Longitudinal Data for Confident ADHD Care

Longitudinal cognitive monitoring is the repeated measurement of a patient’s cognitive function throughout care. In ADHD treatment, it can provide clinicians with objective data to help guide treatment planning and ongoing dose adjustments.

Because diagnosis often marks the beginning of years of follow-up, this ongoing monitoring can help show whether treatment is working, when changes are needed, and if a patient’s condition may be worsening. However, longitudinal monitoring during these visits still relies largely on self-reported measures, which have limitations in how accurately and objectively they capture change over time.

This article examines why the surge in adult ADHD diagnoses has made those limitations more urgent, how objective assessment tools can support ADHD management when used alongside the rating scales most practices already use, and how the Creyos platform supports monitoring change over time.

The surge created a management problem, not just an assessment one

In 2023, an estimated 15.5 million U.S. adults had an ADHD diagnosis, and roughly half of them received it in adulthood, according to the CDC. About half had been prescribed medication in the previous year, and roughly one third reported taking stimulant medication. Over the longer term, dispensing of prescription stimulants in the U.S. rose approximately 60% between 2012 and 2023, according to an IQVIA analysis prepared for the DEA.

Much of the public conversation around this growth has focused on access to care: longer waitlists, telehealth intake, and the stimulant shortages that left 71.5% of treated adults reporting difficulty filling a prescription. These are significant challenges, but they are concentrated at the front end of care.

For mental and behavioral health professionals, another challenge begins once treatment is initiated. A faster path from first visit to first prescription can leave less time to establish a reliable pre-treatment baseline. After that, clinicians must determine whether medication is effective, whether the dose should change, and whether changes in symptoms reflect treatment response, day-to-day variability, or changes in the condition itself.

Each newly diagnosed patient therefore represents not only a new treatment start, but also a long-term medication-management responsibility. As diagnosis and prescribing increase, so does the need for longitudinal measures that can capture changes in ADHD-related symptoms and cognitive functions, accurately and objectively, over time.

Why track cognitive change objectively?

Clinicians who manage ADHD know the limits of follow-up by rating scale and self-report. Recall, mental state on the day of reporting, and expectations about whether a treatment is working can all shape the results, and the subtle shifts in symptom presentation over time often sit below the resolution of those instruments.

Objective cognitive testing adds a second axis: function on the cognitive domains ADHD is linked with, quantified and scored the same way each time. Psychiatrist and Creyos clinical advisor Dr. Rebecca Reyes frames these functions as the cognitive core of mental health, where meaningful shifts in cognitive function can be detectable even when they don’t register in symptom reports.

How the Creyos ADHD report supports longitudinal monitoring

Establishing the baseline

The Creyos ADHD Assessment is a pre-built protocol a clinician can administer at intake and then repeat at follow-ups, producing a comparable report each time. Because each administration measures the same markers in the same way, results line up across visits, which makes changes over time easy to identify.

The ADHD Assessment takes under 25 minutes and returns an instant report. Each assessment includes:

• Four cognitive tasks measuring attention and executive function (Spatial Planning, Token Search, Feature Match, and Double Trouble)
• The Sustained Attention to Response Task (SART)
• An age-appropriate questionnaire (VADRS, SWAN, or ASRS v1.1)

Each task is validated in the research for its association with ADHD, and every result in the report links to the peer-reviewed study (or studies) behind it.

At Telapsychiatry, a remote psychiatry practice, the baseline assessment is the first step in an ongoing monitoring protocol. Dr. Ozan Toy has patients complete it at home before they have taken any medication or morning caffeine, then repeat the assessment at follow-ups to track how they respond to treatment across the months that follow.

Retesting to track change

Performance-based cognitive testing provides a reliable, objective, and quantifiable way to track changes over time. Assessment protocols are designed for repeated assessment through several design features that capture meaningful cognitive change rather than normal variation of learning effects:

• Tasks that adapt to a patient’s performance: Each task adjusts in difficulty based on the patient’s responses, allowing it to efficiently identify the upper limits of their ability while collecting rich performance data in a short period of time.
• Standardized, quantified scores: Consistent administration and scoring make results comparable across assessment dates, reducing the influence of confounding factors and helping clinicians identify meaningful change over time.
• Extensive, randomized problem sets: A large bank of randomized items ensures that no two assessments present the same set of problems.

Because a patient never repeats a task they have memorized, these features minimize learning effects that could otherwise inflate a follow-up score. A change between the baseline and a later assessment can then be read as a potential real shift in the patient’s symptom presentation rather than familiarity with the task.

Comparing a follow-up report against the baseline gives a clinician an objective view of how markers associated with ADHD are changing, alongside symptom reporting collected in the questionnaires. Across repeat assessments, the data can show:

• Whether attention and executive function are improving under a given treatment
• Whether early improvements are maintained over time
• Whether performance has plateaued or declined over time
• Whether attention and executive planning difficulties are consistent or they fluctuate with time, mood, and context

When the data points to something else

A retest that shows no improvement, or a decline, can be a finding in its own right. When cognitive function does not respond to treatment as expected, it may be a signal that there are factors contributing beyond ADHD.

Co-occurring conditions are common: among health center visits by adults with ADHD, 69.6% documented a mental health co-diagnosis, most often anxiety (51.2%) or a mood disorder (48.8%).

Creyos can support evaluation of these co-occurring conditions alongside the assessment for ADHD. A suite of validated questionnaires, including anxiety and mood-related measures, can be added to a patient’s assessment. Tracked across repeat administrations, those questionnaire scores can be reviewed over time alongside the ADHD-specific markers rather than documented elsewhere.

Confident ADHD care is ongoing care

An ADHD diagnosis, in many ways, marks the beginning of clinical care and the decisions that follow: whether a treatment is working, whether something else has emerged, and whether the management plan still fits. These questions are answered best when clinicians can access tools that support accurate longitudinal monitoring.

The Creyos ADHD protocol is one such tool, supporting integrated assessment of objective cognitive function alongside patient self-reports over time, without adding an in-clinic burden for repeat testing.