Autism and ADHD Evaluations

Upward is pleased to offer evaluations for Autism (offered to children aged 24-36 months or up to 5 years for minimally-speaking or nonspeaking children) and Attention-Deficit/Hyperactivity Disorder (ADHD; evaluations offered for ages 6 years-17 years and ages 22 years and older) to all residents of Alabama. Our approach to evaluation is comprehensive and neurodiversity-affirming. Evaluations consist of a variety of assessments and the course of evaluation will generally stretch across a couple of weeks.

Dr. Susan Rathmell offers adult ADHD evaluations for individuals aged 22 years and above. These evaluations are available virtually or in-person in the Birmingham area.

Dr. Kathleen Ramsey offers pediatric evaluations for Autism and ADHD. Dr. Ramsey resides in Pennsylvania and offers virtual (i.e., “telehealth”) evaluation appointments on weekends to children in Alabama. Although virtual evaluation may not be appropriate for all children (see more here and here), virtual evaluations have been demonstrated to be equally as accurate and valid as in-person evaluations. You can read more about virtual evaluations for children here. Virtual evaluations are an especially good fit for the following groups of children:

For pediatric Autism evaluations:

• Toddlers who have screened positive for autism (e.g., score of 3 or higher on the MCHAT-R/F) at their well child visit
• Families of young children who have been encouraged by their pediatrician or other provider (e.g., speech or occupational therapist) to seek an autism evaluation
• Toddlers and preschool-aged children who display social communication differences (e.g., reduced eye contact, not responding to their name being called, preference to play alone instead of with other children)
• Toddlers and preschool-aged children who are minimally- or non-speaking
• Families of young children who would have great difficulty leaving their home for an evaluation due to their child becoming distressed in the new environments or around unfamiliar people

For pediatric ADHD evaluations:

• Families of children who have been encouraged by their pediatrician or teacher(s) to seek an ADHD evaluation
• Children who are struggling academically due to attention or behavioral difficulties and may benefit from recommendations on supporting them at school
• Children who are able to participate in virtual testing activities for 30-60 minutes on a tablet or computer

For all pediatric evaluations:

• Families who live in rural areas and may have difficulty accessing an in-person evaluation due to transportation barriers or time constraints associated with travel
• Families who have access to technology and internet connection

Below, please find answers to the most commonly-asked questions about evaluations at Upward:

What is Autism?

Autism is a neurodevelopmental condition that is characterized by social communication and interaction difficulties in addition to restricted, repetitive patterns of behavior, interests, or activities. This may include repetitive body movements or use of language, behavioral inflexibility or challenges adjusting to change and transitions, intense interests in certain objects or topics, or sensory processing differences. We think of Autism as a “spectrum” which consists of many different traits or ways in which the brain processes information. Importantly, the spectrum is not linear, and it can be harmful to reduce autistic people to being either “high functioning” or “low functioning.” Autism is much more complex and dynamic, and each autistic person has their own unique strengths and challenges which are important to highlight. Children do not grow out of their autism, as it is a lifelong condition, but the way their autism presents may change over the course of time and based on their contexts and support systems.

What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterized by inattention, hyperactivity, and/or impulsivity. This may include difficulties with sustaining attention, time management, organization, planning, regulating emotions and behaviors, restlessness or fidgeting, interrupting or intruding on others, acting without thinking, and more.  While behaviors associated with ADHD often get first noticed at school, they impact other areas of functioning as well (e.g., at home, work, or extracurricular activities). Both children and adults can be diagnosed with ADHD, though symptoms must be present during childhood in order to make a diagnosis.

Do you test for adult-onset ADHD?

One of the diagnostic criteria for ADHD is that symptoms must have been present during childhood. Adults who notice symptoms consistent with ADHD but who did not have these symptoms as a child likely do not have ADHD. That does not mean that these adults are not experiencing symptoms or that they do not meet criteria for any diagnosis at all. It likely means that they are experiencing ADHD-like symptoms as part of another disorder, such as an anxiety disorder.

Plenty of people are diagnosed with ADHD for the first time as adults. During evaluation, these people are able to recall symptoms of ADHD that were present during their childhoods even if they were never evaluated or treated for ADHD when they were children. Sadly, this actually happens quite often for a variety of reasons: sometimes, guardians were not aware of, did not have access to, or did not believe in the diagnosis and treatment of ADHD, and so these individuals were not evaluated or treated as children. The fact that these individuals are diagnosed during adulthood does not mean that the condition has onset for the first time in their lives during their adult years; it simply means that the condition has always been present but that they were not diagnosed in childhood.

If you are an adult experiencing symptoms of ADHD but you do not recall these symptoms being present when you were a child, and if you would like to discuss these symptoms and how they might be evaluated, please call for a free consultation with Dr. Rathmell. She can help determine how your symptoms can best be evaluated and treated.

What is neurodiversity?

