Wender Utah Rating Scale (WURS-25)

The Wender Utah Rating Scale (WURS-25) is a highly validated clinical tool designed to retrospectively assess the presence and severity of…

Questions: 25
Duration: 10 min
Original title: WURS-25 — Wender Utah Rating Scale
Adaptation: Wender Utah Rating Scale (WURS-25)
Authors: Ward, M. F., Wender, P. H., & Reimherr, F. W.
Created: 1993

The Wender Utah Rating Scale (WURS-25) is a highly validated clinical tool designed to retrospectively assess the presence and severity of attention-deficit/hyperactivity disorder (ADHD) symptoms during childhood. Establishing a childhood onset of symptoms is a core diagnostic requirement for adult ADHD across major classification systems. By systematically documenting early life challenges, the WURS-25 helps clinicians gather historical evidence when collateral information or school records are unavailable.

Originally derived from a 61-item pool, this 25-item short form captures the most discriminative symptom clusters, including inattention, impulsivity, and affective lability. The instrument not only screens for neurodevelopmental continuity but also assists in untangling lifelong struggles from acute mood episodes. Clinicians can use the results alongside tools that open the depression conversation in session or track bipolar disorder warning signs to ensure a robust differential diagnosis.

Administered during the intake or assessment phase, the WURS-25 offers a standardized metric of historical impairment. It provides a reliable foundation for conceptualizing the patient's lifelong narrative, illuminating how early difficulties may have shaped current challenges and how they formed adaptive vs maladaptive coping strategies over time.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

50/ 100

A 25-item retrospective self-report questionnaire for adults (≥ 18 years) undergoing evaluation for ADHD. The individual describes their childhood behavior and emotional experiences in order to objectify the presence of childhood ADHD symptoms, a required criterion for diagnosing ADHD in adulthood. The scale examines three dimensions: mood/disruptive behavior, inattention/hyperactivity, and depression/anxiety.

0–29

Normal Range relative to population expectations

30–45

High childhood symptom severity / Likely ADHD

46–100

Very High childhood symptom severity / Very Likely ADHD

Best differentiates between ADHD and depression/anxiety groups. Corresponds to the 99.9th normative percentile.

généralemixed · community sample · United States · n = 120 · Reimherr et al. (2021)

0100

M = 14.51 ± 9.99

cliniquemixed · condition: ADHD · United States · n = 137 · Reimherr et al. (2021)

0100

M = 51.47 ± 15.71

cliniquemixed · condition: MDD, GAD · United States · n = 230 · Reimherr et al. (2021)

0100

M = 29.2 ± 18

Scoring

Sum (total score) + sum by subscale, total score ranging from 0 to 100, each item is scored on a 5-point scale (from 0 to 4).

Depression/Anxiety

5/ 16

Evaluates childhood emotional difficulties including worry, sadness, negative self-perception, and feelings of guilt or regret that may co-occur with or complicate ADHD presentations.

items 2, 9, 11, 17

généralemixed · community sample · United States · n = 120 · Reimherr et al. (2021)

016

M = 2.6 ± 2.8

cliniquemixed · condition: ADHD · United States · n = 137 · Reimherr et al. (2021)

016

M = 7.2 ± 3.9

cliniquemixed · condition: MDD, GAD · United States · n = 230 · Reimherr et al. (2021)

016

M = 7.1 ± 4

Inattention/Hyperactivity

19/ 36

Measures core ADHD symptoms during childhood, including concentration difficulties, distractibility, fidgetiness, impulsivity, academic underachievement, and problems with task completion and follow-through.

items 1, 3, 4, 7, 15, 16, 23, 24, 25

généralemixed · community sample · United States · n = 120 · Reimherr et al. (2021)

036

M = 6.7 ± 5.7

cliniquemixed · condition: ADHD · United States · n = 137 · Reimherr et al. (2021)

036

M = 22.7 ± 6.3

cliniquemixed · condition: MDD, GAD · United States · n = 230 · Reimherr et al. (2021)

036

M = 10.5 ± 6.9

Mood/Disruptive Behavior

22/ 44

Assesses childhood patterns of temper dysregulation, mood instability, oppositional behaviour, and conduct difficulties, including items addressing irritability, angry outbursts, defiance, and trouble with authorities.

items 5, 6, 8, 10, 12, 13, 14, 18, 19, 21, 22

généralemixed · community sample · United States · n = 120 · Reimherr et al. (2021)

044

M = 5.9 ± 4.8

cliniquemixed · condition: ADHD · United States · n = 137 · Reimherr et al. (2021)

044

M = 20.4 ± 9.2

cliniquemixed · condition: MDD, GAD · United States · n = 230 · Reimherr et al. (2021)

044

M = 11.2 ± 8.8

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What the test measures

The WURS-25 retrospectively evaluates the frequency and severity of neurodevelopmental and behavioral difficulties experienced between the ages of 8 and 12.

