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Wender Utah Rating Scale – 25

Wender Utah Rating Scale – 25

What is WURS-25

The Wender Utah Rating Scale (WURS) is a retrospective self-report of childhood attention-deficit/hyperactivity disorder (ADHD) symptoms used by physicians and other healthcare professionals to screen for possible adult ADHD, and by psychologists as one component of a comprehensive adult ADHD evaluation. The Wender Utah Rating Scale (WURS) is a widely used screening tool for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults. Developed by Dr. Paul H. Wender, a pioneer in ADHD research, the WURS was initially designed to assess childhood symptoms retrospectively in adult patients. The original WURS consisted of 61 questions, but the WURS-25, a shorter 25-question version, is now commonly used due to its efficiency and comparable validity.

WURS-25 Printable PDF

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WURS-25 Scoring and Interpretation

The total score is the sum of all responses. Scores of 30 or higher best identify ADHD within a community setting.

Scores of 46 or higher best identify ADHD within a clinical setting.

Factor Scores: Factor score assignment is based on the items that loaded most heavily on each factor with a loading of 0.40 or greater. Factor score were calculated as the average of all such heavily loading items. Items that are omitted by the patient are excluded from the “Sum of Factor Items”. Also, the “Number of Factor Items” is reduced by the number of items omitted.

  • Disruptive mood/behavior Factor: Items 5, 6, 8, 10, 12, 13, 14, 18, 19, 21, 22
  • ADHD Factor: Items 1, 3, 4, 7, 15, 16, 23, 24, 25
  • Anxiety/dysphoria Factor: Items 2, 9, 11, 17

Generation of Fitted Values

  • To identify ADHD within a non-clinical sample use the following equation: -5.84 + (Disruptive mood/behavior factor score X 1.83) + (ADHD factor score X 2.44) + (Anxiety/dysthymia factor score X 0.16) = fitted value.
  • To separate ADHD and MDD/GAD patients create fitted values using the following equation: -3.90 + (Disruptive mood/behavior factor score X 0.73) + (ADHD factor score X 2.51) - (Anxiety/dysthymia factor score X 1.24) = fitted value
  • If the fitted value is equal to or greater than 0 the patient is categorized as ADHD. Negative scores are categorized as not ADHD. Notice that both intercept values are a negative number and that one factor score is subtracted.

Scores of 30 or higher best identify ADHD within a community setting.

Scores of 46 or higher best identify ADHD within a clinical setting.

Factor scores of 2 or higher indicate areas of concern.

If the fitted value is equal to or greater than 0 the patient is categorized as ADHD. Negative scores are categorized as not ADHD.

Individual items scored 3 or 4 deserve further investigation.

PsyPack can automatically score the WURS-25 assessment and prepare corresponding tables and graphs.

WURS-25 sample result

Sample Report of WURS-25

Domain

Attention-Deficit/Hyperactivity Disorder (ADHD)

What does WURS-25 measure

The purpose of the evaluation is to:

  • help identify possible ADHD in adults within a community setting and a clinical setting,
  • identify areas of concern,
  • separate ADHD from non-clinical “patients”, and
  • separate ADHD from MDD/GAD patients.

Administration

Self-administered

Type of outcome tool

Clinical

Assessment modes

Questionnaire

Age and eligibility

Adults

Estimated time

2-5 minutes

Notes

Since the questionnaire relies on client self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the client understood the questionnaire, as well as other relevant information from the client.

A WURS score by itself should not be used to diagnose ADHD. Psychologists administer the WURS as one component of a comprehensive, multi-method assessment.

The 3 factors of the WURS-25 reflect the following problems:

  • The Disruptive mood/behavior factor contains items dealing with temper dyscontrol, mood instability, conduct disorder and oppositional defiant disorder.
  • The ADHD factor items contains items dealing with inattention and academic functioning.
  • The Anxiety/dysthymia factor contains items dealing with anxiety, low mood and self-criticism.

If you ask people to complete the WURS-25 form, which includes only 25 items, most people realize that they are taking an ""ADHD test"" the questionnaire's purpose is transparent. This leads some people to endorse more items at higher severity levels because (for a variety of reasons) they want an ADHD diagnosis.

Why are Fitted Values Important? Calculating fitted values can help differentiate between ADHD-like symptoms caused by depressive and anxiety disorders vs. ADHD-driven symptomatology. As you probably know, substantial overlap exists between symptoms for ADHD, depression, anxiety, and other disorders, e.g., difficulty concentrating. In other words, a patient with major depression and generalized anxiety may look like they have ADHD. The three disorders can coexist but the prevalence of ADHD + MDD + GAD is much lower than MDD + GAD. Of course, one should not diagnose based on fitted values alone.

Attribution and References

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. The American Journal of Psychiatry, 150(6), 885–890.

Reimherr, F. W., Marchant, B. K., Gift, T. E., Steans, T. A., Wilson, M., & Pommerville, C. (2022). Handbook of Utah Scales for the Assessment and Treatment of ADHD in Adults.
Archived link
Official website
Archived link
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. The American Journal of Psychiatry, 150(6), 885–890.
Archived link