Navigating the ADHD diagnosis process
Diagnosing ADHD in adults is trickier than it may seem. Not only do clients need to meet quite specific criteria, but the assessing practitioner needs to be confident that symptoms have been present since before the age of 12, are impacting on at least two areas of functioning, and are not better explained by another issue or disorder. A lot of this is murky and subjective, and can be difficult to determine, especially when the main information source is the client themselves.
On top of this, ADHD seems to be quite a 'popular' disorder at the moment. A significant proportion of the population can relate to many of the symptoms of inattention, hyperactivity and executive dysfunction that typify an ADHD diagnosis, however these people may not actually meet the full criteria. On the other hand, there are likely many people who have had ADHD since childhood, but went undiagnosed and have been compensating (often at the expense of coping) for a long time since. Differentiating between these two groups takes a skilled practitioner and a comprehensive approach. Added to this, demands is high, and not all practitioners will take on the challenge of assessing ADHD in adulthood. Not all psychiatrists and few psychologists will formally diagnose. A neuropsychologist will likely be able to conduct a comprehensive diagnosis but may have limited availability due to demand, or be too costly.
With the above in mind, and presuming you do have ADHD which is as yet undiagnosed, here is a summary of pathways to diagnosis. This information is correct for Australians at the present time, but is subject to change.
Pathways to an ADHD Diagnosis for adults
Option 1. Psychiatrist.
How: You'll need a referral from your GP, and then you need to book in to see a psychiatrist.
The process: Some psychiatrists will conduct an assessment interview and diagnosis from that very quickly. Others will do a comprehensive assessment, or send you to a clinical or neuropsychologist for a comprehensive assessment. Some psychiatrists will not diagnose ADHD in adults at all.
Pros: The diagnosis itself can be quick. The psychiatrist can prescribe medication, if necessary, after diagnosis.
Cons: The psychiatrist may not diagnose at all, or may send you elsewhere for testing. Psychiatric consultations can be costly.
Option 2. Neuro psychological or clinical psychological assessment.
How: You can self-refer to a psychologist or neuropsychologist for an assessment.
The process: Present for an interview and psychological assessment. Usually there will be a test battery of psychometric/ability tests and also a clinical interview.
Pros: The assessment is comprehensive. You can take the confirmed diagnosis to a psychiatrist for further treatment/management.
Cons: You may not have a long wait for the initial assessment, but the process itself from start to finish can be lengthy, and costly. If you are seeing a psychologist, you will need to confirm that they can competently assess ADHD in adults.
Option 3. No diagnosis.
Spend some time reflecting on why you are seeking a diagnosis. For some people, a suspicion of ADHD and then following ADHD coping strategies is enough. For others, a diagnosis is important for validation, or maybe to obtain disability support at university or work.
From the above options the issues are obvious. The psychiatric route is variable, and therefore unpredictable, and without direct experience or recommendation from a previous patient it may be hard to find the right psychiatrist for the assessment. The psychological route is comprehensive but involves a wait for the report, and the need to eventually see a psychiatrist if you're interested in exploring the option of medication. And all options will likely diagnose in a completely different
The good news is one of the aims of the Australian Evidence-based Clinical Practice Guideline for ADHD, currently being developed by AADPI, is to develop a best practice for the diagnosis of ADHD in adults.
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Article author:
Clinical Psychologist
B Psych (Hons), M Psych (Clin), MAPS
Elizabeth Talbot is a Clinical Psychologist and the Principal Psychologist at Clinical Therapy. Whilst Elizabeth enjoys her clinical work, she is also a lover of behavioural science and has a keen research interest in the psychology of decision making, moral reasoning, cognitive biases, magical thinking, and conspiratorial beliefs.
Content note: Unless otherwise labelled, all blog posts are intended as discussion pieces, and are not academic texts. Articles pertaining to research or making an academic argument will be labelled as such and include supporting evidence/references. All examples (including client names) are fictitious, to illustrate a point, and are not based on actual clients.