Neuropsychological assessment of adults with ADHD: A Delphi consensus study

Figures & data

Table 1. Overview of the Delphi rounds “Neuropsychological assessment of adults with ADHD”.

Round 1	Panel members rate the importance of each of the neuropsychological functions of a predetermined list. Panel members suggest additional neuropsychological functions. Panel members suggest measures for the assessment of those neuropsychological functions that they rated as important or very important.
Round 2	Panel members rate the importance of all functions that were additionally suggested in Round 1. Panel members suggest measures for the assessment of those functions that they rated as important or very important.
Round 3	Panel members reconsider their ratings of neuropsychological functions of Rounds 1 and 2 in the light of the average ratings of all panel members. Panel members rate the suitability of measures that were suggested in the previous rounds and that were on average rated as important or very important.
Round 4	A ranking of all neuropsychological functions of the previous rounds is presented. An assessment battery is presented to assess those neuropsychological functions that were on average rated as important or very important. Panel members indicate agreement or disagreement with the assessment battery. In case of disagreement, panel members indicate changes that would make them agree with the assessment battery.

Table 2. Characteristics of the expert panel.

	Round 1	Round 2	Round 3	Round 4
N	27	20	22	21
Age (in years, M ± SD)	45.9 ± 10.4	45 ± 9.7	47.4 ± 10.5	45.8 ± 10.2
Gender (female/male)	10/17	10/10	10/12	10/11
Geographic location^a	9/8/3/2/2/1/1/1	6/7/1/2/1/1/1/1	8/6/2/2/1/1/1/1	6/8/2/2/1/1/0/1
Academic background (psychology/medicine)	22/5	18/2	18/4	17/4
Academic degree/position (Prof/PhD/MSc)	7/16/4	4/13/3	5/14/3	4/12/5
Work (in %, clinic/research/other^b)	39/43/18	42/40/18	38/43/19	40/43/17
Number of publications related to adult ADHD (M ± SD)	20.9 ± 43.1	8.9 ± 7.0	22.6 ± 47.0	23.7 ± 48.0

Note. ^aUSA/Germany/UK/Netherlands/Norway/Turkey/Canada/Argentina. ^bother responsibilities entail teaching, administration, managing, mentoring, or a combination of those.

Table 3. Ratings of the predetermined list of neuropsychological functions according to their relevance for the neuropsychological assessment of adults with ADHD (Round 1).

Function	N	Min	Max	M ± SD	IQR
Sustained attention	27	1	3	1.33 ± 0.56	1
Emotional control	27	1	2	1.59 ± 0.50	1
Distractibility	27	1	3	1.67 ± 0.73	2
Inhibitory control/interference control	26	1	2	1.69 ± 0.68	1
Task planning/organization	27	1	3	1.70 ± 0.72	1
Vigilance	27	1	3	1.70 ± 0.67	1
Working memory	27	1	4	1.74 ± 0.90	1
Self-monitoring	27	1	4	1.96 ± 0.85	2
Focused attention	27	1	4	1.96 ± 0.76	2
Time estimation	27	1	3	2.04 ± 0.65	1
Set shifting/cognitive flexibility	27	1	5	2.15 ± 1.03	2
Task execution	27	1	4	2.22 ± 0.97	1
Processing speed	27	1	5	2.30 ± 0.99	1
Initiation	27	1	4	2.37 ± 0.88	1
Divided attention	27	1	4	2.41 ± 0.84	1
Decision making	27	1	4	2.44 ± 0.75	2
Feedback learning	27	1	5	2.48 ± 0.80	1
Spatial attention	23	1	5	2.70 ± 0.93	1
Problem solving	27	1	4	2.70 ± 0.87	2
Writing	24	1	5	2.71 ± 1.12	1
Short term memory	24	1	5	2.75 ± 1.23	2
Reading	25	1	5	2.84 ± 1.07	1
Verbal fluency	27	1	5	2.89 ± 0.90	1
Reasoning	27	1	5	2.93 ± 0.92	2
Concept formation	27	2	5	2.96 ± 0.85	1
Learning	25	1	5	2.96 ± 1.06	2
Prospective memory	24	1	5	3.00 ± 1.14	1
Visual perception	25	1	5	3.08 ± 1.00	2
Auditory perception	25	1	5	3.08 ± 1.00	2
Long term memory	25	1	5	3.12 ± 1.09	1
Comprehension	25	1	5	3.12 ± 1.24	2
Spatial cognitive functions (e.g., mental rotation)	23	2	5	3.17 ± 0.83	1
Association learning	24	2	5	3.25 ± 0.79	1
Spatial constructive functions	22	2	5	3.27 ± 0.77	1
Recognition	25	2	5	3.28 ± 0.94	1
Expression	25	1	5	3.32 ± 1.07	1
Naming	25	1	5	3.32 ± 0.99	1
Repetition	25	2	5	3.36 ± 0.86	1
Spatial perceptive functions (e.g., face perception)	24	1	5	3.38 ± 0.82	1
Tactile perception	25	2	5	3.40 ± 0.76	1
Autobiographical memory	24	1	5	3.46 ± 0.88	1
Olfactory perception	25	2	5	3.48 ± 0.71	1

