Diagnosing adhd with rating scales

[Childdoconeday]

Background- I worked in an outpatient setting where we conducted very thorough psych assessments to diagnose adhd.

I currently work at a community mental health center where I have noticed all the clinicians diagnose adhd after providing a Vanderbilt rating scale to the parent and teachers and after conducting an interview. Is that sufficient? They then provide the parent a letter to give to the school with the diagnosis and request for accommodations.

Thanks

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[WisNeuro]

Background- I worked in an outpatient setting where we conducted very thorough psych assessments to diagnose adhd.

I currently work at a community mental health center where I have noticed all the clinicians diagnose adhd after providing a Vanderbilt rating scale to the parent and teachers and after conducting an interview. Is that sufficient? They then provide the parent a letter to give to the school with the diagnosis and request for accommodations.

Thanks

Considering your recent threads about coworkers, I fear for the patients who present at your place of work. In school age population this is definitely not sufficient, if anything it is negligent. There are so many rule outs and masquerading conditions in this age range that this is a huge disservice to the children. Granted, its probably better than a primary care doc talking to the parents for 5 minutes and handing out some Adderall, but as a psychologist, if you're not going to do the evaluation in at least a half-assed way, why do it at all?

 

[Childdoconeday]

I know I feel similarly. I don’t know how much longer I will stay here...

QUOTE="WisNeuro, post: 21193931, member: 248083"]
Considering your recent threads about coworkers, I fear for the patients who present at your place of work. In school age population this is definitely not sufficient, if anything it is negligent. There are so many rule outs and masquerading conditions in this age range that this is a huge disservice to the children. Granted, its probably better than a primary care doc talking to the parents for 5 minutes and handing out some Adderall, but as a psychologist, if you're not going to do the evaluation in at least a half-assed way, why do it at all?
[/QUOTE]

 

[WisNeuro]

I know I feel similarly. I don’t know how much longer I will stay here...

You'll have to gauge it for yourself. Sometimes we can effect change in our organizations, sometimes we can't. I would just worry about stagnating and taking on some of the "phone it in" culture when it comes to properly treating patients if you stay there too long.

 

[cara susanna]

What else would you guys include, given that neuropsych testing doesn't seem to be helpful? Clinical interview + rating scales (Barkley) including collateral is pretty much what we do here minus the PAI or MMPI-2.

Edit: I should add that we only assess adults, since we're a VA clinic and don't see children.

 

[Meteora]

Do I think it's sufficient? No. ADHD is often either overdiagnosed or missed entirely. It's a diagnosis where I believe detailed assessment is particularly necessary.

Is there any possibility of at least having some kind of non-self-report measure (e.g. something like the Connors Continuous Performance Test)?

 

[AcronymAllergy]

If you're diagnosing ADHD in childhood, ideally you'll want interviews and rating scales with child, parent, and teacher. Possibly classroom observation. Neuropsych testing or additional assessments could be useful if there are rule-outs for which it may be helpful, which in kiddos is often the case.

For an adult, interview (patient and, ideally, parent and/or other collateral) is technically all you need to make the diagnosis. Adding some rating scales can help inform/support your interviews. Neuropsych or other cognitive testing wouldn't be necessary for diagnosis, unless (as above) you're trying to rule-out other potential factors for which it would be helpful. Psychoeducational testing could be necessary for academic/testing accommodations, and to help with identifying possible learning disorder.

 

[cara susanna]

Right, I stopped giving the CPT because people here say it has poor specificity (and neuropsychology at our facility agrees that it's not necessary).

 

[WisNeuro]

Is there any possibility of at least having some kind of non-self-report measure (e.g. something like the Connors Continuous Performance Test)?

This is meaningless in diagnosing ADHD. Relying on it, especially as the sole measure, would simply lead to a huge increase in false positive diagnoses.

 

[erg923]

If its a thorough clinical interview with child and parents, plus collecting standardized data from at least 2 sources (as you described), I fail to understand peoples outrage here? That's actually more than we do to diagnose most other psychiatric disorders, no?

 

[WisNeuro]

If its a thorough clinical interview with child and parents, plus collecting standardized data from at least 2 sources (as you described), I fail to understand peoples outrage here? That's actually more than we do to diagnose most other psychiatric disorders, no?

There are a lot of caveats here. In terms of kids, there is a lot of misdiagnosis, and this usually leads to them either receiving the wrong services, or no services at all in the school system when they need them. We have mounds of data that suggests that getting appropriate services early on in school can be enormously helpful in cognitive development when needed.

So, yes, we would definitely treat this different if it were say, an adult, with no intention of returning to school, who wants a stimulant. Also, at this point, many of the other neurological conditions that could be mimicking ADHD are generally ruled out by the time they are adults by history.