Key components of an ADHD assessment

By Lucinda Pettit, Clinical Psychologist and Family Therapist

If you’re reading this blog, then you’re probably looking for someone to unpack what an Attention Deficit Hyperactivity Disorder (ADHD) assessment might look like for your child or yourself. Maybe a teacher, your general practitioner, or a family member has suggested an assessment, which could be helpful. So, where do you start?

Psychological assessments are expensive and out-of-pocket expenses in Australia. So you might wonder if it is necessary and how it might help. As a clinical psychologist and as a parent of a teenager with ADHD and Autism, I have personal experience with both conducting and participating in clinical assessments of ADHD. Choosing to have your child assessed is a personal/family-based decision. We decided to proceed with the assessment after careful feedback from professionals already supporting our family, hoping that it would provide some clarity around HOW our child struggles and what supports he may need to make academic, social and emotional learning accessible for him while protecting and growing his self-esteem as a person with a brain-based difference, not a “behavioural problem”.

What elements make an effective ADHD evaluation for your child?

But first, you need the assessment. What constitutes a ‘good’ ADHD assessment for your child? How do you know what is thorough and what is value for money? There is a lot of variability in how professionals assess ADHD. ADHD can be assessed and diagnosed by Psychiatrists, Paediatricians and Clinical Psychologists. General psychologists, Educational and Developmental Psychologists, and other Allied Health Professionals such as Accredited Mental Health Social workers can make a ‘provisional’ diagnosis, but the diagnosis needs to be confirmed by a psychiatrist, pediatrician or clinical psychologist. This is because Doctors and Clinical Psychologists have specialist training in the assessment and diagnosis process and interpretation of information.  

An ADHD assessment that meets the ‘best practice’ criteria includes several variables. 

For children and adolescents, the standard set includes;

-       A parent intake where developmental history and family history are explored using a semi-structured interview or questionnaire.

-       A session (or more than one session) to meet the child/young person to observe and interact to assess if they demonstrate behaviour consistent with the profile of someone with an ADHD brain

-       Information from a third party such as a school teacher, including responses to semi-structured interviews and self-report measures screening for ADHD (and other difficulties such as anxiety or learning difficulties)

-       Completion of self-report measures from the parent/s and the child/young person 

-       Review of school reports and any other reports or assessments completed to date

-       A school observation to view the child/young person in another setting with increased behavioural, cognitive, social and emotional demands. 

If there is ambiguity about a diagnosis after following this process, or more information is required, the following assessments can be considered;

-       A specific test of attention and concentration

-       A cognitive assessment.  This is an assessment of intellectual ability where a score is generated and compared to the scores of same-aged children. This is most useful if there are possible learning difficulties that have been flagged. Cognitive assessments are NOT essential to the diagnosis of ADHD in that they do not confirm the presence of ADHD. Instead, if a child/young person has ADHD, they are likely to struggle more with sustaining attention for the duration of the cognitive assessment. They may experience difficulties in specific areas, such as memory.  Clinical observations like these made during the cognitive assessment can be important diagnostic information. 

And for adults?

For adults, the process is much the same with the addition of self-report measures completed by a significant other. 

Cognitive assessments are usually the most expensive part of an ADHD assessment and are not essential. Still, they can add precious information about supporting children and young people through diagnosis and provide greater accessibility to learning through the recommendations made. There is also a high co-occurance of ADHD and learning difficulties, so screening for learning difficulties is an excellent place to start.

Accessing affordable psychological assessments in Australia is becoming more complex, and unfortunately, there is a lack of adequately trained health professionals who are accurate at identifying and screening ADHD. This means that possible diagnoses are frequently missed, and the implications of this are untreated mental health problems leading to poorer mental health outcomes later in life.  

If your child needs an assessment for ADHD and you can’t afford the package on offer through your helping professional, talk to them about your situation. They may be able to complete some low-cost screening that points you in the right direction as to whether it is worth spending a lot of money pursuing a full assessment. Stay tuned for our next blog, which explores ADHD and what to do about it.