Neuropsychological testing training for psychiatric providers?

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roastedcapers

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Hello! I treat a lot of ADHD. As we all know the differential is challenging at times. I would love to learn some basics of neuropsychological testing I could apply in a 90 minute intake appointment. Does anyone know of neuropsych testing for ADHD training geared toward psychiatric providers or otherwise non-psychologists?

Thank you!

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Hello! I treat a lot of ADHD. As we all know the differential is challenging at times. I would love to learn some basics of neuropsychological testing I could apply in a 90 minute intake appointment. Does anyone know of neuropsych testing for ADHD training geared toward psychiatric providers or otherwise non-psychologists?

Thank you!

No. That time should be spent doing in depth interview with patient and a collateral source, or contacting and talking to collateral informants. And/or behavioral/symptom rating scales with informant. Much more valid/ROI than any neuropsych test.
 
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No. That time should be spent doing in depth interview with patient and a collateral source, or contacting and talking to collateral informants. And/or behavioral/symptom rating scales with informant. Much more valid/ROI than any neuropsych test.
Can you suggest some rating scales with informants?
 
Neuropsych testing for ADHD has poor sensitivity and specificity in general and often just serves to slow down the diagnostic process rather than improving it. The only useful thing a neuropsych test can do from what I have seen is occasionally point out a patient that has red flags for faking their symptoms during testing, but otherwise into the trash they go in favor of a thorough history. Just my two cents though
 
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Generally speaking, it can be necessary and useful if you have concerns about differentials with other neurological issues. Also, testing in kids is useful because you are also usually looking to see if there are comorbid LDs and other ruleouts. But, for the run of the mill "adult with possible ADHD," no, the testing isn't going to be all that helpful above and beyond a good diagnostic interview and certain scale administration.
 
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Hello! I treat a lot of ADHD. As we all know the differential is challenging at times. I would love to learn some basics of neuropsychological testing I could apply in a 90 minute intake appointment. Does anyone know of neuropsych testing for ADHD training geared toward psychiatric providers or otherwise non-psychologists?

Thank you!
We shadowed neuropsychologists for a few patients as part of my residency. Honestly this is just not something you should be doing as a psychiatrist. We don't have the time, nor experience in this manner. You have plenty enough job to be extensively interviewing the patient, collateral, getting old records, etc. Vanderbilt forms filled out by teachers/parents in real time in CAP are a great resource (saves a phone call for collateral) but I am very unimpressed with other scales/testing beyond that in most cases. Of course some patients are ideal to have psychologic testing done for, particularly with LD/ID concerns or with TBI issues (which is actually pretty common in the adolescent population these days).
 
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On a related note, what about psychiatrists getting trained to administer IQ testing, or personality inventories.

I believe this would be very useful. I could see using the MMPI in my outpatient population. And I see a fair amount of inpatients historically diagonsed with schizophrenia who turn out to have more along the lines of low IQ plus/minus drug use, got diagnosed years ago and no one questioned the diagnosis. If we could do IQ testing in the hospital it would be useful. We can get a psychologist intermittently, but he's often booked out 1-2 weeks which isn't really doable for inpatient.
 
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How about brief testing for malingered ADHD? Is there anything similar to and more specific than the MFAST for attention, like the TOMM, for attention/executive functioning complaints?
 
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How about brief testing for malingered ADHD? Is there anything similar to and more specific than the MFAST for attention, like the TOMM, for attention/executive functioning complaints?
The CAT-A has validity scales and takes 20-25 mins to complete. Based on self report.
 
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We shadowed neuropsychologists for a few patients as part of my residency. Honestly this is just not something you should be doing as a psychiatrist. We don't have the time, nor experience in this manner. You have plenty enough job to be extensively interviewing the patient, collateral, getting old records, etc. Vanderbilt forms filled out by teachers/parents in real time in CAP are a great resource (saves a phone call for collateral) but I am very unimpressed with other scales/testing beyond that in most cases. Of course some patients are ideal to have psychologic testing done for, particularly with LD/ID concerns or with TBI issues (which is actually pretty common in the adolescent population these days).

Honestly, for concussions/mild TBI, testing is more likely to be iatrogenically harmful than helpful. Just some good education about recovery is all that's needed there.
 
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How about brief testing for malingered ADHD? Is there anything similar to and more specific than the MFAST for attention, like the TOMM, for attention/executive functioning complaints?

