Parents are sometimes told to “get an ADHD assessment” before speaking with a physician about medication. This can create confusion about who diagnoses ADHD and who prescribes treatment.
A psychologist can assess and diagnose ADHD when this falls within their training and professional competence. Psychologists do not prescribe medication.
Medication decisions are made by an authorized medical prescriber, such as a physician, pediatrician, psychiatrist, or appropriately authorized nurse practitioner.
What Does an ADHD Assessment Contribute?
A thorough assessment can help establish:
- Whether the person meets diagnostic criteria for ADHD
- Which ADHD presentation best describes the pattern
- When symptoms began
- Whether symptoms occur across settings
- How significantly they affect functioning
- Whether another condition better explains the concerns
- Whether co-occurring difficulties are present
- Which non-medication supports are needed
ADHD cannot be diagnosed from one attention test, one questionnaire, or a brief observation.
Clinical guidance emphasizes information from multiple informants and settings, standardized rating scales, clinical interviews, and professional judgment. (American Academy of Pediatrics)
Why Is Differential Diagnosis Important?
Many difficulties can resemble ADHD, including:
- Anxiety
- Depression
- Sleep problems
- Learning disabilities
- Autism
- Trauma
- Language difficulties
- Chronic stress
- Medical conditions
- Environmental mismatch
A child can also have ADHD alongside any of these.
The psychologist’s role is to determine which explanation or combination of explanations best fits the overall pattern.
What Does the Prescriber Decide?
The medical provider considers:
- The assessment findings
- Medical history
- Current medications
- Cardiovascular and other health considerations
- Potential benefits and adverse effects
- Family preferences
- The degree of impairment
- Other available treatments
The prescriber may accept the psychological report, conduct additional assessment, request medical testing, or seek further consultation.
A psychological diagnosis supports the medical decision. It does not compel a physician to prescribe.
Is Medication the Only Recommendation?
No.
A useful ADHD assessment should also identify supports involving:
- Parent strategies
- School accommodations
- Executive functioning
- Task design
- Sleep
- Emotional regulation
- Environmental structure
- Skills development
- Counselling when indicated
The Canadian Psychological Association notes that ADHD assessment should examine other possible causes of symptoms and that treatment may involve both behavioural intervention and medication.
Medication can reduce barriers to functioning. It does not automatically teach organization, coping, communication, or learning skills. Those capacities may still require direct support.
