People are often surprised - and frustrated - to learn that assessment for ADHD, Learning Disorders, or Autism Spectrum Disorder is so time-consuming and expensive. This makes sense; time and money are precious resources, and we are often experiencing quite a bit of stress by the time we reach out to inquire about assessment. It can be helpful to understand why these assessments are designed the way they are and to demystify the process. 

ADHD, Learning Disorders, and Autism Spectrum Disorders are considered "diagnoses of exclusion." As neurodevelopment disorders, they are considered to be brain-based and present at birth or by early childhood. Most (and in some cases, all) of the symptoms of these disorders, however, may also be caused by other concerns; and in fact, it is statistically much more likely that something else is causing those symptoms. To diagnose these neurodevelopmental concerns, we have to rule out all other likely causes; only when we fail to "rule in" another cause can we diagnose these disorders.

Crucially, just because it might not be a neurodevelopmental disorder doesn't mean we aren't struggling with the same symptoms! Let's take ADHD as an example. The diagnostic criteria for ADHD are a collection of symptoms of executive function (e.g., attention, concentration, focus, short-term memory, mental planning). Because these are some of our highest-order functions and the last part of our brain to fully develop, they are also among our most fragile functions. It doesn't take much to disrupt them. We might be struggling with significant executive function symptoms, even to a debilitating degree; but the cause is statistically unlikely to be ADHD. In thorough assessment, we measure the "what" (what EF and other symptoms are there? and to what degree?), but we also seek to identify the why. This is especially important to ensuring that treatment recommendations and actions match the "why." 
 

A medical analogy might be having a headache. A headache has many different causes; some are benign, some are serious. An over-the-counter pain medication could help, but what if we're missing something that requires more significant treatment? Alternatively, what if we assume the worst and begin an invasive treatment - when over-the-counter pain medication and a good night's rest would have sufficed? We can't treat well if we don't know why the headache.The details are slightly different, but the process is the same for Learning Disorders and Autism Spectrum Disorder. 

A comprehensive assessment process will first and foremost include a good amount of time simply getting to know you and your history.  Assessment should be tailored to each person, so it doesn't always look the same; generally, however, it will include cognitive testing (completing puzzles, tasks, answering questions, engaging with computer programs); and, answering standardized, multiple-choice questionnaires about your symptoms and your experiences. An average assessment with me will usually involve 2 to 3 two-hour "interviewing" sessions; approximately 7 hours of cognitive testing (ideally completed in two sessions); and you completing questionnaires that may be online or may be on paper. Then, I review the data and write a detailed comprehensive report for you; this process usually takes a few weeks. Finally, we meet for a final feedback session - approximately two hours - to review the results and recommendations, after which you receive a copy of the report. 

I conduct these assessments 100% by Telehealth. We have good empirical evidence for the equivalence of tele-assessment; the same tests and procedures are used in tele-assessment that we use for in-person assessment. Not every person or situation is right for tele-assessment. Requirements include, but are not limited to:-Ability to meet for sessions in a quiet, private, well-lit place with stable, broadband Wi-Fi; and for cognitive testing sessions, where you can sit at a desk or a table-A laptop or desktop computer with a webcam (a tablet or smartphone is not sufficient)-An additional device such as a tablet or smartphone for cognitive testing sessions (in addition to the laptop or desktop computer with a webcam)-An external computer mouse (does not need to be fancy!)-A place where you can receive mailed testing materials for use during testing sessions-Access to the Google Chrome web browser-Ability to navigate a computer and Zoom; Google Chrome; and email.