Understanding ADHD: A Complete Guide to Assessment and Support

Being “neurodivergent” means having a brain that thinks, processes information, or experiences the world differently compared to what’s considered “standard” or “typical.” It includes differences such as ADHD, autism, dyslexia, or Tourette syndrome, among others (Singer, 1998; Walker, 2021).

Rather than viewing these differences as problems, neurodivergence recognises them as natural variations, similar to differences in height or eye colour. Neurodivergent people may perceive, learn, communicate, or feel in ways that differ from societal expectations, often bringing unique strengths, talents, and perspectives (Kapp et al., 2013).

Understanding these diagnostic criteria helps us identify ADHD more accurately. But remember—behind every diagnosis is a unique person with their own specific challenges and strengths.

ADHD symptoms commonly change over time. For instance, overt hyperactivity generally decreases with age but may become internalised, appearing as inner restlessness or difficulty relaxing. Adults frequently describe experiencing a constant internal drive to stay busy or productive (Faraone et al., 2006).

Additionally, attention and executive functioning difficulties often persist or intensify during major life transitions, such as entering university, starting employment, or becoming a parent (Barkley, 2014).

Historically, ADHD was viewed predominantly as a “male disorder,” which often led to underdiagnosis or delayed diagnosis among women. Research traditionally focused on differences between men and women, highlighting that women typically show less overt hyperactivity and more inattentive or internalising symptoms (Quinn & Madhoo, 2014).

Women often present with inattentiveness, emotional dysregulation, anxiety, or internal struggles rather than overt hyperactivity, complicating diagnosis (Hinshaw & Blachman, 2005).

More recently, research has expanded to explicitly acknowledge ADHD experiences among transgender, non-binary, and gender-diverse (TGD) individuals. Emerging evidence suggests that TGD individuals report significantly higher rates of ADHD compared to their cisgender peers (Warrier et al., 2020).

However, diagnostic tools are often gendered, complicating accurate assessment for non-binary and transgender individuals. Additionally, ADHD symptom expression can be influenced by social expectations related to gender identity, further complicating assessments (Strang et al., 2018).

Therapeutic interventions should be sensitive to the intersections of ADHD and gender identity, ensuring affirming, culturally safe practices. Medication and therapy might require adaptations, including navigating hormone therapies alongside stimulant medications or addressing intersectional discrimination experiences.

Furthermore, stress related to managing gender identity issues in unsupportive environments can exacerbate ADHD symptoms or complicate their recognition (Warrier et al., 2020).

Currently, there’s a significant gap in research explicitly examining ADHD among intersex populations (Hartung et al., 2025). Intersex individuals frequently experience diagnostic overshadowing, stigma, and healthcare access barriers, potentially affecting timely ADHD diagnosis (Zeeman & Aranda, 2020). Although specific prevalence data on ADHD in intersex populations is limited, broader neurodevelopmental differences suggest a potential increased vulnerability to conditions like ADHD (Cederlöf et al., 2014).

Hormonal fluctuations, particularly estrogen changes, can significantly influence ADHD symptoms in women. Changes in estrogen levels affect dopamine regulation, impacting attention, impulsivity, and emotional control.

Symptoms can worsen during menstrual cycles, menopause, or surgical menopause (i.e., after bilateral oophorectomy or bilateral salpingo-oophorectomy), potentially influencing medication effectiveness (Quinn & Madhoo, 2014; Rucklidge, 2010).

Medical issues are common among individuals with ADHD, including but not limited to low iron levels, vitamin deficiency, and hypertension.

The co-occurrence of ADHD with other conditions is actually more common than isolated ADHD. Research indicates that approximately 60-80% of individuals with ADHD have at least one additional condition (Katzman et al., 2017). These comorbidities can significantly impact treatment approach and outcomes.

Mental Health Conditions

Anxiety disorders affect about 25-50% of adults with ADHD (Kessler et al., 2006). The relationship is often bidirectional, with ADHD symptoms exacerbating anxiety and vice versa. Anxiety can also motivate masking behaviours, however, which can make ADHD harder to recognise. For example, an individual with ADHD may exert great effort to mask their symptoms at work or in social settings due to fear of failure or rejection, but then feel burned out afterward.

Major depressive disorder co-occurs in approximately 16-31% of adults with ADHD (McIntosh et al., 2009). The chronic stress and challenges associated with untreated ADHD can contribute to depressive symptoms.

Bipolar disorder appears in about 5-47% of adults with ADHD, presenting diagnostic challenges due to symptom overlap (Asherson et al., 2014).

