Attention-Deficit/Hyperactivity Disorder Rating Scale-5

The Attention-Deficit/Hyperactivity Disorder Rating Scale-5 (ADHD-RS-5) is a highly reliable clinical instrument designed to assess the frequency and…

Attention-Deficit/Hyperactivity Disorder Rating Scale-5
Questions
18
Duration
5 min
Original title
Attention-Deficit/Hyperactivity Disorder Rating Scale-5
Adaptation
Attention-Deficit/Hyperactivity Disorder Rating Scale-5
Authors
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R.
Created
2016

The Attention-Deficit/Hyperactivity Disorder Rating Scale-5 (ADHD-RS-5) is a highly reliable clinical instrument designed to assess the frequency and severity of ADHD symptoms in children and adolescents. By closely mirroring the DSM-5 diagnostic criteria, it provides clinicians with a robust, standardized measure of neurodevelopmental presentations across home and school environments.

Using a validated scale like this helps anchor clinical judgment, moving beyond subjective impressions to objectively quantify behavioral patterns. For clinicians planning interventions or delivering psychoeducation on understanding ADHD mechanisms, the scale establishes a clear baseline. It is a repeatable measure that effectively captures symptom evolution over time, whether you are initiating behavioral scaffolding or tracking the impact of environmental modifications.

When building comprehensive care plans, the ADHD-RS-5 reliably informs the selection of targeted supports. Its structured symptom count helps highlight where a patient might benefit most from managing core ADHD symptoms or where caregivers might need tailored ADHD parenting strategies to better support the child between sessions.

Example result

Fictitious result, computed from a sample set of answers.

Overall score
25/ 54
The ADHD-RS-5 (DuPaul et al., 2016) is an 18-item standardized assessment rating scale mapped onto the DSM-5 diagnostic criteria for ADHD. It measures the frequency and severity of inattention and hyperactivity/impulsivity symptoms through informant-report by parents or teachers (the ADHD-RS-5 is not a self-report questionnaire) to assist in patient diagnosis and monitoring.
cliniquemixed · condition: ADHD (DSM-5), phase 3 trial participants · placebo arm, baseline · 12–17 years · United States · n = 96 · 2021 · Nasser et al. (2021)
054
25
M = 38.8 ± 8.06
cliniquemixed · condition: ADHD (DSM-5) · children, pooled baseline of 4 phase 3 trials (studies P301/P303) · 6–11 years · United States · 2021 · Nasser et al. (2021)
054
25
M = 44.2
cliniquemixed · condition: ADHD (DSM-5) · adolescents, pooled baseline of 4 phase 3 trials (studies P302/P304) · 12–17 years · United States · 2021 · Nasser et al. (2021)
054
25
M = 39.9
For information
Cut-off23–41CGI-S 4 "moderately ill" correspondence — children 6–11 years
Empirical linking of ADHD-RS-5 scores to the CGI-S clinical severity scale, based on 1354 pediatric patients from 4 phase 3 trials. In children aged 6–11 years, a total score between 23 and 41 (median 37) corresponds to a clinician rating of "moderately ill" (n = 266). Note: exclusively clinical sample (confirmed ADHD); these cutoff scores are not screening thresholds for the general population.
Nasser et al. (2021)View the study
Cut-off42–51CGI-S 5 "markedly ill" correspondence — children 6–11 years
In children aged 6–11 years, a total score of 42 to 51 (median 47) corresponds to the CGI-S level "markedly ill" (n = 384).
Nasser et al. (2021)View the study
Cut-off≥ 52CGI-S 6 "severely ill" correspondence — children 6–11 years
In children aged 6–11 years, a total score of 52 to 54 (median 53) corresponds to the CGI-S level "severely ill" (n = 103).
Nasser et al. (2021)View the study
Cut-off11–39CGI-S 4 "moderately ill" correspondence — adolescents 12–17 years
In adolescents aged 12–17 years, a total score of 11 to 39 (median 34) corresponds to the CGI-S level "moderately ill" (n = 290). The cutoffs are lower than in children, reflecting the decline in hyperactivity-impulsivity scores with age.
Nasser et al. (2021)View the study
Cut-off40–50CGI-S 5 "markedly ill" correspondence — adolescents 12–17 years
In adolescents aged 12–17 years, a total score of 40 to 50 (median 44) corresponds to the CGI-S level "markedly ill" (n = 242).
Nasser et al. (2021)View the study
Cut-off≥ 51CGI-S 6 "severely ill" correspondence — adolescents 12–17 years
In adolescents aged 12–17 years, a total score of 51 to 54 (median 52) corresponds to the CGI-S level "severely ill" (n = 59).
Nasser et al. (2021)View the study
Scoring
Sum by subscale and symptom count, total score from 0 to 54, each item is rated on a 4-point scale (from 0 to 3).
Inattention
8/ 27
Sum of the 9 items covering the DSM-5 "inattention" domain: attention to details, sustaining attention, listening when spoken to, following instructions, organization, sustained mental effort, losing things, distractibility, and forgetfulness (domains listed in the Sudanese study, Front Psychiatry 2024).
items 1, 3, 5, 7, 9, 11, 13, 15, 17
cliniquemixed · condition: ADHD (DSM-5), phase 3 trial participants · placebo arm, baseline · 12–17 years · United States · n = 96 · 2021 · Nasser et al. (2021)
027
8
M = 22.4 ± 3.59
Hyperactivity / Impulsivity
17/ 27
Sum of the 9 items covering the DSM-5 "hyperactivity-impulsivity" domain: motor restlessness, leaving seat, running/climbing, difficulty playing quietly, being "on the go", excessive talking, blurting out answers, waiting turn, and interrupting others (domains listed in the Sudanese study, Front Psychiatry 2024).
items 2, 4, 6, 8, 10, 12, 14, 16, 18
cliniquemixed · condition: ADHD (DSM-5), phase 3 trial participants · placebo arm, baseline · 12–17 years · United States · n = 96 · 2021 · Nasser et al. (2021)
027
17
M = 16.4 ± 6.36

