Testing For Attention Deficit Hyperactivity Disorder

How does one go about testing for ADHD?  Ideally, there will be multiple viewpoints and data sources.  The major data viewpoints are:

• clinical interview with patient and parents, if the patient is a minor
• some basic measures of depression and anxiety (these have to be ruled out as causes of ADHD)
• some rating scales to be completed by the patient
• rating scales to be completed by the parent or spouse
• rating scales to be completed by teachers
• a computerized test of attention (vigilance)
• sometimes, an IQ test (more about this below)

Let's take these one at a time.

The clinical interview is absolutely necessary.  It is important to hear what a patient has to say, and it is also important to observe their behavior.  I usually conduct a full clinical interview.  That is, I don't just assume that the problem is ADHD.  I ask about all typical areas of childhood problems, including depression, anxiety, psychosis, and even eating disorders.

When it comes to the ADHD symptoms specifically, I ask the child first what their thoughts are about a symptom (e.g., "Do you have a problem keeping your attention going in class?") and then ask the parent for their opinion, so that I have both perspectives.

I use a self report depression inventory and a children's anxiety inventory, which I read to them.  Depression and anxiety can cause attention problems.  I also want to know if their ADHD is causing them to have low self-esteem or depression.

If the child is a teenager or older, I use a self-report ADD questionnaire.  There are ADD questionaires for children, but generally I only use self-report questionaires for teenagers and adults.  I use the Brown ADD Self Rating Scale for ADD.

I also use the Behavior Rating Inventory for Executive Functioning.  This measures executive functions, which I have written about elsewhere.  It measures nine different types of executive functions. 

• Problems with self-monitoring (being aware of how one is acting and how it is affecting others)
• Problems with initiating tasks
• Problems with working memory (being able to keep things in short term memory to perform actions on them, such as remembering a phone number from the time of reading it in a directory to the time of dialing)
• Problems with planning and organizing time
• Problems with task monitoring (being aware of whether a strategy on a task is working)
• Problems with organization of materials
• Problems with inhibiting impulses–causing acting out and impulsivity
• Problems with shifting from one task to another when needed or shifting from one problem solving strategy to another when one is not working
• Problems with controlling and modulating (smoothing out) emotions

I use the Conner's Continuous Performance Test-II to measure vigilance over a 15 minute period of time.  The Conner’s Continuous Performance Test-II is a computerized test of attention which lasts approximately 15 minutes. It does not measure brief bursts of attention (as measured by some of other types of tests); rather it measures the ability to continue to attend to a simple vigilance task over a period of time.
I use the WISC-IV or WAIS-IV to measure IQ.  I am not really all that interested in IQ.  IQ is in my opinion an oversold concept.  The full scale IQ of someone is not nearly as interesting as understanding what their strengths and weaknesses are.  The Wechsler scales have four major indexes and a minimum of ten subscales.  I want to know if the child's IQ accounts for their problems in school.  I also want to know if they are showing any problems with working memory.  Other items of interest on the WISC or WAIS are the comprehension subtest, measuring social comprehension and the processing speed subtests.

Sometimes, a measure of intelligence is needed, particularly if there has been poor school performance. However, the IQ measure does not really tell us much about whether ADHD is present. Instead, it helps us to know whether the child is underperforming in school, or whether poor grades are perhaps due to something else. Sometimes, a learning disorder is thought to be present, and an achievement test may be needed. Usually, learning disorders are diagnosed by comparing achievement testing with IQ tests. Learning disorders are often present in ADHD. However, ADHD proper does not need IQ tests or achievement testing for diagnosis.