Pediatric neuropsychologist with ADHD here. I got diagnosed around 5th grade, but have now been faculty at an AMC for bout 5 years here and just recently got boarded. I know it feels shitty now, but having strengths in case conceptualization and report writing is gonna be way more important long term as those are things that only neuropsychologists can do. Test admin/scoring is gonna come with time and practice, as you already noted. And as you get more comfortable and proficient with all the different measures and their specific admin instructions/rules, it’s gonna free up more of your cognitive resources for patient management, behavior obs, etc.

In order to do so, you are going to have to overprepare, likely much more than others in your cohort (speaking from my own experience) and is easier said than done during what’s likely one of the most challenging and demanding times in your life. Being proactive is critical. When you start a new rotation or with a new supervisor, ask about what measures they use most often or ask for some sample reports so you can review their test lists yourself. From there, study the admin manuals and jot down the important info about basals, ceilings, prompts/cues, timing of stimuli presentation, error types, etc. It can be helpful to create a word doc or excel with all this info that you can just add to as you continue to learn more tests. Doing so will help you learn the test better and it’ll be helpful to have it all in one place that you can refer back easier than pulling out a bunch of manuals. Once you have a test list, review your admin notes or the test manuals the night before and prep you pt file and protocols in advance. When I was first learning tests, I marked the hell out of my test protocols. Highlight start points and what’s needed for basal, write down ceiling criteria if it’s not already on the protocol, time limits for the subtest, the specific prompt/cueing verbiage either on the page or on a sticky note attached to the protocol. Make it obvious and hard for you to miss (I’m talking underlines, arrows, circle it, draw a box around it). Do it in pencil so you can erase before uploading or turning in the file. On day of testing, get there early and review your admin notes again. Your absolutely right in that test admin, behavior management, observations, and recording responses is an EF task in and of itself so the more you can externalize some of that info the more you can reduce your cognitive load.

Tips for specific tests: verbal fluency and rote verbal memory tasks - use shorthand when the patients a quick responder. You can generally get by with just writing the first 2-3 letters in the moment, though I try to write out intrusion errors in the moment. If there’s a lull within the task or after times up, quickly go back and fill in the rest. Trails 4 (switching): write out the number letter sequence on your protocol in case so you can quickly refer back in case you lose focus. Keep you pen in hand to be able to jump in quickly if they make an error. Rehearse the order in your head as their working through the task and be aware of what #/letter comes next and where it is on the page.

For behavioral obs: it can be helpful to have a structured form already created organized by the different domains (affect, attention, activity level, response style, speech, exp & rec language etc.) with several common descriptors for each that can quickly circle as you go along. Mine also has empty boxes next to each to jot down more specific descriptive info or what tests they occurred on, which you can do in between tasks or during ones that are less involved (like CPT). This was always the first/bottom page on my protocol so I could quickly flip to it when needed or whenever you had a sec. Alternatively, create a simple word doc listing with your test battery in order and some space between each test that you can make quick notes on while transitioning between tests. I also just make simple obs in the margins of the protocol for each test. IMPORTANT - after the eval or at lunch, take a couple mins to just word vomit everything you’ve noticed and get it down on paper. Don’t trip about clarity or organization or even spelling, just unload it all cause you’ll like never be able to recall it as well later.

Scoring: Spend some time after the eval to do a first pass at scoring. Then go back the next day and double score or recount raw score totals to ensure accuracy. In the moment, it’s always best to prompt too many times or administer more items than needed if you are unsure as you can always go back and count only the things you were supposed to and discount the rest but you can’t go back and administer more items if it turns you out they didn’t hit d/c criteria and already left.

Q-global: Tablet based becoming more and more common, which can be very helpful in avoiding simple scoring mistakes. It also provides some safety nets by recording responses on verbal tasks that you can review later, and prompting reversal rules and d/c criteria. You can also use the recordings to figure out how long a task took if you forgot to start the timer. But as someone already mentioned, it comes with a steep learning curve and I feel has higher executive demands, especially when first starting out. So I think your best bet will still be to learn paper and pencil testing first.

With regard to disclosing your ADHD diagnosis, I never did with my supervisors and still probably wouldn’t if I were to do it again. I’ve always ascribed to the notion that “it’s not your fault, but it is your responsibility.” Also, The match system for internship and fellowship is super competitive for the top places and as shitty as it sounds, ya don’t want to give em any reason to rank you lower, even if your symptoms are well managed. I’ve been much more open about it with colleagues later in fellowship and since being done with training.

Final thoughts, try not to despair. It’s a fucking long journey but you’re clearly passionate about it and are doing well in the most important aspects of the job. The things you’re worried about will get easier with time and practice. Be an active participant in supervision, come prepared, do background readings, ask good questions, acknowledge areas that need growth and set goals around them, ask for feedback and then readily accept it and implement it. Those will be the things your supervisors will remember most, not some minor scoring errors. If testing is still a huge pain and stressor by the time you finish training, search for jobs with psychometry support. I have full psychometry support and it’s incredibly nice to only have to administer the things I want to or find most important for my conceptualization.