ADHD Testing

Attention Deficit Hyperactivity Disorder (ADHD), also referred to as Attention Deficit Disorder (ADD), is the most common neurodevelopmental condition affecting 3–5% of children and young people, which often persists into adulthood. ADHD symptoms include poor attention, hyperactivity and impulsivity, yet, how these symptoms manifest and affect children, adolescents and adults can differ greatly. Importantly, various studies also highlight findings regarding gender differences and age bias in ADHD. These factors, combined with the frequent presence of other conditions, including Autism Spectrum Disorder (ASD) – formerly known as Autism or Asperger’s – dysgraphia, dyspraxia and Oppositional Defiant Disorder (ODD), emphasize the need for a comprehensive clinical evaluation and diagnosis.

Brain Regions of Interest in ADHD 

In ADHD, several brain regions have been of interest in understanding the underlying neurobiology and symptoms associated with the disorder, while the exact mechanisms and involvement of each region may vary among individuals. 

It’s important to note that ADHD is a complex and heterogeneous condition, and the specific patterns of dysfunction within the prefrontal cortex can vary among individuals. These dysfunctions contribute to the core symptoms of ADHD, including inattention, impulsivity, and hyperactivity. Understanding the involvement of the prefrontal cortex subdivisions helps shed light on the cognitive and behavioral challenges faced by individuals with ADHD.

Here are some of the brain regions that have been extensively studied in relation to ADHD:

1. Prefrontal Cortex (PFC):  In individuals with ADHD, there is often dysfunction observed in various subdivisions of the prefrontal cortex (PFC). Here are some key aspects of dysfunction in these subdivisions:

a. Dorsolateral Prefrontal Cortex (DLPFC):

• Working memory deficits: The DLPFC is responsible for the storage and manipulation of information in working memory. In ADHD, there may be difficulties in maintaining and manipulating information, leading to impairments in tasks requiring active information retention and mental organization.
• Impaired executive functions: Executive functions such as cognitive control, decision-making, problem-solving, planning, and goal-directed behavior may be compromised in ADHD. This can manifest as difficulties in inhibiting impulsive responses, setting and achieving goals, and managing time and tasks effectively.
• Attentional deficits: The DLPFC is involved in attentional control and maintaining focus. Dysfunction in this region can contribute to attention deficits, including problems with sustained attention, selective attention, and attentional switching.

b. Ventromedial Prefrontal Cortex (VMPFC):

• Emotional dysregulation: The VMPFC plays a crucial role in emotional regulation and the evaluation of emotional responses. Dysfunction in this region can lead to difficulties in regulating emotions, impulsivity, and problems with emotional self-control.
• Impaired social cognition: The VMPFC is involved in social decision-making, empathy, and theory of mind. Dysfunction in this area can result in challenges in understanding and interpreting social cues, recognizing others’ perspectives, and engaging in appropriate social behaviors.

c. Anterior Cingulate Cortex (ACC):

• Impaired error detection and conflict monitoring: The ACC is responsible for detecting errors and signaling the need for adjustments in behavior. Dysfunction in this region can lead to difficulties in error monitoring, self-regulation, and response inhibition.
• Reduced cognitive control: The ACC helps regulate attention, response inhibition, and adaptive behavior. Dysfunction in this area can contribute to problems with sustained attention, impulsivity, and difficulties in controlling and regulating behavior in challenging or conflicting situations.

d. Orbitofrontal Cortex (OFC):

• Impaired reward processing: The OFC is involved in assessing the value and salience of rewards. Dysfunction in this region can lead to difficulties in evaluating rewards and making appropriate decisions based on rewards and punishments. This can contribute to impulsivity and difficulties in delaying gratification.
• Social behavioral problems: Dysfunction in the OFC can result in challenges in social decision-making, social reward processing, and encoding social information. This may lead to difficulties in understanding social cues, interpreting others’ intentions, and engaging in appropriate social interactions.

