The Missing Denominator: Reading a Score That Moved When Life Did Not

In a 2025 New Zealand survey, 97 adults who suspected they had ADHD without a diagnosis filled in the same two questionnaires as 232 adults who had one.

Murray and colleagues found the symptom scores were indistinguishable (p = .573). The quality-of-life scores were not: the undiagnosed group reported worse lives (p < .001), and the gap held whether or not the diagnosed group took medication.

Same symptoms, different lives, and the questionnaire could not see a thing.

A score with nothing underneath it

A symptom questionnaire counts what a person carries. It asks nothing about the weight.

Call that the missing denominator, and then notice how few of the measures on your desk have one.

One r/ADHD commenter puts it better than the instruments do: “as my life responsibilities increased, my symptoms became even more pronounced. I couldn’t keep up anymore.” Same trait, heavier year, and not one questionnaire on the market would have logged the change.

Which is why a flat score tells you almost nothing by itself. A client who held level through a house move and a new manager has done something genuinely hard, and the instrument draws a straight line through it.

The reading I want to argue against is the one where that line means the work failed. The ASRS behaves the same way: it gives you a count, and the count knows nothing about the year it was collected in.

It runs the other direction too, which is the version coaches get blamed for. Scores improve, the load grows into the space they freed, and the client says nothing feels different, because nothing does.

The measure you can actually run every week

There is a proper quality-of-life scale for adult ADHD and most coaches cannot use it. The AAQoL, validated on 989 adults, covers life productivity, psychological health, relationships and life outlook, which is the right ground. Its recall window is two weeks, so weekly use has each score eating the one before it, and the licensing on the standard adult instruments is tight enough that adapting them is off the table.

So build your own, out of a method rather than a scale.

Before the work starts, sit with the client and write five levels for one goal: what you both expect, one better, one much better, one worse, one much worse. Score against those levels at review. Bard-Pondarré and colleagues reviewed the approach in the Journal of Rehabilitation Medicine in 2023, and it has since spread into dementia, geriatric and cervical-dystonia care under the name “personalized endpoint”.

The load is already inside the levels, because you wrote them around this client’s actual year.

The review is blunt about what you are getting. Goal attainment scaling “is not a ‘scale’ but a heterogeneous group of methodologies”, it will not compare one client against another, and it inflates when the same person writes the levels and scores them. So write them with the client, and never rank two clients on it.

What the denominator does not buy you

It does not buy evidence. No randomised trial in adults shows that coaching causes anything, the largest dedicated coaching trial still dates from 2013, and a ladder the two of you wrote together is a record rather than a finding. I would rather say that out loud than let a client work it out later.

What is settled sits one layer up. Medication cuts core symptoms, and across 113 trials no medication improved quality of life. That gap is where coaching works, and it is why the symptom number was never going to answer the question your client is actually asking you.

So write down what the week asked of them, next to whatever the score says. Without that second line you are reading half a sentence and calling it a verdict.