Neuropsych Testing for ADHD
March 16, 2016 3:01 PM Subscribe
Is it standard practice to do neuropsychological testing for ADHD evaluation? Have you done this before?
I'm a graduate student who's school, work and personal life is suffering deeply from what I think may be undiagnosed ADHD. After finally meeting with a psychiatrist through my university's student health services, he agreed that I most likely have attention deficit issues and would benefit from further testing. He gave me a referral to the neuropsychology department of a local hospital to complete this testing, which he said would take "up to 8 hours" and involve an interview, neuropsych testing, and possibly lab tests (?!).
I'm working on getting this scheduled, but I'm pretty anxious about the whole thing. Based on what I've read about other people's experiences, the testing for them was a lot less.. exhaustive. All of my friends who have ADHD were diagnosed when they were much younger and don't remember much from the experience, so it's hard to get an idea of what to expect from them. I don't know if the evaluation seems to be more rigorous because it is through the university and they want to discourage drug seeking students (although the $600 out of pocket cost alone is making me reconsider), but the thought of spending an entire day answering questions about myself and doing tests just makes my head spin.
Is this normal? Have you had experience with this? Help me feel better about this so I can go forward with the testing that I need.
I'm a graduate student who's school, work and personal life is suffering deeply from what I think may be undiagnosed ADHD. After finally meeting with a psychiatrist through my university's student health services, he agreed that I most likely have attention deficit issues and would benefit from further testing. He gave me a referral to the neuropsychology department of a local hospital to complete this testing, which he said would take "up to 8 hours" and involve an interview, neuropsych testing, and possibly lab tests (?!).
I'm working on getting this scheduled, but I'm pretty anxious about the whole thing. Based on what I've read about other people's experiences, the testing for them was a lot less.. exhaustive. All of my friends who have ADHD were diagnosed when they were much younger and don't remember much from the experience, so it's hard to get an idea of what to expect from them. I don't know if the evaluation seems to be more rigorous because it is through the university and they want to discourage drug seeking students (although the $600 out of pocket cost alone is making me reconsider), but the thought of spending an entire day answering questions about myself and doing tests just makes my head spin.
Is this normal? Have you had experience with this? Help me feel better about this so I can go forward with the testing that I need.
I am a neuropsychologist, I am not your neuropsychologist. We can absolutely evaluate for this, but honestly, for a case of uncomplicated ADHD (like no other learning, developmental, psychiatric, medical concerns), a full neuropsychological evaluation is probably overkill. A good psychiatrist who is well versed in adult ADHD would be able to make the diagnosis based on history and behavioral ratings from you and people you know well. The website for CHADD has a good, searchable provider list to find a psychiatrist in your area with this expertise.
posted by goggie at 3:16 PM on March 16, 2016 [7 favorites]
posted by goggie at 3:16 PM on March 16, 2016 [7 favorites]
I had the sticky thingies put on my head and an MRI as part of my psychiatrist's diagnosis of ADHD. He said at the time that sometimes it shows up in the brain, but even if it doesnt (my brain didnt show anything interesting) it can rule out other stuff. The other test i did was a 100+ multiple choice questionaire, and a test for alzhiemers - how many animals can you name, remember these three items, what day is it.
It was all pretty calm and easy, and in due course i was prescribed dexamphetamine (very small doses) which has improved my ability to concentrate unbelievably.
This is in Australia.
posted by b33j at 3:19 PM on March 16, 2016
It was all pretty calm and easy, and in due course i was prescribed dexamphetamine (very small doses) which has improved my ability to concentrate unbelievably.
This is in Australia.
posted by b33j at 3:19 PM on March 16, 2016
Best answer: I did this last year! It was more like four or five hours. After an interview, they had me play an array of memory and attention games, go through a lengthy IQ battery (the WAIS-IV), and fill out some self-assessment questionnaires. The neuropsych office I went to had a casual and friendly atmosphere and I actually had a pretty good time. (However, I do puzzles for fun, ymmv.) After a couple of weeks I went back for the results and a follow-up interview with the doc. We had an insightful talk about what was going on inside my head, and I got a five page report about my test results and diagnosis. I'm glad I went.
posted by theodolite at 3:30 PM on March 16, 2016 [4 favorites]
posted by theodolite at 3:30 PM on March 16, 2016 [4 favorites]
Best answer: This sounds a lot like my life a couple of years ago! I was a grad student and working full time when 25 years of improvised coping mechanisms for barely keeping ahead of my responsibilities suddenly buckled, and I was sleeping in 14-hour blocks three nights a week.