Inattention and Hyperactivity: Evaluates core cognitive challenges such as distractibility, fidgeting, daydreaming, and academic underachievement.
Disruptive Mood and Behavior: Assesses early emotional dysregulation, including temper tantrums, irritability, and oppositional tendencies that can later influence adult communication styles.
Depression and Anxiety: Captures internalizing symptoms, such as persistent worry, low self-esteem, guilt, and pervasive sadness during childhood.
Interpersonal Functioning: Screens for early social difficulties, such as peer rejection, isolation, and struggles to understand others' perspectives, highlighting relational patterns where exploring how emotions motivate actions provides clinical insight.

This instrument is intended for adult patients (18 years and older) undergoing a diagnostic evaluation for suspected ADHD, providing a structured retrospective account of their childhood presentation.

When and why to use it

Clinicians utilize the WURS-25 primarily during the initial diagnostic workup for adult ADHD to confirm the developmental persistence of symptoms.

Diagnostic Intake: To establish a clear historical timeline of symptoms, meeting the criterion that difficulties were present before early adolescence.
Differential Support: To distinguish lifelong neurodevelopmental traits from adult-onset mood disorders, complementing a broader clinical evaluation.
Treatment Planning: To identify long-standing patterns of emotional dysregulation or academic failure that may still require targeted intervention, often explored using a CBT here-and-now model.
Psychoeducational Context: To validate the patient's lifelong lived experience, potentially addressing deep-seated cognitive distortions by framing early difficulties through a neurodevelopmental lens rather than as personal failures.

A validated retrospective score provides an empirical anchor for childhood onset, offering greater diagnostic confidence than unstructured clinical interviewing alone, especially when corroborating early records are absent.

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The questions

Below is a list of items concerning behaviors or problems that individuals with ADHD may have exhibited in childhood. Read each item and indicate to what extent it described you when you were a child (approximately 8 to 12 years of age). As a child I was (or had):
1. Problems with concentration; easily distracted.
Assesses early difficulties with sustained attention and susceptibility to external interference.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
2. Anxious, worried.
Probes for historical signs of internalizing distress and pervasive apprehension.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
3. Nervous, restless, fidgety.
Evaluates the childhood presence of physical restlessness and motor hyperactivity.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
4. Inattentive, daydreamer (head in the clouds).
Captures tendencies toward mental drift and disconnection from immediate surroundings.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
5. Hot-tempered, touchy, short-fused.
Measures early emotional reactivity and a lowered threshold for frustration.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
6. Tantrums, outbursts of rage.
Assesses the frequency of severe behavioral dysregulation and angry outbursts.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
7. Difficulties completing tasks, persevering, finishing what I started.
Evaluates executive functioning challenges related to task persistence and completion.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
8. Stubborn, obstinate, strong-willed.
Probes for early oppositional traits and rigidity in behavioral compliance.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
9. Sad or gloomy, depressed, unhappy.
Captures early depressive symptomatology and persistent low mood.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
10. Disobedient towards my parents, rebellious, defiant.
Assesses childhood resistance to authority and noncompliant behavior within the family.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
11. Had a low opinion of myself.
Evaluates the historical presence of poor self-esteem and negative self-concept.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
12. Irritable.
Probes for a pervasive baseline of crankiness and emotional friction.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
13. Moody, with ups and downs.
Captures early signs of affective lability and rapid emotional shifts.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
14. Angry.
Assesses a general disposition toward hostility and anger in childhood.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
15. Impulsive, acted without thinking.
Measures core behavioral impulsivity and the inability to delay responses.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
16. A tendency to be immature.
Evaluates developmental lags in social or emotional maturity compared to peers.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
17. Feelings of guilt, regrets.
Probes for a tendency to internalize blame and experience excessive remorse.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
18. Lost control of myself.
Captures severe moments of emotional and behavioral dysregulation.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
19. A tendency to be or act irrationally.
Assesses behaviors that appeared disproportionate or illogical to observers.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
20. Unpopular with other children, didn't keep friends for long, didn't get along with other kids.
Evaluates historical peer relationship difficulties and social isolation.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
21. Difficulty seeing things from others' point of view.
Probes for early challenges in cognitive empathy and perspective-taking.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
22. Trouble with authority, problems at school, being sent to the principal's office.
Measures significant disciplinary issues and conflicts in structured environments.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
23. Overall a poor student at school, a slow learner.
Assesses general academic underachievement and pervasive learning difficulties.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
24. At school, difficulties with math or numbers.
Captures specific scholastic challenges related to quantitative reasoning.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much
25. At school, I didn't perform up to my potential.
Evaluates the perceived gap between the patient's intellectual capacity and their actual childhood performance.
- Not at all or very slightly
- Slightly
- Moderately
- Quite a bit
- Very much