velopmental disorder
How do I Ensure an Accurate ADHD Assessment?
Raising awareness among healthcare professionals, educators, parents, and the general public about the complexities of ADHD diagnosis is crucial. This can help prevent hasty decisions and encourage a more informed and thoughtful approach. While ADHD is a genuine and serious condition, the tendency to diagnose it too readily can lead to significant negative consequences for individuals and society at large. ADHD assessments are typically covered by major health insurance companies with a physician referral to a qualified provider such as a clinical psychologist, neuropsychologist, or psychiatrist. It is crucial that an ADHD assessment is completed by a qualified professional such as a clinical psychologist, neuropsychologist, or psychiatrist so that an accurate diagnosis can be provided that is accepted by prescribers, accepted by health insurance payers, and meets requirements for diagnostic rigor.
There are several Red Flags to watch for that can signal an ADHD assessment will not provide the necessary expertise or requirements for adequate clinical care, and are likely to be harmful to patients:
- ADHD assessments completed by masters-level clinicians without any oversight or supervision from doctoral level providers such as clinical psychologists, neuropsychologists, or psychiatrists. This guideline may vary by jurisdiction, though in the state of Missouri and others, clinicians with masters-only levels of training are unable to provide diagnoses that meet qualifications for accurate diagnosis, prescription of medications, or coverage from health insurance companies. This leaves patients and families often having to pay exorbitant out of pocket costs to unqualified providers for assessments that are not even capable of addressing their diagnostic questions or getting them help that they may need. Before engaging services of any clinician for an ADHD assessment, it is important to ask if a doctoral-level provider is conducting or supervising the assessment, or if the provider's credentials meet requirements for insurance billing or recommending prescription of medications.
- ADHD assessments that use any form of neuroimaging such as SPECT, QEEG, DTI, PET/CT, neurofeedback, MRI, CT scans, FNIRSs, etc. While the field of neuroradiology has exploded in its complexity and utility in recent years, as of the writing of this article in 2023, there are currently no reputable studies that are able to incorporate neuroimaging as a diagnostic tool to improve accuracy of ADHD diagnosis. Providers that claim to give ADHD or other developmental diagnoses on the basis of these kinds of scans should be treated with skepticism.
- ADHD assessments that are administered using solely self-report questionnaires. There are a large number of questionnaires that purport to provide examinees with information on whether they meet criteria for ADHD. Self-report questionnaires are those that ask a person about how they are feeling about a certain topic or symptom, and rely on the person to rate how much, how frequently, or how severely they experience that symptom. Unfortunately, many self-report questionnaires that are free and readily available online lack any kind of research that ties their scores to true ADHD diagnoses. Indeed, many of these free online questionnaires exploit the Barnum Effect described above and simply inquire about vague and nonspecific symptoms that are readily experienced by the general population (like disorganization, brain fog, or poor time management). Even reputable self-report measures such as the Connors Adult ADHD Rating Scale (CAARS) are prone to symptom exaggeration, and influence from non-ADHD conditions like depression, anxiety, or traumatic brain injury. When used in isolation by underqualified providers, the CAARS can produce results that are misleading, resulting in false positive diagnostic conclusions.
- ADHD diagnoses given on the basis of an office visit or therapy appointment. ADHD is a complex, nuanced, serious, and frequently debilita