Is there such a thing as an ADHD test?

Ok, last week we learned that ADHD or ADD is not all ‘in our heads’ at least figuratively. Literally, well ADHD and ADD, are in some peoples’ heads.

This week we will consider the question of how do you discern, or better yet, how does a professional ‘diagnose’ whether a person has ADHD or ADD, and better yet, how do they do so with accuracy?

For example, when someone claims that there is an “adhd test” it is true?

Technically no, there is no “adhd test.”

There are computerized assessments of attention and hyperactivity, but that is not the same thing as an “ADHD test.”

An ADHD test implies that if you pass it you don’t have ADHD and if you fail it you do have ADHD.

It is not that simple. Diagnosis involves more variables and accounting for competing explanations.

An ADHD test could not do this.

One might argue, well that is just semantics. No, it is much more than that.

Diagnosing ADHD must take into account several components: family history, clinical history, ratings from more than one setting and finally, sometimes, a computerized test. In terms of researched fact, the first three components are very accurate in diagnosis, the computerized test is not necessary, but it further confirms concerns.

What are the problems with just having a test and claiming it is an ‘ADHD test’?

Even if a person scores poorly on the test there too many possible variables to account for that result, including the setting in which it was given.

There is a reason why a substantial level of education and training are required before a professional is permitted to “diagnose” another person. One is disciplined and thorough thinking.

I realize it’s a bit pedantic, but let’s consider what is necessary to accurately diagnose ADHD or ADD.

First you need a clinical history of a family to assess ADHD or ADD because it is generally genetically transmitted. So, getting a family history is critical.

Secondly, it is preferable to get an assessment of infant temperament which is usually done by asking a person’s mother or having her complete rating scales.

Why does this matter? This matters because there are differences in a person with ADHD or ADD even when they are infants. Mothers can tell. Usually, yes, even fathers can tell there is a difference, but not always – especially if the dad has ADHD! If you ask the right questions it becomes clearer.

Third it is critical to get behavior ratings from more than one setting. For a child this would mean getting rating scales from teachers at school and parents at home. For an adult this might mean getting a rating scale from a spouse as well as an employer or possibly a friend. The concept is that the difficulties with attention or possibly hyperactivity or hyperkinetic behavior is not dependent upon one setting or the environmental cues from that site. To be considered ADHD or ADD the difficulties with inattention and hyperactivity must persist across settings. This data is to establish that it isn’t just the case that someone annoys you or certain settings bother or distract you. So, for the example of an ADHD test or a legitimate computerized assessment of attention and hyperactivity, the setting in which the test is given matters because it could be a highly stimulating environment.

Fourth, a clinical interview is conducted. The purpose of this is to rule out the possibility that other factors are not the reason for inattention or hyperactivity. For example anxiety can cause a person to be distracted. This could account for poor performance. Additionally, other mental health diagnoses can present like ADHD. Post-traumatic Stress Disorder, or PTSD, is when a person has experienced an overwhelming stressor, can cause people to be very distracted. Also they can have startle responses to stimuli in the environment which might appear as hyperactivity. So a person with PTSD might seem like they have ADHD to someone who is not experienced and trained in understanding this. A simple “ADHD test” is not going to discern these possible explanations.

The purpose of the clinical interview is to rule out the possibility that inattention and/or hyperactivity are not due to other mental health issues.

Finally a computerized attention assessment can be used to further assess how a person performs related to attention and hyperactivity compared to a normative group. Such tasks are based upon normative responses and typically have either hundreds or thousands of subjects as their pool of comparison.

As you now can see, a ‘so-called ADHD test’ in and of itself can’t diagnose ADHD because of the other factors involved. That is, inattention or distractibility could be due to setting, it could be due to anxiety, it could be due to depression, it could be due to PTSD, it could be due to a lack of sleep, it could be due to a person who is a presenter being anxious before they present. So to claim that person took an “ADHD test” and was diagnosed or told that they had ADHD is hugely problematic and the belies what is required to do an accurate diagnosis of ADHD or ADD.

This does not mean that some professionals do a poor job or do not do a thorough job of assessing. Some do. That does not excuse sloppy thinking or shaky claims like I took an ADHD test and I was told I have ADHD. Someone is in error here. The people giving the test. The people claiming that they can diagnose based on a test alone or the characterization of a ‘so-called ADHD test.’

Charles Shinaver, PhD

Tweet This Post