Three different things
A diagnosis is a clinical judgment that DSM-5-TR criteria are met, made by a licensed clinician from history, observation, and rating scales. A comprehensive evaluation is a structured assessment with standardized instruments, usually by a psychologist, that produces a report. School eligibility (a 504 plan or an IEP under IDEA) is a school team's decision using its own criteria; a medical diagnosis informs it but does not decide it. Parents often ask a therapist for "the diagnosis" when what they need is the report for school or the evaluation a payer wants before medication.
By license
- Psychologist (PhD, PsyD). Diagnoses ADHD and autism and delivers the comprehensive evaluation, including cognitive and observational testing. The report is what schools and payers most often ask for. See psychological testing codes.
- Psychiatrist and PMHNP. Diagnose ADHD and autism from clinical assessment and prescribe. For autism they usually rely on or request a psychologist's evaluation.
- Pediatrician. Diagnoses ADHD routinely using Vanderbilt scales and history; refers autism concerns to a specialist after screening (M-CHAT).
- LPC, LCSW, LMFT, LMHC. In most states diagnosis is within scope, and an ADHD diagnosis from clinical assessment is common. An autism diagnosis is technically within scope in many states, but schools and payers frequently want a psychologist's evaluation, and many therapists prefer to refer. Check your board's scope language.
- Associates. Diagnose under supervision, with the supervisor's sign-off.
What a therapist can do
Screen with validated scales (Vanderbilt for ADHD, SCARED and PHQ-A for the co-occurring anxiety and mood that often bring a child in), take a developmental and school history, observe, and diagnose ADHD when criteria are met and the picture is clear. Write the F-code in the treatment plan and treat. Coordinate with the pediatrician or the prescriber when medication is on the table.
When to refer for testing
- The question is autism, or ADHD versus autism versus a language or learning issue.
- The school wants a report for eligibility, or the family is heading into an IEP meeting.
- Medication decisions depend on a firmer diagnosis, or the prescriber asks.
- The presentation is mixed (trauma, anxiety, and attention symptoms together) and treatment is stalling.
- The family wants a second opinion on a diagnosis someone else made.
What a comprehensive evaluation contains
Referral question; parent and teacher rating scales; developmental, medical, and school history; structured observation (MIGDAS-2 or a comparable protocol for autism); cognitive testing where indicated (RIAS-2 or similar); behavioral observations during testing; DSM-5-TR criteria reviewed; diagnosis; and recommendations for home, school, and treatment written so a 504 team can act on them. On telehealth the report also states which instruments were delivered remotely and how.
Sharing one plan
The best outcome for a child is one plan across the therapist, the psychologist, and, when needed, the prescriber: the evaluation lands in the treatment plan the therapist is already running, the therapist adjusts targets, and the family hears one story. That requires a shared record and a habit of writing to each other.
Talking to parents about it
Parents want an answer and a plan. Say plainly what you can conclude from your assessment, what an evaluation would add, how long it takes, and that treatment does not wait for the report. Name the school and the medication questions directly, since those are usually why they asked.
How this works on Emora
On Emora the therapist refers inside the record, the psychologist evaluates by telehealth across every PSYPACT state, and the report and treatment plan come back into the same chart the therapist works in. Families who wait months elsewhere for a diagnostic answer get one, and the therapy that was already under way keeps going. If a prescriber is needed, the PMHNP sees the same record.
Questions clinicians ask
- Can an LPC diagnose ADHD?
- In most states, yes, from clinical assessment. Payers and schools may still ask for a psychologist's evaluation for specific decisions.
- Can a therapist diagnose autism in a 5-year-old?
- Scope varies by state, and most therapists refer to a psychologist for a comprehensive evaluation, which is what schools and payers usually want.
- Does a school need a medical diagnosis for a 504?
- No. A 504 team makes its own eligibility decision; a diagnosis and a report make it much more likely.
- Can a PMHNP diagnose ADHD?
- Yes. PMHNPs diagnose and prescribe; for autism they typically request a psychologist's evaluation.
- How long does an evaluation take?
- On Emora, typically two to three sessions across a few weeks plus the feedback session, depending on the referral question.
Sources
This is general information for licensed clinicians, not legal or billing advice. Your board and your payer contracts control.