Offering online/virtual ADHD assessments?

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quickpsych

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Been contemplating branching out on my own with a very small side business idea. I've noticed , at least where I live, there's a growing number of people seeking affordable diagnostic evaluations for ADHD. Some are looking to see if they meet criteria and if so receiving executive functioning coaching and/or recommendations for accommodations in academic settings. Some are told by their PCPs they need a formal diagnosis to be considered for ADHD medications. And a few seem to just want to know if they have ADHD in their adult life or not.

I'm wondering what others' thoughts are on building a small test battery that can be administered 100% virtually/remotely?

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Things to think about:

1. How would you handle complicated differentials? Do you have people to consult with?

2. I'm not sure about your locale, but major insurers don't pay for ADHD testing around here. That's because testing for ADHD diagnosis is unsupported by research (the effect size between TDC and ADHD groups are too small to be clinically meaningful; see this reference). So if your battery consists of a rating scale and a structured interview, I don't see why that can't be done online.

3. Would you screen out LDs, Autism, ID? Those comorbidities are common.

4. Would you only accept ADHD as the referral question?

5. Are you set up as a private practice (e.g., personal liability insurance, business insurance, LLC)?

6. Is your plan to undercut the market by offering a lower rate? How will that impact the quality of your service? Won't you lose money on the service? Or would you try to make up for the low rate in volume?

7. Pediatricians/PCPs/Psychiatrists can diagnose ADHD without you. They have algorithms they can follow. So what is the incremental benefit of your service to patients?
 
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Been contemplating branching out on my own with a very small side business idea. I've noticed , at least where I live, there's a growing number of people seeking affordable diagnostic evaluations for ADHD. Some are looking to see if they meet criteria and if so receiving executive functioning coaching and/or recommendations for accommodations in academic settings. Some are told by their PCPs they need a formal diagnosis to be considered for ADHD medications. And a few seem to just want to know if they have ADHD in their adult life or not.

I'm wondering what others' thoughts are on building a small test battery that can be administered 100% virtually/remotely?
lmao
 
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You're going to get some flack for this one i have a feeling. Also...why do pcp's request "formal testing" for this stuff? They're the reason we're in this mess to begin with (ie the diagnosing from early 80s to late 2000s).
 
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Knee-jerk response: since the "gold standard" of ADHD assessment is basically a thorough interview, I don't see why you couldn't do that remotely, and would probably be better than 90% of what's out there now. Although ideally, you'd also have some access to a collateral informant and/or childhood records, and could potentially mix in some questionnaires/psych testing, which make remote evals start to become less feasible (e.g., how would you get the records, how would you contact the collateral).

Even with a more complex differential than just "ADHD vs. not," I suspect a lot could be done remotely. I personally wouldn't want to be doing any cognitive testing remotely, especially if it's in pursuit of accommodations, which tend to be stricter standards. I also don't know that you'd feasibly be able to administer all of the testing necessary for accommodations, although that can vary substantially depending on the setting (e.g., standardized testing vs. small community college vs. large university).
 
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I offered ADHD testing in my practice the last couple of years. Got a few inquiries and referrals and no takers. Was telling them it was 800 dollars and we don’t take insurance. Apparently that is too much. My new postdoc is wanting to do much more testing and is marketing it in the community, we shall see what kinds of referrals he gets. He actually is doing an evaluation now for a college student who has problems with attention, but is planning in doing a more comprehensive evaluation. In my mind, that almost always makes more sense anyway.
 
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Been contemplating branching out on my own with a very small side business idea. I've noticed , at least where I live, there's a growing number of people seeking affordable diagnostic evaluations for ADHD. Some are looking to see if they meet criteria and if so receiving executive functioning coaching and/or recommendations for accommodations in academic settings. Some are told by their PCPs they need a formal diagnosis to be considered for ADHD medications. And a few seem to just want to know if they have ADHD in their adult life or not.

I'm wondering what others' thoughts are on building a small test battery that can be administered 100% virtually/remotely?

