What is ADHD testing?
To non-psychologists, the concept can seem mysterious and intimidating. What does testing entail? How does a Psychologist determine if a client has ADHD? What should I know before I get an evaluation? In this post, I’d like to discuss what ADHD testing is, how it works, and what you or a loved one can expect when they come in for an ADHD assessment.
First, I will discuss the process I use for conducting ADHD evaluations. Later I will discuss why we use tests to diagnosis ADHD and why Psychologist or other Doctors are required to complete ADHD testing.
Initial Consultation
Before testing, I have a free telephone or face-to-face meeting with a client or their parents to determine if they are a good fit for testing, answer questions about the testing process, and learn more about the case. During the consultation, I will listen for signs of the lived experience of ADHD. If someone seems unlikely to have ADHD, I will discuss this at the initial consultation. Assessments take time and money, and I do not want to waste those for my client. I am happy to make suggestions for care based on whatever I hear during that first meeting, whether the client is interested in continuing with testing.
Next, we move to the actual testing process. The testing process takes place over three appointments: intake, testing, and feedback. The sessions are usually spaced one week apart each, but they can be spaced out further than this if that works better for the client.
Intake Appointment
The first appointment is called the intake session. An intake can be held face-to-face or over a virtual visit. They can take place any time of day and last about an hour. I will ask the patient or their family many questions during this appointment. These questions include the client’s education history, social experiences, developmental and family history, physical and mental health history, work history if the patient has had a job, and other related topics. This intake aims to obtain a relatively deep understanding of the client and build a foundation for the final assessment.
Testing Appointment
The next appointment is the test day. In my practice, these appointments are always in person and take two to three hours. These appointments always begin in the morning. I begin these appointments early in the day to get the best sense of how a client’s mind works. Testing after a good night’s sleep and a good breakfast makes it much easier to see how a mind functions. If someone has testing after a long day of work or school, their mind will be much more tired, and the results will reflect this. Starting testing in the morning gives a much deeper and more accurate sense of a client’s mental performance.
Shorter sessions (closer to two hours) will be for younger children with difficulty sustaining attention. Longer sessions (closer to three) are for teenagers and adults who can get through a longer testing battery. Longer batteries allow more information to be gathered, but when dealing with an eight or nine-year-old, a great deal of information can be gathered in two hours. Test givers use many tricks when working with children to keep clients interested and participating in the assessment.
During testing, I run through a series of activities with my client. The first set of activities is an IQ test; specifically, I use the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) for patients 16 years old and older, or the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) for clients 8 to 15 years 11 months.
After I complete tests of intelligence, the client and I complete several other tests, including the Delis-Kaplan Executive Function System (DKEFS) for clients ages 10+, Stroop Color and Word test (Stroop) for all clients, Conners Continuous Performance Test, 3rd Edition (CPT-3) for all clients, and the Children’s Memory Scale (CMS) (for patients ages 8-10). These tests look at skills such as short term memory, which Psychologists call “Working Memory.” They measure a client’s ability to maintain attention (a short term ability) and concentration (attention over the long term.) They measure mental flexibility and problem solving strategies.
I have primary caregivers, significant others, teachers, and others complete evaluations to obtain their insights into the client’s ability level.
The testing appointment is usually pretty exhausting for clients, and if possible, I suggest that they take the rest of the day off or do their best to take it easy for the rest of the day after testing. Some patients request breaks during testing, and this is fine.
A big part of ADHD testing involves looking for gaps between IQ scores and executive functioning scores. If there is a big enough gap between a client’s IQ score and performance on tasks that measure executive functioning. The tests I administer also have mechanisms that track unusual or extremely poor performance. I always tell my clients to do their best on all measures; this gives the best data. Someone could try to game the system and perform extremely poorly on tests of executive functioning. However, test makers planned for this (and Psychologists trained in test administration are also trained for this!). Unusual test results are identified as part of the scoring process. If someone’s performance does not seem genuine, the test data will not be useable in the final report.
At the end of a testing session, I have a lot of scoring sheets and data to evaluate. I spend a few hours scoring results and then writing my final report. The final report is presented to the client and/or their family at the third appointment.
The Feedback Session
The third and last appointment is the feedback session. During this appointment, I review test results with the client/their caregiver(s). I begin the session by giving them the diagnosis and reviewing the testing results to indicate how this diagnosis was reached. I give copies of my final, signed written report to the client and discuss recommendations (which are also included in the report) based on test results. I answer questions and discuss next steps. This usually included detailed discussions on study strategies for children, teens, college students, and graduate school students. For all clients, there is a lot of discussion about techniques they can use to help reduce difficulties due to ADHD symptoms at home.
Perhaps the most common recommendation for home is using to-do lists to help give their mind a break from remembering things. It is very interesting to me how often patients in their late teens or older have already discovered some methods to help them with their ADHD symptoms before they even knew they had the condition! The final session generally lasts one hour and can be held in person or through a virtual visit. I always make myself available to clients if they have follow-up questions or requests.
Why do we need testing to determine if someone has ADHD?
The reason we test for ADHD is because we want to collect objective data to help determine the scope and severity of a client’s symptoms. Everyone has difficulties remembering things or concentrating, or feeling restless sometimes. ADHD testing includes completing tasks that were very cleverly designed in that people with ADHD will tend to complete them one way, and people without ADHD will tend to complete them another way. By running these tests and recording how a client performed on them, a strong, impartial case is built for or against a client having the diagnosis.
Why can’t anyone do testing? Why does it need to be a psychologist?
Psychologists and some medical doctors receive years of training in ADHD testing and diagnosing ADHD. Thus, they are in the best position to determine who meets the criteria for a diagnosis. While nearly anyone can be trained to administer ADHD tests. Some psychologists hire psychometrists, individuals trained in giving psychological tests, to conduct ADHD testing sessions. However, many factors need to be considered when interpreting scores. Psychometrists are only trained in test administration, not interpretation. Testing is a big part of an ADHD evaluation, but it isn’t the only part. Many factors besides test performance need to be considered. For example, if someone grew up speaking a language other than English, their scores on tasks related to English speaking may be artificially low. Several tests have redundant measures of specific skill areas because certain measures should not be used in certain situations. Psychologists are trained when to look at which measure to determine the most accurate indicator of a client’s actual ability level. If a patient is on the Autism Spectrum, their behavior during testing may impact their ability to complete testing tasks. Sometimes, there can be differences in scores that can be associated with gender or ethnicity. Some tests tend to gravitate towards certain results in some areas regardless of actual patient ability. Psychologists receive a great deal training in these nuances and draw on this training to make the most precise and insightful evaluations possible.
Conclusion
I hope this post has helped explain how an ADHD evaluation is conducted. If you have any questions or want to learn more about obtaining ADHD testing from David Nathan, PsyD PLLC, please email David (at) DavidNathanPsyD.com or call me at (651) 337-3944. Thanks very much!
David