Note. Rating ranges from 1 = very important, 2 = important, 3 = neutral, 4 = not important, to 5 = not important at all; IQR = Interquartile range; N = Number of panel members rating the function in question.

Table 4. Ratings of functions that were additionally suggested by panel members for the neuropsychological assessment of adults with ADHD (Round 2).

Function	N	Min	Max	M ± SD	IQR
Impulsivity	20	1	2	1.20 ± 1.20	0
Hyperactivity/Overactivity	19	1	2	1.21 ± 0.42	0
Attentional control	20	1	3	1.50 ± 0.61	1
Psychological state	19	1	4	1.53 ± 0.84	1
Emotional lability	20	1	3	1.60 ± 0.68	1
Sustained attentional effort	19	1	3	1.63 ± 0.60	1
Low frustration tolerance	20	1	4	1.70 ± 0.92	2
Motivation	20	1	4	1.70 ± 0.87	1
Response variability/Inconsistency	19	1	4	1.74 ± 0.93	2
Social functioning	20	1	3	1.75 ± 0.79	2
Presence of learning disability	19	1	3	1.79 ± 0.79	1
Mind wandering	19	1	3	1.84 ± 0.77	1
Malingering	19	1	4	1.89 ± 0.99	2
Motor inhibition	19	1	3	1.95 ± 0.62	1
Delay aversion	19	1	4	2.00 ± 0.75	0
Reward processing	18	1	4	2.11 ± 0.83	2
State regulation	19	1	3	2.11 ± 0.74	2
Personality	19	1	4	2.21 ± 1.30	2
Multitasking	20	1	4	2.25 ± 0.97	1
Intelligence	19	1	5	2.26 ± 1.15	2
Visual attentional processing	20	1	5	2.45 ± 1.05	1
Ability to synthesize	19	1	4	2.58 ± 0.90	1
Presence of gambling problems	19	1	4	2.63 ± 0.96	2
Audio vs. visual processing speed	19	1	5	2.68 ± 0.95	1
Mathematics	18	1	5	3.11 ± 0.96	2
Figural fluency	19	1	4	3.11 ± 0.94	1
Allocentric visual memory	19	2	5	3.32 ± 0.95	1

Note. Rating ranges from 1 = very important, 2 = important, 3 = neutral, 4 = not important, to 5 = not important at all; IQR = Interquartile range; N = Number of panel members rating the function in question.

Table 5. Final ratings of all neuropsychological functions for the neuropsychological assessment of adults with ADHD (Round 3).