I am going to be very honest and blunt here. If you do this, you are being used. By both "patients" and doctors. For patients, it will be mostly med seeking. No one who flocks to this affordable business model is actually interested in "executive functioning coaching." Come on.

Its also for docs who don't want to do their jobs so they look to someone else to take on the work, the liability, and to do it fast and cheap (aka "affordable") for their patients.

Stop thinking of yourself and your profession as garbage.
 
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I am going to be very honest and blunt here. You are being used.

People don't want to do their jobs so they look to someone else to take on the work, the liability, and to do it fast and cheap (aka "affordable").

Stop thinking of yourself and your profession as garbage.
Well this comment makes no sense.

I'm being used, or thinking of my work as garbage, by considering a way to provide a professional service where I'd take 100% of the fee?... OK.:rofl:

Who are these people you speak of? The doctors that aren't qualified to do the assessments and correctly refer out or?

I'm guessing your reason for creating an account to post this nonsense is simply: projecting hard, out of touch, or trolling. Thanks for contributing nothing of value to my question. Thanks for the laugh.
 
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Well this comment makes no sense.

I'm being used, or thinking of my work as garbage, by considering a way to provide a professional service where I'd take 100% of the fee?... OK.:rofl:

Who are these people you speak of? The doctors that aren't qualified to do the assessments and correctly refer out or?

I'm guessing your reason for creating an account to post this nonsense is simply: projecting hard, out of touch, or trolling. Thanks for contributing nothing of value to my question. Thanks for the laugh.

This is EXACTLY what I am saying. Tell me "best practice" for assessing ADHD in adult in children. Then tell me what various professional position papers say. This is very high value advice.
 
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Things to think about:

1. How would you handle complicated differentials? Do you have people to consult with?

2. I'm not sure about your locale, but major insurers don't pay for ADHD testing around here. That's because testing for ADHD diagnosis is unsupported by research (the effect size between TDC and ADHD groups are too small to be clinically meaningful; see this reference). So if your battery consists of a rating scale and a structured interview, I don't see why that can't be done online.

3. Would you screen out LDs, Autism, ID? Those comorbidities are common.

4. Would you only accept ADHD as the referral question?

5. Are you set up as a private practice (e.g., personal liability insurance, business insurance, LLC)?

6. Is your plan to undercut the market by offering a lower rate? How will that impact the quality of your service? Won't you lose money on the service? Or would you try to make up for the low rate in volume?

7. Pediatricians/PCPs/Psychiatrists can diagnose ADHD without you. They have algorithms they can follow. So what is the incremental benefit of your service to patients?

Good questions, I appreciate it.

1.) Know quite a few, would refer out if needed and ideally screen out these during an initial consultation.

2.) No plan to take insurance. That was the idea, a structured interview, a CPT, some rating scales.

3.) This seems like a good idea and if not screened out would provide further recommendations as needed for outside further services.

4.) Yes. It seems to be a quite common referral question, often from college students, parents of students, or self referred adults in my area. I know a few people who have waitlists of people looking for ADHD assessments.

5.) I have the framework, just need to press the proverbial button on activating these things.

6.) Great question. Mix of both. I wouldn't plan to make it a full time thing, very part time. I wouldn't go cheap just for the sake of cheap, would see what market is bearing around here (highest I've seen is $3,500 and lowest is $800). I suppose I could go for volume if there was a lot of demand , but wouldn't plan on it at this time. I might even consider going at the lower end, not to undercut but to provide a service. It seems like some people need these assessments but can't afford them at the higher rates.

7.) Another great question. I do work with a small private practice and most of the referrals come from psychiatrists who won't prescribe without a formal assessment as well as a mix of schools and college aged students saying they need an evaluation to determine if a formal diagnosis exists to support test and academic accommodations. Actually this small practice, and another one I did some work for in the past, had a couple every few months that were just adults "who wanted confirmation if they indeed had ADHD or not."

