Best-Practice Neurodiversity-Affirming ADHD Assessments

Undiagnosed, unsupported attention-deficit/hyperactivity disorder (ADHD) is associated with a reduction in daily functioning and quality of life in our largely neurotypical-driven world (Hamed et al., 2015; Kosheleff et al., 2023). For example, as a group, people with unsupported ADHD have been observed to have lower academic achievement and lifetime income, and more struggles with peer relationships and risky behaviors. Furthermore, undiagnosed and unsupported ADHD is correlated with overall reduced quality of life and life satisfaction.

Moreover, undiagnosed and unsupported ADHD is associated with a per-person cost of approximately US$15,664 per year. The bulk of this is due to ADHD-related productivity costs. Treatment cost-effectiveness studies show that diagnosing and supporting people with ADHD is much more cost-effective than leaving people without support and undiagnosed.

Diagnosis and supports enhance quality of life and functioning

Interestingly, research shows that diagnosing ADHD (without putting in place supports yet) already has a positive impact on daily functioning and quality of life (Hamed et al., 2015). One possible explanation for this is that an assessment and diagnosis, if conducted well, assists clients in increasing their self-knowledge and allows them to make sense of why certain tasks are more difficult for them. For example, instead of thinking one must be lazy, not smart enough, or clumsy, one can now attribute some challenges to ADHD making specific tasks objectively more difficult to bring to completion. Beyond diagnosis, research indicates that putting in place supports like stimulant medication further increases daily functioning and quality of life for people with ADHD. In short, for many people affected by ADHD, a diagnosis is an important step in a quality-of-life-altering journey.

Best-practice, evidence-based ADHD guidelines

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As health professionals, we have a duty to do no harm with our assessments. At the same time, many clients still experience ADHD assessments as unpleasant, anxiety-inducing, and non-affirming. Things that clients are, understandably, looking for include being heard, being treated with kindness and compassion, receiving best practices, having strengths-inclusive assessments, and learning concrete steps in how to move ahead and advocate for themselves.

One step in providing clients with the ADHD assessments they deserve is for us health professionals to follow the latest best-practice, evidence-based guidelines for assessment. Examples of the most recent guidelines are (1) the Australian Evidence-Based Clinical Practice Guideline for Attention Deficit Hyperactivity Disorder 2022, (2) the UK National Institute for Health and Care Excellence 2018 guideline "Attention Deficit Hyperactivity Disorder: Diagnosis and Management," and (3) the German Association of the Scientific Medical Societies 2017 guideline on ADHD.

Steps toward conducting balanced, supportive ADHD assessments

The recommendations in the most recent guideline are based on recent scientific literature, experts in the field, and consumers (individuals with ADHD). Such guidelines are important as, currently, we do not have a simple test, like a blood test, to determine whether someone meets the criteria for an ADHD diagnosis. Some principles highlighted in all recent guidelines are that we want to rely in our assessment on a multi-tool toolbox including, for example, an intake interview as well as questionnaire measures. Moreover, we ideally want to gather multi-informant perspectives such that we can evaluate how things feel internally as well as how behaviours look on the outside to a close other. Recent guidelines also recommend including strengths-based measures or evaluating current measures from a balanced strengths-limitations perspective. Finally, just as in other aspects of our work, such as therapy supports, we want to be neurodiversity-affirming. The most recent ADHD guideline can be found here. Finally, a self-paced, online training on best-practice ADHD assessment for health professionals can be accessed here.