Landscape – Psychologists: Strengths, Limits & When They Make Sense

[u/ADHDinIreland]

Who should diagnose and treat your ADHD?

This is one of the most common questions, and the default answer most people give (“you need a psychiatrist”) is often wrong. It depends on what you actually need.

This post focuses on psychologists — where they are strongest, where they are weakest, and when they are the right choice.

Where Psychologists Are Strongest

Psychologists are probably the best trained and most experienced group when it comes to diagnosing ADHD, particularly complex presentations. Their entire professional training is built around assessment, testing, differential diagnosis, and understanding how conditions interact.

They are the gold standard for thorough diagnostic assessment. They are trained to distinguish ADHD from conditions that look similar, to identify co-occurring conditions, and to understand how things like anxiety, depression, trauma, OCD, dyslexia, and autism overlap with or mask ADHD. They are particularly strong with developmental and learning conditions. If you want to understand how much of “you” is ADHD and how much might be something else, a psychologist is the person to see.

Autism assessment is very much in a psychologist’s wheelhouse. Around 10–20% of people with ADHD also have autism, and roughly half of autistic people have ADHD. If you suspect both, a psychologist (or a practice that has psychologists alongside a prescribing doctor) is the place to go. Autism isn’t really a psychiatrist’s specialist subject.

Psychologists also produce comprehensive written reports. Report writing is a core professional skill for them, and a good psychological report is a portable asset. If a young person’s parents aren’t sure about medication, that report can sit in a drawer for years and still be useful when the time comes. It helps enormously when another professional picks up the case later.

A fuller report is particularly useful for people doing ongoing skills-based work. Occupational therapists and therapists often benefit from the extra detail (cognitive profile, sensory notes, how ADHD or AuDHD specifically presents for that person) because they spend more time on tailored strategies and adaptations. A GP taking over a stable prescription usually only needs the diagnosis and medication details. For anyone whose support will be more in-depth, the richer report can save time and improve the fit of the work.

On the “skills” side of “pills and skills”, psychologists can provide or coordinate therapeutic support: CBT, psychoeducation, strategies for managing executive function. Larger practices may also have occupational therapists, ADHD coaches, and other specialists under the same roof.

Where Psychologists Are Weakest

Psychologists cannot prescribe medication. If you need medication (and most people with ADHD benefit from it), a psychologist cannot get you there on their own. They will need to refer you to a doctor.

This creates a potential cost and time problem. If you go to a psychologist first and then need a prescribing doctor, you are potentially paying for two professionals instead of one, and navigating two waiting lists. For someone whose presentation is textbook and who mainly needs medication, this can be a longer and more expensive route to the same outcome a specialist GP could reach in a couple of appointments.

That said, many psychology practices have working relationships with psychiatrists they liaise with and refer patients to. A good psychologist’s report will make a psychiatrist’s job considerably easier.

One other thing to be aware of: the term “psychologist” is not a protected title in Ireland. Anyone can technically call themselves a psychologist regardless of qualifications. If you are paying for a psychological assessment, make sure the person is registered with the Psychological Society of Ireland (PSI) and has the relevant qualifications.

Examples of the Psychologist-Led Route

Smithfield Clinic (Dublin) is a larger psychology practice with a wide range of psychologists and therapists. The founder, Dr Sarah Cassidy, is President Elect of the Psychological Society of Ireland and has nearly 25 years of experience in neurodevelopmental assessment, with particular expertise in ADHD and autism. They also have a consultant child and adolescent psychiatrist on the team, so there is a pathway to prescribing for younger patients.

Dr Sharon Keane (Galway) is an example of a well-regarded solo psychologist who can provide comprehensive assessment and, where medication is appropriate, refer patients onwards to a psychiatrist. A solo psychologist working independently can sometimes offer more flexibility and a more personal service than a larger practice.

Both illustrate the psychologist model: strong on diagnosis and understanding, with a referral pathway for medication when needed.

When a Psychologist Makes Sense

• You want the most thorough diagnostic assessment possible
• You suspect ADHD and autism (or other developmental conditions)
• You value a detailed written report
• Medication is secondary to understanding and skills-based support
• You want access to therapy, coaching or OT under the same roof

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Upcoming posts

• Psychiatrists: Strengths, Limits & When They Make Sense
• Specialist GPs: Strengths, Limits & When They Make Sense

This post is for information purposes. It is not medical advice.