Psychological Assessment Referral Checklist

When kids with ADHD aren’t causing behavior problems or failing in school, they’re less likely to be diagnosed. Instead, they’re often labeled as spacey, forgetful, or overwhelmed and they are more likely to develop subsequent mood and behavior concerns later on. Some work extra hard to compensate for their difficulties, thus performing well academically. These symptoms are especially prevalent in girls.

Consider referring for further evaluation when one or more of the following red flags are present.

• ADHD symptoms occur only at home or only at school

• Emotional/behavioral problems or exhaustion immediately after school (occurs when kids strive to ‘hold it together' during school)

• Parents provide more support than typical at this age

• Inconclusive results from screening, such as the Vanderbilt

• Identification of specific strengths and weaknesses is needed to fully understand what support is needed at school

• Diagnostic clarification is needed for conditions that appear similar to and are highly comorbid with ADHD (e.g., anxiety, sensory sensitivity, and learning disorders)

Our understanding of what it means to be on the spectrum has evolved. High-functioning/Level 1 cases can be very subtle. Someone can make good eye contact, have friends, and not engage in any repetitive behaviors and still be on the spectrum.

Here are some indicators to watch out for:

• Child struggles to ‘read the room’ and has difficulty interpreting social cues

• Black-and-white thinking, takes things too literally

• Narrow interests that s/he talks in detail about

• Struggles with changes to routine

• Difficulty relating to peers

• Facial expressions don’t match what the child is saying

• Sensory seeking, avoidance, or sensitivity

Dyslexia is the most common learning disorder. Students with dyslexia can have good reading comprehension, especially in the early elementary years. It’s critical to know that school screeners for dyslexia miss many mild cases!

Consider referring for further evaluation when one or more of the following red flags are present.

• Passed school screening for dyslexia but still not reading as expected

• Inconsistent abilities (e.g., strong in math but weak in other areas)

• Doesn’t seem to be reaching their potential (e.g., great vocabulary that doesn’t translate to reading or writing)

• Treatment for ADHD, mood/anxiety, or other disorders has not improved learning/achievement

Anxiety and mood disorders share symptoms with ADHD, such as difficulty focusing and forgetfulness. They can develop in response to untreated conditions, such as ADHD, ASD, or LD. When therapy and/or medication isn’t helping, testing can help determine if there is more going on.

Consider referring for further evaluation when one or more of the following red flags are present.

• Avoidance interferes with functioning

• Tantrums/meltdowns that aren’t developmentally appropriate

• Significant differences between behavior at home and school

• Excessive reassurance and permission-seeking

• Physical complaints are prevalent with no medical cause

• Complaints of being ‘stressed out’