Who Can Diagnose and Treat ADHD?

Who Can Diagnose and Treat ADHD?

Ned clears up some common misconceptions about who can diagnose ADHD, the types professionals you might encounter on your treatment journey, and what questions you should ask any professional before working with them.

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A transcript of this episode is below.


Dr. Ned Hallowell:
This episode is sponsored by Omega Brite Wellness. Get a free bottle of Omega Brite CBD full-spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned, that’s my name Ned, @omegabritewellness.com.

Dr. Ned Hallowell:
Distraction is also sponsored by Landmark College in Putney, Vermont, the college of choice for students who learn differently. Learn more @lcdistraction.org.

Dr. Ned Hallowell:
Hello, and welcome to Distraction. I’m your host, Dr. Ned Hallowell. Today, we’re going to do a mini based on a few questions that come up all the time in my practice, in many people’s practice and in your lives, as you wonder about ADHD and how to get help so let me address them. I’m going to talk about who is qualified to diagnose ADHD, who is qualified to treat ADHD and what the difference is between a psychiatrist, psychologist and a therapist.

Dr. Ned Hallowell:
Let’s start with that last one. A psychiatrist, which is what I am, has an MD. In other words, I went to medical school, and then I did a medical internship, taking care of heart attacks and GI bleeds, and that sort of thing. Then I did a residency in adult psychiatry for two years and followed that with a fellowship in child psychiatry for two more years. So it was four years of medical school, a year of internship, and then four years of residency and fellowship for a total of nine years after college, before I was set out upon the world to do what I wanted to do, not that I wasn’t happy doing what I was doing as a resident.

Dr. Ned Hallowell:
But a psychologist, on the other hand, has a PhD. So a psychologist does not receive medical training unless he or she goes out of his way or her way to get into biological psychology. So a psychologist has a PhD and in order to get a PhD, you have to go to grad school, take some courses, traditional courses, and then write a thesis, write a dissertation. If you ever hear of a psychologist saying I’m ABD, that means all but dissertation. He or she has done everything, but write the dreaded dissertation, and it becomes kind of a rite of passage for these folks.

Dr. Ned Hallowell:
Then in the grouping of therapists, there’s many different stripes. I think if I were to advise a young person to go into the field, I’d advise them to get an MSW, master in social work. That takes two years. Once you get that, then you have to do some thousand hours, it varies from state to state, to get licensed and become an LICSW, licensed independent clinical social worker. The beauty of their training is it’s very strength-based, unlike psychiatry and psychology, which are skewed toward pathology.

Dr. Ned Hallowell:
Then there are many other people who can do therapy. In fact, anyone can do therapy. You can not even have a high school diploma and put a sign out saying “I’m a therapist.” So, there is zero quality control unless you get into one of the licensed disciplines like social work, nurse practitioner, physician’s assistant.

Dr. Ned Hallowell:
Then there are licensed marital therapists, there licensed counselors. Again, it varies from state to state. But once you see the word ‘licensed’ in front of somebody, that means they had to pass some requirements set by the state board, usually including an exam. Then they have to answer to that board so there’s some quality control and supervision.

Dr. Ned Hallowell:
The word ‘licensed’, not anybody can call themselves a licensed therapist, but truly anyone can call themselves a therapist, which is both good and bad. It does open the door for a lot of people who really shouldn’t be doing it. But then there are some people who were gifted and do a great service.

Dr. Ned Hallowell:
But to review, psychiatrist, someone like me has an MD, and we’re very trained in the medical sciences, the biology of the mind, as well as the psychology. Psychologists do not have the medical background and as a result, unless you have an MD, you can’t write prescriptions. So psychologists have a PhD, but they’re not allowed to write prescriptions with some exceptions. Some states have opened the door for psychologists to write prescriptions, but that’s more the exception than the rule.

Dr. Ned Hallowell:
The only non-MDs who can write prescriptions are nurse practitioners and physician’s assistants, and they are allowed to write prescriptions. They are usually under the supervision of an MD, again, depending upon the state licensing requirements.

Dr. Ned Hallowell:
Then the therapist, as I said, there are many stripes of therapists, but licensed independent clinical social worker, LICSW, is a reliable one, licensed couples therapists, licensed counselor, licensed family therapist. Those are all sort of a summary of the mental health professionals, including nursing.

Dr. Ned Hallowell:
Then occupational therapists who often do get involved in the treatment of ADHD. Don’t want to leave them out, nor the addiction counselors. They do tremendous work, licensed addiction counselor and addiction counselors in general, tremendous amount of work to do there because there’s a big overlap between ADHD and people who have what’s now called substance use disorder. We don’t use the term ‘addiction’ because it’s so pejorative. We go with substance use disorder, which is true. It is a disorder, a disease and needs to be respected and treated as such.

Dr. Ned Hallowell:
Now, who is qualified to diagnose ADHD? Well, the answer is any professional, preferably licensed professional, who has experience in working with children and adults who have ADHD.

