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

Objectives 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.Method Australian psychologists (N = 229) involved in ADHD assessment completed an online questionnaire between February and December 2024. Results 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.Conclusions 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.