You're going to get some flack for this one i have a feeling. Also...why do pcp's request "formal testing" for this stuff? They're the reason we're in this mess to begin with (ie the diagnosing from early 80s to late 2000s).
I see in some of the later comments got some nonsense flack, in that case that commenter seemed like they were just trolling. It's my understanding there was a significant under diagnosis (or least misdiagnosis) of ADHD in the 80s to early 2000s. Almost every patient I've seen in various private settings for ADHD, if they weren't a kid, they were a college aged kid with academic problems or adult women who think they have ADHD and never had an evaluation.


Did you mean "small test battery" or did you actually mean just questionnaires?
Questionnaires, structured interview, CPT. Open for ideas for other measures of use that could be done virtually or remotely.

I offered ADHD testing in my practice the last couple of years. Got a few inquiries and referrals and no takers. Was telling them it was 800 dollars and we don’t take insurance. Apparently that is too much. My new postdoc is wanting to do much more testing and is marketing it in the community, we shall see what kinds of referrals he gets. He actually is doing an evaluation now for a college student who has problems with attention, but is planning in doing a more comprehensive evaluation. In my mind, that almost always makes more sense anyway.
Thanks for the personal experience insight. $800 is lowest I've seen in my area. Most charge least $1,000 or more. And of those who post their information online it was : interview, two questionnaires, a CPT, sometimes WAIS/WRAML.


Overall I'd also be interested in hearing about other niche testing/evaluative services that might be worth considering as well for a virtual/remote service. There's a lot of people paying thousands for personality testing as well in my area but mixed thoughts on that.
 
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most of the referrals come from psychiatrists who won't prescribe without a formal assessment
I think this is what they were alluding to when they wrote, "Its also for docs who don't want to do their jobs so they look to someone else to take on the work, the liability, and to do it fast and cheap (aka "affordable") for their patients."

For patients, it will be mostly med seeking.
Eh, not necessarily. Most universities and colleges I've seen will require testing with the eval to get accommodations for ADHD, as will any orgs that do high stakes testing (e.g., MCAT, LSAT). Sure, there's definitely malingering there as well for undeserved and unnecessary accommodations, but for the others it's not the patients' fault that a third party is requiring them to have formal testing to get the help they need.
 
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Why a CPT? My question would be why not?

Most of my early experiences using them during training and work under neuropsychologists, they seemed pretty common and widespread. I don't think I've seen a report without one included unless it was a personality assessment.
 
Why a CPT? My question would be why not?

Most of my early experiences using them during training and work under neuropsychologists, they seemed pretty common and widespread. I don't think I've seen a report without one included unless it was a personality assessment.

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
 
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Why a CPT? My question would be why not?

Most of my early experiences using them during training and work under neuropsychologists, they seemed pretty common and widespread. I don't think I've seen a report without one included unless it was a personality assessment.

Why not? Because it's exponentially more likely to lead you to misdiagnose someone, than to help you arrive at an accurate diagnosis when it comes to ADHD. I almost never see these outside of FAA evals, and in the snake oil practices these days who do "ADHD testing."
 
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Why not? Because it's exponentially more likely to lead you to misdiagnose someone, than to help you arrive at an accurate diagnosis when it comes to ADHD. I almost never see these outside of FAA evals, and in the snake oil practices these days who do "ADHD testing."

Slightly off topic but the goal for the CPT in FAA evals is to evince sustained attention rather than diagnose ADHD, yeah?
 
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Why not? Because it's exponentially more likely to lead you to misdiagnose someone, than to help you arrive at an accurate diagnosis when it comes to ADHD. I almost never see these outside of FAA evals, and in the snake oil practices these days who do "ADHD testing."
But what if it "feels" more sciencey to the patient and therefore justifies the cost to them.....?
 
Slightly off topic but the goal for the CPT in FAA evals is to evince sustained attention rather than diagnose ADHD, yeah?

Yes. As you can surmise, sustained attention is a fairly important skill for pilots.

But what if it "feels" more sciencey to the patient and therefore justifies the cost to them.....?

Well, as you mentioned earlier about higher rates of malingering, the CPT is absolutely garbage in terms of its validity measures.
 
