The What, When & Why of Neuropsychological Testing for ADHD

The What, When & Why of Neuropsychological Testing for ADHD

The process of reaching an ADHD diagnosis rests primarily on your    personal history. However neuropsychological testing can reveal a ton of useful information for expanding your understanding of your own ADHD. As Dr. H says in this ep, “It’s the closest thing we have to an MRI of your mind.” But as Ned also points out, this type of testing is not necessary for a diagnosis.

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A transcript of this episode is below.


Dr. Ned Hallowell:
This episode is made possible by our sponsor, OmegaBrite Wellness. I’ve taken their Omega-3 supplements for many years, and so has my wife, and that’s why I invited them to sponsor my podcast, I’m proud to have them. You can find all of their products online at omegabritewellness.com and brite is intentionally misspelled, B-R-I-T-E, omegabritewellness.com. This episode is also sponsored by Landmark College, another institution that I have warm personal relationship with in Putney, Vermont. It’s the college of choice for students who learn differently. Learn more at lcdistraction.org.

Dr. Ned Hallowell:
Hello, this is Dr. Ned Hallowell and welcome to Distraction. Today I’m going to do a very short mini on a very important question that comes up all the time in practices around the country and around the world, namely, when, and why, and how much do you get neuropsychological testing? First of all, what is it? There’s psychological testing, and then there’s neuropsychological testing. Well, psychological testing is the kind of thing, you’ve heard of the Rorschach test with the inkblots, and you say what you see there. You maybe have heard of the MMPI, the Minnesota Multiphasic Personality Inventory. You have certainly heard of IQ tests, many different kinds of IQ tests, the Wechsler probably being the most famous, these are all examples of psychological testing.

Dr. Ned Hallowell:
It’s a series of questions that have been researched and normed. So they have some degree of validity in answering descriptions, all trying to give a description of the mind that the individual can’t self-report. They try to get at parts of yourself that are unconscious or out of memory, or simply not part of your everyday self-awareness, for example, your processing speed or the difference between your immediate memory, your recent memory and your distant memory, things like that you can’t self-report, or intelligence, whatever that means, different kinds of intelligence you can’t self-report.

Dr. Ned Hallowell:
So psychological testing is aimed at asking questions or getting you to perform exercises and tests that will help us quantify different elements of cognitive and emotional life, then neuropsychological testing adds an element of neurology. So this gets more at things like processing speed, or evidence of past head injury, or deficits in memory, the neurological elements. Well, the Rorschach can be used that way too, but neuropsychological testing adds in more of the biological exploration to the psychological exploration. And neuropsychological testing is what is commonly offered as part of the diagnostic workup for ADHD.

Dr. Ned Hallowell:
Now, this is a very important point that I’m about to make, and it’s widely misunderstood, so listen carefully. You do not need neuropsychological testing or any psychological testing to make a diagnosis of ADHD. There is no test for ADHD. Many people come to me and say, “Well, I don’t have it, I was tested and I don’t have it.” There is no test that can tell you whether you have it or you don’t have it, really important point. The closest thing we have to a definitive test for ADHD is your history, the story of your life beginning when you were born. And the diagnostic criteria are laid out in the DSM-5 and two sets of nine symptoms. And if you have six out of nine on one or both set, then you by definition have the diagnosis.

Dr. Ned Hallowell:
So the process of reaching a diagnosis rests primarily on asking you questions about your childhood and your immediate life and comparing them to the criteria as set out in the diagnostic manual, that’s it. Sure, there are qualifiers, you need to make sure it’s not something else, you need to make sure you’re in proper shape to offer your history. Usually best taken from two people, because people with ADD are not good self observers. With all of those qualifiers, it still comes down to your history and that is the truth.

Dr. Ned Hallowell:
Now, why do we offer neuropsychological testing? Because it can reveal a ton of important, useful information, not necessary for diagnosis, but certainly helpful in expanding your understanding of yourself or your child. Neuropsych testing is really the closest thing we have to an MRI of your mind. It gets at all sorts of things that you can’t self-report. You can’t self-report processing speed, memory scales, unconscious biases, a specific reading problem, a specific math problem. You can generally report them, but you can’t get more specific and detailed about them.

Dr. Ned Hallowell:
So neuropsychological testing is very valuable, but it is not necessary. And this becomes important because it is expensive. And [inaudible 00:06:31] what city you’re in, the ballpark of $5,000. Now, if insurance doesn’t cover it, and some insurance policies will, some won’t, then you have to think long and hard before you want to plunk down $5,000. Now, if money is no object to you, please get it, it’s worth it, it’s always nice to have. But if you have to decide between spending the 5,000 on neuropsych testing or spending the 5,000 on followup treatment, coaching, tutoring, additional services, by all means, spend it on the additional services, the coaching and the tutoring, not on neuropsych testing. It’s a wonderful thing to have if you can afford it, but it’s not necessary. You do not have to have it in order to make this diagnosis, nor is it definitive.

Dr. Ned Hallowell:
And if the history, for example, says, yes, this is ADHD, but the neuropsych testing says, no, it is not ADHD, believe the history, because neuropsych testing is notorious for producing false negatives, that’s because the combination of structure, motivation, and novelty creates focus, essentially treats ADHD. For example, a video game full of novelty, full of structure, and you’re motivated, you want to win the game, so you focus. Kids with ADHD can focus for hours on a video game.

Dr. Ned Hallowell:
Well, neuropsych testing includes the same three elements. It’s done one-on-one, nothing could be more structured, it’s full of puzzles and games, novelty, and there’s a natural motivator because you want to beat the test, and that’s why a lot of kids and adults who have ADHD on the testing look as if they don’t, because the test itself treats the condition it’s trying to diagnose.

Dr. Ned Hallowell:
That’s a quick summary of neuropsych testing, when to get it, why to get it. And I think the most important point for you to understand is it’s a wonderful thing to have if you can afford it. It’s expensive, but it is not necessary in order to make the diagnosis in a child or in an adult.

Dr. Ned Hallowell:
Well, that’s it for me for this mini episode of Distraction. Thanks to our sponsor, OmegaBrite Wellness. Save 20% on your first order at omegabytewellness.com with the promo code podcast2020. And please reach out to us with your questions and comments by emailing [email protected] And if you’re on TikTok, you can find me there with the username @Dr.Hallowell. I’ve posted lots of videos about common ADHD issues, each one only 60 seconds. Take a look and let me know what you think. Distraction is created by Sounds Great Media. Our recording engineer and editor is the wonderful Scott Persson, and our producer is the also wonderful Sarah Guertin. I’m Dr. Ned Hallowell, until next time when I will still be Dr. Ned Hallowell.

Dr. Ned Hallowell:
The episode you just heard was made possible by my good friends at OmegaBrite Wellness. I take their supplements every day, and that’s why I invited them to sponsor my podcast. Shop online at OmegaBrite, and that’s britewellness.com.

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