Wender Utah Rating Scale WURS-25
Wender Utah Rating Scale WURS-25 overview
Creator and Context
The Wender Utah Rating Scale 25 item short form (WURS-25) asks adults to rate their own childhood behaviour retrospectively, as an aid to the diagnosis of adult ADHD.
It was published by Ward, Wender and Reimherr in the American Journal of Psychiatry in 1993, as the subset of the original 61 item scale that best discriminated adults with ADHD from controls.
Presenting Conditions
The WURS-25 is scored as a single total representing retrospective childhood ADHD symptomatology. It has no author defined subscales.
Item content spans inattention and distractibility, impulsivity, hyperactivity and fidgetiness, temper and irritability, mood lability, low self esteem, oppositionality, peer problems and academic underachievement.
Administration
Self administered. Each statement begins with the phrase as a child I was, and the adult rates it from Not at all or very slightly (0) through Mildly, Moderately and Quite a bit to Very much (4). It is retrospective: the person is rating childhood, not the present.
Desired Audience
Adults being assessed for ADHD. It is used alongside a current symptom measure, not instead of one.
Adult ADHD requires evidence of childhood onset, and most adults present without school reports or a parent who can be interviewed. The WURS-25 is the standard way of gathering that retrospective evidence when collateral history is unavailable.
Considerations
It measures childhood symptoms only. It cannot establish current ADHD and must be paired with a current symptom measure such as the ASRS, plus developmental history where available.
Retrospective self report is vulnerable to recall bias and mood congruent distortion. Adults with depression score higher.
Item content is heavily loaded on temper and mood lability, which inflates scores in emotionally dysregulated people who do not have ADHD.
Cut offs derived against healthy controls lose specificity badly in psychiatric populations. In one study of patients with emotional instability from other causes, specificity fell to 0.59 at a cut off of 36.
The most commonly used cut off of 36 is not the threshold Ward and colleagues recommended.
How to score the Wender Utah Rating Scale WURS-25
Conducting the assessment
The adult rates all 25 items from 0 to 4 in relation to their childhood.
Interpretation
Items are summed to give a total from 0 to 100.
Ward, Wender and Reimherr (1993) reported that a cut off of 46 or higher correctly identified 86 percent of patients with ADHD and 99 percent of normal subjects.
A cut off of 36 has become the most widely used in practice. In the original work, a cut off of 36 gave both sensitivity and specificity of 96 percent against healthy controls.
The two thresholds are frequently conflated. The 86 percent and 99 percent figures belong to the cut off of 46, not 36.
In psychiatric populations, an optimal cut off of 39 has been reported, with sensitivity 0.88 and specificity 0.70.
Clinical Considerations
Never use the WURS-25 alone. It is one leg of an assessment that also needs current symptoms and, where possible, collateral history.
Interpret with caution in people who are currently depressed or emotionally dysregulated, where the scale over identifies.
Choose the cut off deliberately. Against a psychiatric comparison group rather than healthy controls, the thresholds behave very differently.
Wender Utah Rating Scale WURS-25 use cases
Retrospective assessment of childhood ADHD symptoms in adults
Supporting evidence of childhood onset in an adult ADHD assessment
Research into adult ADHD
Category
ADHD
Research Summary
Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(6), 885 to 890.
Ryden, E., et al. (2018). Wender Utah Rating Scale 25 (WURS-25): Psychometric properties and diagnostic accuracy of the Swedish translation. Upsala Journal of Medical Sciences, 123(4), 230 to 236.
Other Assessment Guides
Adult ADHD Self Report Scale ASRS v1.1
A guide to the WHO Adult ADHD Self Report Scale (ASRS v1.1). Covers the six question screener, both scoring methods including the updated 0 to 24 approach, and when to escalate to full assessment.
Vanderbilt ADHD Diagnostic Rating Scale VADRS
A guide to the Vanderbilt ADHD Diagnostic Rating Scale (VADRS), parent and teacher versions. Covers symptom and performance scoring, the DSM-5 aligned criteria and comorbidity screening.
SNAP-IV Teacher and Parent Rating Scale
A guide to the SNAP-IV parent and teacher rating scale for ADHD and oppositional symptoms. Covers average rating per item scoring, the rater specific cut offs and version differences.
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