Assessment of ADHD in Clinical Practice

Marquerite Laban, Fielding's School of Psychology

The essential purpose of this study is to investigate the effectiveness of single-measure, single-modality assessment of ADHD commonly used in clinical practice today. There is a school of thought held by many professional clinicians that making a single measurement of some parameter is a proper test procedure. Specifically, some clinicians argue that it is reasonable to diagnosis ADHD based solely on the results generated from self-report questionnaires designed to assess symptoms commonly associated with attention deficits. Frequently cited reasons for using the single-method, self-report questionnaire results include effectiveness of modern ADHD questionnaires in differentiating ADHD patients from non-ADHD patients, efficiency of evaluation, reduction of costs, and rapid results. However, research supports the multifaceted nature of attention, implying that a comprehensive assessment of brain function is necessary for accurate diagnosis. This study examined the consequences of the single modality approach by examining the effectiveness of the Brown ADD Scales in comparison to results generated from the standard-of-care full neuropsychological evaluation recommended in the evaluation of ADHD. The sample consisted of 196 adult and adolescent case files containing comprehensive neuropsychological assessments including self- and other-report questionnaires, test results, and interview data conducted by a clinician in the context of clinical work. The overall results of this study strongly support the use of neuropsychological test measures in the diagnosis of ADHD in clinical populations. Overall accuracy in correctly differentiating between individuals with and without ADHD improved by over 20% when neuropsychological test scores were used to aid in the diagnosis when compared to use of the Brown ADD Scale scores alone. Overall accuracy did improve slightly (between 1-3%) when both the neuropsychological test scores and the Brown ADD Scale scores were used. However, it appears that including the Brown ADD Scales in the neuropsychological battery was particularly advantageous in the adult population because accuracy of predicting the presence of an ADHD diagnosis improved by approximately 6% over using the test scores alone in the sample tested in this study.