The Role of Psychologists in Adult ADHD Diagnosis: Scope of Practice, Assessment Tools, and Professional Boundaries

The short answer: who is responsible for the ADHD diagnosis?

In clinical practice, diagnosing ADHD in an adult is a team process. The psychologist and the psychiatrist perform different tasks that complement one another.

The psychologist is responsible above all for the in-depth psychological assessment. It covers a detailed clinical interview, screening tools, structured diagnostic interviews, an assessment of cognitive functioning where justified, and differential diagnosis. The result of that work is a comprehensive psychological report, which forms the substantive core of the whole process.^[1,2]

The psychiatrist carries out the full psychiatric examination, assesses the patient's health, rules out possible somatic causes of the reported symptoms, analyses co-occurring disorders and, on the basis of all the information gathered, makes the nosological diagnosis - coded as F90 in ICD-10 and, going forward, as 6A05 in ICD-11. The psychiatrist also decides on any pharmacological treatment.^[1]

The best results therefore come from a psychologist and psychiatrist working together. Each professional brings their own competence, so the diagnosis rests on several sources of information rather than on a single examination or test score. This is exactly how most private diagnostic packages on the market are organised.^[1,25]

No commercial course grants a psychologist the "right to diagnose ADHD" - no such licence exists in the Polish legal system. Certificates confirm attendance and continuing-education hours, while the scope of professional responsibility follows from the profession itself and from clinical standards. The exceptions are purely functional: the Conners 3 publisher training opens purchasing access to a category B2 test for non-psychologists, and the MOXO distributor training gives access to the testing platform.

The scale of the phenomenon - why the topic matters

A dozen or so years ago ADHD was associated mainly with children. Today we know that symptoms do not disappear on reaching adulthood; they often take a different form through masking and a range of compensatory strategies. As a result they directly affect work, relationships, the organisation of everyday duties and mental health.

The scale of the change is best shown by National Health Fund data compiled in the e-Health Centre report. The number of patients with a primary F90 diagnosis doubled in fifteen years: from 32,035 people in 2010 to 64,090 in 2024, with the jump between 2023 and 2024 alone reaching 33.5 per cent.^[4,5]

The adult segment is growing fastest: from 1,443 patients treated in 2010 to more than 11,000 in 2024. Adults nevertheless still account for only about 17 per cent of all patients with an F90 diagnosis. Regional differences are marked as well: in the Pomeranian region 244 patients per 100,000 inhabitants receive treatment, compared with 102 in the Subcarpathian region - almost two and a half times fewer.^[4,5]

Such rapid growth does not mean an epidemic of ADHD. It largely reflects better public awareness, wider access to assessment and a better grasp of the clinical picture in adults. At the same time, with an estimated prevalence of 2-3 per cent of the adult population, the scale of under-diagnosis remains vast - far more people need assessment than are currently under specialist care.^[19,20]

The first Polish diagnostic recommendations, published in 2024

For many years Polish specialists relied mainly on foreign guidelines, chiefly British and European. That changed in 2024 with the publication of the first national recommendations on the diagnosis and treatment of adult ADHD, prepared by the Specialty Training Section of the Polish Psychiatric Association together with a coalition of organisations working for people with ADHD (Gondek et al., "Psychiatria Spersonalizowana" 3/2024).^[1,2]

The most important element of the diagnosis remains the detailed clinical interview. The authors state that it should last no less than 90 minutes and should cover both the patient's current functioning and the history of symptoms from childhood.^[1]

Equally important is what the recommendations do not require: routine intelligence testing, neuropsychological assessment, EEG or neuroimaging. The assessment of functional limitations should cover at least two areas of life, and information from close relatives is helpful but not a condition of diagnosis. That sets the hierarchy: the core of the diagnosis is a long, well-conducted interview, not a battery of tests.^[1]

The Polish guidelines refer directly to international standards. The British NICE guideline NG87 reserves ADHD diagnosis for a specialist clinician performing a full clinical assessment, and the updated European consensus on adult ADHD (Kooij et al., 2019) has long stressed that the disorder is diagnosed far too rarely relative to its actual prevalence.^[19,20]

The ADHD diagnostic process step by step

Contemporary ADHD assessment in adults does not rest on a single test or one consultation. It is a multi-stage process whose aim is not only to confirm the presence of symptoms, but also to establish whether they meet ADHD criteria and whether they are not better explained by other disorders.

