When measures diverge: The intersection of psychometric instruments and clinical judgment in multimodal adult attention-deficit/hyperactivity disorder assessment.

Abstract

Adults are increasingly seeking evaluation for attention-deficit/hyperactivity disorder (ADHD). Current guidelines emphasize a multimodal assessment of ADHD in adults, but do not address how practitioners should integrate findings from multiple measures. The present study examines associations among self-report, behavioral, and neuropsychological measures used during multimodal assessment in an outpatient ADHD assessment group. Archival data of 45 adults seeking assessment were analyzed. Findings indicate measures exhibited weak or no relation to one another, suggesting measures commonly used in ADHD assessment likely assess different underlying constructs. Implications and recommendations for clinicians diagnosing adult ADHD are discussed. The importance of other sources of diagnostic information (e.g., clinical interview, behavioral observations) and consultation among colleagues are also discussed.

Correlates of the Paced Auditory Serial Addition Test (PASAT) in an assessment-seeking sample.

“…Measures of ADHD symptoms (CAARS–ADHD Index) and sustained attention (TOVA-API) were not significantly correlated with PASAT performance. These findings are akin to recent research, suggesting that the PASAT alone may not accurately distinguish individuals with and without ADHD (Bottini et al, 2019; Nikolas et al, 2019). Accordingly, attention deficits may be secondary to other cognitive processes indexed by the PASAT, especially working memory and processing speed, in an outpatient assessment population (Nikolas et al, 2019; Sonuga-Barke et al, 2010).…”

“…Discrepant responding across these trials may prompt practitioners to administer additional measures of arithmetic or processing speed to further evaluate an examinee's cognitive strengths and weaknesses. Thus, interpretation of the PASAT should occur in the context of a comprehensive assessment battery when making clinical decisions, so multiple measures can be used to corroborate findings from the separate PASAT forms (Bottini et al, 2019). Results demonstrated that PASAT performance can be complex and nuanced, and thus, it is important for clinical psychologists to consult with or refer to neuropsychologists when they are faced with complicated questions about interpreting the PASAT and using it to make diagnostic decisions, depending on the nature of the referral question.…”

“…In addition, previous research on statistical power in multiple regression analyses indicated that this sample size is within the adequate range to determine significant effects when conducting multiple regressions (e.g., Jenkins & Quintana-Ascencio, 2020; VanVoorhis & Morgan, 2007). Importantly, similar, or smaller sample sizes were utilized in prior studies involving variables and analyses like those in the present study (e.g., Bottini et al, 2019; Gow & Deary, 2004; Parmenter et al, 2006).…”

“…PASAT scores can also be influenced by one’s attentional and concentration abilities, which is why the instrument is often included in comprehensive ADHD assessments conducted by psychologists (e.g., Bottini et al, 2019; Nikolas et al, 2019). The relation between PASAT performance and attention is further evidenced in neuropsychological research, indicating that attentional networks, especially the anterior cingulate and insular network, become activated during the PASAT (e.g., Gielen et al, 2018).…”

“…Indeed, PASAT performance is related to activation of neural networks relevant to working memory, including the cerebellum, parietal regions, lateral prefrontal cortex, subcortical structures, and supplementary motor area (Audoin et al, 2005;Tüdös et al, 2014). Modest to high positive correlations have been observed among measures of working memory and the PASAT (Bottini et al, 2019;Gow & Deary, 2004). Furthermore, Westerberg et al (2007) found that working memory training improved performance on the PASAT in individuals with working memory deficits following a stroke.…”