Form Structure: Adult ADHD Self-Report Scale (ASRS) v1.1
This form structure is an organized set of data definitions for a copyrighted form
Title:
Adult ADHD Self-Report Scale (ASRS) v1.1
Short Name:
ASRS
Description:
Adult ADHD Self-Report Scale (ASRS) is a self-report scale for adults to help in evaluating adults with attention deficit hyperactivity disorder.
References:
Kessler et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005 Feb;35(2):245-56. https://www.ncbi.nlm.nih.gov/pubmed/15841682
Copyright World Health Organization 2003, 2001. All rights reserved.Used with permission. Requests for permission to reproduce or translate whether for sale or for noncommercial distribution should be addressed to Professor Ronald Kessler, PhD, Department of Health Care Policy, Harvard Medical School
Disease:
General (For all diseases)
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2014-04-09
Owner:
Number of Data Elements:
37
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Recommended | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Recommended | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Recommended | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Recommended | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Recommended | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Recommended | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
| 7 | BRICS data completeness index | Index reflecting the completeness of data in BRICS calculated for a given row as % of missing variables. Calculated in % | BRICSDataCompletIndex | Optional | CDE |
| 8 | Data captured by type | Type of an individual (or a device) who captured the subject data and/or filled out the case report form (CRF), questionnaire, assessment form, computerized test, etc., including eFORMs and automatic sensors | DataCapturedByTyp | Recommended | CDE |
| 9 | Data captured by other text | The free-text field related to "Data captured by whom type" specifying other text | DataCapturedByTypOTH | Optional | CDE |
ASRS- Part A (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Adult ADHD Self-Report Scale (ASRS v1.1) - Wrapping up frequency | The frequency assessment for trouble wrapping up final details in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist, a self-reported questionnaire used to assist in the diagnosis of adult ADHD. | ASRSWrapUpFreq | Recommended | CDE |
| 2 | Adult ADHD Self-Report Scale (ASRS v1.1) - Difficulty organizing frequency | The frequency assessment for difficulty getting things in order when you have to do a task that requires organization related to question in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist. | ASRSDiffOrgFreq | Recommended | CDE |
| 3 | Adult ADHD Self-Report Scale (ASRS v1.1) - Problem remembering appointments obligations frequency | The frequency assessment for problems remembering appointments or obligations related to question in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist, a self-reported questionnaire used to assist in the diagnosis of adult ADHD. | ASRSProbRemberApptObligFreq | Recommended | CDE |
| 4 | Adult ADHD Self-Report Scale (ASRS v1.1) - Delay avoid task frequency | The frequency assessment for difficulty getting things in order when you have to do a task that requires organization related to question in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist. | ASRSDelayAvoidTaskFreq | Recommended | CDE |
| 5 | Adult ADHD Self-Report Scale (ASRS v1.1) - Fidget squirm frequency | The frequency assessment for fidgeting or squirming with hands or feet when sitting down for a long time related to question in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist. | ASRSFidgetSquirmFreq | Recommended | CDE |
| 6 | Adult ADHD Self-Report Scale (ASRS v1.1) - Overly active frequency | The frequency assessment for feeing overly active and compelled to do things related question in the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist, a self-reported questionnaire used to assist in the diagnosis of adult ADHD. | ASRSOverActiveFreq | Recommended | CDE |
ASRS- Part B (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Adult ADHD Self-Report Scale (ASRS v1.1) - Careless mistakes frequency | The frequency assessment for making careless mistakes when you have to work on a boring or difficult project, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSCarelessMistakesFreq | Recommended | CDE |
| 2 | Adult ADHD Self-Report Scale (ASRS v1.1) - Difficulty keeping attention frequency | The frequency assessment for difficulty keeping the subject's attention when the subject is doing boring or repetitive work, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSDiffcltyKeepAttenFreq | Recommended | CDE |
| 3 | Adult ADHD Self-Report Scale (ASRS v1.1) - Difficulty concentrating frequency | The frequency assessment for difficulty concentrating on what people say to the subject, even when they are speaking to you directly, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSDiffcltyConcentrateFreq | Recommended | CDE |
| 4 | Adult ADHD Self-Report Scale (ASRS v1.1) - Misplace difficulty finding frequency | The frequency assessment for misplacing or having difficulty finding things at home or at work, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSMisplaceDiffcltyFindFreq | Recommended | CDE |
| 5 | Adult ADHD Self-Report Scale (ASRS v1.1) - Distracted by activity or noise frequency | The frequency assessment for being distracted by activity or noise around the subject, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSDistractedByActNoiseFreq | Recommended | CDE |
| 6 | Adult ADHD Self-Report Scale (ASRS v1.1) - Leave seat frequency | The frequency assessment for leaving the seat in meetings or other situations in which the subject is expected to remain seated, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSLeaveSeatFreq | Recommended | CDE |
| 7 | Adult ADHD Self-Report Scale (ASRS v1.1) - Restless fidgety frequency | The frequency assessment for feeling restless or fidgety, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSRestlessFidgetyFreq | Recommended | CDE |
| 8 | Adult ADHD Self-Report Scale (ASRS v1.1) - Difficulty unwinding relaxing frequency | The frequency assessment for difficulty unwinding and relaxing when the subject has time to himself/herself, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSDiffculyUnwindRelaxFreq | Recommended | CDE |
| 9 | Adult ADHD Self-Report Scale (ASRS v1.1) - Talk too much frequency | The frequency assessment for finding the subject himself/herself talking too much when the subject is in social situations, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSTalkTooMuchFreq | Recommended | CDE |
| 10 | Adult ADHD Self-Report Scale (ASRS v1.1) - Finish sentences frequency | The frequency assessment for finding the subject himself/herself finishing the sentences of the people the subject is talking to before they can finish them themselves, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSFinishSentencesFreq | Recommended | CDE |
| 11 | Adult ADHD Self-Report Scale (ASRS v1.1) - Difficulty waiting turn required frequency | The frequency assessment for difficulty waiting the subject's turn in situations when turn taking is required, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSDiffcltyWtnTurnReqrdFreq | Recommended | CDE |
| 12 | Adult ADHD Self-Report Scale (ASRS v1.1) - Interrupt busy others frequency | The frequency assessment for interrupting others when they are busy, as part of the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist | ASRSInterptBusyOthrsFreq | Recommended | CDE |
ASRS scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Adult ADHD Self-Report Scale (ASRS v1.1) - Total score | The total score related to the Adult ADHD Self-Report Scale (ASRS) Symptom Checklist, a self-reported questionnaire used to assist in the diagnosis of adult ADHD. | ASRSTotalScore | Recommended | CDE |
Keywords