1. Screening

The first step is usually a screening tool, most often the ASRS v1.1 scale, also recommended in the 2024 Polish guidelines. Its purpose is not to make a diagnosis. A positive result only indicates that a full clinical assessment is warranted, and a negative result does not always rule ADHD out - interpretation always takes the clinical picture into account.^[1]

2. Detailed clinical interview

The most important element of the whole process is the in-depth clinical interview, lasting at least 90 minutes. Among other things, the clinician explores:

• the history of symptoms from childhood,
• the course of education and occupational functioning,
• interpersonal relationships,
• the organisation of everyday duties and finances,
• emotional difficulties,
• the impact of symptoms on particular areas of life.

What matters most is confirming that the symptoms have been present for many years, are persistent and cause real difficulties in at least two areas of functioning.^[1]

3. The structured DIVA-5 interview

The next stage is a structured diagnostic interview, most often DIVA-5. The tool takes the clinician step by step through all the criteria, and its many examples of behaviour from childhood and adulthood reduce the risk of missing relevant information. DIVA-5 does not replace clinical experience, but it structures the conversation and makes it easier to judge whether the criteria are met.^[6,7]

4. Differential diagnosis

At this stage the clinician assesses whether the reported difficulties really stem from ADHD or are better explained by other conditions: depressive and anxiety disorders, bipolar disorder, autism spectrum disorder, complex PTSD, personality disorders, sleep disorders or substance use. Many of them can co-occur with ADHD, so the task is not only to rule them out but also to describe how they interact.^[1,13]

5. Psychiatric examination and diagnosis

The final stage is the psychiatric consultation. The physician reviews the psychological assessment, performs their own examination, rules out somatic causes and decides on the formal diagnosis and any treatment. This is where the final clinical diagnosis is made.^[1]

Optionally the process is supplemented by computerised tests (such as MOXO) and cognitive assessment - as a source of additional data, not as an "ADHD test". No single test result confirms or excludes this diagnosis.^[1,13]

ASRS - the basic screening tool

ASRS (Adult ADHD Self-Report Scale) is currently the most widely used screening scale in adult ADHD assessment. The tool was developed under the auspices of the World Health Organization and has long been the starting point for further assessment. The questionnaire consists of 18 items, and everyday practice makes particular use of the six-item Part A, which quickly gauges the likelihood of the disorder.^[1,12]

The greatest advantages of ASRS are its simplicity and availability. The Polish translation may be used free of charge, which makes the tool suitable both for clinical practice and for screening studies. A Polish adaptation of the newer ASRS-5, aligned with DSM-5 criteria, has also been published in the scientific literature, and the publisher Practest runs training on using the scale - useful at the outset, although the tool itself requires no certificate.^[11,12]

It is worth remembering that ASRS does not serve to make a diagnosis. The score is a pointer towards a full clinical assessment, not independent confirmation that ADHD is present.^[1]

DIVA-5 - the current standard for the structured interview

If ASRS helps answer whether an assessment is worth starting, DIVA-5 makes it possible to carry that assessment out in an orderly way. It is a semi-structured diagnostic interview based on DSM-5 criteria, developed by the Dutch DIVA Foundation, whose public face is Professor Sandra Kooij, co-author of the European consensus. The interview assesses symptoms in both childhood and adult life, their severity, persistence and impact on everyday functioning. There are also Young DIVA-5 (ages 5-17) and DIVA-5 ID variants for people with a disorder of intellectual development.^[6,7]

Another important advantage is its transparent construction. The interview requires no complex scoring or statistical interpretation - what matters most is conducting the conversation competently and relating the information obtained to the diagnostic criteria.^[6]

The licensing model is remarkably accessible: the Polish PDF version costs a one-off 10 euro per clinician (the download link is valid for 14 days after purchase). The foundation does not run certification in Poland and does not require it - the tool is intended for trained clinicians, and responsibility for using it correctly rests with the person conducting the assessment.^[6,8]

Polish DIVA-5 courses are therefore continuing-education rather than licensing courses. A one-day online course on conducting and interpreting the interview is offered, among others, by Dolnoslaskie Centrum Psychoterapii (7 hours, 699 PLN, as of July 2026, for holders of a master's degree in psychology only), with shorter webinars from PsychoMedic EDU and JiM Edukacja. Programmes usually also cover the informant's role, integrating DIVA-5 with other methods and writing the psychological report.^[9,10]

MOXO - what the computerised test shows and where its limits lie

In recent years the MOXO test has become popular. For some patients it has almost come to symbolise a professional diagnosis, although its role is in fact far more limited than marketing materials suggest.

