Role of Neuropsychological Assessment in ADHD
Kevin Antshel, Ph.D.
Professor of Psychology
Director of Clinical Psychology doctoral program
ADHD Lifespan Treatment, Education and Research (ALTER) program
The role of neuropsychology in the assessment of ADHD is a controversial topic and one that generates considerable discourse on both sides of the argument. On the one hand, psychological assessment is often required by standardized testing agencies and universities for ADHD test accommodation determinations under the Americans with Disabilities Act (ADA). On the other hand, some in the field, most notably Russell Barkley, believe that such testing is not useful for diagnosing ADHD.
While supporting the use of IQ and academic achievement measures, Barkley is opposed to the use of performance based tests of executive functioning (EF) in diagnostic evaluations and suggests that the incremental validity of such tests (e.g., continuous performance tests) is quite low, largely due to high false negative classification rates, inability to differentiate diagnoses among disorders and the ease with which such tests can be feigned. In its’ place, Barkley asserts that EF rating scales are more useful, ecologically valid and cost-effective and should be used instead of EF tests. ADHD diagnostic practice parameters from several associations seem to agree with Barkley and either consider neuropsychological tests optional (American Academy of Child and Adolescent Psychiatry) or make no comment on their use (American Academy of Pediatrics).
Others1 believe that EF tests can make contributions to a comprehensive ADHD assessment. For example, neuropsychological tests could provide information about potential treatment targets (e.g., working memory predicts to reading and math attainment) and treatment approaches (e.g., poor EF response inhibition task performance predicts to better methylphenidate response). Factor scores or poor performance on a certain number of EF tasks seems to be a better predictor than single EF tasks. Others believe that performance-based tests and EF rating scales are both important to include as they provide different types of complementary information (EF tests: efficiency of cognitive abilities; EF rating scales: success in goal pursuit) and are weakly correlated (r=.19)2. Anecdotally, I have heard clinicians report that neuropsychological testing can be helpful to specify the ADHD phenotype, decipher some differential diagnoses, guide families and provide valuable information for interventions.
These diverging opinions leave the practicing clinician in a quandary. Given the clear public health, policy and educational implications of this conversation, my colleagues Russell Barkley, Mark Mahone and Russell Schachar and I will be discussing this issue at the APSARD conference. Please join us for continued conversation on this topic at our Lunch Session and Discussion Group on Sunday, January 19th from 12:30 – 2:30 PM. We hope to provide a thoughtful, balanced discussion of this important topic and welcome the input of others who have an interest in the role of neuropsychology in the assessment of ADHD!
1 Molitor, S.J., & Langberg, J.M. (2017). Using task performance to inform treatment planning for
youth with ADHD: A systematic review. Clinical Psychology Review, 58, 157-173.
2 Toplak, M. E., West, R. F., & Stanovich, K. E. (2013). Practitioner review: Do performance-
based measures and ratings of executive function assess the same construct? Journal of Child Psychology and Psychiatry, 54, 113–224.