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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