Expanded, Objective ADHD Screening Tools Needed: Expert Consortium Calls for Diagnosis Overhaul

July 19, 2022

ADHD is a complex diagnosis that most clinicians are ill-equipped to make thanks, in part, to poor understanding of condition comorbidities and inadequate diagnostic tools, especially for adults. This is the finding of the ADHD Expert Consortium, a panel of experts convened to study barriers to effective diagnosis and treatment for attention deficit hyperactivity disorder (ADHD), and to propose solutions in a consensus statement that included five main recommendations:

1. Leverage, expand, and update existing ADHD screening in children to be more universal, across disciplines and improve awareness.
2. Develop adult ADHD diagnostic and treatment guidelines in the U.S.
3. Make evidence-based, objective testing the standard of care for ADHD in children and adults.
4. Better education, rooted in equity, of medical residents and practitioners in pediatrics, neurology, psychiatry, and primary care for the diagnosis and treatment of ADHD.
5. Improve insurance coverage for evidence-based ADHD evaluation and treatment.

“ADHD must be viewed as a public health problem producing a substantial impact on the health, quality of life, and economic viability of the U.S. population,” the panel wrote.

Most primary care providers, psychiatrists, and neurologists today lack the confidence and skills needed to accurately screen, treat, and make referrals for ADHD ¹, leading to “negative effects on personal development, academic outcomes, and family interactions.”^{2, 3} Quality ADHD care is scarce, according to the consortium, because most healthcare professionals lack an “understanding about the intersection between culture and ADHD presentation and management.”

The development of universal best practices and consistent use of objective testing would help improve diagnosis and treatment outcomes for patients, especially adults who don’t present stereotypical hyperactive or impulsive symptoms and those who come from diverse cultures or socio-economic backgrounds. However, few objective, evidence-based tools exist today. Reimbursements by insurance payers are limited and often low, which makes it difficult to maintain an efficient and financially sustainable practice. This is worsened by the addition of high administrative burdens like prior authorization requirements.

“Taken together, low reimbursements coupled with high administrative burden highlights the persistent lack of parity between mental health and physical health in our country today,” the panel wrote. “We believe that payers play a critical role in fixing our current mental health crisis through evolution of their payment and utilization management models for mental health.”

The one-day meeting included psychiatrists, neurologists, developmental pediatricians, pediatricians, nurse practitioners, psychologists, neuropsychologists, and patient advocates.

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