Neuropsychological testing is a common point of confusion for individuals who have been in the process of assessment for ADHD. Although ADHD is widely recognized as a clinical diagnosis, it's not uncommon for mental health providers to insist on psychological testing before making an official diagnosis. In this article we’ll review what ADHD testing is and why you’re not required to do testing to get appropriate diagnosis and treatment.
Neuropsychological testing looks at various cognitive function domains of the brain, including: attention, working memory, executive functioning, and processing speed.
There is a natural variation in these cognitive domains that makes everyone unique in how they process information. That’s where the concept of “neurodiversity” comes in. However, if your brain functions in a way that presents challenges in any of these domains, you may notice substantial distress or impairment in your daily life.
Many mental health centers offer psychological testing. While you often don’t need a referral to schedule testing, if you want your insurance to cover the cost, you’ll likely need a referral from your clinician. Waitlists vary widely, and in some places, you might wait several months to be seen.
Depending on the testing center, ADHD assessment may include:
The whole process can take anywhere from 2 to 5 hours. The ADHD testing is typically conducted by a clinical psychologist who gathers a detailed history and administers cognitive tests to evaluate brain function. When clinicians send people for ADHD testing they are looking for not only the clinical history but for neuropsychological evaluation.
The short answer is no. There are different ways to assess and diagnose ADHD. Most mental health providers consider ADHD a clinical diagnosis. That means a healthcare provider (often a psychiatrist, psychologist or sometimes your family physician) can diagnose you with the condition by conducting a clinical interview and assessment without necessarily needing a psychological testing for ADHD.
Psychological testing for ADHD can be very helpful as it provides objective standardized data that is impossible to collect using clinical interview or self-report questionnaires. ADHD testing also helps differentiate ADHD symptoms from other mental health conditions that can present as ADHD. Your psychiatrist or psychologist can determine whether you would benefit from neuropsychological testing for ADHD.
During ADHD testing, you’ll complete a series of tasks designed to measure different cognitive abilities. For example the Trail Making Test evaluates executive function, visual attention, and processing speed. You’re asked to connect a sequence of dots alternating between numbers and letters. You get a score based on how long it takes you to complete the task—lower scores indicate better performance. While this type of testing can be informative, it’s not always entirely accurate or reliable. Here’s a few reasons why:
Despite the limitations, ADHD testing can still provide valuable insights into how one’s brain works—especially when combined with a comprehensive clinical evaluation.
You may consider testing if you need academic or workplace accommodations. Many schools and employers require formal documentation from testing in order to provide support. Testing results can also be helpful if you're curious about your cognitive profile—your strengths, weaknesses, and how your brain processes information.
You still could have ADHD. Your ADHD symptoms not severely interfering with your day to day life does not rule out the condition.
Let’s say you struggle with executive functioning. You might start a work project but leave it unfinished until the deadline is looming. The pressure builds, anxiety kicks in, and you ride the wave of adrenaline to finish the task—just in time, but with significant stress.
People with ADHD often don’t feel motivated until there’s a sense of urgency. A subset of people with ADHD have difficulty with baseline motivation especially when it comes to mundane, repetitive or multi-step tasks without immediate consequences. The anxiety derived from a tight deadline would kick motivation into high gear and act like a jumpstart, a phenomenon colloquially called panic productivity.
ADHD is a clinical diagnosis. A skilled clinician can diagnose and treat ADHD through a thorough history, clinical interview, and review of symptoms and functioning—even without formal ADHD testing. Testing may be helpful if you need documentation for accommodations or you want detailed information about your cognitive abilities. But it’s not required to get diagnosed or start treatment.
Dr. Hasti Hadizadeh is a psychiatrist offering medication management, psychotherapy, cultural and neurodivergent-affirming care via tele-health in the state of Minnesota. She specializes in reproductive psychiatry and women’s mental health across life stages.
