LOS ANGELES: Many psychologists don’t use standard assessment tools when diagnosing ADHD, a study has found. One researcher with ADHD explains how they’re letting patients down.

Half of the psychologists diagnosing ADHD do not stick to recommended assessment tools, prompting concern about their accuracy, a new study has found.

Only one-third of psychologists who diagnose ADHD can correctly identify standard diagnostic criteria, and some even use the wrong symptoms, according to research from the University of Wollongong.

And up to 97 per cent rely on self-reporting by patients and place variable reliance on medical assessments, the study of 322 psychologists concluded.

Many rely on school or work reports, observation of the client and ratings scales from family, colleagues or teachers.

Although three-quarters of psychologists surveyed said they adhered to guidelines for diagnosis, less than half – 48 per cent – adhered to recommended assessments.

In total, only 31 per cent of psychologists could correctly identify all diagnostic criteria and 23 per cent incorrectly endorsed a non-ADHD symptom such as difficulties learning as relevant.

The authors, Clare O’Toole, Kate Croaker and Stuart Johnstone, said the findings “reveal gaps in ADHD criteria knowledge and inconsistent adherence to best-practice guidelines among Australian psychologists”.

“These findings support the need for systemic improvement in ADHD-specific training and standardised assessment protocols to enhance diagnostic accuracy and client outcomes,” they said.

It comes as general practitioners will soon be able to diagnose ADHD in Victoria, New South Wales and South Australia from next year, and can already do so in Queensland. At present most diagnosing is done by psychologists or psychiatrists, many of whom charge thousands of dollars and have long waiting lists.

Australia does not require any standardised procedures or mandatory tools when assessing for ADHD. Guidelines have been formulated by the National Health and Medical Research Council of Australia and the Australian Psychological Society, among others. The leading guideline is the Australian Evidence-Based Clinical Practice.

Ms O’Toole and her colleagues said the study’s findings “underscore concerns about the accuracy and consistency of ADHD assessments, particularly given the accessibility of criteria information and reliance on self-directed professional development”.

ADHD affects between six and 10 per cent of children and two to six per cent of Australian adults, but diagnosis rates have doubled in recent years, with more than one million people now affected.

Nearly half a million are on common ADHD medications – an increase of around 300 per cent in 10 years, according to figures from the Australian Psychological Society.

University of Melbourne Associate Professor Matthew Harrison said uncertainty about the validity and accuracy of ADHD diagnoses was “doing real harm” among those with the neurological disorder.

“There are a few bad actors and they undermine everyone who has a diagnosis. Some people are too quick to talk about ADHD being a fad – they talk about it as a flippant thing, which undermines what people are going through.”

Dr Harrison, who has ADHD and is a co-leader of the university’s Neurodiversity Project, said some of the commentary around ADHD diagnoses was problematic. “It has a significant impact on those involved,” he said.

He said a diagnosis being dismissed or questioned “caused people who were neurodiverse to gaslight ourselves”.

“It really undermines your sense of self,” he said. “It’s denying how we see the world and suggesting that our experiences are not valid.”

He urged clinicians to “work with the professional associations, look at the evidence-based guidelines and talk to people with lived experience”.

The study’s findings come as doctors in the Medical Journal of Australia criticised what they called the “commercial model” which they said was causing misdiagnosis of ADHD. They highlighted both psychiatrists “charging elevated fees” and “single‐session online ADHD clinics, with very limited follow‐up provided”.