How does the ADHD Diagnosis process work?
With the increased access to information about ADHD many people are left wondering if a diagnosis would fit for them. However, the process of receiving an ADHD diagnosis can be confusing and daunting. In this blog post, I will cover what is involved in an ADHD assessment, how to decide if you need an assessment, and how to find a provider for an assessment.
What is it?
Although a variety of mental health professionals may be able to provide a diagnosis of ADHD, the most common process for receiving a diagnosis is to undergo an assessment.
I understand that the term assessment can mean different things to different people. In this blog post, I define assessment as a formal evaluation process completed by a trained mental health professional.
Typically, the mental health professional that provides assessment services is a psychologist. They also may be assisted by other trained professionals (e.g., psychometrist). Why psychologists? One main differentiating factor between the training of master’s level therapists and psychologists is that psychologists have additional training in administering and interpreting tests that are included in assessments for ADHD (as well as other types of assessments). So, for the sake of conciseness and clarity, I will refer to psychologists in this blog post. However, trained mental health professionals involved in assessing ADHD may vary.
Now that we have covered what I mean by assessment, let’s look at the assessment process itself. What does it look like? Well, each psychologist has their own process. However, the assessment process usually involves attending several appointments that cover the following:
Undergoing a thorough interview of your history and experiences with possible ADHD
Completing self-report questionnaires
Completing online and/or in-person testing that is computer and/or paper based
A feedback session where the results are explained to you and you receive a formal written report of the results
The length of time of this process varies and depends on many factors such as the availability of the psychologist for interview and testing appointments, your attendance of appointments, and the time it takes for the psychologist to interpret test results and write an accompanying report. The report writing process alone can take some time - the reports from these types of assessments can be as long as 30-40 pages! And typically your psychologist will be working on multiple reports at once so they appreciate your patience.
Some of the testing you encounter may not seem directly related to ADHD. One reason for this is because it is best practice for psychologists to test for mental health concerns whose symptoms may mimic ADHD. For example, anxiety often results in some executive dysfunction, which is also present for ADHD individuals. Another reason is that certain tests, such as IQ or memory tests, provide psychologists with information about things like your working memory and processing speed. Knowing about your functioning in these areas can be important to help understand whether or not you may be an ADHDer. We want to make sure that we are giving the most accurate diagnosis possible!
Do I need an ADHD assessment?
Let me begin this section with an important note - there is not a universal agreement on who “should” diagnose ADHD and whether a formal assessment process is always necessary. I gave examples in the preceding sections of common assessment processes based on my knowledge and training. So, full disclosure, this and other sections are based on a combination of my training, current knowledge, and also my opinions. Other mental health professionals may disagree with me, and that’s okay! We all have different training and opinions. Please seek out information from multiple sources to inform your decision-making.
Okay, now onto some of my (possibly) controversial opinions. I do not think a formal assessment/diagnosis is always necessary! I am a psychologist trained in assessment and I know that a formal assessment process is one of the most comprehensive methods to diagnose ADHD. I am also a person that understands we live in a society with a broken, pathologizing healthcare system that can be harmful, oppressive, and inaccessible. Further, I am a neurodivergent individual myself who quite honestly wrestles with the idea of neurotypes being considered as diagnoses. So, for these reasons, I never want to push a certain agenda regarding whether or not an individual should seek formal assessment and diagnosis.
Let’s explore some of the possible reasons “for” and “against” pursuing a formal assessment and diagnosis. Again, please remember that I am writing this based on not only my knowledge and training, but also my own opinions. This is not meant to be medical advice.
Possible reasons “for” pursuing assessment and diagnosis
Let’s talk about medication. Many medical providers still require patients to undergo an assessment and receive a diagnosis of ADHD before they will consider prescribing medications such as stimulants. So, if you are interested in taking medication, it may be helpful and/or necessary to pursue an assessment. That being said, I have noticed that more and more medical professionals within the specialty of psychiatry seem to be willing to complete their own assessment processes “in-house” to diagnose ADHD and prescribe medication. It would appear that this would eliminate the need to pursue assessment and diagnosis from a psychologist before meeting with a medical provider to receive medication. However, some medical providers still prefer that patients undergo a separate assessment by a psychologist and then provide documentation of their diagnosis for the purposes of being prescribed medication. In this case, documentation from your psychologist should suffice.
Work and school accommodations are another reason you may want to consider pursuing a formal assessment and diagnosis. Many colleges, universities, and workplaces ask for documentation of a diagnosis in order to allow for necessary accommodations. (My thoughts on this practice could be its own blog post, so I won’t opine on that right now.) I would personally advise against providing your full assessment report to a college, university, or employer as it contains private information that is not relevant for the provision of accommodations. In other words, you don’t have to provide all your personal information like lived experiences and test results that are included in your report - it’s not their business! Documentation of the diagnosis alone should work just fine. Also, ADHDers should consider factors related to the Americans with Disabilities Act (ADA) when seeking accommodations. While I have informed myself about these factors, I want to avoid providing possibly misleading information. Here is a link to an article by ADDitude Magazine that covers some considerations related to ADHD accommodations and ADA.