Neurodevelopmental Conditions

Autism co-occurs in approximately 15-25% of individuals with ADHD (Rommelse et al., 2010), and roughly 30-50% of people with autism also have ADHD (Lai et al., 2019).

Learning disabilities affect about 20-40% of individuals with ADHD, including dyslexia, dyscalculia, and dysgraphia (DuPaul et al., 2013).

Sleep Disorders

Sleep problems are reported in 50-75% of individuals with ADHD, including insomnia, delayed sleep phase syndrome, and sleep apnea (Hvolby, 2015). These sleep disturbances can exacerbate ADHD symptoms and impact treatment efficacy.

Substance Use Disorders

Individuals with ADHD have a 2-3 times higher risk of developing substance use disorders compared to the general population (Wilens & Morrison, 2011). Early identification and treatment of ADHD may reduce this risk.

Other Medical Conditions

Obesity rates are approximately 70% higher in adults with ADHD compared to those without (Cortese et al., 2016).

Fibromyalgia and chronic fatigue syndrome appear to be more prevalent among individuals with ADHD, with overlapping symptoms often complicating diagnosis (Kooij & Bijlenga, 2013).

Metabolic syndrome components including hypertension, dyslipidemia, and insulin resistance occur at higher rates in the ADHD population (Instanes et al., 2018).

Understanding these co-occurring conditions is essential for comprehensive assessment and effective treatment planning. Clinicians should screen for these common comorbidities to ensure nothing is overlooked and that treatment addresses the full range of challenges a person might be experiencing.

This is an area where research continues to evolve, revealing increasingly complex connections between trauma and ADHD symptoms. Understanding these relationships is crucial for accurate diagnosis and effective treatment.

Childhood Trauma and ADHD

Adverse childhood experiences (ACEs) and chronic stress can exacerbate or intensify ADHD symptoms, complicating accurate diagnosis and management. Such stressors affect brain development, particularly impacting areas related to anxiety, impulsivity, and executive functioning (Brown et al., 2017; Park et al., 2017).

Regarding adverse childhood experiences and ADHD: Traumatic stress, apart from other factors like premature birth, environmental toxins, and genetics, is associated with risk for ADHD. The connection is likely rooted in toxic stress—the result of prolonged activation of the body’s stress management system.

Studies indicate that toxic stress can have an adverse impact on brain development in children. Regions of the brain involved in fear, anxiety, and impulsivity may overproduce neural connections, while areas dedicated to reasoning, planning, and behavioural control may actually produce fewer neural connections (Blakey et al., 2019; Colizzi et al., 2022; Martinez-Torteya et al., 2024; Park et al., 2017; Teicher & Samson, 2016).

Adult Trauma and ADHD

Trauma experienced in adulthood can also significantly impact ADHD symptoms and functioning. Adults with ADHD are at increased risk of experiencing traumatic events and developing post-traumatic stress disorder (PTSD), with studies showing that adults diagnosed with ADHD are more likely than those without ADHD to also have PTSD (Antshel et al., 2013).

The relationship between adult trauma and ADHD appears to be bidirectional. On one hand, individuals with ADHD may be more vulnerable to experiencing traumatic events due to impulsivity, risk-taking behaviours, and difficulties with attention and decision-making. On the other hand, experiencing trauma in adulthood can worsen existing ADHD symptoms or trigger the emergence of ADHD-like symptoms in those who are genetically predisposed (Maxwell et al., 2022).

Adult trauma can manifest in ways that closely mirror ADHD symptoms, including difficulties with concentration, hypervigilance that appears as hyperactivity, emotional dysregulation, and problems with memory and executive functioning. This overlap can make it challenging to differentiate between trauma-related symptoms and core ADHD symptoms, particularly when both conditions are present (Hanselman, 2021).

Research indicates that adults who experience both ADHD and trauma-related symptoms often have more severe presentations and poorer overall functioning than those with either condition alone (Instanes et al., 2018). The stress response system activated by trauma can exacerbate the neurobiological differences already present in ADHD, creating a complex interplay that requires careful assessment and treatment planning.

Importantly, adults who have experienced trauma may also develop negative memory bias—a tendency to focus more on negative experiences and interpret neutral situations as threatening. This cognitive pattern has been linked to increased ADHD symptom severity and can persist long after the traumatic event has occurred (Vrijsen et al., 2017).