Dr. Ned Hallowell:
Now that’s a wide swath, but you can’t, just based on the person’s initials after their name, know whether they have experience so you ought to ask. The people who have the most training in ADHD are the people who are from my discipline, which is child psychiatrists. That’s an MD who’s done extra training in child psychiatry. We get the most training of any professional in ADHD, but we’re rare as hen’s teeth. It’s very hard to find child psychiatrist.

Dr. Ned Hallowell:
But you don’t need to have one. A diagnosis can be made by a pediatrician, family physician, neurologist. Anyone with an MD can do it as long as they have experience in working with ADHD. As I said, among the MDs, among all professionals, the child psychiatrists have the most training and the most experience.

Dr. Ned Hallowell:
A psychologist can also diagnose this condition, so can a social worker, so can any licensed therapist.

Dr. Ned Hallowell:
What you want to do is ask the person you’re seeing how much experience do they have. I’ve treated tens of thousands of people over my 40 years. It’s pretty hard to find someone with my level of experience. But you can certainly find someone who’s treated a thousand people, or even 500. That is what you’re looking for.

Dr. Ned Hallowell:
If you’re having trouble finding somebody, and the best way to get a referral is from somebody who’s seen that person already, but call the nearest medical school. Medical schools are good quality control clearing houses. Call the nearest medical school and ask for the department of psychiatry.

Dr. Ned Hallowell:
If you’re an adult looking for an adult referral, say, “Do you know of any adult psychiatrists on your staff or on your referral base who treat adults with ADHD?” If you’re looking for a child, ask for who on your staff or in your clinic or in your referral base is good with children who have ADHD. That’s a good quality control measure.

Dr. Ned Hallowell:
Every state has a medical school. So no matter where you live, you are within somewhat striking distance of a medical school and a state medical society and a state psychiatric society. You can call all of those people, and those are good resources.

Dr. Ned Hallowell:
Finally, who is qualified to treat ADHD? Well, again, anyone who has experience, the more, the better, in working with children and adults who have it. Now, only MDs or nurse practitioners and physician’s assistants can write prescriptions. So if you want to get medication, and medication is a standard tool in the toolbox of treating ADD, then you have to see an MD or someone who works with an MD.

Dr. Ned Hallowell:
Most psychologists, PhD psychologists, who treat ADD, and most social workers and other professionals who treat ADHD are affiliated with an MD who can prescribe. So if you happen to be with a psychologist, that psychologist almost always has an MD who he can refer you to, if you want to get a trial of medication. You don’t have to reinvent the wheel, and go find an MD and get diagnosed all over again. That’s the way most of those folks take care of that issue.

Dr. Ned Hallowell:
To summarize, who is qualified to diagnose and who’s qualified to treat? Bottom line is a licensed professional who has a lot of experience in doing it and, again, I reviewed which those people are. Then in treatment, the same thing. Find someone who has a lot of experience.

Dr. Ned Hallowell:
Make sure you don’t see a one-trick pony, someone who can only prescribe medication, for example, because there’s a lot more to the treatment of ADHD than prescribing medication. You want to see someone who takes a more inclusive, multimodal approach, where you use some of everything, whether it’s exercise-based treatment or meditation or coaching or cognitive behavioral therapy or medication, all of those treatment modalities you want, whoever you see, to have experience with all of those, or at least many of those. Don’t just see someone who’s pushing one kind of treatment, someone who just does neurofeedback, for example, who just does nutritional counseling. Whatever the angle might be, you want someone who is more eclectic and goes by my motto, which is whatever works. As long as it’s safe and it’s legal, I will do whatever works. That’s the kind of approach you’re looking for.

Dr. Ned Hallowell:
So we’ve reviewed what’s the difference between a psychiatrist, psychologist and a therapist, and we’ve reviewed who’s qualified to treat ADHD and who’s qualified to diagnose ADHD.

Dr. Ned Hallowell:
Before I go, I’d like to thank our sponsor, Omega Brite Wellness. Get a free bottle of Omega Brite CBD full-spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned, that’s my name @omegabritewellness.com.

Dr. Ned Hallowell:
Please reach out to us with your questions and comments by emailing [email protected] That’s [email protected]

Dr. Ned Hallowell:
If you happen to be on TikTok, my new favorite platform, you can find me there with the username @drhallowell. I’ve posted a whole bunch of videos about common ADHD issues, and they’re only 60 seconds apiece. Take a look and let me know what you think.

Dr. Ned Hallowell:
Distraction is created by Soundscape Media. Our recording engineer and editor is the estimable Scott Persson, and our producer is the very talented Sarah Guertin. I’m Dr. Ned Hallowell, until next time.

Dr. Ned Hallowell:
The episode you just heard, just now heard, was made possible by my good friends at Omega Brite Wellness. Get a free bottle of Omega Brite CBD full-spectrum soft gels with free shipping when you buy one bottle of their 7010 MD Omega-3. Use offer code Ned @omegabrite wellness.com.

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