MOXO d-CPT (Continuous Performance Test) is a computerised attention test measuring attention, impulsivity, hyperactivity and reaction time. Its distinctive feature is a set of visual and auditory distractors that simulate conditions closer to everyday functioning. The test takes a dozen or so minutes and results are compared with norms for the relevant age group. There are versions for children aged 6-12 and for adolescents and adults aged 13-70, and the test can be repeated, which is useful for monitoring treatment effects.^[14,15]

It has to be said plainly, though, that MOXO is not a test that diagnoses ADHD. A result within the normal range does not exclude the disorder, and an abnormal result does not confirm it. The test is only an additional source of information that supplements the clinical interview. That is why the 2024 Polish recommendations do not list it as a mandatory element of adult assessment.^[1,14]

In Poland MOXO is available through the exclusive distributor's partner model: a clinic pays a one-off fee of 1,500 PLN, each specialist completes online training (200 PLN at the outset, 350 PLN later), and tests are bought in packs at 75-105 PLN each depending on volume (gross prices, as of July 2026). The assessment can also be carried out remotely, in the patient's home.^[15]

Conners 3 and the missing Polish adaptation of CAARS

In the assessment of children and adolescents, one of the best-known tools remains Conners 3 - an extensive set of questionnaires covering ADHD symptoms and co-occurring difficulties in people aged 6 to 18. The Polish adaptation (Wujcik and Wroclawska-Warchala, 2018) was built on a sample of more than 3,000 questionnaires, which is why the tool is widely used in psychological and educational counselling centres and in private practice. Conners 3 falls into access category B2: a psychologist buys it on the strength of their degree, while people outside the profession must meet additional publisher requirements. A full set costs 1,244.99 PLN net (price list for the first half of 2026).^[16,17]

For adults the situation looks quite different. Although the CAARS questionnaires and the newer CAARS-2 (2023) are widely used internationally, no full, commercially published adaptation with national norms exists in Poland. Only a research version of CAARS-L is available, listed in the 2024 recommendations as a screening option. In practice the gap is filled by the free ASRS scale, and the absence of a Polish CAARS remains one of the most frequently cited holes in the national toolkit.^[1,18]

Differential diagnosis - the most important part of the process

One of the most common mistakes is equating concentration problems with ADHD. Difficulty focusing, restlessness and disorganisation are symptoms of very low specificity that can occur in many psychiatric and neurological conditions. The clinician therefore has to answer not only whether the symptoms meet ADHD criteria, but also whether they are not better explained by another diagnosis: depression, anxiety disorders, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, personality disorders, chronic sleep disorders or addiction.^[1,13]

A further challenge is that many of these conditions can co-occur with ADHD. In clinical practice the point is not merely to exclude other diagnoses, but to describe the patient's overall functioning accurately.^[1]

Growing attention is also paid to how ADHD presents in women. In many female patients inattention, organisational difficulties and chronic mental overload dominate, while hyperactivity is far less visible. That is why women were for years misdiagnosed with depression or anxiety disorders while the real problem was unrecognised ADHD. The topic is now a standard element of Polish comprehensive training.^[21]

The ICD-11 criteria for ADHD (6A05) together with its presentations - predominantly inattentive, predominantly hyperactive-impulsive and combined - are discussed in detail in How is ADHD diagnosed?, and the specifics of adulthood in ADHD in adults.

ADHD assessment training - how to choose a course worth taking

Growing interest in ADHD assessment has made the training market expand very quickly - from short webinars devoted to single tools to extensive courses covering the full diagnostic process. The table below samples what is actually on offer in seven markets, with published prices as of July 2026. Two things are worth noticing before reading it: prices for equivalent training differ by an order of magnitude between countries, and French university programmes - unlike commercial providers - generally do not publish a public price at all, because most participants are funded through the national continuing-education scheme.

Read across the rows and one thing stands out: what you pay depends far more on the provider's business model than on the depth of the training. A self-paced American package with 35 CE hours costs about the same as a single Polish workshop day, a three-hour German webinar costs more than the entire DIVA-5 licence used across an entire career, and French university diplomas of 72 to 101 hours carry no public price because they run on national continuing-education funding. None of these prices tells you anything about whether the holder may diagnose - that question is settled by professional licensure, not by the receipt.

Courses are complemented by diagnostic placements in clinics (for example the "ADHD diagnostician for adults" placement at PsychoMedic). Universities are only now entering this area: apart from the Akademia Humanitas course there is no dedicated postgraduate programme in ADHD assessment in Poland, and the SWPS postgraduate programme on neurodiversity concerns workplace management and inclusion rather than clinical diagnosis.^{[21,22,23,24]}

When choosing a course, three things are worth checking. First, the programme should cover differential diagnosis - knowing the questionnaires alone is not enough for sound assessment. Second, it is worth checking the trainers' experience: the most valuable courses are run by people who assess patients day to day. Third, make sure the provider states how completion is documented and whether the hours count towards continuing professional development - some list them as eligible for renewing a PTTPB psychotherapist certificate.^[21,26]

Even the most extensive course, however, will not replace clinical practice. Diagnostic competence develops above all through work with patients, case analysis and regular supervision.