2. Basal Ganglia: The basal ganglia is located deep in the subcortical region of the brain, near the base of the forebrain and below the cerebral cortex. The basal ganglia is interconnected with other regions of the brain, including the cerebral cortex, thalamus, and brainstem. These connections allow for communication between the basal ganglia and other areas involved in motor control, cognition, and emotion. 

Dysfunction or alterations in the basal ganglia can disrupt the normal functioning of these circuits and contribute to symptoms observed in ADHD, such as hyperactivity, impulsivity, and problems with motor coordination.

The basal ganglia consist of several interconnected structures, including the striatum (caudate nucleus and putamen), globus pallidus, and substantia nigra which are described below:

a. Striatum: The striatum is the largest component of the basal ganglia and consists of two parts: the caudate nucleus and the putamen. It is involved in motor control, reward processing, and cognitive functions.

b. Globus Pallidus: The globus pallidus is divided into two segments: the internal segment (GPi) and the external segment (GPe). It plays a role in motor control by receiving inputs from the striatum and sending outputs to other regions of the basal ganglia.

c. Substantia Nigra: The substantia nigra is divided into two regions: the substantia nigra pars compacta (SNc) and the substantia nigra pars reticulata (SNr). It is involved in motor control and reward processing, and it releases the neurotransmitter dopamine.

3. Cerebellum: The cerebellum is primarily known for its role in motor coordination and balance. However, emerging evidence suggests its involvement in higher-order cognitive functions, including attention and executive control. Dysfunction in the cerebellum has been implicated in ADHD symptoms related to motor coordination and attentional control.

4. Default Mode Network (DMN): The DMN is a network of brain regions that becomes active when the mind is at rest or engaged in internal thoughts. Altered connectivity and activity within the DMN have been observed in individuals with ADHD and may contribute to difficulties in sustaining attention and mind-wandering.

5. Limbic System: The limbic system, which includes structures like the amygdala and hippocampus, is involved in emotional processing, memory formation, and regulation of motivation. Dysfunction in the limbic system has been associated with emotional dysregulation and problems with motivation and reward processing in individuals with ADHD.

It’s important to note that ADHD is a complex neurodevelopmental disorder, and the involvement of these brain regions can vary among individuals. The understanding of ADHD’s neurobiology is still evolving, and ongoing research aims to provide further insights into the underlying neural mechanisms and potential targets for interventions.

Our providers are experienced at diagnosing attention deficit hyperactivity disorder (ADHD), a psychiatric condition that affects a person’s focus, behavior, and ability to pay attention. It is often diagnosed in childhood, when symptoms may affect a child’s social interactions and performance in school.

However, sometimes a diagnosis of ADHD is missed in childhood altogether, or a child’s symptoms may be attributed to conditions such as depression or anxiety, which are often present along with ADHD. Even with treatment in childhood, ADHD symptoms can persist into adulthood. These can include extreme distractibility, poor self-control, and difficulty with planning, organization, and time management. About 50 to 60 percent of children with ADHD continue to have symptoms into adulthood.

Our providers understand the complexities of this condition and recognize that some adults with ADHD may not have been properly diagnosed in childhood, even if they had symptoms. Others may have been misdiagnosed, either in childhood or adulthood, as having anxiety or depression.

ADHD is diagnosed equally as often in men and in women. Its exact cause is unknown, although researchers suspect there is some genetic component. The disorder often runs in families: About 85 percent of people with ADHD have a family member with the condition. Many adults may have been labeled as daydreamers, slackers, troublemakers, or bad students in childhood only to be diagnosed with ADHD in adulthood—often after their own child receives this diagnosis.

Depending on the symptoms, an adult or child may be diagnosed with one of three presentations of ADHD—predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type ADHD. Children are more likely than adults to show hyperactive symptoms, because hyperactivity tends to wane as a person reaches adulthood.

