Questions and Answers about ADHD and ADHD Assessment

How big of a deal is ADHD?

When ADHD symptoms are left undiagnosed and untreated they increase a person’s risk for a multitude of negative health, mental health, social, job, financial, and educational consequences. These include increased risk for: diabetes, dental problems, sleep issues, addiction, heart disease, obesity, depression, anxiety, eating disorders, divorce, peer rejection, poor school performance, dropout, repeated job termination, lower income, severe car accidents, and lower life expectancy. ADHD is a big deal.


Is ADHD Overdiagnosed?

Prior to getting specialized training in ADHD, I would have expected the answer to be yes. I had always heard about overdiagnosis growing up. Certainly it causes multiple problems when disorders like ADHD are misdiagnosed, and this can and does happen. That being said, it turns out that only around 20% of people living with ADHD ever receive a diagnosis. What’s more, experts in the field (Russell Barkley, Kevin Blake) have shared that the diagnostic rules used to identify ADHD are clearly too strict but that, due to political reasons, this has not been fixed as it would increase prevalence rates. Taken together, ADHD overdiagnosis is a myth. As it’s currently defined, about 8-9% of children and 4% of adults meet all of the DSM-5-TR ADHD diagnostic criteria. 

How do you make sure that an ADHD diagnosis is correct?

To make sure that I have confidence in a diagnosis, I use multiple types of assessment, including collateral reports of symptoms taken from others. In addition to asking about ADHD symptoms, I assess for the presence of executive dysfunction (i.e., the neurocognitive impairments at the heart of the disorder) and associated functional impairments. I compare scores from various assessment measures to normative sample data (large groups of people who’ve completed the same measures) to determine where a client’s scores are relative to others with and without ADHD in the same age group. Such comparisons allow psychologists to know how greatly a client’s scores deviate from the average (percentiles are determined).


What happens after a diagnosis is made?

Following a diagnosis, it is important that information be shared on what ADHD is and how it can be managed. Often, people living with ADHD receive harmful messages growing up that they are lazy, not trying hard enough, irresponsible, or uncaring. These beliefs create a lot of insecurity, doubt, and anxiety. Understanding how ADHD affects the brain and a person’s functioning allows one to appreciate that their struggles are attributable to neurobiological differences, not character traits. 

It is also important to learn about treatment approaches (there are numerous), get assistance with potentially needed accommodations at school or work, and be linked with the right mental health professionals and resources. I make sure that all of my assessment clients get the information and assistance I’m describing.

Why does ADHD require a more detailed level of assessment?

When assessing ADHD, it is important to collect a detailed family history, obtain collateral reports from others, identify the presence of specific ADHD symptoms, look for possible executive dysfunction (i.e., problems with specific neurocognitive tasks), assess the most common co-occurring mental health conditions, and assess the degree of functional impairment caused by symptoms. For this reason, quality ADHD evaluations require multiple forms of assessment and are more time intensive. Thankfully, these detailed assessments provide useful results that can help clinicians pick out the specific types of therapy likely to offer the greatest benefit to you or your loved one.

Does insurance cover this?

I am in-network with three insurance providers: Aetna, Custom Design Benefits, and Lyra Health. If you have one of these forms of insurance, I will work with you to ensure that it covers the cost of an assessment as best as possible. 

If you have a different form of insurance that I do not accept, I can provide a superbill following the completion of an assessment. A superbill is a detailed receipt that includes all information insurance companies need to process mental health appointments as out-of-network claims. Upon receiving a superbill, insurance companies count the cost of appointments toward your out-of-network deductible (assuming your plan has one). Once this deductible is reached for the year, insurers often reimburse the cost of care. I recommend that you contact your company directly (using the customer service number on your insurance card) to inquire about your plan details.


How important is medication?

Medication can be a tricky topic for a lot of my clients. Some have strong feelings about what it means to be on it. Others have had negative experiences in the past. For these reasons, I tend to make my clients aware of all their treatment options but otherwise support them in what they choose. One area that may be an exception to this, however, and be deserving of more conversation is ADHD. This is because when moderate-to-severe ADHD is left unmedicated, it can greatly increase risk for a variety of bad incomes, including depression, anxiety, addiction, eating disorders, and fatal accidents. In fact, research has actually shown that when moderate-to-severe ADHD is left untreated, life expectancy decreases, on average, by roughly a decade!

Given all this, the world’s leading experts on ADHD (individuals such as Russell Barkley) strongly encourage individuals living with it to begin with medication management as a first-line treatment. There are multiple reasons for this: (1) In most cases, medication for ADHD is more effective than any other treatment option; (2) ADHD is a neurobiological developmental disorder that is highly genetic, often lifelong, and affects multiple parts of the brain. For those with ADHD, these brain differences result in multiple neurotransmitter deficiencies (chemicals like dopamine and serotonin that brains need to function properly). Medications correct for this; and (3) Research has shown that being on stimulant medication for longer periods may lead to neuroprotection, meaning that certain parts of the brain can actually change and improve. 

What else helps besides medication?

Although medication is the first-line treatment for ADHD, some people experience limited responsiveness to these prescriptions and continue to experience issues with organization, time management, goal focus, motivation, job/career success, and social/relationship functioning. Thankfully there are multiple treatments and strategies that can help. These include but are not limited to: