You Asked, We Answered: How to Get Tested for ADHD in Ontario

by Marielle Tye, MSW, RSW; edited by Krista Carvin, MSW, RSW & Alison Moreau, MSW, RSW

Does it seem like everyone is getting an ADHD diagnosis these days? As a team of ADHD therapists at The Curious Collective, we see that rise in diagnosis as a GOOD thing. We are thrilled that more and more adults are finally getting answers about their mental health. But with ADHD, we also know that the path from being ADHD-curious to finally getting answers is complicated and MANY people have no clue where to start.

That’s where we come in! As Registered Social Workers and Psychotherapists, a big part of our job is helping our clients feel fully informed about the ADHD diagnostic process so they can make the best decisions about their healthcare. Here, we will walk you through how to get an assessment and possible diagnosis for ADHD as an adult in Ontario, Canada. Although we wish we could help ADHDers worldwide, this post only reflects the current diagnostic system here in Ontario at time of publishing.

Below, we will walk you through the process for being assessed and possibly diagnosed with ADHD through both public and private services; clarify who can diagnose; explain a common screening tool used to help diagnose ADHD; and address some common misconceptions.

If you are an adult who is wondering if this too could be you, but have felt underwater with ADHD misinformation-overload, keep on reading!

How to get an Adult ADHD Assessment in Ontario for Free

Like getting any mental health diagnosis, sometimes it can be confusing to know who can diagnose you. And sometimes it isn’t clear what the differences are between free and paid services. For ADHD, this is especially important because living with difficult symptoms and the fear of talking to a medical professional about them can be intimidating enough on its own.

I get it! It took me almost three years to get assessed after a previous therapist recommended it to me. The following list breaks the process down so it’s easier to digest and to decide what pathway is best for you.

Family Doctor

• medical doctors that are trained as general practitioners, meaning they can assess for and treat any health-related issues including common mental health disorders (i.e. anxiety, depression, ADHD, trauma/PTSD, etc.) 
• can prescribe medications and/or refer you to specialists if your needs require more specialized care than they can provide
• fees are covered by the Ontario Health Insurance Plan (OHIP) – just show a valid health card!

Psychiatrist

• medical doctors with advanced training and specialization in mental health. They can assess, diagnose, and treat (prescribe medication for) your mental health. Some psychiatrists offer psychotherapy, however this is more usually accessed through a private or fee-based counselling service.
• like family doctors, psychiatry services are covered by OHIP 

Nurse Practitioners (NP)

• nurses with advanced training, giving them the ability to diagnose and prescribe treatments for certain ailments, including mental health. Some family doctors’ offices have NPs on-site, and they may have shorter wait times than other healthcare providers such as doctors
• NPs can assess and diagnose for ADHD, as well as prescribe medications
• NP services are covered by OHIP if your doctor’s office has an NP on staff

If you think you might have ADHD, we recommend starting by talking to your family doctor (or if you see a Nurse Practitioner more often, try them) as the first point of contact for seeking assessment. Most often, a first visit will be in-person and you will be asked to share your concerns, describe your symptoms, and answer questions to screen for symptoms of ADHD. They may also ask you to complete a screening tool called the Adult ADHD Self-Report Scale (otherwise known as the ASRS).

At the end of this first appointment, they may have enough information about your symptoms to determine if an ADHD diagnosis is likely, based on the information discussed. In some cases they may require a follow-up appointment to gather more information.

If they are able to confirm an ADHD diagnosis following their assessment, they may begin talking to you about treatment options, including medication and/or psychotherapy. They should also be able to inform you which sub-type of ADHD you have: inattentive, hyperactive, or combined (see our blog post #3 for more information about ADHD sub-types).

In some cases, your doctor or nurse practitioner may refer you to other mental health professionals, such as a psychiatrist, to clarify your diagnosis through a more formalized assessment process. These specialized professions may also be more knowledgeable about specific treatment options such as medications and therapy.

Don’t fret! There are many reasons why one healthcare provider may refer to others. Perhaps your family doctor believes you could benefit from a more specialized approach to your mental health care. If your family health team or doctor’s office has a psychiatrist in-house, that is often their first step, but if not, you may be referred to a psychiatrist in another clinic or even an out-patient hospital program. Either way, seeing a psychiatrist means you will get screened for many mental health disorders, including ADHD – which might be something you appreciate if you have wondered about other concerns too.