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Eh, not necessarily. Most universities and colleges I've seen will require testing with the eval to get accommodations for ADHD, as will any orgs that do high stakes testing (e.g., MCAT, LSAT). Sure, there's definitely malingering there as well for undeserved and unnecessary accommodations, but for the others it's not the patients' fault that a third party is requiring them to have formal testing to get the help they need.

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.
 
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I've also heard that there are also states that will only allow psychologists to diagnose ADHD?
 
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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.
 
Eh, not necessarily. Most universities and colleges I've seen will require testing with the eval to get accommodations for ADHD, as will any orgs that do high stakes testing (e.g., MCAT, LSAT). Sure, there's definitely malingering there as well for undeserved and unnecessary accommodations, but for the others it's not the patients' fault that a third party is requiring them to have formal testing to get the help they need.
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.
 
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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.
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).
 
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.
 
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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).

I can think of some R2s, at least, that don't require this kind of testing for accommodations vis-à-vis the 'standardized tests are biased' wave affecting academia lately. Still, I don't think that justifies not being equipped to provide such evaluations in the first place.

@OP, the link I provided in my first post on this thread will link you to several metas for more information on the problems with using neuropsych testing to diagnose ADHD.
 
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My favorite cases are the ones where the prescriber goes, "but they responded well to the stimulant...", as if that somehow confirms a diagnosis of ADHD. The vast majority of people do better on stimulants and report they are helpful.
 
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My favorite cases are the ones where the prescriber goes, "but they responded well to the stimulant...", as if that somehow confirms a diagnosis of ADHD. The vast majority of people do better on stimulants and report they are helpful.

Ah, yes, the guess-and-check method of psychiatry. What could go wrong?
 
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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.
 
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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.

You are free to do as you please. You are doing so with the knowledge that the use of the CPT to diagnose ADHD in adults is at best inconclusive.
 
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You are free to do as you please. You are doing so with the knowledge that the use of the CPT to diagnose ADHD in adults is at best inconclusive.


The CPT/TOVAs with ADHD are great to use.....as long as you give zero ****s about false positives.
 
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My favorite cases are the ones where the prescriber goes, "but they responded well to the stimulant...", as if that somehow confirms a diagnosis of ADHD. The vast majority of people do better on stimulants and report they are helpful.
I once saw notes from a provider (NP) use a pre/post CPT to "prove" the patient responded to the stimulant and, therefore, had ADHD. They literally circled the one or two T-scores on the score printout that had bumped up a couple points on the re-administration and wrote, "see, ADHD!" to the side.

To add anecdotal experience to what the research generally shows, I never found the CPT to be particularly helpful in diagnosing ADHD; for the folks who showed things like poor vigilance and response inhibition, you could usually have a conversation with them for 5 or 10 minutes and get the same information. Stroop may have as much empirical support and is faster and cheaper.
 
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As I think more about my ADHD referrals, I am thinking that they never come through because the NPs who are sending them are starting the medication and then making the referral but the patient does not have to follow through. It’s just a recommendation. I am actually glad that they don’t make it a requirement because I really don’t want to be involved in this stuff. Stimulant prescription has caused way too many problems for my patients with severe mental illness and most of them were started on them from a very early age because “kid has problems, maybe it’s ADHD let’s try a stimulant and see if it helps”. The beauty of testing is when it is used to correctly diagnose and clarify what is going on and then guide appropriate treatments. Unfortunately our entire system pushes against that.
 
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The CPT was always really annoying to administer in my setting, and I eventually decided it's not worth the hassle. In addition to the research showing poor specificity, I just never found it useful in terms of my own assessment.
 
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The CPT was always really annoying to administer in my setting, and I eventually decided it's not worth the hassle. In addition to the research showing poor specificity, I just never found it useful in terms of my own assessment.

$1600 is a lot to spend to get very little in the way of useful information. Particularly when time spent on the task is not billable.
 
