 point);

■ Moderately (2 points);

■ Quite a bit (3 points);

■ Very much (4 points).

61-item Wender Utah Rating Scale

The WURS model is based on the DSM criteria of attention deficit diagnosis. These are seven classes (that are contained in the full 61-item version):

■ Attention difficulties;

■ Hyperactivity/restlessness;

■ Temper;

■ Affective liability;

■ Emotional over-reactivity;

■ Disorganization;

■ Impulsivity.

The administration of the scale can help clinicians understand the mechanisms of adult attention deficit with hyperactivity disorder. The scale has shown good psychometric properties in various populations and demographics.

The following table introduces the full version, which can also be downloaded as pdf and printed for patients to use or for notes during the evaluation.

Result interpretation

The results range between 0 and 100 when the 25-item scale is used and a cut-off at 46 points was provided. This means that patients who score 46 or above are likely to be diagnosed with attention deficit hyperactivity disorder.

In the original study: 86% of patients with ADHD, 99% of normal persons and 81% of depressed subjects were accurately diagnosed using this cut off value.

Because adult ADHD is mostly a condition with early onset and 60% of children with ADHD continue to display symptoms in adulthood, investigation of childhood symptoms has real value in diagnosis.

It is important to note that there is also a strong genetic determinism with this mental health condition likely to be inherited.

About the study

The scale was designed following a study by Ward, Wender and Reimherr in 1993. The complete 61-item Wender Utah Rating Scale (WURS) helps distinguish adults who could have been diagnosed with ADHD as children.

The scale was administered to 81 subjects already diagnosed with attention deficit hyperactivity disorder, 100 subjects that didn’t present any mental health conditions and 70 subjects diagnosed with unipolar depression.

The difference between the mean total scores of the patients with attention deficit hyperactivity disorder and the normal subjects was also highly significant.

The results from the scale were compared with results from the Parents' Rating Scale. A subscale with the most relevant 25-items for ADHD was also published.

The WURS is recommended as a sensitive scale for the identification of childhood ADHD and in the assessment of patients with ambiguous adult psychopathology.

ADHD symptoms

Adults who suffer from attention deficit disorders may also experience symptoms pertaining to other mental health conditions such as anxiety, depression or substance abuse.

The manifestations of this mental disorder may not be as obvious in adults as they are in children but there are patterns of behaviour which indicate an attention deficit, such as:

■ Task (anticipatory) avoidance;

■ Impatience;

■ Irritability;

■ Inability to concentrate;

■ Pseudo efficiency;

■ Juggling activities and mixing professional with personal life;

■ Improper reactions to interpersonal problems;

■ Susceptibility to substance abuse.

Original source

Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993; 150(6):885-90.

Other references

1. Stein MA, Sandoval R, Szumowski E, Roizen N, Reinecke MA, Blondis TA, Klein Z. Psychometric characteristics of the Wender Utah Rating Scale (WURS): reliability and factor structure for men and women. Psychopharmacol Bull. 1995; 31(2):425-33.

2. McCann BS, Scheele L, Ward N, Roy-Byrne P. Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. J Neuropsychiatry Clin Neurosci. 2000; 12(2):240-5.