People are pretty divided on the CPT. It doesn't account for much variance past the interview/questionnaires, but that doesn't stop folks from recommending it. IMO, it's too costly for what it does and may even mislead you so I wouldn't recommend it.
Two papers:
https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1433&context=psych_fac
Seems like people are pretty divided on many different test measures. As for being misleading, I guess it depends. A colleague asked if I knew any CPTs, gave them one, then had to go over the CPT's manual with them as they were incorrectly associating the results with other symptoms.
This also varies widely. Some universities require formal testing and even have specific batteries to prove the accommodations are necessary. For others, students just need to document impairment, broadly defined.
This is indeed correct I've learned. I suppose in my original question of the feasibility, I could review the required batteries and see how feasible a remote/virtual option is in building it out. I've had some (in person traditional stuff) where they ask for a specific test battery, others go "a psychologist needs to evaluate and provide recommendations" and very vague.
The proposed battery of some self report surveys, a cpt, and an interview won’t meet most uni reqs for accommodations assessment and definitely won’t meet reqs for mcat/lsat/gre accommodations assessment tho.
Usually the WAIS, WRAML, sometimes WIAT/WJ are also needed. But it depends. Most of the one's I've done and seen in more traditional in person settings for accommodations for extended time just needed evidence that the person would not perform to their expected ability without the additional time or accommodations. Maybe it depends. Good info for me to research with this idea.
1) The pandemic stuff really opened the door to overprescribing. If the worker data following the 2008 market taught us anything, it’s that productivity more than doubles during an economic downturn. Add in vyvanses approval for binge eating disorder, which is short hand for “weight loss drug”, and there is a perception that stimulants are a miracle pill.
2) I think that the vast majority of the assessment market is people looking to get someone to agree that they need stimulants. If you disagree with those people, you are bound to have some difficulty.
3) In the online space, the means of retaliation are: fighting credit card payment and filing a board complaints. Both sound like a hassle.
4) IIRC, there is some specific test needed for accommodations on the standardized tests. Starts with an L maybe? You have to do both the timed and untimed versions. I don’t think that can be done online, but I haven’t even looked at that test in a decade. If you can’t find it, DM me and I’ll go searching through the test closet.
1.) Was it pandemic era issues or has it been longstanding? Back in undergrad 20 some years ago people were using ADHD medications to "focus."
2.) I can see that. But in my own professional experience where I'm at it's many students or adults looking for accommodations. We have a lot of colleges and universities around here. Most evals I do in a group practice involving ADHD refer out for further evaluation by a psychiatrist at that point if it's clear medication is being considered.
3.) I've seen colleagues get bulled by wealthy private pay parents to try to say what they think they need to say in reports for their kids so I could see some of that "I paid a lot give me what I want." I think setting the expectations in writing in consent forms is probably a good idea.
4.) I know what you're tailing about but I can't recall the name. It's in your testing closet somewhere.
I know the test you're talking about, and at least the last time I saw and administered it (admittedly more than a few years ago as well), it couldn't be given online.
I strongly agree with point 2, unfortunately. At least for folks who are self-referred. You might be able to reduce some of that by requiring that they be referred by a healthcare provider (or a MH provider specifically), which could result in seeing more folks who are genuinely curious vs. those who are specifically seeking something tangible (e.g., medication, accommodations). I would not be surprised to hear that patients looking exclusively for online providers/evaluations are more likely to fall in the external incentive group.
If you move forward with it, I think the informed consent, and explicitly discussing that it's very possible the evaluation will not result in a diagnosis of ADHD (or perhaps anything else), will be very important. Doubly so if you go the self-pay route, as you may see a not-insubstantial number of folks who assume that because they're paying out-of-pocket, they should get what they're wanting.
And to speak to the comments about requirements for accommodations, I'd agree. Most larger universities, and all standardized tests, that I've had experience with require some combination of a full IQ test, full academic achievement battery (e.g., WIAT, WJ), full WMS or thereabouts, MMPI/PAI or equivalent, and a smattering of other stuff. That's also something you'd want to be explicit about up front (i.e., that your eval is solely for clinical purposes, and that it may or likely will not be useful for things like academic accommodations).
Thanks, this is good advice for sure. I think moving forward I might do some research on what these requirements are, seeing if a feasible virtual/remote battery could be conceptualized and go from there. I definitely agree on informed consent covering clinical only purpose of evaluation.
OP, what kind of experience do you have in assessing ADHD? From what has been said in here, you may be able to just offer a quick diagnostic assessment, no neuropsych testing (hopefully), that serves no purpose other than to say yes or no if they have ADHD. It does not sound like you are trained or equipped to handle referrals that need an assessment that meets criteria for accommodations, nor would telehealth be appropriate for that anyway. In either case, may need to brush up on Barkley's stuff so you don't give unnecessary tests that lead you to misdiagnose people, and also figure out a way to suss out feigning and/or exaggeration in a competent way.
My academic training was a lot of psychoeducational/learning disability type testing with some personality testing training in other courses. But most of my practical testing and evaluating experience is neuropsych as most of my assessment practicums, internship, some post doc, and work experience was within this realm. Lot of "did this accident cause cognitive impairment" type stuff. There was also ADHD/academic accommodations/LD cases, and in my post doc hours also got trained on autism spectrum evaluations. I also contributed to literature on embedded validity measures for suboptimal effort detection while in grad school so one big question I'd look at is how can i find a measure suitable in the available remote/virtual tests that might aid in that. I should read up more on Barkley, he was brought up quite a bit during my practicum at a neuropsych/forensic psych practice, I vaguely remember meeting him as one of the docs there went to school with him I think.
But name a test measure and chances are I've administered it, scored it by hand, wrote the findings, and provided the feedback on each ones dozens of times if not more across a decade plus of hands on in person experiences. Obviously I'm not implying knowing people and having trained under many neuropsychologists means I'm off to the races on this idea , which is why I'm exploring the feasibility of my original post question. Most of my experiences with these measures and testing were pre-pandemic and when online testing was still very limited.
That said if I took the group practice work I do now on the side, I'd just do that but some of the measures can't be done remotely (WAIS, WIAT, WRAML/WMS) or virtually so yes i'm left with exploring diagnostic assessments and keeping that scope nice and narrow.
I know there's probably other aspects of testing/diagnostic assessments I could also explore in a remote/virtual setting , so the exploring of what's feasible continues.
You're probably not surprised to hear there's providers out there who just pull test measures off the shelf so to speak, administer them, and copy/past the printout into reports and say 'well it says you have this condition so you do." Meanwhile people are watching Tik Tok videos from midlevels telling them they have ADHD, autism, or something else if they "do these 5 things!", school psychologists (and I've seen reports) diagnosing autism, depression, etc in school reports with one questionnaire and a WAIS, and non-psych folks creating "apps" that people think replace therapy. And at a recent APA convention there was a booth of some company showcasing their "new" software program to "diagnose adult ADHD reliability and accurately , learn in one minute, administer to patients on their own time, no office space or materials needed!"
But I digress. I appreciate the insight and thoughts on this thread, there's some good resources and ideas.