Guide · 21 articles
For Clinicians
Most licensed counselors were trained to refer ADHD testing out, and most of the referral options have months-long waitlists. In many states, LPCs and LMHCs are permitted to conduct and interpret standardized ADHD assessment. Knowing whether and how your state allows it is the first step.
The scope-of-practice guide below covers every state and the District of Columbia. The clinician course teaches the full evaluation model I use: interview, standardized testing including the TOVA, differential diagnosis, report writing, and feedback.
These are also useful for physicians and school staff who want to understand what a comprehensive evaluation should contain before accepting a report.
Updated
The access problem
Waitlists for ADHD evaluation at hospital systems in West Michigan and most of the country run months. Many of the referrals end up at brief-screening clinics whose reports schools and universities do not accept. Licensed counselors and therapists see these clients first and could, in many states, evaluate them.
Scope of practice
Whether an LPC, LMHC, or LCPC may administer and interpret standardized psychological instruments depends on state statute and board rules. Some states are explicit, some are silent, and a few reserve testing to psychologists. The state-by-state guide below is the reference I wish had existed when I started.
What competent ADHD assessment requires
Training in the instruments (the TOVA and rating scales at minimum), a structured interview model, a working knowledge of differential diagnosis for anxiety, trauma, mood, sleep, and learning disorders, and report writing that a school team, university disability office, or physician can act on. The clinician course teaches this evaluation model end to end.
Differential diagnosis first
The most common error in ADHD assessment is not a bad instrument but a skipped step: confirming ADHD before ruling out anxiety, trauma, depression, sleep disorders, and learning disabilities, each of which produces the same intake complaint. The differential checklist walks through the questions that separate them in twenty minutes of interview time, and what to do when two are true at once.
Objective measures and their limits
A continuous performance test such as the TOVA adds something rating scales cannot: a measure of sustained attention and inhibition that does not depend on how the client sees themselves. It also cannot establish onset, pervasiveness, or impairment, and it is routinely over-read. The TOVA guide covers the four variables, the attention comparison score, and where the test sits in a full evaluation.
For the people who receive the reports
Physicians prescribe on the strength of evaluation reports and schools grant accommodations on them, yet few were taught to read one. The report-reading guide lists six things to check and the red flags that mean a diagnosis rests on a fifteen-minute screen.
Start here
ADHD testing and LPC scope of practice, state by state, then the differential diagnosis checklist, then the TOVA guide. If you receive reports rather than write them: how to read an ADHD evaluation report. Referring instead of testing: how to refer a patient.
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