As pediatricians managing an increasing volume of ADHD cases, staying current with the updates in ADHD testing and treatment is essential.
In this article, you will learn:
One recent shift in ADHD testing has been the re-evaluation of performance-based assessments. According to research published in the American Academy of Child and Adolescent Psychiatry's (AACAP) journal, performance-based tests like the Test of Variables of Attention (TOVA), once considered promising adjuncts to clinical evaluation, show no advantage over comprehensive clinical assessments.
The more reliable method continues to be structured clinical interviews paired with validated rating scales completed by multiple informants across different environments like home, school, and community.
Transition from Vanderbilt to Conners Scales
Many practices are transitioning from Vanderbilt Assessment Scales to Conners Scales, primarily due to age range considerations. While Vanderbilt scales are validated for ages 6-12, Conners Scales extend coverage to ages 6-18. This broader age range eliminates the need to switch assessment tools as children mature.
New stimulant formulations have seen incremental rather than revolutionary changes. These reiterations may have slightly different side effect profiles and duration of action. These new formulations provide additional options for fine-tuning treatment but not fundamentally changing therapeutic approaches.
The most notable addition is Qelbree (viloxazine), a new non-stimulant medication that offers an alternative to atomoxetine (Strattera). Qelbree is particularly valuable for complex cases or patients with contraindications to stimulants. Qelbree addresses both hyperactive and inattentive symptoms and provides another option for patients who either cannot tolerate stimulants or whose families prefer non-stimulant approaches.
Non-pharmacological interventions are an important part of ADHD treatment. Adapted for ADHD, cognitive behavioral therapy (CBT) teaches children practical skills for managing attention, impulse control, and emotional regulation. Executive function coaching builds organization, time management, and planning abilities, while parent management training helps families develop ADHD-informed strategies.
Digital therapeutics are also emerging, including Endeavor, an FDA-approved video game that improves attention through evidence-based mechanisms that adapt to continuously build focus abilities.
Today's practice shows dramatic improvement. Enhanced recognition of inattentive presentations by parents, educators, and clinicians has resulted in girls being identified as early as kindergarten and first grade, preventing the accumulated negative experiences of masking symptoms for years or decades.
This shift addresses the historical pattern where school referrals came predominantly from disruptive, hyperactive presentations, systematically missing girls with inattentive symptoms. Today educators recognize that daydreaming, consistent underachievement, or requiring disproportionate effort for adequate grades may indicate underlying ADHD.
Clinicians now recognize that girls with ADHD often present with co-occurring anxiety disorders, requiring simultaneous treatment for optimal outcomes. This awareness helps explain why some girls may not respond optimally to stimulant medication alone.
While ADHD subtypes remain consistent, there’s increased focus on identifying and addressing co-occurring conditions such as speech and language disorders, processing disorders, sensory processing differences, anxiety, or mood disorders.
This is critical because unidentified co-occurring conditions often explain why some patients don’t respond optimally to standard ADHD treatments including stimulant medications.
A key clinical indicator for co-occurring conditions is treatment response patterns: When patients fail to respond adequately to two different stimulant medications, this typically signals underlying conditions that require comprehensive evaluation rather than continued medication adjustments.
Changes to typical 504 Plan accommodations
School accommodations through 504 plans have become increasingly sophisticated and individualized. Current accommodations include sensory regulation tools (fidget items, specialized seating), movement or “wiggle breaks” to support self regulation, environmental modifications to reduce distracting stimuli, structured check-ins to maintain task engagement. These changes reflect the deeper understanding of ADHD as a neurobiological condition requiring environmental support rather than behavioral management.
Collaboration between mental health professionals and schools
Mental health providers are increasingly serving as crucial liaisons between families and schools. Extended visit times (typically 30 minutes for follow-ups versus the average 8-minute pediatric encounter) allow for comprehensive discussion of accommodation options, navigation of varied school district requirements, and detailed advocacy letter writing. Some practices, including Blackbird Health, offer formal school advocacy services, sending professionals to accompany parents to school meetings. This collaborative approach ensures students receive appropriate accommodations and helps schools feel supported in their efforts to serve children with ADHD.
Better-informed parents, aware of ADHD’s genetic component, are more actively seeking early evaluation when they recognize familiar patterns in their children. This increased parental awareness, combined with improved school-based identification of both hyperactive and inattentive presentations, is leading to earlier intervention and better outcomes.
It’s also increasingly common for parents, particularly mothers, to seek their own ADHD evaluations after their child’s diagnosis. This recognition that their own long-standing struggles mirror their child’s experience is leading to better family-wide management and reduced stigma.
Telehealth has permanently expanded access to ADHD evaluation and treatment, particularly valuable in addressing mental health provider shortages in underserved areas. Beyond accessibility, virtual evaluations offer unique diagnostic advantages that often surpass traditional office-based assessments.
Observing children in their natural home environment provides more authentic behavioral data than novel clinical settings. Office environments can mask ADHD symptoms, while home-based evaluations allow you to observe the child at home in their environment, providing insights that structured office environments often cannot reveal.
Virtual evaluations also allow providers to offer real-time environmental coaching, suggesting immediate home modifications during the assessment itself. This immediate feedback helps families implement supportive strategies before formal treatment even begins.
The flexibility of hybrid care models has become standard practice for many providers including our approach at Blackbird Health, allowing families to choose the most appropriate format for each visit based on individual needs and circumstances.
Blackbird Health provides comprehensive ADHD evaluation and treatment services for children and young adults across Pennsylvania and Virginia through both virtual and in-person care models. Our whole-child diagnostic approach examines physical health factors, mental health conditions, and sensory-developmental considerations to identify not just ADHD symptoms but underlying causes and co-occurring conditions. Our extended visit times allow for comprehensive discussion of treatment options and coordination with pediatricians, ensuring families receive the collaborative support needed for optimal outcomes.