Attention-deficit hyperactivity disorder (ADHD) affects 6–10% of children and 2–6% of adults, presenting with varied symptoms including inattention, hyperactivity, and impulsivity. Accurate diagnosis requires specific clinical knowledge and expertise.
A recent study indicates that half of psychologists assessing for ADHD in Australia do not consistently follow established diagnostic guidelines or criteria.
This inconsistency may lead to overlooked diagnoses for individuals with less typical presentations, such as women, girls, quiet inattentive adults, and high-achieving students.
Australia's Diagnostic Landscape
ADHD is diagnosed by psychologists, psychiatrists, or pediatricians. In Queensland, General Practitioners can also diagnose the condition, with more Australian states and territories expected to follow. Diagnosis is not based on a single test but requires considering multiple factors, information sources, and clinical judgment.
The 2022 Practice Guideline: A Standard for Assessment
Australia's 2022 evidence-based practice guideline for ADHD outlines a standard for assessment and treatment. It recommends that ADHD assessments include a comprehensive developmental, mental health, and medical history. Medical evaluations are crucial to rule out other conditions that can present with ADHD-like symptoms, such as sensory impairments, thyroid disease, anemia, or medication side effects.
Clinicians are also advised to consider the social, psychological, and clinical context of a person’s symptoms, gathering input from more than one setting and individual (e.g., teachers or family members). Assessments should not rely solely on questionnaires or direct observation.
Core Diagnostic Criteria
Diagnosis must align with criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Disease (ICD). These criteria stipulate that impairments must be inconsistent with the person’s age, have begun before age 12, and impact multiple settings (e.g., home, school, or work).
A comprehensive ADHD assessment typically includes interviews with the individual and a family member, a review of school reports, completion of diagnostic questionnaires, and investigation of any medical issues causing ADHD-like symptoms.
Study Reveals Gaps in Psychologist Practices
The study involved an online questionnaire completed by 322 Australian psychologists involved in ADHD diagnosis and treatment. While three in four psychologists reported always following guidelines, fewer than half actually demonstrated assessment practices consistent with these guidelines.
Key findings from the study include:
- Most psychologists utilized client interviews and gathered developmental history, but only three in four conducted mental health assessments.
- Less than one in three assessed for other illnesses, and no psychologists reported performing sensory assessments.
- Fewer than one in three psychologists surveyed correctly identified all ADHD criteria while also rejecting a non-ADHD item from specific learning disorder criteria.
- Four in ten clinicians did not recognize that symptoms must be inconsistent with the person's age and developmental stage for a diagnosis.
Implications of Inconsistent Assessment
These inconsistencies may increase the risk of misdiagnosis or prevent individuals from receiving appropriate support, particularly for those whose symptoms overlap with conditions such as anxiety, depression, trauma, sleep problems, thyroid issues, hearing or vision problems, or learning disorders.
Guidance for Individuals Seeking Assessment
Individuals concerned about ADHD symptoms for themselves or their children are advised to consult their GP to explore available services. It is recommended to compare assessment options, including wait times and costs. For medication-based treatment, consultation with a pediatrician, psychiatrist, or, in some states and territories, an authorized GP is necessary, as psychologists cannot prescribe medications. Before booking an assessment, individuals should inquire about the specific procedures involved and compare them against established guidelines.