Getting “Tested” for ADHD?

Saturday, August 25th, 2012

From time to time I will hear that an individual “is being tested for ADHD” as though there were some objective diagnostic tool which allows certain identification of the underlying condition, in the same way that one may be “tested” for Lyme’s disease.

In fact, there is no “test” for attention deficit hyperactivity disorder. Rather, ADHD is a clinical
diagnosis made on the basis of:

  • Clinical interview
  • History
  • Behavioral observations
  • Review of pertinent medical and educational records
  • Collateral report (interview with a roommate, spouse, parent, or teacher)
  • Checklists completed by client, parent, and others
  • And in my own practice, I include selected neuropsychological assessment.

Now that final bullet point regarding neuropsychological assessment is actually a big deal in terms of the time and financial commitment required. How might standardized assessment of emotional functioning and cognitive and academic skills improve upon the basic interview and clinical history for determining the presence and functional impact of ADHD?

How do we make this determination, To Test or Not to Test?

My perspective as a clinician who conducts this type of evaluation is threefold:

First, we consider the complexity of the clinical presentation. In addition to attention/focus/ impulsivity are there are other clinical concerns? Do we have other considerations such as depression or substance abuse or trauma related anxiety, or concerns about general intellectual functioning? If so, then neuropsychological evaluation may help “tease out” these factors so that
we may speak to the specific functional impact of ADHD versus some of these other concerns.

A second consideration is a practical concern: How will these test scores facilitate services or treatment or predict success in an academic or vocational setting? What will you do with this data? What these test scores might provide me, over and above that clinical history, is a context. A way of understanding the client and his/her ADHD symptoms as it impacts academic or vocational settings. After confirming an ADHD diagnosis, I am sometimes asked whether or not this 17-year-old will be able to manage the demands of college or university. And I will make use of my test scores to better answer that question. Can a 17-year-old with ADHD reasonably expect college success? If his/her general cognitive functioning is average or above-average, my response might be “yes.” He can likely manage college coursework if he has good academic and study skills supports, starts out with one or two college courses in order
to “ease into” the demands of college coursework, lives at home with supportive family for a semester or so before making the transition to dormitory life and campus social life, and if he/she is really motivated and inspired by the particular course of study. On the other hand, the student with ADHD whose cognitive abilities are below average might find college coursework unmanageable. And the student with adequate general intellectual functioning but with below-average reading achievement score may find college coursework overly demanding. So the additional neuropsychological data provides a context for understanding an individual client andmaking some useful recommendations her predictions.

A final concern is the extent to which a client actually needs my consultative input. Many parents, or adult patients, come to me fairly certain that they have some of the attentional and executive challenges associated with ADHD. And what they need from me is not a confirmation of this diagnostic label but, rather, some specific advice or direction or patient-education type support.

In summary, the decision to pursue this type of evaluation will depend upon:

The complexity of the clinical presentation, The practical “what will you do with this information” consideration, and The extent to which the client actually needs diagnostic confirmation.

To test or not to test? Talk to your doctor or healthcare advisor about your concerns and help choose your next step. You can also contact me at the link below.

 Getting “Tested” for ADHD? was written by ADHD Specialist David D. Nowell, Ph.D. — Dr. Nowell’s expertise and experience enables him to offer unique programs that help to solve real problems that are not of a clinical nature. His EnCompass one-on-one workshop can help get your life back on course. Dr. Nowell’s Adult ADHD Weekend Retreats are designed for those who are impacted in any way by ADHD. The goal of the reatreat is to empower participants to discover how they can actually live the life that, for them, might be just a dream. In his Deep Happiness by Design workshop, which Dr. Nowell presents at Kripalu, participants are enabled to re-discover the true happiness we have deep within — and it is something our bodies already know!