Review of Studies on Incremental Validity of Assessment Measures Used in Psychological Assessment of Attention-Deficit Hyperactivity Disorder

Abstract

Few studies have summarized the literature relevant to the incremental validity of tools and procedures for the assessment of attention-deficit hyperactivity disorder (ADHD). The current project reviewed such studies published in the prior 18 years. Results from studies on the incremental validity of measures used in the assessment of ADHD were reviewed. Measures included symptom reports, clinical interviews, behavioral observation, continuous performance and other psychomotor tasks, intelligence tests, and measures of executive function. Twenty-nine published studies and two reviews were identified from 2004 to 2022. Incremental validity was determined using various statistics including R2, classification metrics, odds ratios, and post-test probabilities. Findings suggest that symptom reports from a collateral source and continuous performance test measures have incremental validity over self-reports and clinical interviews. Measures of intellectual and executive functioning did not show incremental validity in the diagnosis of ADHD. Findings are relevant to the practitioner, as they bear on the optimization of both the cost-effectiveness and the diagnostic accuracy of combined procedures in the assessment of ADHD.

Should patients be evaluated for ADHD while using ADHD medication?

“…are even more clearly external, since they were not generated for a diagnostic evaluation. As we discussed earlier, clinicians' observation of patient behavior can be helpful to have, and many evaluators find cognitive tests valuable as well, but these should not be the sole sources of evidence, or even the principal ones, when making a diagnosis (Sawaya et al, 2023). The foregoing is just as true when the primary purpose of the evaluation is not diagnosis per se.…”

“…Cognitive measures can aid with differential diagnosis, determining functional impairment, and so forth, but it appears that scores and score profiles from most cognitive measures lack the sensitivity and specificity needed to provide much unique value beyond other established diagnostic tools (such as rating scales). An exception must be noted for CPTs, which have been repeatedly found to add incremental validity (for a review, see Sawaya et al, 2023). Because, as we noted above, CPTs are quite sensitive to medication effects, clinicians who use CPTs should consider the advantages of measuring CPT performance in patients who are not taking medication at the time of the evaluation.…”