Rating scales have been gaining favor in diagnostic assessment of children with psychiatric and/or neurodevelopmental disorders. While they have their benefits, misuse or overreliance on rating scales can interfere with the assessment process and lead to misdiagnoses, inappropriate interventions, and poor outcomes.

A comprehensive table of selected diagnostic and rating scales.

There are six dimensions of executive function, and with ADHD show widespread failure of the executive system, often in all six dimensions.

We know that for many conditions, both medications and psychotherapy work about equally well. Common sense would dictate that there is some final common pathway of neuropsychiatric change underlying the symptomatic improvements we see. But identifying what is happening in a living human brain is extremely tricky.

Most psychiatrists rely on the Folstein Mini Mental State Exam for a rapid, office-based neuropsychological assessment. But the MMSE has some serious limitations. A hot new test, called the Montreal Cognitive Assessment (MoCA) appears to work much better.

Psychiatric conditions are easy to fake, because there are no truly objective tests for their diagnoses. The prevalence of malingered PTSD symptoms is hard to assess. The actual prevalence of ADHD malingering has never been formally studied, but the high rate of stimulant diversion on college campuses implies that the problem is significant.

To begin, Dr. Woo, what sort of training does a neuropsychologist have?