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What the test measures

The ADHD-RS-5 evaluates the primary dimensions of attention-deficit/hyperactivity disorder through a direct operationalization of DSM-5 criteria.

  • Inattention: Captures difficulties with sustained focus, task organization, and memory, pinpointing areas where patients may require targeted study and test-taking strategies.
  • Hyperactivity: Assesses excessive motor activity, restlessness, and difficulty engaging in quiet leisure, providing insight into the child's physical regulation needs.
  • Impulsivity: Measures challenges with inhibitory control, such as interrupting others or blurting out answers, which often require specific self-regulation skills for children.

This measure is primarily designed for children and adolescents aged 5 to 17, with ratings typically provided by parents or teachers based on recent observations.

When and why to use it

Clinicians typically integrate the ADHD-RS-5 across multiple phases of care, from initial diagnostic evaluation to long-term monitoring.

  • Intake baseline: Establishes a comprehensive profile of symptom severity across the two core diagnostic dimensions before beginning treatment.
  • Cross-context screening: Gathers standardized behavioral data from multiple informants (parents and teachers) to verify if symptoms are pervasive across environments.
  • Monitoring change: Tracks the trajectory of specific symptoms over time, providing objective feedback on the efficacy of practical ADHD management tools.
  • Differential support: Helps distinguish primarily inattentive presentations from combined or hyperactive-impulsive ones, guiding the clinician to target the relevant brain functions and executive skills during psychoeducation.

A validated score adds critical reliability over clinical impression alone, anchoring the diagnostic process in standardized, age-calibrated data while guiding precise therapeutic decisions.

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The questions

  1. Please read each statement and indicate how often this behavior was observed over the past 6 months. Check the response that best describes the situation.
    1. Fails to give close attention to details or makes careless mistakes in work (schoolwork or other).
    Assesses challenges with meticulousness and the tendency to make careless errors in structured tasks.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  2. 2. Fidgets with or taps hands and feet, or squirms in seat.
    Evaluates physical restlessness and the inability to remain physically still when seated.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  3. 3. Has difficulty sustaining attention in tasks or play activities.
    Probes the capacity to maintain continuous focus during tasks or recreational activities.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  4. 4. Leaves seat in situations when remaining seated is expected.
    Examines the ability to adhere to expectations of remaining seated in structured environments.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  5. 5. Seems not to listen when spoken to directly.
    Measures apparent deficits in auditory attention during direct social interactions.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  6. 6. Runs about or climbs in situations where it is inappropriate (or feels restless).
    Assesses developmentally inappropriate levels of motor activity, such as excessive running, climbing, or internal restlessness.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  7. 7. Does not follow through on instructions and fails to finish work (or chores).
    Evaluates difficulties in executing multi-step instructions and following tasks through to completion.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  8. 8. Has difficulty playing or engaging in leisure activities quietly.
    Probes the capacity to modulate physical energy and engage quietly in leisure settings.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  9. 9. Has difficulty organizing tasks and activities.
    Examines executive functioning deficits related to structuring, sequencing, and managing tasks.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  10. 10. Is 'on the go' or acts as if 'driven by a motor'.
    Assesses persistent, driven motor activity and internal feelings of generalized restlessness.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  11. 11. Avoids tasks that require sustained mental effort.
    Measures avoidance behaviors directed toward activities demanding prolonged cognitive engagement.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  12. 12. Talks excessively.
    Evaluates challenges with verbal inhibition and the regulation of conversational output.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  13. 13. Loses things necessary for tasks or activities.
    Probes organizational memory and the frequency of misplacing essential personal items.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  14. 14. Blurts out an answer before a question has been completed.
    Assesses verbal impulsivity and the inability to wait for a conversational prompt to conclude.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  15. 15. Is easily distracted by external stimuli.
    Examines susceptibility to environmental interruptions and off-task shifts caused by external stimuli.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  16. 16. Has difficulty waiting their turn.
    Measures difficulties with delayed gratification and patience in turn-taking scenarios.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  17. 17. Is forgetful in daily activities.
    Evaluates the frequency of minor memory lapses and oversights in routine daily obligations.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
  18. 18. Interrupts or intrudes on others.
    Probes behavioral impulsivity regarding personal boundaries and conversational turn-taking.
    • Never or rarely
    • Sometimes
    • Often
    • Very often
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