Masking refers to the conscious or unconscious efforts and strategies that individuals with ADHD employ to hide or compensate for their symptoms, often in attempts to fit in socially or meet societal expectations. Masking can take various forms, including (but not limited to):

• Developing compensatory strategies such as extensive note-taking or creating elaborate reminder systems to manage forgetfulness (Sedgwick et al., 2019).
• Rehearsing social interactions or closely observing others to mimic socially appropriate behaviours (Hull et al., 2017).
• Suppressing natural impulses like fidgeting, interrupting, or blurting out responses (Livingston et al., 2020).
• Working excessively hard to maintain attention in social situations despite internal distractibility (Cage & Troxell-Whitman, 2019).

While not limited to specific genders, masking is particularly common among women, who often face greater social pressure to conform to behavioural norms. This can lead to significant delays in diagnosis, and many women do not receive an ADHD diagnosis until adulthood (Hinshaw et al., 2022). Research by Loyer Carbonneau et al. (2021) found that girls with ADHD were more likely than boys to develop strategies to mask their symptoms, potentially contributing to their underdiagnosis.

The consequences of masking can be substantial, including increased stress, anxiety, and burnout (Lai et al., 2017), development of secondary mental health issues like depression (Livingston et al., 2020), delayed diagnosis and treatment (Hinshaw et al., 2022), and loss of self-identity and authenticity (Hull et al., 2017). As such, it is crucial for clinicians to be trained in identifying areas where masking may be limiting the extent to which symptoms present or impair function in certain settings, while possibly still negatively impacting other areas of functioning.

Despite advances in understanding ADHD, several misconceptions persist that can hinder accurate diagnosis and effective treatment:

1. ADHD is just a lack of willpower or laziness. Research demonstrates that ADHD involves neurobiological differences in brain structure and function, particularly in areas related to executive functioning and reward processing (Faraone et al., 2015). These differences are not a matter of willpower but reflect fundamental differences in neurological functioning.
2. ADHD only affects children. Longitudinal studies show that ADHD often persists into adulthood, with approximately 60-70% of children with ADHD continuing to meet diagnostic criteria or experiencing significant symptoms as adults (Faraone et al., 2021). However, symptoms may manifest differently across the lifespan.
3. ADHD is overdiagnosed. While concerns about overdiagnosis exist, research suggests that ADHD is actually underdiagnosed in many populations, including girls, women, and culturally diverse groups (Visser et al., 2014). Cultural biases, limited access to healthcare, and variations in symptom presentation contribute to underdiagnosis.
4. ADHD is caused by poor parenting. Research consistently shows that ADHD has a strong genetic component, with heritability estimated at 74-80% (Faraone & Larsson, 2019). Environmental factors may influence symptom expression, but they do not cause ADHD in the absence of genetic predisposition.
5. ADHD medications are dangerous and lead to addiction. When properly prescribed and monitored, ADHD medications have been shown to be safe and effective for most individuals (Cortese et al., 2018). Research indicates that appropriate ADHD treatment may actually reduce the risk of substance use disorders and other adverse outcomes (Chang et al., 2014).
6. People with ADHD can’t focus on anything. Many individuals with ADHD experience hyperfocus—intense concentration on activities of interest—alongside difficulties with directed attention (Ashinoff & Abu-Akel, 2021). This variable attention regulation, rather than a complete inability to focus, is characteristic of ADHD.
7. You can’t have ADHD if you’re Autistic. Until 2013, clinicians couldn’t officially diagnose someone with both ADHD and autism—the previous diagnostic manual explicitly prohibited it. This didn’t match what was being seen in practice, where many individuals clearly had symptoms of both conditions, and meant some people weren’t getting the full support they needed. However, the DSM-5 (American Psychiatric Association, 2013) removed this restriction, acknowledging evidence that these conditions frequently co-occur. Studies have shown that roughly 30-50% of people with autism also have ADHD (Lai et al., 2019).

These misconceptions can prevent individuals from seeking help and receiving appropriate support. Public education and awareness campaigns are essential for dispelling these myths and promoting accurate understanding of ADHD. For more information about ADHD misconceptions, Annika Marsh (2021) published an article a few years ago: Myth Busting ADHD.

The Australasian ADHD Professionals Association recommends a multimodal approach combining psychoeducation, medication, and psychological therapy (AADPA, 2022).

Medication Versus Psychological Therapy

Stimulant medications typically act rapidly to reduce core ADHD symptoms such as inattentiveness, impulsivity, and hyperactivity by increasing dopamine levels in the brain (Cortese et al., 2018). In contrast, psychological therapy typically focuses on developing long-term behavioural and emotional strategies to improve self-regulation abilities and capacity. Psychological therapy can be particularly beneficial to address concerns like impaired self-perception, coping difficulties, shame, anxiety, depression, and encouraging self-compassion and insight into how past experiences shape present challenges, as well as strategies targeting symptoms of inattention, hyperactivity, or impulsivity.