Neurodiversity is the idea that brain differences are important and necessary for our advancement as a society. While this does not discount the challenges that neurodivergent people face, it does value the differences that set them apart from others. When we approach evaluations from a neurodiversity-affirming framework, we can best understand and support neurodivergent people and empower them to be themselves authentically. 

Do you evaluate for other conditions, like depression or PTSD?

Yes, we do. We provide detailed evaluations for these and other conditions in our standard, 90-minute comprehensive intake, diagnosis, and treatment planning session that all psychotherapy-seeking clients receive prior to entering psychotherapy treatment with Upward. We also provide evidence-based, effective psychotherapy for conditions such as depression, anxiety, and PTSD. You can read more about our evaluation and psychotherapy offerings here.

As part of an Autism or ADHD evaluation appointment with Upward, we do provide brief evaluations to assess for these and other mental health conditions. These conditions can play a role in the experience of Autism and ADHD-related symptoms, so we do evaluate for them as a part of an Autism or ADHD evaluation. The results of these evaluations also appear in the report your Upward provider will compile at the conclusion of your evaluation.

Why should I or my child get an evaluation?

Sometimes, clients schedule evaluations at Upward on the advice of a teacher or physician; other times, clients self-refer for evaluation. You do not need a formal referral from a doctor’s office in order to receive evaluation at Upward.

There are several reasons that clients seek evaluation at Upward. Some need an evaluation to substantiate a request for an Individualized Education Program (IEP) or 504 plan with their school or to request accommodations at their place of employment. Some suspect that they or their child could benefit from medication to manage their symptoms, but their prescriber requests an evaluation before prescribing they will consider prescribing the desired medication. Some clients self-refer for an evaluation because they suspect they are experiencing symptoms and simply want to know if they meet diagnostic criteria for a suspected diagnosis because knowing this information is of interest to them and may help them explain some of the challenges they have faced over the course of their lives. All of these are good reasons for seeking an evaluation.

What happens during an assessment?

The process of evaluation begins with a free consultation call with either Dr. Ramsey (for child evaluations) or Dr. Rathmell (for adult evaluations). Over the course of this call, we will determine whether Upward is a good fit for your evaluation needs. If so, an evaluation will be scheduled.

Prior to the evaluation date, you will receive some assessments to complete at home. Some of these assessments will be delivered to you through our client portal while others may come to you through the mail. Your provider will tell you what to be on the lookout for and how to complete these assessments. These assessments will take some time to complete, and some of them will give you the opportunity to include what is called collateral reporting. This is reporting done by someone other than you (e.g., a teacher, a spouse). Using data from a variety of sources helps us provide the most comprehensive, accurate report possible for you.  We generally give about 2 weeks for clients to complete the at-home assessment portion of the evaluation because it can take some time (probably a couple of hours altogether). Ideally, you will complete the at-home assessments prior to your evaluation date and either send them back to us through the client portal or bring them with you to the evaluation appointment.

On the evaluation date, you will meet for 2-3 hours with your Upward provider for the assessments that a professional must administer. These assessments usually include cognitive testing and structured interviewing. It is important that you do your best to get a full night’s sleep and eat a good breakfast before your appointment as these assessments take awhile to administer and the appointment can feel long. You will be permitted to take breaks as needed. Our goal is to make the evaluation appointment a pleasant, positive experience for you. As we said earlier, our evaluations are neurodiversity-affirming! Many people who seek evaluations have been struggling with symptoms for quite some time, and conversations about these symptoms can sometimes be upsetting. It is our goal to provide a warm and engaging setting for your evaluation that helps you feel good about yourself and your brave decision to pursue an evaluation.

After this appointment, your Upward provider will take 1-2 weeks to compile all of your evaluation data and write a comprehensive report. This report will contain any diagnosis that your provider feels is appropriate as well as treatment recommendations for you. You will have a final meeting with your Upward provider about 2 weeks after your evaluation date to receive this report and go over it together. Your Upward provider will explain your results and answer any questions you may have about your report. Your report will be uploaded to your client portal account for you to use as you see fit. If you wish, Upward can also send a copy of your report to your referring provider. We will not provide a copy of your evaluation to anyone without your consent and a signed Release of Information form from you.

How should I talk to my child about their evaluation?

Many caregivers wonder whether they should tell their child about their upcoming evaluation, and if so, how they should go about doing this. Here are some tips:

· The purpose of an evaluation is to learn about a child’s strengths and areas of difficulty, determine whether any diagnoses are warranted, help others best understand how to support them, and potentially open up access to services. Depending on your child’s age and developmental level, the amount of information you decide to give about the evaluation may vary. Ultimately, this process is about caregivers and children investigating challenges together rather than trying to figure out what is “wrong” with them.

· Instead of using the worst “test” (which may lead to worry about performance) or “game” (which can minimize the importance of the evaluation or confuse them when some aspects of testing are not enjoyable), you may consider using the word “activities.”

· You may decide to ask your child what they are good at and what they struggle with to get a sense of their insight. Using your child’s words when discussing these topics can be extremely helpful to ensure understanding.