Possible reasons “against” pursuing assessment and diagnosis
Once more, I will remind you these are my opinions, but I will also note that these opinions are informed by my personal and professional experiences. Be sure to explore other sources of information and consult with trusted individuals in your life to make the most informed decision possible for yourself!
Assessment and diagnosis can be a relatively inaccessible process. Finding an affirming and knowledgeable psychologist with availability as well as financing the cost of the process through insurance or cash pay are just a couple of possible barriers that come to mind. Does this mean that you absolutely should not pursue assessment and diagnosis? Well, no. Again, there are several factors in favor of pursuing assessment and diagnosis.
Medical and mental health records, which would include assessment reports and diagnoses, are confidential. However, insurance companies determine whether they will pay for the services you seek under their coverage based on “medical necessity.” To determine if a service is deemed “medically necessary,” insurance companies often require a diagnosis. Therefore, if you use insurance to cover the cost of assessment and diagnosis, chances are very high that your assessor will need to provide your diagnosis to your insurance company to ensure that you are covered and that they are paid for their services. Luckily, this typically does not include your full report, although in certain cases insurance companies can in fact request further documentation such as your report or other notes kept by your psychologist. So, all of these are things to consider when seeking an assessment using insurance. I do not mean to imply that certain information (such as diagnoses) will be held against you in any way, but I also cannot guarantee that this will never happen. For example, consider the implication of “pre-existing conditions” on individuals’ ability to qualify for insurance coverage in the US. While, anecdotally, it doesn’t appear that a diagnosis of ADHD would prevent someone from gaining insurance coverage, it is also not out of the realm of possibility. I don’t share this information with the intention to provoke anxiety or engage in any sort of fear mongering. I just want you to have as much information as possible when considering whether or not a formal assessment and diagnosis process feels right for you!
How to find services
So let’s say you have decided that you do in fact want to pursue the assessment process. The first step will be to find a professional that offers assessment services. A recent blog post of mine walks you through the steps of finding a mental health professional for therapy services. The process of finding a mental health professional for assessment services is very similar, with a few differences. So, if you have not read my blog from 8/28/23 titled “Five Steps to Finding a Therapist” I would suggest you do so now and then come back to this post.
You can use directories that I referenced in my Five Steps to Finding a Therapist post to find assessment services as well. One key difference is to look for search filters that include words like “testing” or “assessment.” This will help you to find professionals that specifically provide assessment services. Not all mental health professionals that specialize in working with neurodivergent folx are willing or able to provide these services, so make sure to thoroughly review directory profiles and websites to see if there is mention of assessment services. For example, I am not currently able to provide assessment services (at the time of this post) and I state that explicitly in the “services” pages of my website. If I were to provide assessment services, I would most likely create a separate page on my website describing those services.
In addition to using directories, you can also use a search engine like Google to explore testing options in your area. I would suggest using search terms such as “ADHD testing in my area” or “ADHD testing in [your location here].” This should give you results of practices that have advertised assessment services in your area. I suggested the use of the term testing as many practices use the terms testing and assessment interchangeably. But feel free to also use assessment as a keyword in your search!
Finally, if you plan to utilize your insurance, you can ask your insurance provider (BCBS, Aetna, etc.) to provide you with a list of mental health professionals that accept your insurance and provide assessment services. Previously this required you to call the company, but luckily now most large private insurance companies have a provider search tool on their websites! Check the website of your insurance company - you should be able to create an account and find a provider search tool. You can also still call into the companies, but wait times may be long.
Summary
Whew, that was a lot of information! I’ve summarized the key points below:
A formal ADHD assessment process often includes several appointments with a trained mental health professional. You should expect to receive a written report of results at the end of the process. The report should be explained to you.
There are several factors to consider when deciding whether a formal assessment process is right for you. Some include:
Do I need documentation of a diagnosis for medication or accommodations?
Are the time and cost involved accessible and worth it for me and my needs?
Can I use insurance? If so, do I feel comfortable with my insurance company having documentation of my diagnoses?
There are several ways to find a trained mental health professional that provides assessment services. Some include:
Searching therapist directories (like Therapy Den or Mental Health Match) and using search filters related to “assessment” or “testing.”
Using a search engine to explore local services using keywords such as “ADHD testing in my area” or “ADHD testing in [your location here].”
Using online “provider search” tools typically provided on your insurance company’s website. (This may require you to create an account.)
While it is impossible to cover all of the nuance of the assessment decision-making process, I certainly hope this blog post helped to answer some of the more common questions. It is my goal to demystify as many of the mental health services processes as possible!