To learn more about talking to clients about psych testing referrals, we recommend this article.
Psychological testing can be a powerful tool for diagnostic clarity and treatment planning, especially when symptoms are complex or progress stalls. But because testing is a limited, high-demand resource, referrals must be clinically necessary, supported by strong documentation, and likely to influence treatment decisions. Making appropriate, well-documented referrals ensures patients receive timely, effective care- while preserving equitable access to testing for patients whose treatment effectiveness hinges on diagnostic clarity. This guide outlines what you need to know to submit a strong, appropriate referral and collaborate effectively with our psychological testing partners.
When Is Psychological Testing Clinically Indicated?
Testing should support changes to the current treatment plan.
Appropriate referrals typically meet all of the following:
- The patient presents with psychiatric, neurological, or developmental symptoms.
- These symptoms cause functional impairment in work, school, relationships, or daily life.
- Testing results will guide clinical decision-making (e.g., medication, treatment modality, diagnosis clarification).
Testing is NOT clinically indicated when:
- The patient is making progress in treatment without the need for diagnostic clarification.
- You’re still early in assessment, or other interventions haven’t been tried.
- The request is primarily patient- or third-party-driven (e.g., accommodations, curiosity, legal evaluations)
- There's no anticipated change in clinical decision-making or treatment regardless of the test outcome.
- Other resources (a course of outpatient therapy, a higher level of care, medication management, etc) have not yet been explored
- Functional impairments are not present or are not caused by symptoms
- For initial evaluation of ADHD (with no differential diagnosis or treatment history)
- For Autism evaluation for adult patients with no functional impairments, and where treatment options would not differ based on testing results
At a Glance: What Type of Testing Might Be Indicated?
Psychological Testing Referral Guidelines
| Assessment Type | Clinically Indicated Referrals | Typically Inappropriate Referrals |
| Psychodiagnostic | Clarifying differential diagnosis in complex cases where the patient is unresponsive to treatment or baseline functioning has not improved despite adjustments to the treatment plan | - Patient- or third party–driven requests with no clinical necessity - Patient is making progress in treatment - Diagnosis would not change treatment approach - No significant functional impairment - Initial ADHD evaluation without differential diagnosis or treatment history - Adult Autism evaluation with no functional impairments and no anticipated treatment changes |
| Neuropsychological | - Establishing a baseline to monitor cognitive, mood, or personality changes (e.g., pre/post surgery)- Supporting differential diagnosis, particularly when brain-based impairment is suspected- Treatment planning for cognitive disorders, adjustment issues, or to assess functioning related to work, school, or daily living | - Patient- or third party–driven without clinical necessity - Patient is progressing in treatment - Diagnosis would not change treatment approach - No functional impairments |
| Developmental | - Children under 18 with symptoms of Autism, intellectual disability, or developmental delays causing functional impairment- Complex adult presentations suggestive of Autism or intellectual disability with functional impairment that interferes with treatment | - Patient- or third party–driven with no clinical necessity - Adults over 18 with no functional impairment - Self-driven request to confirm suspected Autism without impact on treatment planning - Concerns limited to speech, motor, or coordination issues (refer to OT/PT/Speech instead) |
Downloadable Quick Guide found here!
Common Misconceptions
Some therapists understandably believe that certain diagnoses- like ADHD or Autism Spectrum Disorder (ASD)- require formal psychological testing. In most cases, that’s not true.
Misconception: "As a therapist, I cannot diagnose ADHD."
Reality:
- It is within the scope of practice for licensed therapists to assess and diagnose ADHD, presuming their license permits them to diagnose (which is the case with all Rula therapists).
- A thorough clinical assessment- including history, current functioning, symptom impact, and administering screeners- can and should be conducted in therapy treatment when ADHD is suspected.
- Testing is not part of the practice standards for routine adult ADHD evaluation.
- Psychological testing is not required prior to prescribing ADHD medication.
Misconception: "Adults need testing to confirm an Autism diagnosis."
Reality:
- While ASD testing can be helpful in complex cases, many effective treatment approaches for adults with ASD (e.g., CBT, skills training, peer modeling) can begin without formal testing.
- Providers can assess for ASD within scope, especially when clinical history and functional impairment are clear.
- Psychological testing is only appropriate when the results would change or guide treatment.
ABA is not considered the most effective treatment for adults with ASD.
What Makes a Strong Psychological Testing Referral?
Referrals must tell a clear clinical story. The reviewing psychologist needs to understand:
- What’s going on with the patient (specific symptoms and impairments)
- Why it matters (how it’s impacting functioning)
- Why testing is the right next step (what you hope to learn and how it will guide care)
Include These Elements:
- Symptom detail (onset, frequency, intensity, duration)
- Functional impairment(s) caused by the symptoms
- A brief overview of the patient’s treatment history, including what interventions have been effective, what additional supports have been utilized, and any factors contributing to stalled or limited progress.
- How test results will inform treatment (e.g., clarify diagnosis, support med management, modify interventions)
- Any confounding factors (e.g., active substance use, acute psychiatric symptoms)
- Recent outcome measures and relevant diagnoses
- Patient informed consent and attestation of medical necessity
Common Referral Pitfalls to Avoid
Even well-meaning referrals can be delayed or denied if they lack clarity or clinical justification. Here are the most common reasons referrals are not approved:
- Vague symptom descriptions
- Example: “Struggles with focus” is not sufficient. Instead, document specific symptoms using FIDO (frequency, intensity, duration, onset).
- No clear functional impairment
- The testing must help understand and address impairments in the patient’s daily life, work, school, or relationships.
- Unclear treatment relevance
- If testing results will not lead to a change in diagnosis, treatment modality, or medication, approval is unlikely.
- Referral made too early
- Testing is often denied when the patient has been in treatment for a sustained period of time to see benefits, or when other interventions haven’t been tried.
- Missing documentation
- Referrals that don’t include a rationale for testing, informed consent, or a summary of treatment history may be declined.
Submitting a Referral: Step-by-Step
- Determine clinical necessity (based on symptoms, impairments, and treatment relevance)
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Document clearly in your notes:
- Symptoms (FIDO: frequency, intensity, duration, onset)
- Functional impairments
- Rationale for testing
- Informed consent
- Complete the Referral Form
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Be available for a collaborative consult if the reviewing psychologist needs clarification
After Submission:
If testing is approved:
- Clinical Interview: 1–2 hours
- Test Administration: 2–4 hours (varies)
- Scoring & Report Writing: 2–4 hours
- Feedback Session (if indicated): 30–60 minutes
If testing is not approved, Rula will get feedback about the referral.
Thoughtful, well-informed referrals not only strengthen our collaboration with testing partners; they also help ensure that each patient receives the right care at the right time.
Have questions about this process? Reach out at care@rula.com
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