When to Refer Clients for Psychological Testing

Psychological testing (also referred to as a psychological assessment) is a service performed by a Psychologist at the request of a licensed clinician seeking diagnostic clarity for their client. Psychological testing referrals are clinician-driven to clarify diagnostic uncertainty and aid in treatment planning. Rula does not coordinate psychoeducational testing for learning disabilities, as this is not typically covered by commercial insurance.

It can be difficult to prove medical necessity to insurance companies in order to cover this service. Payers often ask “How will this testing change the course of your treatment with the client?” If you believe that testing is needed to alter the course of treatment, please include a detailed clinical rationale where prompted on the Care Coordination Form so that we can advocate for the request on behalf of your client. 

Please reference this article: Documenting Clinical Rationale for Psychological Testing Requests


Rula’s Clinical Quality team does not recommend referring clients for the sole purpose of diagnosing ADHD. ADHD is fundamentally diagnosed through history and psychiatric evaluation, and often insurance will not cover neuropsych testing for ADHD diagnosis (especially in adults), as there is no research showing neuropsych testing to be necessary or accurate. This is due to many factors, including poor sensitivity of tests for higher-level executive function deficits, and the testing environment that removes the environmental factors that affect function in daily life for people with ADHD. 

Please make this provisional diagnosis on your own and/or consider referring to an adjunct service such as Psychiatry and/or rematching to another therapist who specializes in ADHD if/as needed based on your clinical recommendation. If you feel that assessing an adult client for ADHD falls outside of your scope and the client is interested in medication, they could be referred for a psychiatric evaluation, as psychological testing may not be necessary. If your client is in school, an ADHD assessment regarding its potential impact on learning may be able to be done by their school.

The Adult ADHD Self-Report Scale is another option available HERE. (This tool is not available as an online form. If a client has 4 or more items checked in Part A, then the client has symptoms highly consistent with ADHD.)

Here are additional resources for ADHD:

Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD and how this condition impacts public health.

Autism Spectrum Disorders

There are several barriers to getting diagnosed with ASD as an adult. Since Autism is classified as a “developmental disorder” and there is not an established diagnostic test for ASD in adults, not all psychological testing resources offer ASD testing. Therefore, finding a doctor (usually a psychologist or psychiatrist) in a client’s area who is willing to diagnose adults can be challenging. Most doctors who do offer diagnostic testing do not take insurance, and the cost can be thousands of dollars. 

As an alternative, a therapist can complete standardized screeners to help assess the diagnosis. 

  • There is no established diagnostic test for ASD in adults (more info HERE

The Adult Repetitive Behaviors Questionnaire-2 (RBQ-2A) has shown some promise as a self-report measure. It can be found HERE.

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