Here are some examples of how to explain the evaluation to your child:

You know how _____ is really hard for you? We’re going to meet with someone who is going to help us figure out why that’s so hard for you so we can figure out ways to make that easier. You’ll be doing a lot of different activities with her so she can learn how your brain works!

The other day, you told me that you “zone out” a lot and feel like it’s really tough sitting still. How would you feel about meeting with someone to figure out what’s going on? That way, your teachers and I can make sure you have everything you need to learn the best you can.

This isn’t going to be like a test you take at school, so you don’t have to study for it, and you can’t fail – even if you don’t know the answers to some of the questions. We just want you to try your best!

Why do I need an evaluation with a psychologist when there are free tests online that tell me what diagnosis I should have?

Online quizzes and free-domain self-assessments can provide useful information about what diagnosis may be appropriate for you or your child. For many people, these assessments serve as a valuable first step in helping you to understand what your symptoms may mean. However, online quizzes alone are not considered a valid method for evaluation or diagnosis of a neurodevelopmental or mental health condition. Most schools, workplaces, and prescribers require a trained professional’s comprehensive evaluation to substantiate a suspected diagnosis before they will grant accommodations or write a prescription.

Does Upward perform child custody evaluations or forensic psychological evaluations?

We do not. If you are considering using the results of an evaluation in a child custody dispute or for legal purposes, please consult with providers whose expertise is specifically in these areas.

For Autism and ADHD evaluations in children whose parents or guardians are separated or divorced, please note that all custodial guardians must consent to the evaluation before it can be performed. If one guardian retains sole legal custody of a child, this guardian must provide documentation of this custody assignment in order for the evaluation to proceed. In the case of joint custody, all legal guardians must consent to the evaluation.

After my assessment, will I get a report so that I can get accommodations and/or medication?

Yes. You will receive a lengthy report which details the results of all of the assessments that you have completed as part of your evaluation. This report will describe all assessment instruments used over the course of your evaluation, a description of score ranges, your individual scores, and an analysis of your scores on individual assessments as well as an interpretation of your scores when they are all considered together. The data we collect over the course of your evaluation will allow us to assess your symptoms from several different angles, and your report will tie all of that information in together.

Do you prescribe medication?

We do not. Although medication may be one of the treatment recommendations contained within your report following your evaluation, we do not have a prescriber on our staff. However, we are happy to provide referrals to prescribers as needed.

Do you provide treatment for Autism or ADHD?

We do not currently provide psychotherapy to children younger than 14 years at Upward.

For adults interested in psychotherapeutic treatment for ADHD, we offer Executive Functioning coaching. Adults with ADHD typically struggle with inattention, distractibility, disorganization, planning, working memory deficits, emotion regulation, and difficulty fitting in with peers and colleagues. Executive Functioning coaching offers strategies to help adults navigate these challenges while focusing on individual strengths and building self-esteem. If you are interested in enrolling in Executive Functioning coaching, please click the scheduling button below to request a free consultation call.

How much do assessments cost?

Pediatric evaluations for Autism and ADHD are $825, and adult evaluations for ADHD are $750. Please note that we do not accept health insurance.

Upward is an out-of-network healthcare provider. If you have health insurance, your insurer may provide out-of-network benefits and may reimburse some of the cost of your evaluation. The best way to determine whether you can expect out-of-network reimbursement is to enter your insurance information into Thrizer’s benefits calculator. Upward provides Superbills to help clients file for out-of-network insurance reimbursement. If you so choose, we can bill you through the Thrizer portal which may streamline your reimbursement request to your insurance company.

Payment for evaluation is due upfront when the evaluation is scheduled. If upfront payment presents an obstacle to care for you, you may consider financing your care through CareFund. For clients who qualify, CareFund offers the opportunity to pay for your care in 6 monthly installments rather than upfront. Please ask your Upward provider for more details as needed or click here for more information about CareFund.

Do you offer evaluations through Medicaid?

We do not.

Why is evaluation so expensive? Are shorter or abbreviated evaluations available that are less expensive?

Although Upward has set our rates to be competitive with or lower than others offering evaluations, it is a fact that Autism and ADHD evaluations are expensive. It is reasonable to ask why these evaluations cost so much.

First, the training required to perform these evaluations is extensive, time-consuming, and expensive. Drs. Ramsey and Rathmell invested many years into their training, which allows them the skills necessary to deliver high-quality evaluations to you or your child.

Second, the contact time spent with clients is considerable. You will spend 2-3 hours of time with your Upward provider while they guide you through a number of assessments. Hours of time spent with a specialized provider cost more than a psychotherapy session.

Third, overhead to Upward is high for evaluations. Purchasing and maintaining testing supplies and licenses is an expense that we must factor in when setting our rates for evaluations.

What is the wait time to schedule an evaluation?

Currently, our wait time to schedule an evaluation is a few weeks.

How do I get started?

Your first step is to schedule a free consultation call with Dr. Ramsey (for child evaluations) or Dr. Rathmell (for adult evaluations). Please click the button below to schedule your consultation with the appropriate provider.