A prominent psychiatrist has issued a stark warning about the potential dangers of online ADHD assessments, suggesting they could be fuelling a concerning trend of over-diagnosis. The caution comes amid reports of private clinics using social media channels to promote quick-fire tests.
The Problem with Quick-Fire Online Assessments
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting an estimated 2.5% of adults and 7% of children in the population. It is characterised by difficulties with attention, impulsivity, and hyperactivity. Left undiagnosed and untreated, it can severely impact education, career prospects, and social and emotional wellbeing, while increasing risks of accidents, mental illness, and substance abuse.
However, as highlighted in a recent article in the Medical Journal of Australia, access to proper diagnosis and treatment can be a struggle for many. Into this gap, some private clinics are reportedly offering streamlined online assessments, sometimes costing thousands of pounds, after individuals screen positive on social media-promoted 'tests'.
Professor David Coghill, the Financial Markets Foundation Chair of Developmental Mental Health at the University of Melbourne, explains that these brief assessments often fail to meet evidence-based guidelines. They typically focus only on ADHD symptoms without evaluating other potential issues, rely solely on the individual's self-report without input from family or friends, and crucially, do not properly assess the impact of symptoms on day-to-day functioning.
Why 'Functional Impairment' is the Key to Diagnosis
A cornerstone of an accurate ADHD diagnosis is proving that symptoms cause significant impairment in social, academic, or occupational functioning. "No matter how many symptoms you have, if they’re not having an impact on your day-to-day life, a diagnosis of ADHD shouldn’t be made," Coghill states.
A comprehensive assessment, therefore, is far more involved. It requires a detailed clinical interview exploring the presence of the 18 core ADHD symptoms, both currently and historically. It must also include a broader evaluation of mental and physical health, developmental history, and family background. Crucially, it should seek corroborative accounts from someone who knew the person in childhood and understands their current functioning.
Determining what counts as 'functional impairment' is highly individual. Common themes in ADHD research include impaired relationships, parenting difficulties, reduced educational or occupational achievement, increased accidents, driving offences, and substance use. Symptoms are also frequently linked to emotional dysregulation, restlessness, low self-esteem, and high stress.
The Risk of Missed and Mis-Diagnoses
The lack of a rigid, standardised definition for impairment has led some to fear it could cause over-diagnosis. However, Coghill argues that a strict list would be impractical due to ADHD's broad impacts and would fail to capture personal circumstances. What is impairing for one person may not be for another.
This nuanced understanding is vital. Some high-achieving individuals may be compensating for immense difficulties or experiencing exhaustion and impairment in less visible areas of life. Conversely, others may present issues that, upon exploration, are not true functional impairments linked to core ADHD symptoms.
The solution, according to Coghill, lies in improved clinician training. The skill of accurately assessing impairment can be learned through observation and structured practice, leading to high levels of agreement between professionals. However, he notes that few health professionals currently receive high-quality ADHD training during their core education, a gap that must be addressed to improve diagnostic accuracy and reduce both missed and incorrect diagnoses.
