(PS1-79) Which Measures Matter Most? A Study of Clinical Psychologists’ Rankings of Adult ADHD Diagnostic Tools

Abstract Text: In recent years, there has been an increase in the assessment and diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. The symptoms of adult ADHD differ from those observed in childhood, which makes the assessment process challenging. Common assessment tools for adults can be categorized into several groups, including symptom questionnaires, clinical interviews, behavioral observations, reviews of medical and academic records, intellectual and achievement tests, continuous performance tasks, neurological tests of executive functioning, malingering assessments, and measures of adaptive functioning. However, best practices for assessing adult ADHD are not clearly defined, and there is currently no consensus among clinicians regarding the most sensitive and appropriate tools for this purpose (Fuermaier et al., 2019).
This study explores psychologists' perceptions of the significance of various assessment tools employed during adult ADHD evaluations and identifies which tools they frequently use. Furthermore, this exploratory research was designed to identify factors that may influence differences in the perceived importance of these ADHD assessment tools.

A national sample of 200 participants was randomly recruited from two sources: the Facebook group “The Testing Psychologist” and the APPIC internship directory. Participants ranged in age from 27 to 75 (M = 41.59, SD = 9.15), were 77% female, and 92% Caucasian/White. Participants were 93.5% licensed psychologists. Participants rated ADHD assessment tools based on how often they use each tool when conducting adult ADHD assessments. Participants were shown seven commonly used adult ADHD assessment tools and asked to rank them based on their diagnostic utility. Lastly, participants rated the relative importance of the seven assessment tools.

The mean use of each assessment tool was calculated. The highest use was unstructured clinical interviews with clients (M = 3.57, SD = 0.85). Continuous performance tasks were rated in the middle among the assessments (M = 3.04, SD = 1.17), whereas malingering assessments (M = 2.45, SD = 1.20) were rated among the lowest. Ordinal regressions were run to examine which participant variables predicted perceived importance and use of assessment tools. Results showed participants who identified using primarily self-pay were significantly (p < .05) more likely to use self-report executive functioning assessments (β = .878). Contrarily, participants who reported presenting an article or poster related to ADHD assessment were significantly (p < .05) less likely to use malingering tests (β = -.320).

The data was fitted to the PLM using the first item in the list (working memory and processing speed scores) as the reference. Based on the results, the use of clinical interviews with clients (worth = 2.46) was ranked the highest, followed by self-report ADHD symptom questionnaires (worth = 0.44), informant rating scales and/or interviews (worth = 0.32), and executive functioning assessments (worth = 0.29), all of which had statistically significant (p < .05) positive worth values. Understanding these preferences can inform training and policy decisions, ultimately leading to improved diagnosis and treatment of adult ADHD.