Hi, I'm Elysia Thomas, a neuroaffirming psychologist based in Melbourne. I am often asked questions by those seeking to better understand how to navigate and how to access an ADHD and Autism assessment, so I have put this post together to collate this info in one place.
Please note: This information is applicable in Australia only, and may change without notice. It is factual to the best of my knowledge based on the system as it is right now, May 2024. It may not consider all perspectives and options.
Topics of this post include:
How to access ADHD and Autism Assessments.
How much does it cost?
What if I want to trial medication (for myself or my child)?
Can any psychologist conduct assessments and diagnose?
How to choose the right professional, or set of professionals for diagnosis, psychologist/psychiatrist/paediatrician or other.
What about NDIS?
What is a Cognitive Assessment and do I (or does my child) need one?
ADHD & Autism Assessments for internalised/masked presentations.
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How to access ADHD and Autism Assessments.
Step 1 is commonly to visit the GP to inform them you have noticed symptoms/common experiences with Autism and/or ADHD and would like to be referred for an assessment. The next step after the GP often depends on if you are seeking assessment for a child, teenager or adult. It is helpful if your GP is neurodiversity/neurodivergence aware and is savvy to navigating the system.
** You do not need to visit the GP to access a psychologist assessment, you can choose to go directly to your choice of psychologist (however GP's can also help refer you to an appropriate one if needed). A GP visit is required though to access a referral for a psychiatrist or paediatrician.
If the assessment is for a child, the next step is commonly a referral to a paediatrician with speciality in Autism/ADHD/learning disorders. Sometimes the wait lists for these services are long. It is also helpful to ask in Facebook groups such as Yellow Ladybugs or your local Autism parenting groups for positive recommendations of paediatricians to work with.
Simultaneously it can be worth getting on the waiting list or starting the process to find a psychologist for a comprehensive psychological assessment. A neuroaffirming psychologist (see here for definition of neuroaffirming) is a great option.
The paediatrician will then do their own assessment, but likely be highly informed by the psychologist's assessment, and then if medication is required or requested, the paediatrician can provide this.
For both Adults and Children, there is a high co-occurence of Autism and ADHD (ie. many people have both) so it is worth discussing having an assessment for both to avoid having to come back for a second assessment.
For adults and anyone over 16 it can be a slightly different picture. Requesting a 291 Assessment Referral from your GP and going directly to a psychiatrist (as opposed to a psychologist) can be useful for those seeking an ADHD assessment and wanting to trial medication.
A comprehensive assessment with a psychologist can also be very useful as psychiatrists do assess differently to psychologists. Often a psychologist's report will be 15-40 pages compared with a psychiatrist's 2-4 pages (with neither better or worse, as they seek to achieve different things).
A psychologist report is useful for detailed information about your neurotype, and recommendations on how to support yourself, or your child, following on from diagnosis. Psychologist's will conduct multiple assessment sessions using a range of assessment tools, and will then provide a comprehensive feedback session when delivering your report. A psychologist who conducts a functional assessment as part of their assessment is also highly regarded, both from the perspective of more useful information, but also in terms of navigating NDIS.
If wanting to be assessed for Autism (irrespective of if a psychiatrist assessment has already been conducted for ADHD) a psychologist may be needed. Some psychiatrists do assess for Autism (and can be savvy to internalised and masked presentations), however this is not common. There are many neuroaffirming psychologists who are excellent at assessing for Autism, and are particularly good with internalised or highly masked presentations.
2. How much does it cost?
All prices vary but a ballpark for ADHD assessment with a psychiatrist with a 291 referral from the GP is often $900-$2000 with an approx $450 Medicare rebate.
Psychologist assessments commonly cost between $1200 and $3500 approximately depending on whether its ADHD, Autism and Cognitive assessment, or just 1 or 2 of those. Sometimes very small Medicare rebates (of a total of $300 ish of the total cost) can be available for those referred via a paediatrician.
Psychologist assessment pricing is understandably prohibitive for many, and challenging to afford for many more individuals and families. Pricing is this way due to the significant number of hours needed to conduct a comprehensive assessment, often its 4-5 hours in person and then 6 hours of analysis and report writing for a psychologist. Often split payments are available across the multiple sessions (or payment plans).
For free options - Assessments done through the Department of Education (state dependent) organised by a child's school can be free, or accessing publicly funded assessments (eg. Krongold, Amaze, Turner Clinic etc.) is possible. Waitlists are long, often 18 months or longer.
