The Keshev-A: An adult ADHD screening measure incorporating indirect questioning and developmental indicators

This study examined the psychometric properties of the 35-item Keshev-A, one of the first adult ADHD screening questionnaires to include indirect questioning and retrospective school-age indicators. A sample of 1,668 volunteers completed the new scale and the ASRS-v1.1. The internal consistency of the Keshev-A's composite score was excellent (α = 0.94), as was that of each of the eight content-based subscales (α = .70 to .85). An exploratory factor analysis (EFA; n = 904) using principal axis factoring identified three latent factors (1) Executive Functioning/Inattention, (2) Preadolescent Hyperactivity and Attentional Difficulties, and (3) Low Self-Concept. A confirmatory factor analysis (CFA; n = 844) showed acceptable fit (CFI = .94, TLI = .93, SRMR = .044, RMSEA = .069, 90% CI [.066, .071]). The convergent validity of this new scale was supported by its strong positive correlation with the ASRS-v1.1, r(1,668) = .885, p < .001. Additionally, receiver operating characteristic (ROC) analyses showed that the Keshev-A had higher screening accuracy (AUC = .881) than the ASRS-v1.1's total score (AUC = .851) (ΔAUC = .030, z = 2.94, p = .003). This difference was primarily driven by improved negative predictive value (NPV = 63.82% vs. 54.20%) and a lower negative likelihood ratio (LR- = 0.24 vs. 0.35), indicating better identification of individuals without a self-reported ADHD diagnosis. In sum, these results show that the Keshev-A may serve as an effective instrument for screening probable ADHD. Implications for scale use, future integration within multiscale mental health instruments, and the development of symptom exaggeration subscales are discussed.