Creyos ADHD Assessment: A Clinical Protocol and Automated Report

With greater public awareness of attention deficit hyperactivity disorder (ADHD), clinicians face more requests from patients for ADHD testing, for both child and adult ADHD. Widespread awareness, open conversations, and reduced stigma are all positives. But more people may be self-diagnosing ADHD, based on symptoms they learn about online.

So the pressure is on healthcare providers to offer confident, efficient, and accurate diagnosis. With a lot of subjective information out there, clinicians have an opportunity to use objective measures to give patients clear answers about the nature of their symptoms, evaluate their cognitive performance and mental health, and identify a referral or treatment plan.

Relying only on the diagnostic criteria outlined directly in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is often not enough for healthcare professionals to confidently assess and diagnose patients. To meet the difficulty of this rising demand, Creyos has created a specific ADHD Assessment and Report, available right in the Creyos Health platform.

This report improves patient experiences and outcomes, while offering healthcare professionals the confidence that comes with a screening tool that is:

• • Scientifically validated.

  • Built specifically to measure objective markers corresponding to diagnostic criteria shown for child and adult ADHD, more than just hyperactivity impulsivity.

  • A set of objective measurements that complement self reported subjective questionnaires and clinical interview.

  • Effective for ongoing tracking of efficacy of medication and other interventions on cognition.

  • Flexibly administered in clinic or at home to kids and adults of any age.

  In this article, we’ll address ADHD diagnostic criteria, scientific validity, rating scales, score interpretation, and a step-by-step guide for administering the Creyos Health ADHD Assessment Protocol and Report.

  Please note: The Creyos ADHD Clinical Protocol and Report is not a standalone diagnostic tool. As with other Creyos Health assessments, any conclusions drawn from the Creyos ADHD Clinical Report should be paired with clinical interviews and observations, other mental health examinations or assessments administered, and other evaluations of the patient and/or the patient's family history.

The Rise of Attention Deficit Hyperactivity Disorder (ADHD) 

Current Research on the Prevalence of ADHD

Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity impulsivity and other difficulty that affects a child or adult’s life, with varying severity—including problems remembering appointments, careless mistakes, difficulty concentrating on tasks that require organization, kids or adults that feel overly active, trouble wrapping up tasks before deadlines, among others.

ADHD has become one of the most common conditions that healthcare providers deal with every day. As per one article in the National Library of Medicine (Abdelnour et al., 2022), ADHD is one of the fastest growing disorders, among youth in particular.

Other studies are exploring whether instances of ADHD have only increased since the onset of the COVID-19 pandemic in 2020. The causes they cite include “a lack of structure and anxiety about COVID or jobs during the pandemic” (Donnelly, 2022). There are increasing instances of adult ADHD self report that physicians are having to assess and validate.

Challenging the Status Quo of Adult ADHD Symptoms Assessment

Patients want to know—what assessments are used to diagnose ADHD? With the readiness of social media information, a person who identifies with ADHD symptoms might first turn to a Google search for “ADHD test online,” seeking to validate their experience.

Many online ADHD tests lack scientific credibility. Yet, on the other hand, patients might feel hesitant to bring their concerns to a clinician because of the long and costly process typically involved in ADHD diagnosis, including many challenging parts:

• 6 to 8 month referral and booking period wait times.

• 1 to 3 hour neuropsychiatric assessment.

• Out-of-pocket expenses for health plan members and all patients.

Some tools are available freely online, such as the following scales: the World Health Organization Adult ADHD Self Report Scale (ASRS v1.1) developed for screening adults, and the ADHD Rating Scale-IV (ADHD RS-IV) for children. These are both short screening scales designed to be administered by healthcare professionals, as traditional pen-and-paper questionnaires. While computerized ADHD tests also exist, they often require:

• More than 20 minutes to complete continuous performance tasks.

• ADHD specialists to administer assessments and interpret results.

• Hardware that restricts the setting for completing the test.

How is this impacting clinical workflows? Long wait times and high costs mean clinicians and patients often rely solely on the Adult ADHD Self Report Scale (ASRS v1.1), developed to follow the DSM-IV criteria from the American Psychiatric Association. The ASRS was designed by the World Health Organization with researchers from various universities, including Harvard Medical School. Alone, this assessment is brief and subjective, and may not be enough to justify diagnosis.

Using only self reported perceptions and subjective measures, it can be challenging to determine if symptoms of inattention are coming solely from ADHD, other comorbidities, or another condition or disorder altogether.

