NEUROPSYCHOLOGICAL EVALUATION FOR ADHD
(cost $1200) (procedure code 96101 OR 96118)
This is for the purpose of determining whether a child or adult meets the criteria to receive a formal diagnosis of ADHD
or ADD. It involves an assessment of attention and related cognitive capacities through questionnaires, rating scales and
selected tests. This test results in an integrated written report.
Problems with ADHD or ADD testing:
- There is considerable controversy at the present time over what are the core symptoms of ADHD or ADD.
ADD, which is ADHD, Predominantly Inattentive Type, is particularly difficult to diagnose because hyperactivity
or impulsiveness are not the primary symptoms. People with ADD are not disruptive and are often well behaved
in classrooms. Their symptoms involve internal, silent problems of mental processing of information that results
in poor academic performance. Because their symptoms are not readily noticed by observers, their condition
often goes undetected despite the suspicion that something is just not right. Because of the controversy
regarding the core symptoms and the difficulty detecting symptoms evaluations often result in false negatives
when in fact there is a problem. Evaluations require a care review of all tests, history, grade reports, teacher
reports and parent reports.
- A typical and insufficient evaluation will have parents and teachers fill out questionnaires using wording from the
Diagnostic and Statistical Manual-Fourth Edition criteria. If the parent and teacher do not endorse enough
symptoms, it is then concluded that ADD or ADHD is not present. Or if many of the symptoms are endorsed it
is concluded that ADD or ADHD is present. Unfortunately the wording of these questionnaires is often
misinterpreted by the parent or teacher who are not trained in identifying ADD or the different ways the
symptoms can be manifested. Such questionnaires are useful instruments, but a diagnostic conclusion should be
based on a psychologist's professional judgment of information gathered from many sources.
- "Managed Care" evaluations that insurance companies impose on participating providers only allow for the most
obvious symptoms to be detected greatly increasing the chance of misdiagnosing a condition. ADD may be
diagnosed when in fact it is something else. Sometimes the clinician says there is no ADD, when in fact ADD is
present.
- Other conditions can cause ADD type symptoms and must be ruled out through carefully considering
information from multiple sources. The presence of the inattentive type ADD that has little or no
hyperactivity/impulsiveness is not readily observed by parents, teachers or spouses and also requires that multiple
information sources be carefully scrutinized. The information sources necessary are current testing, extensive
review of the patient's history, previous testing, patient self observations, teacher observations, spouse
observations and school records whenever available.
- The DSM-IV criteria have been criticized for identifying too few symptoms. The DSM-IV has also been
criticized for being based on elementary school students and the criteria are misleading when applied to
adolescents and adults.
- The type of evaluations imposed by insurance companies do not allow for such detailed scrutiny.
- Is it ADHD or ADD? The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-
CM) is the system your physician uses when making a medical diagnosis. The American Psychiatric Association
felt that they could improve on the psychiatric definitions and diagnostic criteria included in the ICD-9-CM and
produced the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The DSM-IV
kept much of the same basic organization of psychiatric conditions included in the ICD-9-CM, but names and
criteria were altered. The ICD-9-CM uses the term Attention Deficit Disorder (ADD) while the DSM-IV use the
term Attention Deficit Hyperactivity Disorder (ADHD). They both mean the same thing, but the two different
labels has resulted in considerable confusion. In the United States it is generally expected that physicians and
psychologists will use the DSM-IV labels and criteria. The discussion below uses the ADHD terminology from
the DSM-IV.
There are Four types of ADHD as specified in the DSM-IV:
- ADHD, Predominantly Inattentive Type, which has little or no hyperactivity/impulsiveness symptoms.
- ADHD, Predominantly Hyperactive-Impulsive Type, which has few inattention symptoms
- ADHD, Combined Type, which has many symptoms of hyperactivity-impulsiveness and inattention.
- ADHD, Not Otherwise Specified, which is expected to have either prominent symptoms of inattention or
symptoms of hyperactivity-impulsiveness, but not enough to officially meet the criteria as defined in DSM-IV.
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