3. What if I want to trial medication (for myself or my child)?
If your main priority is to trial medication for ADHD it is often recommended to focus on getting in with a paediatrician or psychiatrist, depending on the relevant person's age. A paediatrician and psychiatrist can also support with medication for anxiety, OCD, depression, or other co-occuring mental health experiences.
Psychologists cannot prescribe medication.
4. Can any psychologist conduct assessments and diagnose?
There is a lot of misinformation about this. All psychologists (clinical, counselling, educational and developmental, general, provisional etc.) are trained to conduct assessments and make diagnoses.
It is recommended to seek diagnosis with a psychologist who is highly trained and experienced with ADHD and Autism assessments. Not all psychologists choose this as their area of expertise. It is also great to consider gaining an assessment with a psychologist who is neurodivergent themselves, or a psychologist who describes themselves as neuroaffirming.
Please note, NDIS currently lists clinical psychologists as the only type who can currently assess and diagnose without a multi-disciplinary team, or secondary diagnosing professional (such as a paediatrician or psychiatrist). In most cases, a paediatrician and psychiatrist are already involved in someone's care team, so it is not often a problem to be diagnosed by a general psychologist (or other type of psychologist), but still important to be aware of. It is hoped that NDIS will change their processes to reflect the capacity of all psychologists to effectively assess and diagnose.
5. How to choose the right professional, or set of professionals for diagnosis, psychologist/psychiatrist/paediatrician or other.
This has been touched on above, but some considerations are:
a) if your priority is to trial medication or not
b) finding a psychologist who is neuroaffirming or neurodivergent themselves, or experienced with internalised and masked presentations
c) finding someone you feel a 'good fit' with
6. What about NDIS?
NDIS is not currently available for those with an ADHD diagnosis only.
Those with Autism diagnoses are able to apply for NDIS if this is something they are interested in accessing. Funding is allocated on a case-by-case basis. A functional assessment within the Autism assessment is useful for this, or a separate Functional Capacity Assessment (FCA) with an Occupational Therapist (OT), as is an assessment by multiple professionals (ie. psychologist + paediatrician/psychiatrist or OT/speech therapist). NDIS information can be accessed on their website or by calling your Local Area Coordinator.
7. What is a Cognitive assessment and do I (or does my child) need one?
Often those undertaking an ADHD or Autism assessment with a psychologist will be offered or recommended to do a Cognitive assessment. Normally a Cognitive assessment is a WISC-V or WAIS, however, some other cognitive assessments can be used depending on the psychologist.
A Cognitive assessment is not required as part of an ADHD or Autism assessment, and does not form part of the diagnostic criteria for either.
For a child the paediatrician will often request a Cognitive assessment in addition to Autism and/or ADHD assessment. This is because a Cognitive assessment provides useful information in conjunction with these assessments.
If the person being assessed is a child, a Cognitive assessment can be very useful in gaining an understanding of their cognitive strengths and areas of challenge for the purpose of supporting their education. In particular, if the child is appearing to have either higher academic achievement or capacity, or areas of significant notable challenge, then a cognitive assessment (and an Educational assessment such as the WIAT-III) can be very useful to gain a better understanding of the person's unique capacity across many educational and cognitive areas. This can then assist schools to better support this individual.
Adult Cognitive assessments can also be useful for similar reasons, to support university or higher education, or to promote self understanding around neurotype, cognitive strengths/challenges, or any learning challenges such as dyslexia, dysgraphia or dyscalculia.
It can add significant cost to the assessment process to engage in the Cognitive and/or Educational assessment.
8. ADHD & Autism Assessments for internalised/masked presentations.
Up until recently it was often more challenging to receive an accurate diagnosis of ADHD and Autism if a person was female, gender-diverse, multiply neurodivergent, gifted, non-white, or an adult. This is thankfully changing.
Not all professionals are able to identify internalised or masked presentations as yet, so it is recommended to seek out a diagnostic professional (psychologist, psychiatrist or other) who openly advertises as being able to assess 'internalised or masked presentations'. Again, an openly neurodivergent psychologist is also a great idea to explore.
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I am able to provide specific recommendations for psychologists and psychiatrists via email at info@elysiathomaspsychology.com.
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This post is not intended for self promotion (my books are often full for assessments but you are welcome to contact me if you're interested) as I do also conduct neuroaffirming ADHD and Autism assessments via telehealth for ages 12+ to Adult, or in person in Ringwood (VIC) for ages 6+ to Adult. I am an autistic adhd gifted psychologist with significant experience working with and assessing internalised and masked presentations. For more information click here.
Wishing you all the best with your assessment seeking & a more easeful time navigating the system with this information.
Elysia Thomas
Psychologist
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