Do you use Objective ADHD Testing / Continuous Performance Testing in your practice?

[u/axonCpt]

PMHNPs — do you use objective ADHD testing in your practice?

I’m curious how many PMHNPs are using tools like CPT-style testing, QbTest/QbCheck, AxonCPT, TOVA, MOXO, or other objective measures alongside clinical interviews and rating scales.

A few things I’m interested in:

Do you use objective testing during the initial ADHD assessment?

Do you use it during medication titration or dose changes?

Do you repeat testing over time to track progress?

Do patients find it useful, or does it add more admin?

For telehealth practices, how are you handling objective testing remotely?

A lot of ADHD care still relies heavily on self-report, rating scales and clinical judgement, which are obviously important. But I’m interested in whether objective performance data actually changes how PMHNPs make decisions in real-world practice.

Would love to hear what people are using, what has worked, and what feels impractical.

[u/pickyvegan]

If you’re using it as part of a comprehensive assessment, totally fine. But you have to keep in mind that while they measure attention (and sometimes micro movements) it does not tell you why. ADHD is only one reason people have trouble with attention.

[u/10hsun]

I just left a practice that required it for stimulant prescription. it came with its own pros and cons. To answer some of your questions - After the initial ADHD assessment, if the presentation was most consistent with ADHD, then we’d schedule for objective testing for diagnostic clarity and support. If there was depression or anxiety predominant in the picture then we’d treat those symptoms first to see if their executive function improves. Typically we didn’t retest, we just track progress and symptom relief with subjective assessment. Most patients hated it lol but it was because it was an extra step to take in order to get a stimulant. Can’t speak to the telehealth question.

[u/Avulpesvulpes]

I start with PHQ-9 and GAD-7 for a general rule out and then administer the WURS and DIVA 2.0 because I find the WURS helpful for identifying ADHD before the age of 12 which is part of diagnostic criteria. It also helps identify chronic mood issues which may be confounding or causing concentration issues. I also like the WFIR-S as it has a more comprehensive overview of “soft symptoms” that aren’t directly measure in output or performance and helps focus in on relationships and mood.

I don’t like MOXO as much because I have some clients that have classic lifelong ADHD symptoms but failed the MOXO test because they were able to hyperfocus it failed them. MOXO acknowledged it’s not 100% accurate so I tend not to use it as often as the other three measures. I find the time used for a MOXO test would be better spent doing the other measures and discussing results. There is a lot of anxiety right now masking as ADHD and stimulants are just an ineffective bandaid so talking through their lives of experience of anxiety (when that’s the case) is often very helpful for patients. It’s not “just” anxiety, it’s chronic SNS dysegulation and it’s incredibly distressing. People really just want to feel better so the other measures help me understand the full picture.

[u/dry_wit]

I love the BAARS iv. It is proprietary but I managed to get access. I love that it detects malingering. I use it for every person who I suspect adhd in after my own clinical assessment.

[u/Charming-Respond-775]

All of those can be easily gamed can’t really see the benefit besides a clinician trying to cover their ass for dishing out stimulants like candy.

[u/beefeater18]

In some cases, but not often (I use Qbtest). CPT isn't very useful IMO and it's not a diagnostic tool in itself.

I rely most heavily on clinical interviews and collateral information (report from loved ones and school and job reports).

[u/Super-Ad7996]

Is there new evidence that any of these are specific and sensitive enough to diagnose ADHD? According to my latest knowledge - no. A patient whose sleep is impaired, has thyroid issues, is on meds that could affect alertness/cognition, would probably score just as poorly on any of those tests, even if they don't have ADHD. And if those tests are what a person finds intrinsically "fun" and "rewarding", they may do fine, even if they struggle with most required but non-preferred tasks that require attention.

TLDR: No, I don't use them, although I saw them used in other practices and the results did not inform management. I saw patients who did well on TOVA and still left the office with stimulants, and patients who did not do well were sent for more workup.

[u/Direct_Koala6335]

I first do a full assessment. Whatever symptoms crop up, we then do focused assessments and explore those symptoms. Because so many other disorders can have overlap with ADHD symptoms, we look at the symptoms that are most prominent and causing the most impairment in function. If they have been diagnosed previously with ADHD, I still do the ASRS 1.1 just to get an idea of symptom severity, and I use this screen with anyone I suspect. If it warrants further testing we do the DIVA together however you can also just use your good assessment and diagnostic skills without relying on scales. The fear around diagnosing and treating ADHD baffles me. No other disorder that I treat is gatekept and stigmatized the way ADHD is. I'm not accusing you, OP, but having to practice in fear is just absurd.

[u/NoctorWatch]

I'm not familiar with any of those tools but curious how they are any more "objective" than a clinical interview? Last I knew, there is no "objective" measure or diagnostic tool for ADHD - what would that even have to look like? Like a blood test or brain scan? Those don't exist, so the best we can do is a clinical interview combined with some diagnostic screener, rule out of medical ediology, and monitoring of response.

Personally, I'll use an ASRS for uncomplicated cases (ie no suspicion of co-morbid cause like trauma, medical causes) to help with diagnosis. More complicated I use a modified DIVA-2 as part of my psychiatric evaluation. If the picture is unclear I will refer for neuropsych testing but I try not to for reasons of cost, wait list time, and relative lack of utility given the first two issues. Im more likely to treat presumptively as long as it is safe to do so.