Clinical decision-making and barriers to change in ADHD assessment: Australian psychologists’ perspectives

Given the reliance on clinical discretion in Attention-Deficit Hyperactivity Disorder (ADHD) assessment in Australia, this study investigates psychologists’ perspectives on factors impacting clinical decision-making, choice of assessment measures and barriers to new processes. Australian psychologists (N = 229) involved in ADHD assessment completed an online questionnaire between February and December 2024. Contrary to hypotheses, psychologists did not report predominantly negative impacts of available time and workplace setting on decision-making, and the importance of clinical intuition was not related to years of clinical experience or ADHD-related caseload. Knowledge and training had the greatest positive influence on decision-making. Major challenges included differential diagnosis and the lack of recognition of psychologists’ reports by other clinicians. The most influential factors in selecting assessment measures were the research base, objectivity of the assessment and resource availability. Psychologists viewed themselves as the most willing to adopt new ADHD assessment processes and the broader system (e.g. Medicare) as the least willing. Key barriers to new processes included cost, time and supporting research. These findings support ADHD-specific knowledge and training as key to clinical decision-making. System-level changes regarding the consistency and acceptance of assessments are needed to avoid costly reassessment by prescribing clinicians. What is already known about this topic: Australian health authorities do not require any standardised procedures or mandatory tools when assessing for ADHD, leading to a reliance on clinical decision-making to determine assessment procedures.Australian studies have reported that ADHD assessments are substantially varied, with inconsistent use of guidelines and evidence-based measures.Research with other clinician types has found that practice setting, time and resources, clinical intuition and experience, training and perceived risk can influence clinicians’ decision-making and willingness to manage ADHD. Australian health authorities do not require any standardised procedures or mandatory tools when assessing for ADHD, leading to a reliance on clinical decision-making to determine assessment procedures. Australian studies have reported that ADHD assessments are substantially varied, with inconsistent use of guidelines and evidence-based measures. Research with other clinician types has found that practice setting, time and resources, clinical intuition and experience, training and perceived risk can influence clinicians’ decision-making and willingness to manage ADHD. What this article adds: Australian psychologists reported that ADHD knowledge and training have the strongest positive influences on clinical decision-making.Multiple sources of information (e.g. interview, questionnaire) were rated as more important than reports from multiple people, clinical experience, or standardised measures in ADHD assessment.Key barriers to implementing new assessment processes were cost, time, supportive research and lack of acceptance of psychologists’ reports by other clinicians. Australian psychologists reported that ADHD knowledge and training have the strongest positive influences on clinical decision-making. Multiple sources of information (e.g. interview, questionnaire) were rated as more important than reports from multiple people, clinical experience, or standardised measures in ADHD assessment. Key barriers to implementing new assessment processes were cost, time, supportive research and lack of acceptance of psychologists’ reports by other clinicians.