Testing for ADHD is a complicated issue. I probably have done thousands of them over the years. I am less enthusiastic about doing them now. Often these referrals are generated by a physician or other prescriber who needs backup, documentation, or reassurance before prescribing a stimulant. Hence these referrals have a risk management, rather than scientific, qualit--taking on that task is not a particularly  rewarding or good practice. To some extent, that role subordinates psychologists to a rubber stamping function. A quality  report, thought out and nuanced, with personality features, is really not wanted. Many that I read seem to have a perfunctory quality. Also, many clients seem interested in only getting the diagnosis, without interest in the nuances--it is seen as a yes/no evaluation, and testing becomes less the valuable exercise of logically finding the diagnosis, but a form of rubber stamping for a referral source or client that is expecting or hoping for a certain outcome.  Half the art and science of testing go unused, with this type of evaluation, and the process becomes a concession to simplicity. The procedure becomes dumbed down and secondary to the medical and pharmaceutical marketplace. Fortunately, the providers I have worked with over the years have a very good ability to use the full extent of the information on the report. And I tend to avoid accepting referrals from providers or clients who simply want a yes/no type of report. Same is true for individuals who want a risk management report for bariatric surgery or other procedures. Educating the client about the breadth of knowledge that a psychological report can provide, and the purpose of the evaluation to establish a range of treatment options, can be helpful.

Towards the end of his life,  Keith Conners, who developed many of the commonly used ADHD scales, told me that he thought the diagnosis was overused and that his own tests, which in America were the main tests for ADHD, overpredicted the diagnosis. He sent me an article from the New York times on his efforts to reign in hte monster. 

With ADHD testing, a small proportion of testees are drug seeking.  The test should be undertaken with alertness to malingering, drug diversion, diversion, or symptom exaggeration. Many people were incorrectly diagnosed with ADHD as kids, or by an examiner who was unaware of the range of rule-outs and conditions that mimic ADHD. Once a client has been diagnosis and medicated, they are loathe to give up that diagnosis. A larger, more comprehensive diagnosis is missed.  And if the true diagnosis is not within their knowledge range or has a less palatable medication (say, some variant of bipolar disorder), there is less interest in further treatment.

So frequently. PTSD or hypomanic symptoms, other conditions as well, supersede in importance what ADHD symptoms there are, and the person is placed on a stimulant. That stimulant may help somewhat or marginally, but not be the best medication for that condition.  Years go by with the individual helped marginally or not at all, and with some clients, negative reactions such as anxiety, irritability, increased hypomania, magnification of prodromal risk in those so predisposed, and  and infrequently, psychosis. Feeling somewhat more improved or accelerated seems cure enough, while full functionality is never achieved.  This is not to sa that, for someone who truly has ADHD, stimulants work excellently much of the time.