ADHD diagnosis often also requires a patient’s academic records. But for adults getting diagnosed later in life, getting those records can be impossible. The standard process often leaves all parties wanting more concrete information.

Introducing the Creyos Health ADHD Focused Protocol and Report

What is the Creyos ADHD Assessment Tool?

This new condition-focused protocol is a direct result of feedback received from the Creyos community and is fundamentally different from the reports and protocols you may have used and reviewed to date. Specifically, this new report involves five Creyos cognitive tasks that examine 14 specific markers of ADHD. It highlights whether the individual is within or outside the typical rating scale range for each when compared to a representative sample of the general population, making it easy to identify atypical performance on diagnostic criteria associated with child or adult ADHD.

What Does the Assessment Tool Include?

Our pre-built ADHD evaluation is different from any existing protocols you may have created or used in Creyos Health.

It is made up of:

• Four cognitive tests that efficiently measure aspects of attention and executive function.

• The Sustained Attention to Response Task (SART), a short continuous performance task.

• An optional, age appropriate questionnaire (e.g. the Adult ADHD Self Report Scale, ASRS).

How Long Does ADHD Testing Take?

The Creyos ADHD Assessment takes less than 25 minutes to complete, making it easy for patients to be assessed in the appropriate setting for focus, either in clinic or at home. Patients taking the assessment from their home have the ability to have whatever support person they need present, such as the person’s spouse, a close relative, or a parent or guardian.

What are the Benefits of the Creyos ADHD Assessment and Screening Tool?

The protocol features the SART, a brand new, 6-minute task within the family of continuous performance tasks commonly used with ADHD populations. The entire ADHD assessment is pre-built and tailored to the condition with appropriate scales, so a healthcare professional can easily administer the tasks and produce an objective, precise evaluation.

As with all Creyos Health evaluations, an easy-to-interpret report is instantly generated upon completion. The ADHD report you’ll receive:

• Is scientifically validated and objective.

• Based on extensive research (hundreds of papers using Creyos tasks have been published).

• Conveys performance with respect to the typical range on specific ADHD markers, in addition to specific percentile ranks.

The Science Behind The ADHD Focused Protocol and Report

How We Built the ADHD Assessment

In speaking to healthcare providers, we consistently heard the need for an objective clinical report focused on child and adult ADHD. Our solution became clear: Use the latest neuroscience, drawn from over 350 peer-reviewed studies involving Creyos tasks, to develop a fast and efficient ADHD-focused protocol that results in a comprehensive, yet easy-to-interpret, report.

This ADHD protocol also draws from existing assessments and rating scales including:

• The Vanderbilt ADHD Diagnostic Rating Scale, or VADRS

• The Strengths and Weaknesses of Attention-Deficit/Hyperactivity Symptoms and Normal Behavior Scale, or SWAN

What are the 14 Markers of ADHD?

The Creyos ADHD Assessment is focused on 14 markers—specific cognitive performance metrics within Creyos tasks that are associated with an ADHD diagnosis. The evaluation can be tailored to include age appropriate questionnaires for adults and children.

To find markers and factor structure validated through scientifically-supported associations with ADHD, Creyos examined over 100 peer-reviewed papers in international journals. We found:

• Ten markers derived from four existing Creyos cognitive tasks (Spatial Planning, Token Search, Feature Match, and Double Trouble).

• Four more markers derived from the Sustained Attention to Response Task (SART), a task available exclusively as part of the Creyos ADHD assessment.

What is SART?

The SART is a common task used with ADHD populations, and is part of the continuous performance test family—that is, tasks that measure attention and response inhibition over longer periods of time.

As outlined in depth in the Creyos ADHD Clinical Report Science Guide, the SART has proven to be a valid and reliable measure of sustained attention. It specifically measures the ability to sustain mindful, conscious information processing, even in repetitive work, boring or distracting situations.

Completing the SART is simple: numbers flash on the screen and patients must press the spacebar or click the "Go" button for all numbers except the number 3.

How to Administer the Creyos ADHD Assessment

1. Start Protocol
2. Choose Administration Method
3. Choose Custom or Condition-Focused
4. Select ADHD Protocol
5. Add Questionnaire

1. Get Started: Click "Start Protocol" on the Patient Details page as you normally would.

2. Choose Your Administration Method: You can choose to send a link or an email to your patient to complete the assessments either in clinic or at home.

3. Choose Custom or Condition-Focused: A new screen will appear with the option to choose between two types of protocols.

