ADHD · 0–100 · Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993.
Licensed instrument
WURS-61: scoring, cutoffs & interpretation
The 61-item parent form of the Wender Utah Rating Scale; standard scoring uses the 25-item subset (WURS-25).
The Wender Utah Rating Scale asks adults to rate, retrospectively, how they were as children. Its 61 items cover attention and concentration, activity level and impulsivity, conduct and oppositional behaviour, mood and anxiety, academic difficulty, and social functioning. The stem is "As a child I was (or had)...", and each item is rated from "not at all or very slightly" through to "very much". Its purpose in adult ADHD assessment is to establish the childhood-onset requirement, which cannot be met by any measure of current symptoms.
What it measures in practice is broader than its purpose suggests. The items were selected for their power to discriminate adults with ADHD from controls, not for content validity against ADHD criteria, and the consequence is a scale that indexes general childhood psychopathology and adult personality as much as childhood attention. In one large clinic sample, personality variables from the PAI accounted for around 37% of WURS variance while neuropsychological measures accounted for 4%, and the scale correlated significantly with every clinical scale on the PAI. Read a high score as evidence of a difficult childhood that warrants careful history-taking, not as evidence of childhood ADHD specifically.
02 - Origin & purpose
Where it comes from.
Ward, Wender and Reimherr published the scale in the American Journal of Psychiatry in 1993, working at the University of Utah under an NIMH grant. Their study compared 81 adults with ADHD, 100 normal adults and 70 adults with unipolar depression. They administered all 61 items but, as the paper states, "arbitrarily chose to analyze data from the 25 items showing the greatest mean difference" - and it is those 25 items that became the WURS-25, the form that carries all the published norms, cutoffs and accuracy data. The full 61 items were printed in an appendix, in the authors' words, "for use by other researchers".
That history explains the page you are reading. For nearly thirty years the 61-item form had no scoring rule of its own. Interest revived in 2021, when the original Utah group published a five-factor analysis showing that the full instrument, scored through logistic regression on factor scores, distinguished ADHD from depression and anxiety considerably better than the WURS-25 total did. That finding is real and is the best argument for administering all 61 items - but it does not amount to a total score, and it has not been independently replicated.
03 - Scoring & cutoffs
How scoring works.
There is no published total score for the WURS-61, and no published cutoff for it. This needs saying directly, because a threshold of "greater than 112" circulates widely online. It traces to a single 2004 paper that attached no citation to it, and the source that paper lists contains no such figure. It is unsourced and should not be used. Summing all 61 items produces a number, but not a meaningful statistic.
What is scored is the 25-item subset. Each of those items is rated 0 to 4, giving a range of 0 to 100, with no reverse-scored items. Two cutoffs come from the original 1993 validation: a score of 36 or more separated adults with ADHD from normal controls with 96% sensitivity and 96% specificity, and a score of 46 or more correctly classified 86% of the ADHD group, 99% of normal controls and 81% of the depressed group. The second threshold is the one that matters clinically, because the comparison that matters clinically is against other psychiatric presentations, not against healthy controls. Later work has proposed lower thresholds in specific populations - 30 against population controls, 35 in a Norwegian sample, 39 in psychiatric outpatients aged 18 to 25, 32 in a Spanish addiction unit.
The case for administering all 61 items rests on factor scores rather than a total. Scoring the full instrument through its five factors, the Utah group reported 84% sensitivity and 94% specificity against combined depression and anxiety controls, against 62% and 86% for the WURS-25 total in the same sample. If you want that performance you need the published regression equations, not a sum. For ordinary clinical use, the WURS-25 remains the practical choice.
Standard scoring sums the 25 selected items (each 0-4, range 0-100). In the original validation, a cutoff of 46 or more identified 86% of adults with ADHD while correctly classifying 99% of normal controls and 81% of adults with depression. The remaining 36 items are not scored; in practice, administering the WURS-61 yields the same score as administering the WURS-25, plus additional unscored clinical context. Retrospective self-report is memory-dependent, and high scores also occur in other conditions, so the score supports - never replaces - a structured diagnostic assessment.
04 - Validation evidence
How well it performs.
The evidence base for the WURS belongs almost entirely to the 25-item form. No Cronbach's alpha has ever been published for the 61-item version, and no test-retest coefficient - two retest studies were conducted, one with 83 adults over four weeks and one with 57 adults over a month, and neither published a number. The WURS-25 is reliably internally consistent across five language versions. Its weakness is specificity in real referral populations rather than reliability: against healthy controls it performs very well, but against patients with depression and anxiety, which is the comparison a clinic actually faces, sensitivity falls to around 62%. Its factor structure is unstable, varying between three and five factors across studies and differing between men and women. It has no validity scale and is straightforwardly feignable.
Not published (61-item)
Internal consistency
Not published for the 61-item form. WURS-25: alpha = .967 (Norwegian, n = 1,554), .95 (US clinic, n = 141), .94 (Swedish and Spanish), .93 (Turkish); WURS-K alpha = .91 (German).
Not published (61-item)
Test-retest
No coefficient published for the 61-item form. WURS-25 and short forms: r = .981 at one week and .924 at two months (Italian), r = 0.9 (WURS-K, German), r = .81 at four weeks (Turkish), r = .68 at one month (US college sample).
Sens 96% / Spec 96%
Diagnostic accuracy, WURS-25, original validation
Cutoff of 36 or more against normal controls - sensitivity 96%, specificity 96%. Cutoff of 46 or more across three groups - 86% of ADHD, 99% of normal controls and 81% of depressed patients correctly classified (Ward et al. 1993, n = 251).
Sens 84% / Spec 94%
Diagnostic accuracy, full 61 items vs psychiatric controls
Five-factor logistic regression - sensitivity 84%, specificity 94%, PPV 88%, NPV 91%. WURS-25 total in the same sample - sensitivity 62%, specificity 86% (Gift et al. 2021, n = 487). The companion papers report AUC as 0.955 and 0.995 for the same comparison without reconciling the discrepancy; we cite the lower figure.
Free and open. Reach for it essentially always, in preference to the 61. The same construct at 40% of the length, and the only version carrying published cutoffs, norms and accuracy data.
Free, no permission required. Reach for it when the question is current adult symptoms rather than childhood recall. Complementary to the WURS, not a substitute: you need both onset and persistence.
Commercial, qualification level C. Reach for it when you need norm-referenced T-scores, an observer-report counterpart and validity indices - medicolegal, disability or forensic work. It is the only instrument here with malingering-detection capacity; the WURS has none.
BAARS-IV
18 / 27
Commercial
Commercial, one-off purchase with photocopy licence included. An 18-item childhood retrospective form and a 27-item current form. The closest direct competitor for retrospective childhood assessment, and better when you want recall anchored to DSM criteria, a matched current-symptoms form and an other-report version from a spouse, parent or sibling.
WURS-K
21 + 4
Commercial
Commercial, part of the HASE battery. Twenty-one scored items plus four control items. Reach for it in German-speaking practice: the built-in control items give a response-bias check the English forms lack. It uses a different item selection from the WURS-25 and the two are not interchangeable.
Semi-structured interview covering 18 DSM-5 criteria rated for both childhood and adulthood, EUR 10 per clinician. Reach for it as the confirmatory step after a positive screen. It supplies the concrete childhood examples that let a clinician probe recall rather than accept a self-rating, and establishes impairment and age of onset, which no questionnaire does.
06 - When to use it
Right tool, wrong tool.
Reach for it when
-Establishing the childhood-onset requirement in an adult ADHD assessment, alongside a measure of current symptoms.
-Screening in settings where a high negative predictive value is useful - a low score is reasonably informative.
-Research where comparability with a very large existing WURS literature matters.
Reach for something else when
-As a diagnostic test. NICE NG87 states that a diagnosis of ADHD should not be made solely on the basis of rating scale or observational data.
-As an outcome or change measure. No MCID, responsiveness or sensitivity-to-change data exist for any WURS version, and one review notes explicitly that sensitivity to change is missing.
-In forensic, disability or medicolegal contexts. The scale has no validity or infrequency scale, and in one study 65% of coached simulators with no ADHD history produced a positive result after five minutes' exposure to the diagnostic criteria. Use the CAARS instead.
-In patients with alcohol dependence - one German study of 402 inpatients concluded the WURS-K "cannot be recommended" as a single screening instrument in this group.
-In veterans with a history of PTSD or traumatic brain injury, where sensitivity fell to 27.7% in a study of 332 combat-deployed post-9/11 veterans.
-In anyone under 18. The entire evidence base is adult; the youngest validated sample is 18 to 25.
07 - Confidence & precision
Reading the score with care.
No standard error of measurement has been published for any WURS version, so we cannot place a confidence interval around a score and will not invent one. Two specific sources of imprecision deserve weight. Current state contaminates retrospective recall: adults with current ADHD symptoms rate their childhoods more severely, which is why collateral history from a parent or sibling materially improves the assessment. And positive predictive value falls sharply outside enriched clinic samples - one Finnish study found a PPV of .53 in-sample but only .21 when recalculated at true population prevalence. In a general or primary care setting, most positive WURS screens will not be ADHD.
08 - Limitations
What it cannot tell you.
- No total score and no cutoff exist for the 61-item form. The widely circulated threshold above 112 is unsourced.
- The scale largely measures personality and general psychopathology rather than childhood attention specifically.
- Poor specificity in real referral populations - roughly half of non-ADHD patients are misclassified in clinic samples.
- Items were selected for discriminative power, not content validity, so most do not tap core ADHD symptoms.
- No validity scale, and demonstrably easy to feign. One study also found a sex bias, with men more likely to reach a positive result.
- Factor structure is unstable across studies and differs between men and women.
- Retrospective recall is contaminated by current symptom state.
- Normative data are thin; a collegiate sample scored considerably higher than the original normative group.
- No administration time has been published for either the 61- or 25-item form.
- Note on sources: a frequently quoted reliability string - test-retest .96, inter-rater .75, alpha .78 - belongs to the WRAADDS, a clinician-rated interview, not to the WURS. The presence of an inter-rater coefficient is the giveaway, since it is meaningless for a self-report questionnaire.
09 - Licensing, explained
How licensing works.
The licensing position for the 61-item form is genuinely unresolved, and we say so rather than guess. The items were published as Appendix 2 of an American Journal of Psychiatry article; AJP authors transfer copyright to the American Psychiatric Association, whose permissions policy reserves all rights with no carve-out for scales or appendices. Against that, an original co-author states in the 2022 Handbook of Utah Scales that "we published the scale without restrictions, which encouraged use of the scale", and the complete 61 items have been reprinted in an open-access Data in Brief article under a CC BY-NC-ND licence. The University of Washington instrument library, the most authoritative neutral catalogue, records simply: "Copyright information unavailable." A claim that the scale is public domain circulates on one commercial site; it cites no source, is internally incoherent, and should not be relied on. The instrument is not a US Government work - the authors were University of Utah employees, and federal grant funding does not create a federal work. On that basis we publish scoring structure and metadata only, and do not reproduce item wording.
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