According to the Australian Evidence-Based Clinical Guideline for ADHD (Australasian ADHD Professionals Association [AADPA], 2022), clinicians conducting ADHD diagnosis assessments should be registered, trained in diagnostic assessment techniques, and experienced in ADHD diagnostic assessment specifically.

In practice, this means that paediatricians, psychiatrists, adequately trained and experienced GPs, and clinically experienced psychologists are able to make an ADHD diagnosis. Psychologists are unable to prescribe medications, however. The full guideline can be accessed here.

One of the questions we’re often asked is whether to seek an ADHD assessment from a psychologist or go directly to a psychiatrist. Both pathways have their merits, and the best choice depends on your individual circumstances and preferences.

The Multidisciplinary Approach

The most comprehensive care often comes from a multidisciplinary approach—starting with a thorough psychological assessment, followed by psychiatric consultation for medication management. This pathway often provides:

• Faster access to the assessment process.
• Comprehensive understanding of how ADHD impacts your life.
• Detailed strategies for managing symptoms.
• Streamlined psychiatric referral when medication is appropriate.

This approach is increasingly recognised as best practice and helps ensure you receive both thorough assessment and timely access to all treatment options.

The ADHD assessment process can vary between clinicians, particularly as there are a range of validated assessment and diagnostic tools that can be used.

According to AADPA’s guidelines (AADPA, 2022), assessment should be comprehensive and multifaceted. The process for conducting an ADHD assessment typically includes two or more hours of clinical interview, completing standardised questionnaires, and obtaining collateral information from one or two individuals who have known you well long-term—ideally, at least one person who has known you since before age 12 such as a parent, guardian, or older sibling, as we need to demonstrate evidence of childhood symptoms in order to diagnose.

It’s important to understand that it’s not expected that your informants will have the exact same (i.e., complete) awareness and recollection of your symptoms/difficulties as you, and this is taken into consideration during the assessment.

School reports, particularly primary school reports, offer valuable insights into early symptom patterns if available. If these reports or suitable informants are unavailable or not suitable, you should discuss alternative assessment approaches with your clinician.

Due to difficulty with memory recall of childhood information, evidence of symptoms commencing prior to age 12 years does not mean you must demonstrate that all of your symptoms were present during childhood.

If you are assessed by a psychologist, a comprehensive diagnostic report is typically provided to you. This is less common when assessed by a psychiatrist but varies by clinician/practice. The report will ideally follow AADPA (2022) guidelines, and typically includes a detailed account of your background information, results of completed psychometric tests and an interpretation of these results, thorough analysis against ADHD diagnostic criteria, consideration and evaluation of potential differential diagnoses or co-occurring conditions, and personalised recommendations. The report is typically designed to help both you (such as guiding your next steps, or a parent/guardian’s next steps in the case of a minor) and any other health professionals involved in your care such as your GP or a psychiatrist. The report can also help streamline access to psychiatric services when needed.

For the assessment of adults, commonly used assessment tools include the Diagnostic Interview for ADHD in Adults (DIVA-5), Conners Adult ADHD Rating Scale (CAARS-2), ADHD Symptom Rating Scale (ASRS), alongside other tools designed to investigate conditions such as anxiety, depression, PTSD, autism, and medical conditions.

For the assessment of children and adolescents, commonly used assessment tools include the Diagnostic Interview for ADHD in Young People (Young-DIVA-5) and Conners-4 (administered to both the young person, a parent/guardian, and a teacher), alongside other tools designed to investigate conditions such as anxiety, depression, PTSD, autism, and medical conditions. It’s worth noting that diagnosing ADHD in children and younger adolescents can sometimes require an additional cognitive assessment to help rule out intellectual disability, specific learning disorder, or intellectual giftedness.

Social Pressures and Masking

Masking (as described above) can lead to significant delays in diagnosis and is particularly common among women, who often face greater social pressure to conform to behavioural norms. This can lead to significant delays in diagnosis, with many women not receiving an ADHD diagnosis until adulthood (Hinshaw et al., 2022).

Access to Care

As outlined in the AADPA’s (2023) submission to the Senate Standing Committee on Community Affairs, one of the biggest barriers for neurodivergents (or potential neurodivergents) seeking psychiatric services is the long wait times. This is often compounded by the time required for clinicians—particularly paediatricians and psychiatrists—to accurately assess and diagnose neurodivergent conditions like ADHD without multidisciplinary input in the assessment process.

