When do you recommend neuropsychological testing in adults being evaluated for ADHD?

We should consider “testing” only when our main tool of diagnosis, a thorough psychiatric interview, history, and physical (mental status exam), demands more data for a diagnosis. Demanding neuropsych testing would be akin to relying more on an MRI than on a clinical assessment for a headache diagnosis. We, as psychiatrists, need to emphasize our main skill, which is clinical diagnosis based on history and exam.

Neuropsych testing is not necessary to diagnose ADHD. Even with neuropsych testing, results must be considered in the context of clinical evaluation. A comprehensive psychiatric evaluation is still the most reliable way to diagnose ADHD. I generally teach my residents to ask 3 questions:

1.) Do the symptoms of ADHD apply (e.g., 5 symptoms of hyperactivity/impulsivity or inattention that are developmentally inappropriate and cause significant impairment in at least 2 settings, such as home/work/s...

In theory versus in practice:

If resources and access weren’t barriers, I would say that every adult who doesn’t already have a well-documented ADHD diagnosis should ideally undergo full neuropsychological testing. A comprehensive evaluation not only clarifies ADHD but also helps rule out or identify other contributors to inattention, such as cognitive impairment, mood disorders, or sequelae of traumatic brain injury (TBI). That’s the “best practice” or academic answer.

In reality, access is the...

With children in school (pre-college), often the schools or counties will have resources to get formal neuropsychological testing to evaluate for ADHD. It becomes harder as people transition into young adult (college age plus). My general rule of thumb is:

1.) If the patient is in college and has never been diagnosed with ADHD, but comes saying they want to get treated for it, I ask them to get a neuropsych eval first. At the school where I treat a significant number of students (UPenn, but I’m ...

Many people misconstrue symptoms of bipolarity as ADHD, and they would probably prefer to carry that diagnosis anyway. And especially impatience with bipolar disorder, who also have a history of substance use disorder, they are often very eager to receive a psychostimulant. Of course, both could coexist, but if there is doubt in trying to tease apart and obtain an accurate diagnosis, neuropsych testing can be helpful.

Though it would be nice to get neuropathy testing on all patients where there is an overlap in symptoms between sash’s and molar mania, as they share several symptoms. The more extreme the symptoms, the more emotion-laden they are. I think first of bipolarity, especially if there is a family history. If a cause of the emotional distress is more due to academic failings and struggling to keep a job, or really if in college or graduate school, the symptoms of ADHD could be causing a lot of distres...

I mostly see adults in general outpatient psychiatry and in substance‑use rehab settings. I, too, believe that a thorough clinical history, especially looking for symptoms that go back to childhood, is crucial. When that part of the history is fuzzy, I’ll use the BAARS‑IV because it brings in collateral reports for both past and current symptoms, which can be extremely helpful. I do feel there is an overreliance on the ASRS, which is a good screening tool, but not diagnostic.

As for neuropsychol...

I agree with other comments in that the clinical evaluation, history, and collateral information are critical in making this diagnosis.

If there is a question, however, or 1 suspects a differential, then I go to neuropsych testing.

Fascinating discussion interfacing the different skills and disciplines in mental health treatment.