How to get an Adult ADHD Assessment in Ontario Through a Private Service

If you have private coverage (aka “insurance benefits” or “extended healthcare insurance,” such as through an employer), and/or you can afford to pay out of pocket for services, you have the additional option of seeking an ADHD assessment through a private (paid) healthcare provider. Pro tip: if going through benefits/insurance, be sure to check with your provider which services are covered (and how much) to ensure your eligibility and determine what you can afford.

Practitioners in the private sector are regulated healthcare providers who are self-employed, so their services are not covered by the Ontario Health Insurance Plan (OHIP).

Private Nurse Practitioner

• much like in the public sector, a nurse practitioner (NP) in private practice can assess and diagnose for ADHD. Unlike the public sector, however, there will be a fee. See our Blog Post #4 for some private Ontario assessment services we have come to recommend. 
• the Average cost of ADHD assessment in the private sector ranges from about $300 to $800
• NPs can prescribe medication for ADHD (among other things)

Psychologist 

• A psychologist will conduct a robust psychological and/or psycho-educational assessment. This is much broader than a simple screening tool, because it examines your cognitive abilities and academic-related skills, along with emotional and social abilities. This process might assess for multiple diagnoses at a time, such as ADHD, Autism Spectrum Disorder (ASD), and other cognitive disabilities. This assessment typically takes 1-2 full days, and may also include input from your family or loved ones, in order to produce a comprehensive evaluation for the psychologist. 
• Average cost: $2,500-$3,000
• Psychologists in Ontario cannot prescribe medication
• Provides you with a detailed report post-assessment
• This can be a good option if you have wondered about having ADHD as well as potentially ASD and/or other learning disabilities, and if you are seeking for better self-understanding and awareness. An additional advantage of this type of assessment is, in work and school settings, having formal diagnoses can improve access to accommodations to better support your needs. 

The ASRS (Adult ADHD Self-Report Scale) Explained

The ASRS is the most commonly used self-assessment questionnaire for diagnosing ADHD. It was created by the World Health Organization (WHO) for adults over the age of 18. Typically, mental health professionals such as family doctors, nurse practitioners, psychiatrists, psychologists, social workers, and psychotherapist will use it with individuals who are curious if they meet diagnostic criteria for ADHD. And because it is a self-assessment, anyone can complete it to see how they score!

There are two versions of the ASRS: the ASRS-5 and the ASRS – v1.1. The first (ASRS-5) is a short, six-question screening tool which is typically administered by a healthcare provider in order to determine if someone presents with at least some symptoms, and should proceed for further testing or not. The long-form ASRS (v1.1) has eighteen questions to screen for ADHD symptoms. Both forms will ask you to rate yourself with how often you experience or are bothered by a range of symptoms associated with ADHD.

Although anyone can complete a self-assessment tool, only certain healthcare professionals are allowed to interpret these screening results and make a formal diagnosis such as for ADHD. We always recommend completing assessments and discussing your concerns with a regulated health professional in order to best understand your symptoms and get support.

Deciding Which Assessment Route is Right for You

This ultimately will be a personal decision, based on your relationship with your family doctor or other primary healthcare provider, as well as their own comfort in assessing ADHD – especially in women. It also may require financial consideration, to determine if you can afford or access benefits for private services. A private service can be more specialized and in some cases will provide comprehensive reports after. You can also ask your doctor, NP and/or psychiatrist (OHIP covered) for a report of your assessment results as well. 

Before you proceed, we suggest considering some challenges that may come up during the diagnostic process, which we often see as ADHD therapists.

Outdated information and myths about ADHD

While we are actively working to change this here at The Curious Collective, there are many health professionals who still hold outdated beliefs about ADHD – or even those who continue to buy in to myths that have been busted by research and data.

Such myths often overlook how ADHD symptoms can differ across genders, cultures, and age; or else misunderstand some of the core features of ADHD and the various sub-types. For example, it is a common misconception that all ADHDers can be seen and recognized as having ADHD (a la hyperactive young boys in a classroom). But we now know that for many (many!) ADHDers, this is not the case.

Providers with Conscious or Unconscious Bias

Some providers may simply not know what they don’t know, and will miss key signs and symptoms of ADHD because of unconscious biases. For example, depression and anxiety are more common diagnoses (and also common co-occurrences with ADHD), and some providers may be more comfortable diagnosing depression and anxiety, and may brush off ADHD symptoms as related to one of these other diagnoses.