I went to the health center; they referred me to a psychologist. It was all pencil-and-paper testing and interviews. They also sent surveys to my parents, because part of the ADHD diagnosis is (or at least was, I'm not sure about DSM-V) early development of the symptoms.
After two days of testing—about eight hours total—the psychologist worked up a long report suggesting I was a very obvious ADHD (primarily inattentive) case, and as a bonus also have an enormous, unusual gap separating my verbal and quantitative intelligence scores. (I expected this to trigger my recurring suspicions that I am a glib imposter who doesn't actually know anything, but I just found it interesting and, uh, illuminating.)
Back to the health center: A psychiatric nurse practitioner read the report, did a much shorter evaluation herself, and put me on stimulants, which render me capable of self-improvement. (This is a huge upgrade.)
I've always suspected justifiable caution on the university's part—I looked every bit like a 26-year-old guy who slept three days a week and kept forgetting to shave—and I'm sure there are other doctors who wouldn't have put me through the whole battery. If the price is a hardship for you, it wouldn't hurt to say so; they might try you on something else in the meantime. (Unfortunately the best non-stimulant treatment, Strattera, was still pretty expensive last time I looked.)
But in a way I really do appreciate having some kind of "proof" I can look back at, and especially that I can show psychiatrists every time I move or my insurance changes. (These Are Not Your Delusions, but it's also helpful when I get to wondering whether I'm a glib imposter who just understands how helpful stimulants are.)
posted by Polycarp at 3:39 PM on March 16, 2016
I went to the health center; they referred me to a psychologist. It was all pencil-and-paper testing and interviews. They also sent surveys to my parents, because part of the ADHD diagnosis is (or at least was, I'm not sure about DSM-V) early development of the symptoms.
After two days of testing—about eight hours total—the psychologist worked up a long report suggesting I was a very obvious ADHD (primarily inattentive) case, and as a bonus also have an enormous, unusual gap separating my verbal and quantitative intelligence scores. (I expected this to trigger my recurring suspicions that I am a glib imposter who doesn't actually know anything, but I just found it interesting and, uh, illuminating.)
Back to the health center: A psychiatric nurse practitioner read the report, did a much shorter evaluation herself, and put me on stimulants, which render me capable of self-improvement. (This is a huge upgrade.)
I've always suspected justifiable caution on the university's part—I looked every bit like a 26-year-old guy who slept three days a week and kept forgetting to shave—and I'm sure there are other doctors who wouldn't have put me through the whole battery. If the price is a hardship for you, it wouldn't hurt to say so; they might try you on something else in the meantime. (Unfortunately the best non-stimulant treatment, Strattera, was still pretty expensive last time I looked.)
But in a way I really do appreciate having some kind of "proof" I can look back at, and especially that I can show psychiatrists every time I move or my insurance changes. (These Are Not Your Delusions, but it's also helpful when I get to wondering whether I'm a glib imposter who just understands how helpful stimulants are.)
posted by Polycarp at 3:39 PM on March 16, 2016
When I was diagnosed as an adult it involved filling out a couple questionnaires, a meeting with a doctor, and an attention test of some kind on a computer that took about an hour, so the whole thing took two hours total, maybe.
posted by MsMolly at 3:40 PM on March 16, 2016
posted by MsMolly at 3:40 PM on March 16, 2016
I'm a therapist who has frequently worked with adults in evaluating the possibility of ADHD. This typically, in my practice, involves an interview, observation, and surveys completed by yourself and someone who has watched you perform in an environment (school?) that would reflect this problem. I then refer to a psychiatrist for evaluation and to write an RX if they agree.
I would not suggest that anyone go through a full neuropsychological evaluation for this, it is overkill (IMHO).
posted by HuronBob at 3:55 PM on March 16, 2016
I would not suggest that anyone go through a full neuropsychological evaluation for this, it is overkill (IMHO).
posted by HuronBob at 3:55 PM on March 16, 2016
My kids and I were part of a UCLA study on ADHD, some years ago, and we went through all of these tests and more. Made their educational lives much easier, and my new neurologist is always glad of all the paperwork.
posted by Ideefixe at 4:48 PM on March 16, 2016
posted by Ideefixe at 4:48 PM on March 16, 2016
Yikes....
My daughter was diagnosed by her pediatrician based on reported symptoms, which the meds help with immensely. Pediatrician writes the prescription.
Doing research, I read that ADD was quite possibly inherited, I started looking at my life and the problems I had at work, I talked to my GP, and walked out with a prescription for meds that day.