Adults with ADHD are more likely than children to show inattentive symptoms. Adults with all forms of ADHD are more likely than adults without the condition to have a history of poor educational performance, to perform inadequately at work, to lose jobs or to change employers frequently, and to have relationship or marital problems.

Both adults and children with predominantly inattentive type ADHD may often be distractible and forgetful, have difficulty sustaining attention or listening, and have trouble attending to detail. They may have poor organizational and study skills, easily lose things, and have difficulty managing time.

People with the predominantly hyperactive-impulsive type ADHD may seem to be restless or in constant motion. They often talk excessively, interrupt or intrude, and have difficulty waiting in professional and social situations. However, people with this type may have few or no problems with attention or concentration. Less than 5 percent of people with ADHD are estimated to have this subtype of the condition.

Combined type ADHD is the most common subtype. People with this type of the condition have a combination of the inattentive and hyperactive-impulsive symptoms.

Our founder and medical director, Betty Yu, brings years of experience and expertise in the field of ADHD assessment and treatment. With her deep understanding of the disorder and commitment to personalized care, she is dedicated to improving the quality of care and clinical outcomes for patients with ADHD through the advancement and dissemination of research, and evidence-based practices. She is a member of the American Professional Society of ADHD and Related Disorders (APSARD). Her area of clinical interest is the development of guidelines for the diagnosis and treatment of ADHD in adults. 

Betty Yu performs thorough evaluations that go beyond mere observation, ensuring accurate diagnoses and personalized treatment plans. With her expertise, we proudly offer T.O.V.A.® ADHD testing, an FDA cleared computerized ADHD assessment tool that enhances diagnostic accuracy and guides personalized treatment plans.

Several types of professionals who can diagnose ADHD, including clinical psychologists, clinical social workers, nurse practitioners, neurologists, psychiatrists and pediatricians. Regardless of who does the evaluation, he or she will make a clinical decision following a comprehensive clinical evaluation, which can include, but is not limited to:

1. Physical examination
2. Clinical interviews
3. Parent / teacher / self-reports by use of validated rating scales
4. Objective ADHD test such as T.O.V.A or neuropsychological testing

Based on information gathered during a clinical comprehensive evaluation, a diagnosis is made when the child or adult’s ADHD symptoms meet the criteria as set out in a medical classification system, the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5)

An FDA-cleared, computerized, and objective measure of attention and inhibitory control normed by gender for ages 4 to 80+.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K170082

**This test is not covered by most health insurances. We charge a flat fee of $400 for self-pay clients. If you are using health insurance for the visit, the fee is reduced to $200. We can provide you with an invoice for HSA/FSA reimbursement.

ABOUT THE T.O.V.A.®

The Test of Variables of Attention (T.O.V.A.®) is a computerized assessment cleared by the FDA in 2017 specifically designed to evaluate attention and impulse control in individuals suspected of having ADHD. By measuring various measures of attention and inhibitory control normalized by gender for ages 4 to 80+, T.O.V.A.® testing provides valuable objective data to support clinical decision-making and enhance the accuracy of ADHD diagnoses. It is a scientifically proven computerized assessment tool designed specifically for diagnosing and evaluating ADHD.

Why Choose T.O.V.A.®?

✅ Accurate Results: T.O.V.A.® provides a highly accurate and objective measurement of attention and impulsivity, allowing for a comprehensive evaluation of ADHD symptoms.

✅ Precise and Objective Results: T.O.V.A.® ADHD testing offers an objective evaluation of attention and impulsivity, reducing the subjectivity often associated with traditional assessment methods. The results provide comprehensive data on attention and impulse control in individuals suspected of having ADHD, helping our clinicians make precise and personalized treatment recommendations.

✅ Time-Efficient: With T.O.V.A.®, you can get detailed results in just 20 minutes, saving you precious time.

✅ Comprehensive Reporting: T.O.V.A.® generates detailed reports that provide a clear analysis of attention and impulsivity, aiding in accurate diagnosis and treatment planning.