Sadly, it’s also not uncommon to encounter providers who have conscious biases – who feel that ADHD has become ‘trendy’ and are not inclined to believe their patients when they seek help with this concern. If this has been your experience, always remember that if you feel like your concerns were dismissed, you have the right to a second opinion! 

Untreated ADHD symptoms like Executive Dysfunction or Masking can get in the way

Literally, a common symptom of ADHD is: “Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.”

The process of getting a diagnosis requires a TON of sustained mental effort, that you may have been avoiding because of ADHD. If you can even get yourself to the point of seeing a doctor (which we know can be a huge challenge on its own), ADHD symptoms can get in the way during the ADHD assessment. Problems such as memory (literally forgetting what your symptoms are or what you’ve struggled with in the past, especially when put on the spot to explain them) and communication (unable to explain your experience or describe your symptoms) can be big barriers to getting the right help, and they’re common challenges among ADHDers.

It’s also fairly common for us – especially women – to minimize our symptoms or question if our experiences are real or valid, especially when we have to put so much time and energy into trying to hide those symptoms in our day-to-day. For instance if you struggle with memory and time management, and are always forgetting or running late for appointments, you still might not be able to communicate this as an issue because you’ve developed such strong work-arounds – with your calendar, setting multiple alarms and reminders in your phone, getting a friend or loved one’s help to remind you of things, or adjusting your car clock so you think you have less time than you have (we see you!).

All these things can make us look like we’re not struggling when we are, and make it even harder to explain our needs to a professional when we feel put on-the-spot.

Our Tips on Getting Tested for ADHD in Ontario (from 3 Therapists with ADHD)

Talk to an ADHD therapist

…because we can work with you if you are diagnosed or not! We can help you explore your curiosity about ADHD and help you make a decision about whether or not to seek diagnosis. We can support you with understanding your suspected symptoms and how they show up in your life, which can help you prep for the assessment process. We can also help you organize your thoughts and implement strategies to help you remember what you want to say in your appointment. Remember, this is not cheating the system – this is help and an accommodation that you may very well need! 

Consider self-identifying as neurodivergent

See how we used the term self-identify here, not self-diagnose? That’s because legally, diagnosis is a process that can only be completed by a regulated health care professional who has the scope of practice to diagnose in Ontario. While we might encourage you to try to access diagnosis, we are realistic about the challenges and barriers out there because of systemic issues in the diagnostic process; and we don’t want that to keep you from implementing ways to support yourself!

By contrast, self-identifying is when you learn about a trait or diagnosis, such as ADHD, and find that it deeply resonates with and describes your experience. If you have learned about ADHD, and you are not diagnosed, but feel that it describes you to a tee… you have every right to self-identify as an ADHDer and as neurodivergent. This won’t gain you access to treatments such as medication, but can still help you connect with other types of support, such as ADHD-specific therapy, coaching, or peer groups. You may decide that a formal assessment or a diagnosis is not needed to affirm how you move through the world! 

Advocate for yourself

…Especially if you are a woman or have been dismissed in the past! You know your body, your distressing symptoms, and how much you have struggled throughout your life. You have the right to seek a second opinion if you see yourself in the diagnosis yet feel that your doctor has not quite heard or understood your concerns.

We appreciate that the process of getting assessed for ADHD is hard. There is a lot of information out there to make sense of, along with plenty of barriers (such as anxiety and self-doubt) that make it difficult to make it to the assessment stage. It is a big deal, and you likely wouldn’t have read this entire article if you didn’t strongly suspect that you could have ADHD – or know of someone else you care for who might.

The biggest take-away we hope you gain is that you are not alone in the process, and you can get support from start to finish by working with an ADHD therapist and/or another trusted healthcare professional. Having all the facts helps so that you feel informed when you make your decision. It takes courage to reach out for help, and we want you to know we are so proud of you for wanting to get answers – so you don’t have to keep trying to keep your head above water and can surf the waves soon instead. 

Sources

Adult ADHD Assessments in Canada: Navigating the Options @adultadhdcentre.com

Adult ADHD Tests, Self-assessments, & Quizzes [2023 Guide] @ talkwithfrida.com

References: 

1. Schweitzer JB, et al. Med Clin North Am. 2001;85(3):10-11, 757-777. 

2. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. 1998.

4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association. 2000: 85-93.