One of the best ways to reduce this barrier is implementing a multidisciplinary approach, such as where an adequately trained psychologist conducts the ADHD assessment, after which a psychiatrist provides follow-up when appropriate. This reduces strain on psychiatric services (and therefore wait-times, allowing faster access to pharmacological treatment), often allows time for a more comprehensive assessment, and can help direct individuals to the most suitable treatment services—especially if ADHD is not indicated, pharmacological treatment is not being sought, or an individual is most likely to benefit from a combination of pharmacological and psychological treatment. This streamlined process can also improve access to multimodal treatment and care following diagnosis.

It’s worth noting that since recent changes to the stimulant act in December last year, multimodal treatment and access to care following diagnosis has improved, as psychiatrists are now able to delegate the management of stimulant medication (i.e., co-prescription) to individuals’ regular GPs once medication is stabilised—without authorisation of the WA Department of Health’s CEO and for up to 3 years between specialist reviews. When implemented in practice, this also helps free up time for psychiatrists to assess and treat more individuals for ADHD.

How Much Does an ADHD Assessment Cost?

According to The ADHD Foundation’s Christopher Ouizeman, ADHD assessment costs typically range from $1,500 to $2,500 (ABC News, 2023), with variations depending on complexity and quality of available information.

An ADHD assessment typically takes between 6–7 hours. This includes time for the clinician to conduct interviews, administer assessments, score and interpret results, prepare a comprehensive diagnostic report, and conduct a feedback session discussing assessment findings and recommendations. As above, the time required may be longer depending on complexity and quality of available information, and if further tests are required for an accurate assessment. In addition to the time needed to complete the assessment, many of the standardised assessment tools we use have fees associated with licensing and administering these tests.

As of 1 July 2025, my standard fee for an ADHD Assessment at Clear Health Psychology is $1440. This fee covers both the time required to conduct the assessment and the cost to license and administer standardised assessment tools.

As most clinicians at Clear Health Psychology run their own independent practice and engage Clear Health Psychology to provide administrative and other business services, fees may vary among other Clear Health Psychology clinicians.

If you think you might have ADHD, you may find it useful to complete the Adult ADHD Self-Report Scale (found here) to help determine whether further evaluation may be warranted. This screener was developed by the World Health Organization and Harvard Medical School and assesses symptoms of inattention and hyperactivity-impulsivity based on DSM-5 criteria (Kessler et al., 2005).

If you wish to pursue a formal ADHD assessment, you can contact Clear Health Psychology at 6424 8177, Clear Health Psychiatry at 6378 4799, or speak with your GP about your concerns.

Medicare and Private Health Rebates

As of June 2025, Medicare rebates still do not cover ADHD assessments conducted by psychologists. The Senate Community Affairs References Committee (2023) highlighted this gap, noting it contributes to significant out-of-pocket expenses, and recommended extending Medicare rebates to cover psychological assessments for ADHD. However, the Australian Government (2024) has only supported this recommendation in principle and has not committed to implementing this change.

Private health insurance policies may partially or fully cover ADHD assessment fees. If your private health policy includes psychology services and you are considering seeking a formal ADHD assessment, it’s recommended to contact your insurance provider.

I recognise that many psychiatrists and psychiatric practices are experiencing unprecedented demand for ADHD assessments, often resulting in lengthy wait times that can delay crucial support for individuals seeking help.

If you’re a psychiatrist or work within a psychiatric practice and are interested in exploring collaborative pathways, I’d love to discuss how we can work together.

A multidisciplinary model offers:

• Comprehensive psychological assessments conducted by an experienced, ADHD-trained psychologist.
• Detailed diagnostic reports that streamline psychiatric consultations.
• Reduced wait times for your patients.
• Collaborative care planning for complex presentations.
• Ongoing therapeutic support for non-pharmacological interventions.

I’m seeking partnerships for:

• Referral pathways where psychologists such as myself conduct initial ADHD assessments and refer to you for medication management.
• Collaborative care models where you refer patients for comprehensive assessment before psychiatric follow-up.
• Consultation and shared care arrangements for complex cases.

If you’re interested in discussing how we might work together to improve ADHD assessment and treatment access in our community, please reach out. Together, we can ensure individuals receive both the comprehensive assessment they deserve and timely access to all treatment options.

ABC News. (2023). ADHD clinics capitalise on diagnosis explosion, with some charging up to $3,000 and paying doctors up to $900,000 a year. https://www.abc.net.au/news/2023-05-24/adhd-clinics-diagnosis-explosion-3000-a-visit/102380452

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