Remember not to conflate performance validity with symptom validity. While these domains share some overlap, they are distinct.
 
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How is testing harmful?

It reinforces a belief that they actually have a deficit, whereas in in uncomplicated mildTBI/concussion, there are only temporary changes that are present for weeks at most. Expectations matter, some of the child lit suggests that simply telling people that they'll be fine in a week or two is teh best ting you can do for recovery.
 
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It reinforces a belief that they actually have a deficit, whereas in in uncomplicated mildTBI/concussion, there are only temporary changes that are present for weeks at most. Expectations matter, some of the child lit suggests that simply telling people that they'll be fine in a week or two is teh best ting you can do for recovery.
That's why they are retested at a later time. And I haven't seen acute concussions tested, more cases where there's complexity or symptoms aren't improving. But that's just where I live
 
That's why they are retested at a later time. And I haven't seen acute concussions tested, more cases where there's complexity or symptoms aren't improving. But that's just where I live

It's simply unnecessary testing. It's akin to having them serially MRI'd. It's a waste of resources, and you will have a share of somaticizers who will actually get worse. You'll also get some people who become somaticizers because incompetent PCPs will send these patients to OT/ST who will diagnose them with made up disorders.

The part of me that likes money doesn't mind, as some of these people will make it to me for IMEs, and these are pretty easy evaluations to do to collect a hefty paycheck.
 
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That's why they are retested at a later time. And I haven't seen acute concussions tested, more cases where there's complexity or symptoms aren't improving. But that's just where I live
"Friends dont let friends be part of head bump sensationalism. "
-The Bee Gees
 
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That's why they are retested at a later time. And I haven't seen acute concussions tested, more cases where there's complexity or symptoms aren't improving. But that's just where I live
Yup, if you are presenting for adolescent ADHD evaluation (which already has it's own string of suspicions that need to be investigated) and part of the history is of repeated or higher severity head trauma, I'm still referring these folks 10/10 times. Unless WisNeuro or someone else has literature to show me otherwise, the local pediatric neuropsychologist I most frequently use has been very helpful for the small handful of cases like this I've seen in the past few years.
 
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The training I assume you're asking for requires statistical training far above the intro to stats level. So if you want to do good testing that psychologists do that we MDs don't such as an MMPI, no. Unless you've taken the appropriate statistics courses and then you have to get the training for the specific tests.

Many places dumb things down and say only psychologists. Can an MD with the right statistics and other training do it? Yes but because the psychology training has it there anyways they just often times on their list of required criteria to administer the test they say psychologists only. The term "dumb down" is in no way shape or form meant to throw shade at our psychologist-colleagues. High level statistics is tough and is leaps and bounds way more sophisticated vs an intro class. Further I've seen a lot of psychiatrists think they know what they're doing and make up a lot of BS claiming they know more than they really know. On the other hand I've seen some MDs who have mastered the highest orders of statistics, know psychometric on the order with the best psychologists but even they will have the psychologist due the test because they want to follow the rules on paper.

This can become a legal pickle. Even if you have the right training to understand the tests many psychological tests say psychologists only. Some however are more open-minded and give a list of criteria such as "a prior course in psychometric testing." If you don't meet the requirements to administer the test, do the test, and this goes to court this can be flung into your face.
 
Yup, if you are presenting for adolescent ADHD evaluation (which already has it's own string of suspicions that need to be investigated) and part of the history is of repeated or higher severity head trauma, I'm still referring these folks 10/10 times. Unless WisNeuro or someone else has literature to show me otherwise, the local pediatric neuropsychologist I most frequently use has been very helpful for the small handful of cases like this I've seen in the past few years.

Well, these would not be uncomplicated mTBI. However, if you would like literature on uncomplicted mTBI/Concussion, and how treatment and testing is unnecessary, how many terabytes of storage do you have?
 
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The training I assume you're asking for requires statistical training far above the intro to stats level. So if you want to do good testing that psychologists do that we MDs don't such as an MMPI, no. Unless you've taken the appropriate statistics courses and then you have to get the training for the specific tests.

