How Much Should an ADHD Diagnosis cost? Some disagree in the New York Times

New York Times Article on Adult ADHD: click here.

Response letter from Neuropsychologists: click here.

There's a fight going on in the ADHD/ADD world and it's become rather public. There are two schools of thought about ADHD diagnosis. One is that a diagnosis of ADHD should be made through a series of simple questions and a structured interview. Of course, this is pretty cheap. Dr. Russell Barkley supports this method of ADHD diagnosis.The other is that psychological testing, often neuropsychological testing, is appropriate when doing a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). One of the issues at hand was that some statements were made in the Times article about how much an exam should cost, and Dr. Barkley pretty much low balled it (around $500 or less!).

The NYT article follows Liz Goldberg, age 53, through the process of deing diagnosed with ADHD. It addresses many of the problems and difficulties with the diagnostic process for adults and adolescents. First, adults rarely exhibit the most noticeable symptom, hyperactivity. They often, instead, display symptoms of being distracted and disorganized. Often adults with ADHD also are procrastinators and avoiders of tasks that don't seem to be of interest to them. 5% of the adult population has ADHD. While you may have read about the over use of medications and the over diagnosis of this disorder in some news articles or on the web, the scientific estimate is that of the 5% of adults who have ADHD or ADD only 10% have a formal diagnosis. 10%!

Adults with ADHD, especially women, are often misdiagnosed with depression, anxiety and bipolar disorder. Sometimes their symptoms are just dismissed and ignored as a problem of "women," leaving them untreated and at the mercy of some serious symptoms.

THe article stresses that for most it might be best to avoid a lengthy neuropsychological assessment, often unnecessary and almost always expensive. Usually that means completing a series of questionnaires or self-reports, and having someone who knows you also fill out reports. From these we are often able to make a preliminary diagnosis. MRI scans, brain scans, neuro-brain-mapping are really all unnecessary for a preliminary diagnosis. This should include a Mental Status Examination, and at a minimum a structured diagnostic interview that helps rule out other possible causes for your symptoms. This should take 3-4 hours. And a little longer if you need a report written. While the Times says this can cost from $200-500 it really requires a minimum 3-4 hours, and at the going rate for psychologists in British Columbia this would put the cost in the range from $480-640 or so. That's for an examination that consists of no more than the gathering of information and a structured interview.

What Dr. Barkley and Tuckerman suggest in their article is that most importantly you find an experience clinician to do the ADHD diagnosis.

Now Dr. Barkley also says to, "avoid an expensive neuropsychological evaluation." He, and Dr. Tuckerman, think this is overkill. I think their explaination is a little too simple. After a diagnosis a good neuropsychological examination can help point out specific learning disabilities, tell you what your neurological strengths and weaknesses are, and be used as a grounding point in developing a comprehensive intervention plan. Sometimes it is useful, sometimes, when other disorders are suspect it is necessary, and yes, Dr. Barkley is right, sometimes it's more than you need. You and your psychologist should be able to make that decision together after discussing the severity and nature of your specific symptoms. At any rate, the NYT's article lists the cost of a neuropsychological exam at somewhere between $2,000 and 5,000. You need to decide if this is a necessary expense. Remember, as Dr. Barkley says, neuropsychological tests are "inaccurate when it comes to ADHD." That may be true, some would argue with that, but it Is misleading. Most of the time the neuropsychological exam is not being given to diagnose ADHD at all. It is being given to rule out other possible neurological causes of symptoms, and to develop an understanding of the clients strengths and weaknesses. So don't be afraid to ask your doctor "Why am I going to take this exam?" "What, exactly, might we learn from it?" There are many good reasons to take a neuropsychological exam. For children, adolescents or young adults having educational and learning problems we need to look at a number of factors in order to rule out, or diagnose, a specific learning disability. For individuals with impulsivity and anger issues, or problems with emotional regulation, we need to look at possible mood disorders vs ADHD. There are many good reasons, just don't be afraid to ask why.

Read the original article about Attention Deficit Hyperactivity Disorder in the Times, and read the reply by the neuropsychologists.

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As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!