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michellerhyder

Best Practice with ADHD assessment

ADHD assessment is a complex process and should only be completed by suitably trained health professionals. This includes paediatricians, psychiatrists, and/or psychologists. It is easy to get confused about which professional would best suit your needs when you are seeking an ADHD assessment. Furthermore, most of these professions are experiencing a shortage in available clinicians and appointments, with waitlists spanning several months in Western Australia.


Here is some information that allows you to understand the ADHD assessment process better and help you make informed decisions regarding which professional/s you may seek help from.



Who can diagnose ADHD?

Clinicians conducting diagnostic assessments should be:

  • appropriately registered (such as with Australian Health Practitioner Regulation Agency), you can check the registration of a health professional here.

  • adequately trained in diagnostic assessment using the Diagnostic and Statistical Manual of Mental Disorders (DSM) and/or International Classification of Diseases (ICD).

  • experienced with conducting clinical interviews, administering, and interpreting standardised rating scales, and assessment of functional impairment

  • experienced in ADHD diagnostic assessment or undergoing ADHD specific supervision with an experienced clinician.


The assessment process

Assessment for diagnosis of ADHD should include all the following:

  • a full clinical and psychosocial assessment, including discussion about the person’s symptoms and strengths and how these present in the different domains and settings of the person's everyday life

  • a full developmental, mental health and medical history

  • observer reports and assessment of the person's symptoms and mental state

  • a medical assessment to exclude other causes of the symptoms and identify any associated disorders that also require investigation, intervention, and support. Medical investigations should only be performed if clinically indicated.

My personal assessment process is based on the above recommendations and requires several sessions to obtain this information. The exception to this is the direct observation session. Direct observations of the individual being assessed is not always required, as the Guidelines note that observations do not increase the accuracy of diagnosis:


"Direct observations such as observing children in their educational setting, neuropsychological and psychoeducational assessments, computerised cognitive assessments, neuroimaging and electroencephalography (EEG) did not increase the accuracy of diagnosis. However, it is noted that psychometric/neuropsychological evaluation (including IQ/cognitive, and educational assessment) could assist with identifying differential and co-occurring conditions when there is diagnostic uncertainty." (Page 82)


There are many differential and co-occurring conditions with ADHD, and the Diagnostic Manual (DSM) recommends considering the following diagnoses during the assessment process:

•Oppositional Defiant Disorder •Intermittent Explosive Disorder •Other Neurodevelopmental Disorders (E.G., Autism) •Specific Learning Disorder

•Intellectual Disability •Reactive Attachment Disorder •Anxiety Disorders •Posttraumatic Stress Disorder •Depressive Disorders •Bipolar Disorders

•Disruptive Mood Dysregulation Disorder •Substance Use Disorders •Personality Disorders •Psychotic Disorder •Medication Induced Symptoms •Neurocognitive Disorders


In my experience, direct observation allows me the opportunity to consider some of these differential and co-occurring conditions and rule them out (or not).


The assessment process may look different when completed by other professionals, so ask your preferred professional what their assessment process involves. A thorough assessment gives most people more confidence in the outcome.


After the assessment process

Support for people with ADHD can include non-pharmacological interventions and

pharmacological interventions.


Pharmacological treatment is most effective in reducing core ADHD symptoms and non-pharmacological treatments provide additional support to minimise the daily impact of ADHD symptoms and associated difficulties.


Pharmacological intervention

Pharmacological intervention often involves the administration of a stimulant medication, which is a controlled drug under Schedule 8. Given the evidence supporting pharmacological intervention for symptom reduction, many people with ADHD will seek support from a medical professional who is an authorised stimulant prescribers during or after their assessment process.


Specialists that may be authorised as stimulant prescribers for an ADHD diagnosis include:

  • paediatrician;

  • paediatric neurologist;

  • neurologist;

  • psychiatrist;

  • child and adolescent psychiatrist;

As authorised stimulant prescribers, these professionals have strict guidelines they must follow when prescribing stimulant medication. Therefore, even after being diagnosed by a psychologist, the authorised stimulant prescribers will need to do their own assessment to follow these prescription guidelines. Please note this assessment may look different to the process I undertake, as I prefer to follow the Australian Evidence-Based Clinical Practice Guidelines specifically.


Conclusion

There are a range of options to explore when seeking an ADHD diagnosis. Access to a specific professional, desired treatment, and urgency of support needs will all be factors to consider when finding a professional for assessment. At the end of the day, utilising a combination of professionals may assist with ensure timely and evidence based support, such as having a psychologist to complete the initial assessment and identify suitable non-pharmacological supports, while waiting to see a medical professional to explore pharmacological treatment.


Summary

  • ADHD assessment should involve thorough information gathering from multiple sources of information.

  • Only a suitably qualified and registered health professional can complete ADHD assessments. However, different professionals will conduct the assessment process differently - don't be afraid to ask what they will do as a part of their assessment.

  • If you anticipate seeking pharmacological intervention for symptom reduction, a paediatrician or psychiatrist would need to be consulted, even if a psychologist has completed the assessment already.

  • Given the wait times to access a paediatrician or psychiatrist in Western Australia, an assessment by an experienced psychologist can provide timely support for home and educational settings, with regards to non-pharmacological treatments to minimise the daily impact of ADHD symptoms and associated difficulties.

Please feel free to contact me if you have any questions about the assessment process!

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