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$1600 is a lot to spend to get very little in the way of useful information. Particularly when time spent on the task is not billable.
$1600 spent on what? The MOXO CPT for example is under $30 a usage and has been found to be more accurate than older CPTs:


 
$1600 spent on what? The MOXO CPT for example is under $30 a usage and has been found to be more accurate than older CPTs:



I was referencing the current cost of CPT-3 with unlimited usage.
 
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The jury's still out on the MOXO. See the following reference.

Important quote from the discussion

When taken at face value, our analyses suggest a higher accuracy for the MOXO compared to other CPTs. However, our confidence in this difference is low and might not replicate in future studies. On 1 hand, there were very few studies per implementation; on the other hand, the studies on the MOXO had a high risk of bias.
 
The jury's still out on the MOXO. See the following reference.

Important quote from the discussion

The numbers always seem to get a little worse once you include data from people with no financial interest in a measure ;) Like before, seems like a great instrument to use, as long as you don't care about false positives.
 
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The numbers always seem to get a little worse once you include data from people with no financial interest in a measure ;) Like before, seems like a great instrument to use, as long as you don't care about false positives.

I'm sure you know this, but there is no shortage of people trying to sell gadgets and doohickeys to assess and treat ADHD. I'm all for innovation, but often these studies seem to skimp on basic design/measurement, which leaves me unsurprised when they are rated as biased in a meta or found to be unreproducible.
 
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I'm sure you know this, but there is no shortage of people trying to sell gadgets and doohickeys to assess and treat ADHD. I'm all for innovation, but often these studies seem to skimp on basic design/measurement, which leaves me unsurprised when they are rated as biased in a meta or found to be unreproducible.

Just waiting for the day when someone starts selling a CPT that is administered while someone is concurrently getting a PET and EEG done.
 
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Hey, if you can dream it, Daniel Amen can market it.
Holler Emmy Awards GIF by Emmys
 
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The numbers always seem to get a little worse once you include data from people with no financial interest in a measure ;) Like before, seems like a great instrument to use, as long as you don't care about false positives.
What are these measures with zero false positives?
 
What are these measures with zero false positives?

I mean, we have plenty of measures that have specificity in the .95+ range. But, what we're really concerned about is that most, if not all of these "ADHD" measures have exceedingly high false positive rates. I'm all about good faith debate around these measures, but your comment is disingenuous here. You know that <5% is far different than some measures being at 30%+.
 
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$1600 is a lot to spend to get very little in the way of useful information. Particularly when time spent on the task is not billable.
Annoyingly a lot of unis/ standardized testing require some kind of continuous attention test.
They don’t specify which one tho.
Little coding gets you a go/no-go test for free. MCAT and LSAT people never had a problem with mine.
 
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Annoyingly a lot of unis/ standardized testing require some kind of continuous attention test.
The requirement of it is also part of the reason for my OP question and brainstorming.
Little coding gets you a go/no-go test for free. MCAT and LSAT people never had a problem with mine.
Are you referring to the WAIS ? Also CPTs are go/no go tests. I think I understand your point and agree; and an added benefit is you have an embedded validity measure in another subtest. Turns out WAIS can be administered via telehealth: https://www.pearsonassessments.com/...ce-documents/telepractice-and-the-wais-iv.pdf . Obviously some caveats there.


I mean, we have plenty of measures that have specificity in the .95+ range. But, what we're really concerned about is that most, if not all of these "ADHD" measures have exceedingly high false positive rates. I'm all about good faith debate around these measures, but your comment is disingenuous here. You know that <5% is far different than some measures being at 30%+.
Fair point.
 
Are you referring to the WAIS ? Also CPTs are go/no go tests. I think I understand your point and agree; and an added benefit is you have an embedded validity measure in another subtest. Turns out WAIS can be administered via telehealth: https://www.pearsonassessments.com/...ce-documents/telepractice-and-the-wais-iv.pdf . Obviously some caveats there.
I wasn’t referring to the WAIS; I’m not sure what you mean. I’m saying a pricey cpt/ tova that isn’t useful diagnostically isn’t the only way to conduct a continuous attention test.
 
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