Dr. Richey, Clinical Director of the Colorado Women’s Collaborative Healthcare, specializes in ADHD assessment and testing, as well as psychoeducational assessments. I was lucky enough to learn more about her expertise in the following interview.
- When would you recommend neuropsychological testing versus clinical interview alone for an ADHD diagnosis?
There are a few specific situations in which I would recommend completing a full neuropsychological
diagnostic ADHD evaluation in lieu of a clinical intake alone:
+When a person presents with a particularly complex mental health picture. When meeting
with an individual who reports a personal history of bipolar (I or II) diagnosis, learning
impairments, treatment-resistant depression, significant/lifelong anxiety, obsessive-
compulsive symptoms, trauma, or complex personality components, it is often helpful to have
an ADHD diagnostic workup to differentiate and more clearly define the diagnostic picture.
This can inform both medication management and other treatment recommendations.
+When a female/woman patient presents for ADHD diagnosis in the context of a significant
hormonal shift. Typically, this would occur in adolescence, peripartum, or perimenopause.
Particularly with the latter, hormonal shifts can present significant changes in ADHD
symptoms. Many women present for ADHD testing in perimenopause due to concerns about
their cognitive ability, increasing emotional dysregulation, and/or changes in their ability to
function, both at home and at work.
+When an individual needs accommodations for a testing event that is overseen by a specific
governing body. While a clinical interview alone will allow for accommodations at school or
work, many times individuals who hope to take the bar exam, MCAT, NCLEX or other board-
regulated exams need cognitive/ability testing along with the clinical interview.
+When an individual just WANTS to know more about themselves! In-depth ADHD testing
offers information about an individual’s cognitive ability, emotional/behavioral functioning,
social functioning, neuronal functioning, and other clinical pieces that may be complicating
their lives. While a clinical intake typically occurs over the course of an hour or so,
neuropsychological testing lasts several hours and taps into an individual’s subjective
experience as well as collecting objective evidence of functioning in several areas, obtaining
collateral information from others, and ruling out many comorbidities.
2. What have you noticed in your practice regarding women who are undergoing significant
hormonal change?
Women often present for ADHD testing when they are experiencing a significant hormonal shift, typically
in adolescence, peripartum, or perimenopause. While many concerns arise in adolescence and
peripartum, the majority of ADHD testing at Colorado Women’s Collaborative Healthcare occurs during
perimenopause. Most women are experiencing perimenopause in the context of major life shifts at the
same time—perhaps they are launching children, caring for elderly parents, or taking on executive roles
at work. No matter what’s going on personally, women in perimenopause often experience difficulties with cognition (word finding, memory, and processing speed) sleep disturbance, emotional dysregulation and a host of physical symptoms. Women who may have suffered symptoms of ADHD throughout their lives often struggle significantly with these symptoms during perimenopause, much of the time to the extent that their work or personal lives are affected. Obtaining an ADHD diagnosis during this time often offers women a chance to observe their cognitive functioning (which is typically “normal” despite these changes) and emotional symptoms in context, which can provide relief and an opportunity to offer grace to themselves during this tumultuous time.
3. What do you find are the biggest benefits of women completing a neuropsychological evaluation?
The biggest benefits are clarity in diagnosis, access to a host of tailored treatment recommendations, the opportunity to get objective evidence of functioning across several areas, and assistance with advocating for themselves to obtain necessary accommodations. Women most often leave neuropsychological testing for ADHD with a sense of a clear path forward and the resources needed to embark on this journey.
4. What are some common recommendations you give women who are diagnosed with ADHD?
Women who are diagnosed with ADHD through neuropsychological testing are offered several
recommendations, focused on improving their mental, emotional, and physical health. First, I always
recommend each woman/girl meet with a PCP or psychiatrist to discuss medication management. Even if
she isn’t interested in medication, it’s helpful for her PCP/psychiatrist to know she’s been diagnosed.
Women or girls considering medication can have a conversation with their providers regarding what
medications are available to/appropriate for them. With patient permission, I consult with every patient’s
PCP/psychiatrist/therapist to ensure appropriate continuity of care, often sending the testing report. I also recommend therapy to almost everyone diagnosed with ADHD. I tailor therapy recommendations based on each woman/girl’s history with treatment, payment preferences, and specific diagnosis. For example, women diagnosed with ADHD and depression may respond better to a specific therapeutic modality than those who are diagnosed with ADHD alone. Some women/girls may benefit from family or couples’ therapy, and I offer specific recommendations for those services as well. I also typically offer suggestions for executive coaching, which can help women with behavioral suggestions for streamlining their lives. In addition, a list of some of these more typical behavioral suggestions are provided as well. There are several excellent podcasts, books, and websites for women who struggle with ADHD—these are all offered in the recommendations. Finally, there are many self-care strategies that are helpful for women who struggle with ADHD, which I add as well. So many recommendations can be overwhelming, and generally help women and girls prioritize their next steps as part of the feedback/follow up session.
If you are interested in Dr. Richey’s services, find her here: https://cowomenscare.com
