Validation of a Simplified Scoring Method of the ADHD Symptom and Side Effect Tracking (ASSET) Scale

Background: Accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD) is difficult due to the heterogeneous nature of symptoms and high potential to overlap with other disorders. There is still unmet need for accessible rating scales with quickly-interpretable outcomes. The ADHD Symptom and Side Effect Tracking (ASSET) Baseline Scale, originally validated with a factor-weighted scoring method, may also be scored by a simple sum of 10 item responses. This study aims to validate the Sum scoring method and establish a clinical cut score.Methods: This retrospective study was conducted using de-identified medical treatment records (N=2,718) obtained from the Rochester Center for Behavioral Medicine (RCBM) between May 1, 2022, and March 5, 2024. Before their first visit with a clinician, participants completed digital pre-visit surveys, including three validated self-report assessments for ADHD: the Adult ADHD Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), and the ASSET Baseline Scale. Convergent validity was tested using bivariate correlations between scales, and receiver operating characteristic (ROC) curves established sensitivities and specificities to identify an optimal cutoff score aligning with positive results on the established rating scales.Results: There is a high degree of agreement between the two methods (Factor and Sum) of scoring the ASSET. With a cutoff point of 42.5 on the ASSET Sum, the model predicted meeting the Factor cut score with a sensitivity of 80.1% and specificity of 91.6%, and correctly classified 96.81% (2547/2631) of participants. To evaluate the ASSET Sum’s performance, a true positive was defined as achieving a positive score on two of the three other rating scales (ASRS, WURS, and ASSET Factor). Using any combination of two rating scales, the ASSET Sum had excellent differentiation in identifying true positives. The area under the ROC curve (AUC) for ASSET Factor and WURS was .926 (95% CI: 0.916–0.935), for ASRS and WURS was .838, (95% CI: 0.806–0.870), and for ASSET Factor and ASRS was .951 (95% CI: 0.934–.968).Conclusion: This study validates the simplified Sum scoring method of the ASSET Baseline Scale, showing similar performance to the original Factor scoring method and aligning with outcomes on widely-used ADHD screeners. As a short assessment with straightforward scoring and strong diagnostic accuracy, the ASSET has the potential to be a valuable clinical tool for specialists and non-specialists.