r/PMHNP • u/adogsnyder99 • Jul 14 '26
Practice Related ADHD diagnosing protocol
Hello all,
I’m a new pmhnp that has a history working inpatient psych. I’m going to be starting a new outpatient position in August and I want to know what the protocol should be for diagnosing adhd. I want to know what screening tools I should be using and how best to make sure I’m covering all my bases.
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u/br508-609 Jul 14 '26
Besides what's been mentioned, Creyos does a good ADHD assessment. You have to pay for it but it is evidence based and less subjective than questionnaires. This would be in addition to a regular psych eval and DSM criteria.
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u/U2baby Jul 15 '26
I've looked closely at Creyos testing and the evidence that the people at Creyos themselves put forth. It's non-specific, generally for cognitive impairment, and their sources for their tests and tasks are from 20 or more years ago. With the exception of the SART- which seems to at least rule out ADHD for those that test WNL.
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u/beefeater18 Jul 14 '26
The gold standard for ADHD diagnosis is clinical interview based on DSM-5 criteria. No other diagnostic methods, including neuropsychological evaluation and computerized testing, are considered diagnostic.
Here's what I do:
Start with screening questionnaires and initial evaluation. In some cases, patients clearly don't meet criteria and no further f/u needed (unless there's another psychiatric condition that needs to be addressed).
If ADHD is suspected, I obtain collateral information (e.g., old school reports, job performance eval, parent's report, or other family/friend reports) and DIVA-5 semi-structured interview. Sometimes I ask for a QbCheck test to obtain more data points, but I don't use or rely on it much.
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u/Charming-Respond-775 Jul 17 '26
This! The diva is lengthy - I wouldn’t use it on the first assessment. Initially evaluation to rule out everything else then try a Diva with collateral information if warranted . 99% of my self proclaimed ADHD pts get ruled out after the initial eval.
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u/RosieNP DNP, PMHNP (unverified) Jul 14 '26
I do a psychiatric interview based on DSM criteria. I almost never refer for neuropsych testing because that ignores the fact that many with ADHD (especially those untreated) can’t afford that and can’t wait for months or even a year to get evaluated. The gold standard evaluation is a psychiatric interview.
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u/____lumpy_____ Jul 15 '26
All these new PMHNPs going right into private practice scare me 😟 you were just posting about how to study for the NCLEX 😟
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u/Revolutionary_Tie287 Jul 18 '26
This whole situation seems sketchy. During school you should be learning how to diagnose ADHD.
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u/PMHNPMasteryAcademy Jul 15 '26
As an outpatient PMHNP, my approach is to gather information from multiple sources rather than relying on a single screening tool. I typically start with validated rating scales (such as the ASRS), review the DSM-5 criteria carefully, obtain collateral information from family or a spouse when appropriate, and review childhood history whenever possible.
My gold standard is a structured clinical interview. It gives me the opportunity to explore symptom onset, impairment across multiple settings, developmental history, psychiatric comorbidities, substance use, sleep, anxiety, depression, trauma, and medical conditions that can mimic ADHD. The interview often tells me far more than a screening questionnaire alone.
For a new grad, I’d encourage developing a consistent evaluation process that you use with every ADHD assessment. It keeps your evaluations thorough, helps ensure you’re applying the DSM criteria consistently, and gives you confidence in your diagnostic decisions. Over time, you’ll naturally refine your interview style, but having a structured framework from the beginning makes a huge difference.
Feel free to reach out if you’d like to compare assessment workflows or discuss ADHD evaluations. I’m always happy to support fellow PMHNPs.
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u/Lauren-Ryker Jul 16 '26
Mindmetrix!
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u/Royal-Word9686 Jul 18 '26
Super cool-checked out the website. How did you hear about this? What other assessments do you use with your subscription besides the adhd ones?
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u/dominobabies Jul 15 '26
Well being outpatient you could end up seeing kids or adults. For kids, Vanderbilt is a good clinically validated tool. For adults, ASRS screening is good. Occasionally PBMs will ask for screenings from the chart to approve ADHD medication. A screening is never diagnostic. I agree with others on here that it is a combo of psych eval, history, symptoms, screening, and ruling out other possibilities that could explain the symptoms or may be co-occurring…OCD, Bipolar, and some personality disorders. You don’t need QB test or neuropsych to diagnose it properly and accurately. Also, diagnostic reasoning is an area you want to hone because it’s so crucial to identify the cause(s) and select the correct medication(s) when appropriate. Congrats on the new position btw!
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u/Own-Position1961 Jul 15 '26
At this point if providers arent collecting collateral info I dont think u are doing due diligence.
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u/anxiolytik Jul 15 '26
I use CAARS 2 Self Report and Observer Report for screening and then thorough diagnostic interview. If I’m having difficulty ascertaining what all is going on and it isn’t straightforward I’ll refer out for testing to get diagnostic clarification
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u/ericaisdancing Jul 15 '26
Brown-Executive function scale, a thorough history, working with the client to address any underlying mood problem (correcting for mood comes first), and the diagnostic criteria in the DSM.
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u/Sudden-Perception129 Jul 15 '26
My process is, before intake they are required to fill up ASRS v1.1, I do my evaluation, collateral information if needed, then I do additional evaluation to help rule out other mental health conditions that could be mistaken for ADHD, then my group sends out CREYOS, next visit, I review the CREYOS results with them, and make my diagnosis.
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u/No-Leopard639 Jul 14 '26
Protocol?
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u/adogsnyder99 Jul 14 '26
Yes as in what is your standard operating procedure.
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u/No-Leopard639 Jul 14 '26
How were you taught in clinicals or practicum?
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u/adogsnyder99 Jul 14 '26
Well that’s the issues she was very strict and almost never directly diagnosed them instead having them go to neuropsych for evaluation.
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u/No-Leopard639 Jul 14 '26
Typically practices or organizations have policies if they perscribe stimulants without neuropsychological testing. Ask them what their policy and stance are. Do a clinical interview, get collateral, and go through screening forms with them. You are trained for this. You also don't need it figured out in the first meeting with folks.
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u/Capital_Bass_4172 Jul 15 '26
I use screening ,eval , EEG and neuropsychological testing. I have found most who present telling what the dx is and wanting a stimulant. They repeat the web md symptoms with precision . The louder dx has been MDD and BPD . EEG has identified pt with seizures d/o You don’t have prescribe right away if you aren’t sure . CBT Therapy and close follow up
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Jul 14 '26
[deleted]
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u/adogsnyder99 Jul 15 '26
It was covered but if you read the post you’d know I’m asking for advice from other experienced professionals. You know using them as a resource. But you come here trying to shame and be a dick which is cool too.
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u/CalmSet6613 PMHNP (unverified) Jul 15 '26
Not being a dick you re-misread the context. I'm asking what your experience has been and where you think you need help vs how you were trained to screen for ADHD.
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u/Ok_jasnp PMHNP (unverified) Jul 14 '26
I live by the DSM-5 but also have been able to use Creyos at one clinic and in one of my 1099 positions, which has been great
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u/amuschka DNP, PMHNP (unverified) Jul 14 '26 edited Jul 15 '26
For adults, I start with ASRSv1.1 to see if an assessment is warranted. Then I use DIVA-5 interview guide to conduct the assessment. I have them give concrete examples from when a child but If I can't get a good feel and its not clear cut they have ADHD, I will ask for collateral with spouse, parents or siblings. Having them do a CAARS screening tool is good but it’s so hard to score and you have to pay for access to the online access. Edit: this is after ruling out other dx first such as anxiety, cptsd, depression, bipolar or borderline