Wender Utah Rating Scale Scoring

Wender Utah Rating Scale Scoring - there is more to know than you might think!

Scoring—and interpreting—the Wender Utah Rating Scale (WURS) is more complicated than online scoring calculators would lead you to believe.

Table of Contents

• Key Points
• What is the Wender Utah Rating Scale?
• Terminology
• Wender Utah Rating Scale Scoring: What You Need to Know
• Wender Utah Rating Scale Interpretation
• Scoring Sheet for the WURS-45 (image)
• Recommended Reading

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Key Points

• The Wender Utah Rating Scale (WURS) is a retrospective self-report of possible childhood 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. 
  
  
• There are different WURS forms—scoring and interpretation procedures differ depending on which form you use.
  
  
• Read the WURS Handbook (manual) to form your own opinion, but I suggest using the WURS-45 because:
  
  (1) You can calculate the original WURS score based on 25 of the 45 items (the WURS-25 score), which works well as a screening test in primary care settings.
  
  (2) The WURS-25 form looks like an "ADHD test"; the WURS-45 form does not (if you use a slightly modified version I created: WURS-45-clean.pdf). Since many adults want an ADHD diagnosis for various reasons, the WURS-25 form might lead to higher false positive results.
  
  (3) For differential diagnosis (depression/anxiety vs. ADHD) you can calculate a "fitted value score" from the WURS-45. Calculating the fitted value score takes too long for screening, but is an effective Wender Utah Rating Scale scoring method when used as one component of a comprehensive adult ADHD evaluation conducted by a psychologist. (The fitted value score relies on advanced statistical procedures explained in Gift et al. (2021) - see the Recommended Reading section below.)
  
  
• Note that the WURS-45 in the Handbook includes an introduction that states: "This scale assesses childhood symptoms and/or behaviors associated with persistence of ADHD into adulthood." I created a WURS-45 without that statement. I also removed asterisks next to many of the questions and a notation at the end of the questionnaire: "*items scored in the WURS-25 **items with negative factor loading scores". It is useful to know that information, but it is in the Handbook and incorporated into the WURS-45 Scoring Sheet, and are not needed for individuals completing the instrument.

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What is the Wender Utah Rating Scale?

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Download the Wender Utah Rating Scale Handbook

→ Click here to download the Wender Utah Rating Scale Handbook. 

You can also access the Wender Utah Rating Scale Handbook at: perma.cc/F4VS-TMU5. 

The WURS Handbook is licensed under CC BY-4.0, which means you are free to copy and redistribute the Handbook in any medium or format, provided you:

1. give appropriate credit,
2. provide a link to the license [https://creativecommons.org/licenses/by/4.0/], and
3. do not charge for its use for commercial purposes.
   
   

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Terminology

• "WURS-25" refers to both a scoring method and a form, which is confusing. I therefore use the terms "WURS-25 scoring" (or "WURS-25 score") and "WURS-25 form" for clarity.
  
  
• "ADHD-specific items" also has two meanings:

1. In the original (1980s) Wender Utah Rating Scale research, 25 out of the original 61 items were found to best distinguish adults with ADHD from adults who did not have ADHD. Those 25 items appear on the WURS-25 form and they are embedded in the WURS-45 and WURS-61 forms.
   
   Regardless of their source, those 25 items constitute the (original) WURS score, which I refer to as the "WURS-25 score" to distinguish the score from the "WURS-25 form".
   
   
2. More recent research has identified items that load onto an ADHD factor (based on factor analytic research). This ADHD factor score is used in a regression formula to calculate a "fitted value" score, which is a more sophisticated statistical approach to WURS scoring that helps psychologists to differentiate adult ADHD from other mental disorders that have many of the same symptoms.
   
   For example, Major Depressive Disorder, PTSD, Generalized Anxiety Disorder, and ADHD all include "difficulty concentrating" (or similar) in their diagnostic criteria.
   
   

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Wender Utah Rating Scale Scoring: 
What You Need to Know

Here is what you need to know about Wender Utah Rating Scale scoring:

(1) There are several WURS forms. WURS scoring differs depending on which WURS form you use. The most used forms are:

(a) WURS-61: the original Wender Utah Rating Scale.

