Psychological Evaluation 101: ADHD

One of the most common referral questions I get for psychological evaluations is for ADHD, so I thought I would speak a bit about what an evaluation for ADHD looks like.

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Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder, meaning that the brain of a person with ADHD has structural differences compared to a brain that does not have ADHD. It is listed in the DSM-5 as a disorder, though there is evidence that ADHD brains evolved to meet specific needs that just don’t exist anymore. This makes sense when you consider that countries with child-centered approaches to learning have lower rates of diagnosed ADHD despite a review of research sources showing that rates are pretty consistent worldwide. Basically, if you play to a child’s strengths and support them, they might not exhibit “bad” behavior leading to a diagnosis.

I have a theory that this is why the “rate” of ADHD is lower in adults than children despite our knowledge that it is a lifelong condition. As adults, we are able to choose our job and a lot of our environmental factors that kids have no control over, so we self-select environments where we thrive. That being said, adults can absolutely get testing and benefit from additional support.

ADHD can be diagnosed as young as age four, though many clinicians are hesitant to diagnose at that age because there is a pretty big range of “appropriate” behavior for a four-year-old!

In my own clinical work, there are two ways that I do evaluations for ADHD. First, at my full-time practice, I complete a real-time test of an individual’s ability to focus and compare their performance to people with ADHD and people without ADHD. I give an assessment with a form for the client to complete and a second form for someone close to them to complete, which gives me data on their experience of symptoms compared to how they look to other people. (For kids, there is a form for the parent and teacher so I can track behavior across settings.) Then, if the client is willing and old enough, I give a personality measure that looks at a broad range of symptoms. I like to include this measure because most people with ADHD have a secondary diagnosis, and this information gives me a bigger picture of the client rather than a simple yes or no answer to the question, “Do I have ADHD?”

Although what I described above is a very thorough approach to an ADHD evaluation, not everyone is interested in completing testing in this depth. Some might also not have the finances for a full evaluation. ADHD Online offers a more affordable option that can be completed anywhere in the United States, which both makes getting tested affordable and makes this service accessible to people living in rural areas who can’t travel to complete testing. This assessment specifically answers the yes/no question of ADHD, but this is a great starting point to someone who needs services.

You get to decide what treatment route is the best fit for you. My goal is just to give you the information you need to make that decision.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

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