How other countries handle it: the United States and Europe

The Polish market described above is easier to judge against a wider background. The three cases below are the ones Polish clinicians most often look to: the United States, the United Kingdom, and the Netherlands, where the structured interview used across Europe originates.

United States: state licensure, and no national adult guideline yet

There is no single federal licence to diagnose ADHD. Diagnostic authority flows from state professional licensure, and several professions hold it within their own scope: physicians, psychologists, nurse practitioners, social workers and licensed counsellors. Prescribing authority is narrower than diagnostic authority and stays with medical professionals.^[32]

The best-known American credential, ADHD-CCSP, is a voluntary certificate, not a licence. It requires an existing master's-level licence, 30 continuing-education hours and 200 career clinical contact hours, and costs USD 299.99 for two years. Its issuer states the position plainly: "Certification does not imply endorsement of clinical competency."^[38]

One contrast runs the opposite way to what Polish readers might expect. The United States still has no national clinical guideline for diagnosing ADHD in adults. The first is being written by APSARD with a coalition that includes the American Psychiatric Association and the American Psychological Association, with release targeted for 2027 - which means Poland published national adult recommendations before the American professional community did.^[32]

United Kingdom: a narrow definition of who diagnoses, and a long queue

NICE guideline NG87 restricts the diagnosis to "a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD", and adds that it "should not be made solely on the basis of rating scale or observational data". That is the same principle that places the 90-minute interview at the centre of the Polish recommendations.^[31]

The best-known British training, UKAAN's "Diagnosis and Assessment", is a one-day CPD course costing GBP 375 and ending in a certificate of attendance - not an entitlement to diagnose. The scale of the backlog is the sharpest difference from Poland: NHS England counted up to 683,088 open referrals potentially for an ADHD assessment in March 2026, and the NHS warns adults they "may have to wait several months or years". Private assessment runs from roughly GBP 400 to GBP 1,700, with one of the largest providers publishing a fee of GBP 950 - proportionally close to the Polish 1,000-2,000 PLN, and driven by the same gap between demand and publicly funded capacity.^[36,37,38]

The Netherlands and the rest of Europe: the tool that skipped the gatekeepers

Instrument access in the Anglophone markets works through a mechanism Polish clinicians will recognise from the A/B1/B2/C category system. Publishers gate purchases by qualification level: CAARS 2, the adult Conners scale, is a Level B product sold per administration at USD 9.50 with a minimum order of 25 uses. No training course raises a buyer's level - only a qualifying degree does.^[33]

The DIVA Foundation bypasses that model entirely. DIVA-5 costs EUR 10 per clinician per version, is sold directly from the Netherlands to clinicians anywhere, and carries no certification, examination or accredited-user registry anywhere in the world. That accessibility is exactly why it became the default structured interview in Poland and across much of Europe - and why the responsibility for competent use rests entirely on the person conducting the interview.^[34]

What actually differs, and what does not

The pattern holds across all four markets. Nowhere does a commercial certificate grant the right to diagnose ADHD. What differs is who already holds that right under national law, and how tightly the instruments are gated.

One boundary deserves stating plainly, because marketing blurs it in every market discussed here. ADHD coaching credentials are not clinical qualifications. Coach training schools admit students with no clinical degree and no licence, and coaching bodies award titles for accumulated coaching hours rather than diagnostic training. Such a credential authorises no assessment, no diagnosis and no clinical opinion - worth knowing when a patient arrives holding a report from a "certified ADHD professional" who never had the standing to write one.^[35]

Public or private assessment? Waiting times and costs

Wherever adult ADHD is assessed, the binding constraint is the same: publicly funded capacity has not kept pace with demand, so a parallel private market has grown to absorb the overflow. What differs between countries is who pays, how long the queue is, and how much of the bill falls on the patient.