Rank	Function	N	Min	Max	M ± SD	IQR
1	Sustained attention	22	1	3	1.36 ± 0.58	1
2	Distractibility	22	1	3	1.36 ± 0.58	1
3	Inhibitory control/Interference control	22	1	3	1.55 ± 0.60	1
4	Task planning /Organization	22	1	3	1.59 ± 0.67	1
5	Working memory	22	1	4	1.82 ± 0.80	1
6	Self-monitoring	22	1	4	1.82 ± 0.73	1
7	Motor inhibition	22	1	3	1.91 ± 0.53	0
8	Focused attention	22	1	4	1.91 ± 0.75	1
9	Malingering/Motivation	22	1	5	1.95 ± 0.95	1
10	Task execution	22	1	3	2.05 ± 0.72	1
11	Time estimation	22	1	3	2.09 ± 0.61	0
12	Processing speed	22	1	4	2.23 ± 0.75	1
13	Set shifting/Cognitive flexibility	22	1	4	2.27 ± 0.83	1
14	Reward processing	22	2	4	2.32 ± 0.65	0
15	Initiation	22	1	4	2.32 ± 0.78	1
16	Decision making	22	1	4	2.45 ± 0.67	1
17	Divided attention	22	2	4	2.55 ± 0.60	1
18	Short term memory	22	1	4	2.59 ± 0.85	1
19	Visual attentional processing	22	1	5	2.73 ± 0.94	1
20	Feedback learning	22	1	5	2.73 ± 0.83	1
21	Spatial attention	22	1	4	2.73 ± 0.63	1
22	Problem solving	22	1	4	2.73 ± 0.83	1
23	Ability to synthesize	22	1	4	2.77 ± 0.81	1
24	Audio vs. visual processing speed	22	1	4	2.82 ± 0.73	1
25	Verbal fluency	22	1	5	2.86 ± 0.99	1
26	Learning	22	1	4	2.91 ± 0.81	1
27	Long term memory	22	1	5	3.00 ± 0.87	0
28	Comprehension	22	1	5	3.05 ± 0.90	0
29	Reasoning	22	1	5	3.05 ± 0.90	1
30	Prospective memory	22	2	5	3.05 ± 0.84	0
31	Concept formation	22	1	5	3.18 ± 0.91	1
32	Spatial cognitive functions	22	2	5	3.18 ± 0.80	0
33	Auditory perception	22	2	5	3.23 ± 0.75	0
34	Visual perception	22	2	5	3.27 ± 0.77	1
35	Figural fluency	22	2	5	3.32 ± 0.89	1
36	Association learning	22	2	5	3.41 ± 0.85	1
37	Expression	22	1	5	3.55 ± 0.96	1
38	Naming	22	2	5	3.55 ± 0.86	1
39	Repetition	22	2	5	3.59 ± 0.85	1
40	Spatial constructive functions	22	3	5	3.64 ± 0.79	1
41	Recognition	22	2	5	3.64 ± 0.85	1
42	Autobiographical memory	22	1	5	3.68 ± 0.95	1
43	Allocentric visual memory	22	3	5	3.73 ± 0.83	1
44	Spatial perceptive functions	22	3	5	3.77 ± 0.75	1
45	Olfactory perception	22	3	5	3.82 ± 0.66	1
46	Tactile perception	22	2	5	3.82 ± 0.73	1

Note. Rating ranges from 1 = very important, 2 = important, 3 = neutral, 4 = not important, to 5 = not important at all; IQR = Interquartile range; N = Number of panel members rating the function in question.

Table 6. Ratings of functions that were suggested for the clinical evaluation of adults with ADHD that do not fall within the scope of a neuropsychological assessment (Round 2).

Function	N	Min	Max	M ± SD	IQR	Reason for exclusion^a
Impulsivity	20	1	2	1.20 ± 1.20	0	a
Hyperactivity/Overactivity	19	1	2	1.21 ± 0.42	0	a
Psychological state	19	1	4	1.53 ± 0.84	1	d
Emotional control^b	27	1	2	1.59 ± 0.50	1	c
Emotional lability	20	1	3	1.60 ± 0.68	1	a
Low frustration tolerance	20	1	4	1.70 ± 0.92	2	a
Social functioning	20	1	3	1.75 ± 0.79	2	c
Presence of learning disability	19	1	3	1.79 ± 0.79	1	b
Mind wandering	19	1	3	1.84 ± 0.77	1	a
Delay aversion	19	1	4	2.00 ± 0.75	0	a
State regulation	19	1	3	2.11 ± 0.74	2	d
Personality	19	1	4	2.21 ± 1.30	2	c
Multitasking	20	1	4	2.25 ± 0.97	1	c
Intelligence	19	1	5	2.26 ± 1.15	2	c
Presence of gambling problems	19	1	4	2.63 ± 0.96	2	b
Mathematics	18	1	5	3.11 ± 0.96	2	c

