Since the diagnosis of ADHD is sometimes hard to establish, it is tempting for mental health clinicians to order neuropsychological testing. The role of neuropsychological testing in patients with ADHD is widely misunderstood. There are important potential problems with doing this without a clear understanding of the limitations of the testing. We should remember that neuropsychological testing is very expensive–typically costing over a thousand dollars. On this page, we explain very briefly why the routine use of neuropsychological testing for the diagnosis of ADHD is not recommended:
ADHD is neuropsychologically heterogenous
What does it mean to say “neuropsychologically heterogenous“? Persons with ADHD can have deficits in several different aspects of neuropsychological testing but none of them is necessarily present (Bolea-Almanac et al., 2014). The findings on neuropsychological testing in persons with ADHD can show a very wide range of profiles. There is no neuropsychological test in which abnormalities are found in all or even most patients with ADHD.
So, neuropsychological testing can neither reliably differentiate between persons with ADHD and “normal” individuals nor between persons with ADHD and those with a variety of other conditions (e.g., Wasserman and Wasserman, 2012; Pettersson et al., 2018).
Neuropsychological testing can neither diagnose nor rule out ADHD and is not recommended for routine use for either of these purposes by any of the practice guidelines (Bolea-Almanac et al., 2014; Kooij et al., 2018; NICE 2018).
As one practice guideline summarized it: “There is currently insufficient evidence to warrant the use of neuropsychological testing to determine the diagnosis of ADHD or to predict impairment in major life domains” (Kooij et al., 2018).
Well, then does neuropsychological testing have any role at all in persons with ADHD? Yes, it does. But not for diagnosing ADHD. We’ll discuss that role on another page on this website. See Related Pages below.
Bolea-Alamañac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, Heal D, Müller U, Nash J, Santosh P, Sayal K, Sonuga-Barke E, Young SJ; British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2014 Mar;28(3):179-203. doi: 10.1177/0269881113519509. PubMed PMID: 24526134.
Pettersson R, Söderström S, Nilsson KW. Diagnosing ADHD in Adults: An Examination of the Discriminative Validity of Neuropsychological Tests and Diagnostic Assessment Instruments. J Atten Disord. 2018 Sep;22(11):1019-1031. doi: 10.1177/1087054715618788. Epub 2015 Dec 17. PubMed PMID: 26681530.
Wasserman T, Wasserman LD. The Sensitivity and Specificity of Neuropsychological Tests in the Diagnosis of Attention Deficit Hyperactivity Disorder, Applied Neuropsychology: Child, 2012:1:2, 90-99, DOI: 10.1080/21622965.2012.702025
Copyright 2019, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other lay persons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified health care professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.