You may have noticed more therapists advertising ADHD and autism assessments lately. In many states, master's-level therapists are allowed to diagnose mental health conditions, including ADHD and autism, as long as the diagnosis is within their training.
That condition, "within their training," is easy to overlook. Being allowed to diagnose ADHD or autism isn't the same as being trained to evaluate them. Some assessments may rely mostly on a short questionnaire, which can lead to a diagnosis that doesn't fit you or isn't accepted when you need it.
This guide explains how a screening differs from a full psychological evaluation, and what to ask so you end up with a diagnosis you can trust.
Licensed to Diagnose vs. Trained to Evaluate
Several kinds of licensed professionals can diagnose mental health conditions. Here's what the common licenses mean:
- Licensed Marriage and Family Therapists (LMFTs) have a master's degree and often work with individuals, couples and families.
- Licensed Clinical Social Workers (LCSWs) have a master's degree in social work and are licensed to provide therapy.
- Licensed Professional Clinical Counselors (LPCCs) have a master's degree in clinical counseling.
- Licensed psychologists (PhD or PsyD) hold a doctorate that includes training in giving and interpreting psychological tests.
- Psychiatrists (MD or DO) are medical doctors who specialize in mental health and can prescribe medication.
A license tells you what a provider is allowed to do. It doesn't tell you how much training they have in evaluating ADHD or autism specifically.
Master's-level therapists train mainly to provide therapy, so their assessment training varies. Some have taken extra training in ADHD or autism evaluation, and others haven't.
So when you look for an evaluation, check more than the provider's license. Ask what kind of evaluation they'll use, too. It might be important to know if you'll be getting a quick screening or a full psychological evaluation.
What to Expect in an ADHD or Autism Screening
A screening is a short questionnaire about your symptoms. A typical ADHD screening may ask how often you lose focus or feel restless. An autism screening may ask about social situations and daily routines.
Screenings work well as a first step. They show whether your symptoms are common in ADHD or autism and whether a closer look makes sense.
A screening mostly reflects how you describe yourself, though. It records which symptoms you have, but it doesn't look into why you have them.
What to Expect in a Full Psychological Evaluation
A full psychological evaluation looks at why you have your symptoms, not just which ones you have. It includes psychological testing, which means standardized tests that compare your results to large groups of people your age.
A full evaluation usually includes:
- An interview about your concerns and what brought you in
- A review of your history, including your childhood and school years
- Psychological tests that measure skills like attention and memory
- Input from someone who knows you well, like a parent or partner, when possible
- A written report and a feedback session to go over your results
A full evaluation may be the right choice if:
- You've struggled with attention or organization for years, and no one has explained why
- You suspect ADHD or autism but have never been evaluated
- You've tried therapy or medication without clear improvement
- You need documentation for accommodations at work or school
The Limits of a Screening Compared to a Full Evaluation
A screening and a full evaluation can look at the same symptoms and reach different answers. Say you've had trouble focusing at work and feel worn out after social events since starting a stressful new job two years ago. Here's how each approach might handle your symptoms.
What a Screening Might Find
A screening records your symptoms as they are today. You'd report trouble focusing and feeling drained after social time, and your answers may point to ADHD or autism.
The questionnaire doesn't ask what's behind those symptoms, even though ADHD and autism share signs with several other conditions:
- Anxiety can make it hard to concentrate.
- Depression can drain the energy you need to stay organized.
- Trauma can leave you on edge and worn out around people.
- Poor sleep can affect your focus and memory.
On a screening, all of these look the same. The results may point to ADHD or autism when anxiety, depression, or another condition is the cause, and that can lead to the wrong diagnosis.
What a Full Evaluation Might Find
A full evaluation also looks at your childhood, since ADHD and autism both start early in life. If your history shows no signs of attention or social struggles when you were young, ADHD or autism becomes less likely.
Psychological testing helps narrow it down further. In this example, testing might show typical attention alongside high anxiety, which points to anxiety instead of ADHD.
As ADHD and autism can also occur alongside these conditions, a full evaluation can show when you have more than one, so each condition gets treated.
A wrong diagnosis affects your treatment. You might spend months on ADHD medication or strategies that don't help, while the anxiety behind your symptoms goes untreated.
When You Need More Than a Screening Result
The type of evaluation also affects whether others will accept your diagnosis:
- Most colleges ask for a written diagnosis from a physician or psychologist before they approve accommodations like extra time on exams. That diagnosis also needs to explain how your condition affects your schoolwork.
- If you ask your employer for accommodations, such as a quieter workspace, they may want a written report that shows how your condition affects your work.
- Before starting ADHD medication, your prescriber may want to know that your evaluation checked for other causes first, like anxiety.
- Insurance plans have their own rules about which evaluations they'll cover, so check with your plan before you book.
If your diagnosis doesn't meet these needs, you may have to pay for a second evaluation.
Questions to Ask Before You Book
Before you schedule with any provider, ask these questions. The answers will help you understand whether you're getting a screening or a full psychological evaluation:
- What training do you have in ADHD or autism evaluation?
- Will you use standardized tests, or mainly a questionnaire?
- Who will give me the tests, and who will make the final diagnosis?
- Will you ask about my childhood, and can someone who knew me then share what they remember?
- How will you rule out anxiety or other conditions?
- Will I receive a written report I can share?
Clear, specific answers are a good sign. If a provider can't explain how they'll reach a diagnosis, consider talking with another provider before you proceed.
What to Expect From an Adult Evaluation at PCCC
Positive Change Counseling Center offers psychological testing for adults in California. Each evaluation is tailored to your concerns and takes three appointments:
- First, a one-hour intake. Your provider asks about your history and what brought you in, and collects contact information for people who know you well. Afterward, your provider meets with Dr. Owens-Wilson, PCCC's Assessment Director, to choose the tests that fit your concerns.
- Next, a testing appointment of 3 (up to 6) hours at our Rancho Bernardo office.
- Finally, a one-hour feedback session to go over your results and recommendations. Your written report follows shortly after.
Dr. Owens-Wilson reviews and approves every final diagnosis and report before your feedback session. Evaluations are available in person at our Rancho Bernardo office or by secure telehealth, depending on clinical needs. You'll need to be in California for any telehealth session.
If you're already seeing a PCCC therapist and questions about ADHD or autism come up, your therapist can refer you to our testing team. Your results can then help guide your therapy.
Before your testing appointment, we'll send you an estimate of your costs.
Find Out What's Behind Your Symptoms
Whether you're new to therapy or already working with a therapist, a full evaluation can help you understand what's going on and what to do next. Learn more about adult evaluations at PCCC, or contact our team to get started. A member of our scheduling team will reach out to talk through your concerns and provider availability.