Wender Utah Rating Scale - 61-item version: Scoring, Cutoffs & Interpretation

What this scale measures.

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.

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.

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.

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.

How it compares to the alternatives.

Right tool, wrong tool.

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.

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.

How licensing works.

The rights holders confirm the WURS-61 may be hosted publicly as long as access is not placed behind a paywall. Aisel provides it free of charge; please do not resell or paywall this content. Items from Wender, P. H. (1995), Attention-Deficit Hyperactivity Disorder in Adults, Oxford University Press.

Common questions from clinicians

FAQ

References

Source literature.

1. [1]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;150(6):885-890 (1993) ↩
2. [2]Gift TE, Reimherr ML, Marchant BK, Steans TA, Reimherr FW Wender Utah Rating Scale: psychometrics, clinical utility and implications regarding the elements of ADHD. J Psychiatr Res 2021;135:181-188 (2021) ↩
3. [3]Reimherr FW, Marchant BK, Gift TE, Steans TA, Reimherr ML Psychometric data and versions of the Wender Utah Rating Scale including the WURS-25 and WURS-45. Data in Brief 2021;37:107232 (2021) ↩
4. [4]Brevik EJ, Lundervold AJ, Haavik J, Posserud MB Validity and accuracy of the ASRS and the WURS symptom checklists in discriminating between adults with and without ADHD. Brain Behav 2020;10(6):e01605 (2020) ↩
5. [5]Hill BD, Pella RD, Singh AN, Jones GN, Gouvier WD The Wender Utah Rating Scale: adult ADHD diagnostic tool or personality index? J Atten Disord 2009;13(1):87-94 (2009) ↩
6. [6]McCann BS, Scheele L, Ward N, Roy-Byrne P Discriminant validity of the Wender Utah Rating Scale for ADHD in adults. J Neuropsychiatry Clin Neurosci 2000;12(2):240-245 (2000) ↩