Granted, I'm over 50, don't use any substances but tobacco and coffee, pretty clean cut, and I've been seeing the same doc for years, but still, it sounds like I really got off easy.
posted by rudd135 at 5:22 PM on March 16, 2016
My daughter was diagnosed by her pediatrician based on reported symptoms, which the meds help with immensely. Pediatrician writes the prescription.
Doing research, I read that ADD was quite possibly inherited, I started looking at my life and the problems I had at work, I talked to my GP, and walked out with a prescription for meds that day.
Granted, I'm over 50, don't use any substances but tobacco and coffee, pretty clean cut, and I've been seeing the same doc for years, but still, it sounds like I really got off easy.
posted by rudd135 at 5:22 PM on March 16, 2016
Back in 1992 I went through a whole day of testing, as I recall. They interviewed my SO, sent questionnaires to my parents (I was 37!) Hooked me up to some kinda brain thing with sticky bits, and generally put me through the wringer. This was through the neuropsych dept. of a major research university, though, and I can't recall if I was part of a study or not. I was referred by my psychiatrist. So, that was my experience.
Saved my life, it did.
Saved my life.
posted by Floydd at 5:37 PM on March 16, 2016
Saved my life, it did.
Saved my life.
posted by Floydd at 5:37 PM on March 16, 2016
If you're going through your university's health system, I wouldn't be surprised if their defaulting to extensive testing is meant to filter out drug-seeking and recreationally-using students, which the news tells me is a thing with the coeds these days.
posted by rhizome at 5:57 PM on March 16, 2016 [1 favorite]
posted by rhizome at 5:57 PM on March 16, 2016 [1 favorite]
Best answer: When I found out how long the wait and how costly the testing was there, my university health center gave me a list of community docs that offered testing. I ended up at a clinical psychologist, who specialized in working with adults with ADHD and charged $200 for testing. Not chump change, but not $600.
She gave me a survey to fill out in the waiting room ≈20 minutes, then evaluated me during a regular 50-minute session, after which she wrote a letter to my GP with the diagnosis and her recommendation to prescribe stimulants. Pretty painless and also totally, 100% life-changing. We met weekly after that until I moved.
I'd call back and ask if they can refer you elsewhere, or call around to local doctors yourself and ask if they offer testing, the process, availability, the $$$...
posted by circle at 6:23 PM on March 16, 2016 [1 favorite]
She gave me a survey to fill out in the waiting room ≈20 minutes, then evaluated me during a regular 50-minute session, after which she wrote a letter to my GP with the diagnosis and her recommendation to prescribe stimulants. Pretty painless and also totally, 100% life-changing. We met weekly after that until I moved.
I'd call back and ask if they can refer you elsewhere, or call around to local doctors yourself and ask if they offer testing, the process, availability, the $$$...
posted by circle at 6:23 PM on March 16, 2016 [1 favorite]
Response by poster: Thanks everyone for chiming in, especially folks who have undergone this testing before.
I spoke with my psychiatrist who made the referral in the first place. He agreed that it is kind of overkill, but that this was the process they had to go through if I were to eventually be prescribed stimulant meds to treat ADHD. Even if I were to be diagnosed by a different doc who did not require the full neuropsych testing, any student diagnosed after 15 years of age and wanting to be prescribed meds through the university health service would have to undergo this testing (merely doing an interview and filling out questionnaires is not adequate). Since I am on the university health insurance, this is the cheapest option for me, unless I find a different hospital to which I can be referred for the testing that does it slightly cheaper. There used to be the option to do this testing through the university for only ~$10 out of pocket, but this is no longer available.
posted by gumtree at 7:42 AM on March 17, 2016
I spoke with my psychiatrist who made the referral in the first place. He agreed that it is kind of overkill, but that this was the process they had to go through if I were to eventually be prescribed stimulant meds to treat ADHD. Even if I were to be diagnosed by a different doc who did not require the full neuropsych testing, any student diagnosed after 15 years of age and wanting to be prescribed meds through the university health service would have to undergo this testing (merely doing an interview and filling out questionnaires is not adequate). Since I am on the university health insurance, this is the cheapest option for me, unless I find a different hospital to which I can be referred for the testing that does it slightly cheaper. There used to be the option to do this testing through the university for only ~$10 out of pocket, but this is no longer available.
posted by gumtree at 7:42 AM on March 17, 2016
Best answer: I went through it and I'm glad I did. The official diagnosis carries weight with doctors/nurses/medical community, so I don't get the side-eye for drug-seeking behavior (especially as I live in a college town).