✅ FDA Cleared: T.O.V.A.® version 9.0 was cleared by the FDA

*It should be noted that T.O.V.A.® is less comprehensive and does not take the place of a full neuropsychological evaluation. It is designed specifically for diagnosing and evaluating ADHD. It is not intended for use in the diagnosis of autism spectrum disorder (ASD), complex challenges, such as dyslexia, nonverbal learning (NLD) or Alzheimer’s disease. 

What to Expect from Our ADHD Evaluation:

✅ Comprehensive Assessment: Our ADHD evaluation encompasses a comprehensive evaluation that includes a detailed clinical interview, physical examination, standard clinical scales, administration of the T.O.V.A.® test and interpretation of results. If the patient meets the DSM V diagnostic criteria for ADHD, your provider will review non-pharmacological and pharmacological treatment options with you. 

✅ Diagnostic Clarity: We will utilize evidence-based assessment tools, validated measures, and diagnostic criteria to determine if ADHD is present and provide you with a formal diagnosis. We focus on uncovering the underlying factors contributing to your symptoms, ruling out other disorders with similar symptoms and providing you with a clear diagnosis. Obtaining an accurate diagnosis is the first step towards finding the right strategies and treatments. 

✅ Individualized Treatment Recommendations: Following the evaluation, Betty will discuss the results with you in a supportive and collaborative manner. She will provide personalized treatment recommendations tailored to your specific needs, which may include medication, therapy, lifestyle modifications, or a combination of approaches tailored to your specific needs.

Adult attention deficit hyperactivity disorder (ADHD) is a common condition affecting more than 4% of adults in the United States—many who remain undiagnosed and untreated. Without proper diagnosis and care, ADHD can create personal and professional difficulties, including relationship problems, substance abuse, and problems at work and school.

Adult attention deficit hyperactivity disorder (ADHD) is a common condition affecting more than 4 percent of adults in the United States—many who remain undiagnosed and untreated. Without proper diagnosis and care, ADHD can create personal and professional difficulties, including relationship problems, substance abuse, and problems at work and school.

Specialists at Aspire Medical Group offer comprehensive diagnostic and treatment services for ADHD, including:

• comprehensive diagnostic evaluations
• medication consultation and management
• neuropsychological testing

Since ADHD treatment frequently involves the use of a special class of medications called stimulants, we take extra care to confirm the diagnosis of ADHD. Stimulants have a lot of benefits, and risks involved with their usage. Hence, an appropriate diagnosis of ADHD is crucial. Due to the lack of informants such as teachers and parents to corroborate their symptoms, adult ADHD is significantly more challenging to diagnose than childhood ADHD.

Adult patients seeking ADHD evaluation without a documented ADHD diagnosis and adults with a self-reported history of childhood ADHD who are unable to provide documentation of prior diagnosis or treatment records will need a T.O.V.A.® test or a neuropsychological evaluation to confirm ADHD diagnosis. 

**At our clinic, individuals with a history of neurological or cardiovascular disease and/or family history of sudden cardia death are advised to use non-stimulant medications. If non-stimulant medications are not effective in controlling ADHD symptoms and the use of a stimulant medication is clinically indicated, additional medical work-up and lab work may be requested at our discretion. ECG screening is required prior to initiation or continuation of stimulant medication if the comprehensive history and physical examination suggests underlying cardiac disease or cardiac risk factors. Urine drug screening will be performed at the initial evaluation.

Adults Seeking ADHD evaluation Without Documentation of Childhood ADHD diagnosis 

• It is suggested that the diagnosis of adult ADHD requires at least 2 visits. 
• Assessment of ADHD is not a clinical emergency and requires enough time to gather necessary evidence for the diagnosis. 
• As well as allowing for a thorough evaluation, two visits allow the clinician to assess motivation for follow up, persistence of symptoms and dysfunction, and likelihood for alternative diagnoses.