Adult ADD

A Guide to the Diagnosis and Treatment of Adult ADD

Tests for ADD

Questionnaires are different from tests.  Questionnaires can provide an efficient way to gather preliminary information that can be used and interpreted by a clinician.  The term test, on the other hand, suggests an instrument that will give reliable information on its own to justify a diagnosis or treatment.

There are a number of questionnaires for ADD, but at present, there is no definitive test for it. Just because something is called a “test” does not mean that it can replace clinical judgment. Research has shown that psychological or neurological tests for ADD rarely improve diagnostic accuracy. However, they can be useful in designing a treatment or coaching plan or in monitoring treatment progress. Psychological tests may also be helpful in identifying specific learning problems or in explaining why a person’s functioning in some areas, such as math or language skills appears to be unexpectedly low relative to the patient’s overall intellectual ability.

It is the editors’ opinion that routine tests for diagnosing ADD are not worthwhile. The diagnosis should be made by clinical history and a personal interview with the patient. It should be based on a trained clinician’s finding that a patient has a number of specific ADD symptoms of sufficient severity that they disturb the person’s life in significant ways.

Questionnaires can be used to identify symptoms that might be caused by ADD or to do a quick screening for medical problems that might be causing what looks like ADD. But the interpretation of the questionnaire should be done by a trained clinician.

A history of ADD symptoms since childhood or adolescence is generally no longer thought to be required to make the diagnosis of ADD. This is because it has been found that often people cannot accurately remember their childhood symptoms and/or their symptoms were masked by their hard work or superior intelligence. Still, when ADD symptoms can be definitely be established to have been present in childhood, it does make the diagnosis in an adult much more likely.

The diagnosis of ADD requires excluding other medical or psychological conditions that may cause symptoms similar to those of ADD, such as bipolar (manic depressive) disorder, brain injury, thyroid problems, and others. The ADD Related Medical History page provides a questionnaire for gathering relevant information about such conditions.

A set of guidelines for evaluating and monitoring patients with ADD was published in early 2007 by the American Academy of Child and Adolescent Psychiatry. The guidelines are based on a review by a committee of experts of more than 5,000 papers published since 1996.  The guidelines state that the diagnosis of ADD should be based on a clinical assessment of the patient. Expensive neurological or psychological tests add little or no information to what the clinician can learn from interviewing the patient, reviewing the patient’s reported symptoms, and exploring the social, medical, and family history. In uncommon circumstances during the evaluation process, diagnostic questions may arise about a neurological or psychological condition that may require neuropsychological testing. Tests should also be performed if the patient appears to have low general cognitive ability or low achievement in language or mathematics despite having a normal intellectual ability.

The seven major recommendations of the Academy’s report are as follows:

  • Screening for ADHD should be part of every patient’s mental health assessment (since it is so common among those who seek mental health assistance).
  • Evaluation of the preschooler, child, or adolescent for ADHD should consist of clinical interviews with the parent and patient, obtaining information about the patient’s school or day-care functioning, evaluation for comorbid (co-existing) psychiatric disorders, and review of the patient’s medical, social, and family history.
  • If the patient’s medical history is unremarkable, laboratory or neurological testing is not indicated.
  • Psychological and neuropsychological tests are not mandatory for the diagnosis for ADHD, but should be performed if the patient’s history suggests low general cognitive ability or low achievement in language or mathematics relative to the patient’s intellectual ability.
  • The clinician must evaluate the patient with ADHD for the presence of comorbid psychiatric disorders.
  • A well thought-out and comprehensive treatment plan should be developed for the patient with ADHD.
  • The initial psychopharmacological treatment of ADHD should be a trial with an agent approved by the US Food and Drug Administration for the treatment of ADHD

Students and others who request special accommodations for their ADD are often asked by school or employer disability specialists to take costly tests to certify their diagnosis of ADD. Such tests may give the diagnosis an appearance of science and certainty but in fact, they provide very little or no diagnostic information beyond that obtained by a good history and clinical examination.

In addition, the guidelines state that there is no scientific justification for electronic or radiological imaging of the brain (CT scans, PET scans, EEG, etc) for the purpose of establishing a diagnosis of ADHD/ADD. It is generally agreed that these tests, some of them quite expensive, presently have no value in the diagnosis of ADD.

Some of the tests have shown differences between large groups of individuals with and without ADD, but they still have no diagnostic value for an individual being evaluated for the disorder. How could this be so? Imagine testing all professional football players for height and weight. Their averages will be significantly different from those of the average office worker, but measuring someone’s height and weight cannot be considered a diagnostic test for identifying football players since many tall and overweight office workers would be diagnosed as football players.