What to Expect in a Good-Quality ADHD Assessment
A thorough and high-quality ADHD assessment is essential to ensure accurate diagnosis and appropriate support. A proper assessment should be comprehensive, evidence-based, and tailored to the individual’s specific experiences and needs. Below is an outline of what to expect in a well-conducted ADHD assessment. At Attention to Health we follow the guidelines and practices set out in the AQAS paper by Adamou et al (2024) and use regular supervision to maintain these standards.
1. Initial Screening and Referral
The assessment process with us typically begins with an initial screening or referral. Many people are self-referring given that the information on ADHD is now much more widespread. We can offer a shorter 30-minute consultation appointment to determine whether a full ADHD assessment is warranted based on the individual's history, symptoms, and impact on daily life, if someone is not sure they want to have the longer appointment immediately. The cost of the screening assessment will be deducted from the full assessment if the person decides to proceed with a formal assessment.
2. Comprehensive Clinical Interview
A key component of a high-quality ADHD assessment is a detailed clinical interview conducted by a specialist, such as a psychologist, psychiatrist, or other doctor specialising in ADHD. This interview should cover:
Developmental History: Understanding pregnancy, birth, early childhood behaviours, milestones, and any difficulties experienced.
Medical and Psychiatric History: Reviewing past and current medical conditions, medications, and mental health concerns, including the impact of ADHD symptoms in mental wellbeing.
Family History: Identifying any genetic links to ADHD or related conditions.
Educational and Occupational History: Examining how symptoms have affected academic performance, workplace functioning, and social interactions.
Current Symptoms: Evaluating the presence and impact of ADHD symptoms in different settings, such as home, school, and work.
A good assessment ensures that symptoms are present in multiple domains and have been persistent over time, rather than being situational or due to other factors.
Another important feature is getting observational or collateral information from sources other than the person seeking an assessment. This is usually obtained by interviewing a friend or family member at the assessment appointment or speaking to them at another time. School reports, employers record etc can also be very useful where they are available.
ADHD can be carried out online or face-to-face. It is important that they last long enough for the clinician to be able to observe what’s going on and typically last between two-three hours, with breaks built in. This may be shorter depending on the pre-assessment information received and the complexity of the diagnostic picture. Some assessments take multiple appointments, as we more concerned with making a sound judgement call rather than rushing things at the cost of the quality of the work.
3. Standardised ADHD Rating Scales
Clinicians typically use validated ADHD rating scales and questionnaires to gather additional information from multiple sources, such as parents, friends or partners. We use the WEISS functional impairment and symptoms scales, plus the Wender-Utah retrospective scale, which have been specially designed for adults with ADHD. We ask that these be completed before the assessment in addition to our own history questionnaires to ensure that the assessment clinicians have the best and most up-to-date information before they meet you.
These tools help quantify symptoms and assess their severity, offering a structured comparison against diagnostic criteria.
4. Differential Diagnosis and Rule-Out of Other Conditions
A high-quality ADHD assessment considers and always attempts to rule out other potential explanations for symptoms. Conditions that can mimic or co-exist with ADHD include:
Anxiety and depression
Autism spectrum disorder (ASD)
Learning disabilities
Sleep disorders
Trauma or attachment issues
A skilled clinician will ensure that symptoms are not better explained by another condition and will consider co-existing conditions that may require additional support.
5. Feedback and Diagnosis Discussion
Once the assessment is complete, the clinician should provide a clear and detailed explanation of the findings. If a diagnosis of ADHD is made, the discussion should cover:
The type of ADHD diagnosed (inattentive, hyperactive-impulsive, or combined type)
The severity of symptoms and their impact on daily life
Recommendations for treatment and support
If ADHD is not diagnosed, the clinician should explain why and offer alternative explanations or suggestions for further assessment or management. We pride ourselves in helping the person understand what is going on for them, even if it is not ADHD.
6. Treatment and Support Recommendations
A good-quality assessment does not end with the diagnosis. The clinician should provide a comprehensive management plan, which may include:
Medication Options: Discussing stimulant and non-stimulant medications, if appropriate.
Therapeutic Interventions: Coaching, or psychotherapy tailored to ADHD.
Workplace and Educational Support: Reasonable adjustments, such as extra time on tasks or structured routines.
Self-Management Strategies: Lifestyle changes, organisational tools, and mindfulness techniques.
Conclusion
A high-quality ADHD assessment is a multi-step process that goes beyond just checking off symptoms. It requires a holistic, evidence-based approach to ensure accurate diagnosis and tailored recommendations. Whether an ADHD diagnosis is confirmed or not, a good assessment should leave individuals with a better understanding of their difficulties and avenues for support.
References
Adamou M, Arif M, Asherson P, Cubbin S, Leaver L, Sedgwick-Müller J, Müller-Sedgwick U, van Rensburg K, Kustow J. The adult ADHD assessment quality assurance standard. Front Psychiatry. 2024 Aug 2;15:1380410. doi: 10.3389/fpsyt.2024.1380410. PMID: 39156609; PMCID: PMC11327143.
Adamou M, Jones SL, Fullen T, Galab N, Abbott K, Yasmeen S. Remote assessment in adults with Autism or ADHD: A service user satisfaction survey. PloS One. (2021) 16:e0249237. doi: 10.1371/journal.pone.0249237
Blank R, Barnett AL, Cairney J, Green D, Kirby A, Polatajko H, et al. . International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Dev Med Child Neurol. (2019) 61:242–85. doi: 10.1111/dmcn.1413