• Selecting "Administer Your Own Protocol" will take you down the familiar path of either choosing an existing protocol you have created, or creating a custom protocol on the fly.
• Selecting "Choose A Condition-Focused Protocol" will allow you to administer the new pre-built ADHD protocol.

4. ADHD Protocol: On the next page, select from the available condition-focused protocols.

Please note: while ADHD is the only one available now, you will have the ability to choose from other condition-focused protocols in the future.

You can also navigate back to a custom protocol flow by clicking "Would you rather administer your own protocol?" and then assemble your own set of tasks and questionnaires.

5. Add Questionnaire: On the next screen you will have the chance to review the cognitive tasks included in the assessment, as well as the time required to complete the overall protocol.

Regardless of what is added, the whole protocol should take 25 minutes at most to do.

Depending on your patient’s age, the appropriate questionnaire will automatically be included, alongside scientifically validated tasks that are proved to correlate with ADHD via peer-reviewed academic papers.

How to Interpret the ADHD Assessment Score

Once your patient finishes their assessment, you'll be able to access a simple, easy-to-read report focused on ADHD in the same ways as you always do—right from the patient’s details page or the general reports page. Rather than having the results spread out across assessment types, you’ll get a unified report that offers a summary, symptoms, rating scales, plus a deeper dive into performance on each task.

In this next section, we’ll walk you through how to find and read the report. For more in-depth information, please download the Creyos ADHD Report Interpretation Guide.

1. Summary Page

2. Markers

3. Typical vs. Outside the Typical Range

4. Optional Questionnaire Scoring

5. Final Details Section

1. Summary Page: The first page of the report is a summary that you can use to quickly derive useful clinical insights. An executive summary appears at the top of the first page for a quick overview of the results.

2. Markers: On the summary page, the rows highlighted in orange flag when a marker is outside the typical rating scales range. This gives you an easy way to review the information that matters most. The executive summary at the top both verbally and visually shows how many markers were met for that particular section.

An overview of all data and metrics on the summary report is provided below:

3. Typical vs. Outside the Typical Range: Each marker has a rating scale threshold used to determine if a patient’s scores falls outside the typical range. You can find these details under the Typical Range column.

The typical range corresponds to performance commonly associated with people who are not diagnosed with ADHD.

Outside the typical range corresponds, statistically speaking, to the patient’s performance being one standard deviation away from the mean, in the same direction as people diagnosed with ADHD in published studies. Note, these can be reflected in either higher scores or lower, depending on the marker.

4. Optional Questionnaire Scoring: If an ADHD questionnaire is included—such as the VADRS or SWAN—a total score is calculated, then compared to a rating scale threshold for ADHD symptoms.

These self reported questionnaires combine subjective input from the patient with a systematic method of tracking and recording symptoms over time.

Here is what the VADRS summary report looks like:

Behaviors tied to each individual response that indicate ADHD symptoms are also highlighted in the Details Section. This allows you to quickly see specific behavioural problems or issues that the patient is experiencing:

5. Details Section: The Details Section provides additional context behind each task and its associated markers, allowing you to evaluate how close or far away from the rating scale threshold the individual scored. Also included on the Details pages are references that speak to the validity of each marker in the report:

That covers the end-to-end experience for this new clinical psychiatry report focused on child and adult ADHD.

Frequently Asked Questions

As you’re using the Creyos Health ADHD Protocol and Report, you may run into several questions, including:

1. What does the number of markers outside typical rating scale range mean?

2. Can ADHD types be identified by the Creyos ADHD report?

3. Do ADHD medications and other interventions affect cognitive testing performance?

4. Does fatigue affect cognitive testing performance?

To help you answer these questions and more, please download the Creyos ADHD Clinical Report Interpretation Guide.

Start Using the ADHD Assessment and Report in Your Practice Today

With this protocol and report, healthcare professionals can better respond to patients’ questions and concerns around potential ADHD diagnosis, determine the need for psychological medicine or other interventions, and monitor adults and children's ADHD symptoms with age-appropriate data. It’s clear that as greater awareness and prevalence of ADHD emerges, assessments that can provide an objective, scientifically-backed, and comprehensive look at cognitive markers are key to taking patient care to the next level.

Start Using The Creyos Health ADHD Protocol and Report

Backed by over 30 years of research, Creyos is here to help you confidently measure the markers of ADHD—and deliver better patient outcomes, faster.

If you have any questions or comments as you begin to use The Creyos ADHD Assessment Protocal and Report, please let us know—you can contact us at help@creyos.com or send a line directly to your customer success manager. We look forward to hearing from you.

Reviewed by Sydni Paleczny, Staff Scientist

Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.