(b) WURS-25: ADHD-specific items only, drawn from the WURS-61. 

(c) WURS-45: Forty-five items drawn from the WURS-61.

The WURS-45 is the most psychometrically sound version because it includes only those WURS-61 items that load onto symptom clusters (factors) derived from factor analytic and related statistical analysis.

The WURS-45 also includes all the WURS-25 items, so you can calculate the WURS-25 score when you use the WURS-45 form.

In addition, 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. 

→ However, the WURS-45 in the Handbook includes an introduction that states: "This scale assesses childhood symptoms and/or behaviors associated with persistence of ADHD into adulthood."

I created a WURS-45 without that statement:

WURS-45-clean.pdf

I also removed asterisks next to many of the questions and a related notation at the end of the questionnaire which states: "*items scored in the WURS-25 **items with negative factor loading scores".

It is useful to know that information, but it is in the Handbook and incorporated into the WURS-45 Scoring Sheet, and it is not needed for individuals completing the instrument.

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Wender Utah Rating Scale Interpretation

Scoring Sheet for the WURS-45 (image)

Before using the WURS-45, please download the entire Wender Utah Rating Scale Handbook because you should read the Handbook before scoring and interpreting WURS-45 results.

• Reimherr, Frederick W., Barrie K. Marchant, Thomas E. Gift, Tammy A. Steans, Melissa Wilson, and Camille Pommerville. Handbook of Utah Scales for the Assessment and Treatment of ADHD in Adults. Version 1, 2022. perma.cc/F4VS-TMU5. 

→ Note that the WURS-45 in the Handbook includes an introduction that states: "This scale assesses childhood symptoms and/or behaviors associated with persistence of ADHD into adulthood." I created a WURS-45 without that statement:

WURS-45-clean.pdf

I also removed the asterisks next to many of the questions and a related notation at the end of the questionnaire: "*items scored in the WURS-25 **items with negative factor loading scores" because that information is in the Handbook and the asterisks tend to distract or perplex test-takers.

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Recommended Reading

Brevik, Erlend Joramo, Astri J. Lundervold, Jan Haavik, and Maj‐Britt Posserud. "Validity and Accuracy of the Adult Attention‐Deficit/Hyperactivity Disorder (ADHD) Self‐Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) Symptom Checklists in Discriminating Between Adults with and without ADHD." Brain and Behavior 10, no. 6 (Apr 2020): e01605.

Gift, Thomas E., Matthew L. Reimherr, Barrie K. Marchant, Tammy A. Steans, and Frederick W. Reimherr. "Wender Utah Rating Scale: Psychometrics, Clinical Utility and Implications Regarding the Elements of ADHD." Journal of Psychiatric Research 135 (2021): 181-188.

Marchant, Barrie K., Fred W. Reimherr, Diane Robison, Reid J. Robison, and Paul H. Wender. "Psychometric properties of the Wender-Reimherr Adult Attention Deficit Disorder Scale." Psychological Assessment 25, no. 3 (2013): 942.

Reimherr, Frederick W., Barrie K. Marchant, Thomas E. Gift, Tammy A. Steans, and Matthew L. Reimherr. "Psychometric Data and Versions of the Wender Utah Rating Scale including the WURS-25 & WURS-45." Data in Brief 37, art. no. 107232 (Aug 2021).

Reimherr, Frederick W., Barrie K. Marchant, Thomas E. Gift, Tammy A. Steans, Melissa Wilson, and Camille Pommerville. Handbook of Utah Scales for the Assessment and Treatment of ADHD in Adults. Version 1, 2022. https://perma.cc/F4VS-TMU5.

Ward, Mark F., Paul H. Wender, and Fred W. Reimherr. "The Wender Utah Rating Scale: An Aid in the Retrospective Diagnosis of Childhood Attention Deficit Hyperactivity Disorder." American Journal of Psychiatry 150, no. 6 (1993): 885-890.

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