United Kingdom

The English backlog is the starkest illustration. NHS England counted up to 683,088 open referrals potentially for an ADHD assessment in March 2026, against an estimated 2.5 million people with ADHD in England, most of them undiagnosed. The NHS tells adults outright that they "may have to wait several months or years" for specialist services. Privately, assessment runs from roughly GBP 400 to GBP 1,700, and one of the largest providers publishes a fee of GBP 950 for the initial assessment.^[36,37]

The Netherlands

Dutch basic health insurance covers the diagnosis and treatment of DSM-5 disorders, but the patient still pays the mandatory annual deductible, EUR 385 in 2026, before cover starts. Access is rationed by time rather than by price: reported average waits in specialist mental health care run to roughly half a year, and ADHD referrals are among the categories pushing those figures up.^[43]

United States

The American picture is set by insurance status rather than by queues. An insured patient typically pays a copay of USD 20 to 75 per appointment across the two to four appointments a full evaluation takes. Without insurance, a standard evaluation by a licensed psychologist usually costs USD 900 to 1,500, and a comprehensive neuropsychological assessment can exceed USD 2,500 - which is why community mental health centres and university training clinics with sliding-scale fees matter as much there as public clinics do in Europe.^[44]

Poland

Adult assessment is available in mental health clinics funded by the National Health Fund, but access is the problem: in many regions the wait for a first consultation runs from several to a dozen or more months, and in extreme cases the full process takes 12 to 24 months. Not every facility offers a comprehensive assessment covering both psychological and psychiatric evaluation, so patients are sometimes referred to several specialists with long gaps between stages.^[25,27]

Privately, a first consultation can usually be arranged within days or weeks and the whole assessment closes within a few appointments, increasingly as a ready-made package covering a psychological consultation, a DIVA-5 interview, a psychological report and a psychiatric consultation. A full diagnosis costs between 700 and 3,000 PLN, most often 1,000-2,000 PLN (as of July 2026) - proportionally close to the British private market, and driven by the same imbalance.^[25,27]

The warning signs travel across all four systems. A higher price does not mean higher quality, and the core of a sound assessment remains the in-depth clinical interview - so an offer that cuts the conversation to a dozen minutes in favour of numerous computerised tests, or that sells further tests without clinical justification, should raise doubts regardless of the currency on the invoice. Where no official standard exists, professional recommendations such as the Polish 2024 document or NICE NG87 are the best reference point for judging how a proposed package is structured.^[1,27,31]

Building an assessment toolkit: the minimum cost of starting out

For a clinician, the striking thing about adult ADHD is how cheap the core toolkit is compared with most other areas of clinical assessment - and how little of that cost is country-specific. Two of the three essential elements are priced identically worldwide:

• ASRS v1.1 - free everywhere, developed under WHO auspices, with translations including Polish,
• DIVA-5 - EUR 10 per clinician per version, sold directly by the DIVA Foundation to clinicians in any country, with no certification requirement,
• a long clinical interview - the one element that costs nothing to license and the most to learn.

Everything beyond that is gated by national publishing arrangements, and this is where budgets diverge. In the United States the adult Conners scale CAARS 2 is a Level B product priced per administration at USD 9.50 with a minimum order of 25 uses, while in Poland the equivalent extension for children and adolescents, Conners 3, is a category B2 purchase at 1,244.99 PLN net for a full set. Computerised testing is optional in both markets and priced through distributors rather than publishers.^[33]

A Polish clinician's minimum path therefore looks as follows (prices as of July 2026):

• ASRS v1.1 - 0 PLN,
• DIVA-5 - a 10 euro licence, plus an optional continuing-education course at around 700 PLN,
• Conners 3 - for assessing children and adolescents: a full set at 1,244.99 PLN net, publisher training 793.35 PLN,
• MOXO - only if the clinic enters the distributor's partner model (from about 1,700 PLN to start for one specialist),
• a comprehensive course - from 900 PLN (10 h) to 3,190 PLN (23 h with an exam), depending on needs.

Buying the tools is only the beginning. What contributes most to the quality of a diagnosis is clinical experience, regular supervision and the ability to conduct a long, structured interview and write a sound psychological report. Even the most advanced tests will not replace a well-conducted conversation with the patient - which is precisely why the cheapest item on the list above is also the one that decides the outcome.

Summary

The question of whether a psychologist can diagnose ADHD in adults needs to be made more precise. The psychologist plays a key role throughout the process: conducting the in-depth clinical interview, using screening tools and structured diagnostic interviews, and preparing the psychological report that underpins further clinical decisions. The formal nosological diagnosis, however, remains the psychiatrist's remit.^[1,2]

Current recommendations stress that ADHD assessment should rest above all on a sound interview, differential diagnosis and cooperation between professionals. Computerised tests and questionnaires play a supporting role but do not replace clinical judgement. For psychologists planning their professional development this means that investing in diagnostic competence, knowledge of current guidelines and clinical practice pays off far more than collecting further certificates or tools.^[1]

Our ICD-11 classification browser and the ICD Diagnostica diagnostic application will help you work with the ICD-11 criteria for ADHD and differential diagnoses day to day.

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