But it also was important to me, objective confirmation by professionals. I grew up making any excuse not to do work, and if I hadn't had the full diagnosis, it would always be in the back of my mind, "is this really my issue or do I just want to have another excuse?" The full diagnosis lets me take myself seriously, manage the issue effectively, and I am a different person today because of it.
posted by aabbbiee at 10:50 AM on March 17, 2016
But it also was important to me, objective confirmation by professionals. I grew up making any excuse not to do work, and if I hadn't had the full diagnosis, it would always be in the back of my mind, "is this really my issue or do I just want to have another excuse?" The full diagnosis lets me take myself seriously, manage the issue effectively, and I am a different person today because of it.
posted by aabbbiee at 10:50 AM on March 17, 2016
Best answer: I literally just had this done a few weeks ago and was diagnosed with ADHD-PI last week. I haven't yet been back to my primary care doctor for possible medication, but when I presented with suspected ADHD I did get a neuropsych referral. It was honestly pretty fun. It took the better part of a morning and early afternoon. There were no needle sticks or anything, just lots of questions and puzzles and two computer tests. I suspect, as others have said, that this is how they weed out drug-seekers.
posted by woodvine at 4:13 PM on March 17, 2016
posted by woodvine at 4:13 PM on March 17, 2016
I went to a psychiatrist who didn't want to bother with spending more than 7 minutes with me, and I managed to convince her that I had ADHD. (Huge list of my complaints + breaking down into tears over my inability to function like every other person my age probably did it, but she was concerned I could be bi-polar. I was not concerned, because all my mood swings are in response to things going wrong or right due to my ADHD symptoms.) She sent me away with a starter dose of Adderall, which was strange since if you have bi-polar, Addy can make you manic, but whatever.
Taking the first dose confirmed it for me. I'm calm. No mania. It's like putting on eyeglasses, for real. I feel the meds kick in as my mind clears... like a fog is lifting. I have one thought at a time and can hold a thought in reserve and not interrupt other people in conversation! I can sort a pile without feeling like I might have a panic attack! I can do simple daily tasks without messing up the order and forgetting what comes next! My non-stop anxiety almost entirely goes away.
My next psychiatrist spent more time with me, but he gave me the ADHD-PI diagnosis officially. I really, really don't think a full 8 hour thing is necessary for this. (Though you should get your thyroid tested, including antibodies to it, and also your iron levels, because those things can cause bad brain fog, too.)
But I would do an in-depth test for a child because a child can't explain what I just did, and it affects school in every way, and because I wouldn't want my child on stimulant medication unless I was sure there was no other option. (And I'd follow up with some serious heart testing.)
I don't need a full work-up when the medication for ADHD resolves the biggest struggles of my life and every ADHD book I read felt like reading a book about me and my life. So I don't think you do, either.
posted by chaos_theory at 5:47 PM on March 25, 2016
Taking the first dose confirmed it for me. I'm calm. No mania. It's like putting on eyeglasses, for real. I feel the meds kick in as my mind clears... like a fog is lifting. I have one thought at a time and can hold a thought in reserve and not interrupt other people in conversation! I can sort a pile without feeling like I might have a panic attack! I can do simple daily tasks without messing up the order and forgetting what comes next! My non-stop anxiety almost entirely goes away.
My next psychiatrist spent more time with me, but he gave me the ADHD-PI diagnosis officially. I really, really don't think a full 8 hour thing is necessary for this. (Though you should get your thyroid tested, including antibodies to it, and also your iron levels, because those things can cause bad brain fog, too.)
But I would do an in-depth test for a child because a child can't explain what I just did, and it affects school in every way, and because I wouldn't want my child on stimulant medication unless I was sure there was no other option. (And I'd follow up with some serious heart testing.)
I don't need a full work-up when the medication for ADHD resolves the biggest struggles of my life and every ADHD book I read felt like reading a book about me and my life. So I don't think you do, either.
posted by chaos_theory at 5:47 PM on March 25, 2016
This thread is closed to new comments.
Ultimately, I didn't bother with actually getting the diagnosis, but I did start on stimulant medication, along with therapy to help work on things like my executive functioning issues. I still have problems, but it's made a big difference. I'd already been working with this psychiatrist for a couple years at this point, so that may have made him more willing to try the meds without the psych testing.
How big a hardship is the cost for you? Can you put off the testing and meet with the psychiatrist again to discuss your concerns? Another option would be to get a second opinion, ideally from someone not affiliated with the student health services in case there is a bias about drug seeking students.
posted by litera scripta manet at 3:12 PM on March 16, 2016