Note. Ratings range from 1 = very important, 2 = important, 3 = neutral, 4 = not important, to 5 = not important at all; IQR = Interquartile range; N = Number of panel members rating the function in question. ^aReasons for exclusion: (a) clinical symptoms, (b) coexisting problems, (c) concepts related to other skills or characteristics, (d) general concept or condition. ^bRating was based on results from Round 1 due to an administration error in Round 2.

Table 7. Test battery for the neuropsychological assessment of adults with ADHD as suggested by the expert panel.

Rank	Neuropsychological function	Mean rating	Most suitable measure^a	Suitable^b (%)	Not suitable^c (%)	Alternative measure^d	Suitable^b (%)	Not suitable^c (%)
1	Sustained attention	1.36	CPT (1. TOVA, 2. CPT III)	91	5	TAP	50	0
2	Distractibility	1.36	CPT (1. CPT III, 2. IVA + PLUS)	73	18	TAP	59	14
3	Inhibitory control/Interference control	1.55	GNG	86	5	Stop signal task	82	5
4	Task planning/Organization	1.59	BRIEF	64	18
5	Working memory	1.82	Digit Span test	81	18	TAP	46	0
6	Self-monitoring	1.82	Self-report	64	14
7	Motor inhibition	1.91	Stop signal task	18	0
8	Focused attention	1.91	CPT (TOVA/CPT III)	73	18	TAP (1. GNG, 2. Alertness)	50	9
9	Malingering/Motivation	1.95	TOMM	55	14	Reliable Digit Span	36	9
10	Task execution	2.05	Self-report	50	14
11	Time estimation	2.09	Temporal estimation	55	9
12	Processing speed	2.23	Digit symbol substitution test	91	5	WAIS	91	9
13	Set shifting/Cognitive flexibility	2.27	TMT	82	14	WCST	73	18
14	Reward processing	2.32	Iowa Gambling task	55	14
15	Initiation	2.32	Self-report	55	5	DKEFS	41	9
16	Decision making	2.45	Self-report	68	14	Gambling tests	55	18

Note. Rating ranges from 1 = very important, 2 = important, 3 = neutral, 4 = not important, to 5 = not important at all; CPT: Continuous Performance Test; TOVA: Test of Variables of Attention; CPT III: Conners Continuous Performance Test 3rd Edition; TAP: Tests of Attentional Performance; IVA + Plus: Integrated Visual and Auditory Continuous Performance Test; GNG: Go/No Go test; BRIEF: Behavior Rating Inventory of Executive Function; TOMM: Test of Memory Malingering; WAIS: Wechsler Adult Intelligence Scale; TMT: Trail Making Test; WCST: Wisconsin Card Sorting Test; DKEFS: Delis-Kaplan Executive Function System. ^aShows the measure with the highest percentage of suitability ratings. ^b% of participants that rated measure as suitable. ^c% of participants that rated measure as not suitable. ^dShows the measure with the second highest suitability rating and the lowest percentage of disapproval.

Table 8. Duration of a comprehensive neuropsychological assessment of adults with ADHD according to panel members.

	25th percentile	Median	75th percentile	Median absolute deviation
Actual time^a	1 h 8 min	2 h 15 min	4 h 45 min	1 h 15 min
Desired time^b	1 h 30 min	3 h	4 h	1 h 15 min

Note. ^aTime spent on average on a comprehensive neuropsychological assessment of adults with ADHD. ^bDesired time to spend on a comprehensive neuropsychological assessment of adults with ADHD.