Many places dumb things down and say only psychologists. Can an MD with the right statistics and other training do it? Yes but because the psychology training has it there anyways they just often times on their list of required criteria to administer the test they say psychologists only. The term "dumb down" is in no way shape or form meant to throw shade at our psychologist-colleagues. High level statistics is tough and is leaps and bounds way more sophisticated vs an intro class. Further I've seen a lot of psychiatrists think they know what they're doing and make up a lot of BS claiming they know more than they really know. On the other hand I've seen some MDs who have mastered the highest orders of statistics, know psychometric on the order with the best psychologists but even they will have the psychologist due the test because they want to follow the rules on paper.

This can become a legal pickle. Even if you have the right training to understand the tests many psychological tests say psychologists only. Some however are more open-minded and give a list of criteria such as "a prior course in psychometric testing." If you don't meet the requirements to administer the test, do the test, and this goes to court this can be flung into your face.

All true, but maybe a bit paranoid or overly restrictive, frankly.

I think the big issues with this are:

1. The vast majority of psychiatrists don't want to do this and certainly won't actually end up doing this. And certainly not full-scale IQ assessments like the WAIS. Thus, it will likely be completely wasted training the vast majority of the time.

2. I think we really, really need to push past the 1940s,50s,60s,70s, 80s MMPI mystic/allure and move-on with more tailored, robust, simplistic, and/or outcome-driven measures for diagnosis and treatment planning. "Empirically keyed" measures are great, but only have so much ROI. This may just mean moving back to more skilled structured interviewing/investigation and assessment, as well as looking at other allied health assessments and markers of psychopathology. There will always be a place for the MMPI and alike (especially in forensic cases/questions)....I just don't think doing *more* of them is the answer (we already do tons of MMPIs that probably add very little to treatment in the end), or will be at all helpful for the average clinic patient.

3. Everyone needs to be careful about "muddying the waters" with too much speculation, too much information, and/or (sometimes) too much psychobabble during your assessment of the patient that may not actually/functionally change the treatment plan for that patient. Right? The overuse of psychological or personality testing can easily do this.
 
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The CAT-A has validity scales and takes 20-25 mins to complete. Based on self report.
Can this be done by a psychiatrist? Their website's "levels" are hard to decipher. Psychiatrists can order and utilizer "Level B" testing?
 
Can this be done by a psychiatrist? Their website's "levels" are hard to decipher. Psychiatrists can order and utilizer "Level B" testing?

If all you're really doing is a short interview and a rating scale, might as well stick to a shorter measure, like the BAARS-IV, because it's shorter, and you still have the same issues with specificity problems. If you're only giving one scale, that looks at a disorder with non-specific symptoms, SVT/PVT scales are not going to be all that helpful.


 
If all you're really doing is a short interview and a rating scale, might as well stick to a shorter measure, like the BAARS-IV, because it's shorter, and you still have the same issues with specificity problems. If you're only giving one scale, that looks at a disorder with non-specific symptoms, SVT/PVT scales are not going to be all that helpful.


Yeah, BAARS-IV as a rating scale + DIVA 5 as a structured clinical interview is my typical practice when evaluating for ADHD. This CAT-A looks pretty interesting though.
 
Yeah, BAARS-IV as a rating scale + DIVA 5 as a structured clinical interview is my typical practice when evaluating for ADHD. This CAT-A looks pretty interesting though.

If you're already giving structured interview, BAARS-IV would still be my pick, because at that point your interview got the most sensitive information presumably, and all you really need at that point is co-normed collateral info. Also, longer the self-report/collateral report, better chance of people just haloing answers.
 
I refer out any testing and then do my own evaluation. The fact that I require it for new diagnoses helps screen out the med seekers. That way there is another opinion involved before prescribing stimulants.
 
Yeah, BAARS-IV as a rating scale + DIVA 5 as a structured clinical interview is my typical practice when evaluating for ADHD. This CAT-A looks pretty interesting though.
CAT-A is ok in that it has current and retrospective report (and I like their version of the latter better than the WURS). It also provides information for various life domains. It's certainly not always necessary if you're already doing a DIVA, but could be helpful. And in addition to the BAARS, there's also the BDEFS if you want to mix things up.

Our psychiatrists refer their less straightforward cases to me for evaluation, although I seldom actually perform in-depth cognitive testing. As psyguru mentioned, much of the time it's to have another opinion involved, for diagnostic clarification of multiple comorbid conditions in which psychodiagnostic testing may be helpful, and just because I'm able to spend longer with the pts (e.g., for targeted clinical interview) than our psychiatrists.
 
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