This is a VERY common question in the therapeutic fields of mental health counseling, clinical social work, marriage and family therapy.

It is asked FREQUENTLY in Therapist Facebook groups, Reddit posts and Quora indicating a HIGH degree of uncertainty and misinformation.

The answers people often receive to this question fall into two camps:

PROFESSIONAL / POLITICAL Opinion  OR “Check with your State Laws and Licensing Board.”

Reese Ramponi and I set out to answer this question for folks who attend our course on Neurodiversity Affirming ADHD Evaluation. While it is ultimately the responsibility of EVERY therapist to know their scope of practice and the general restrictions via their state laws and licensing board regulations, the truth was that tons of clinicians reached out to us and DIDN’T know.

These were folks who had done their own research and couldn’t find a conclusive answer!

So it became clear that we needed to provide that research and our best guess at the answer for students attending our course. Because, as a snarky internet comment demonstrates in the image below:

“Why would I pay $500 to attend a course *to learn* if I’m ALLOWED to evaluate / diagnose ADHD?”

What a WILD thing.

Dozens of therapists with a multitude of licenses and higher education degrees don’t know if they can support their clients in exploring and/or receiving a diagnosis as described in the DSM.

The DSM-V-TR is the foundational text (while deeply problematic/colonialist/supremacist) at the center of most mental health related education and work. So why don’t therapists know the answer?

I initially set a goal to gather research primarily on the State Law and Statute which ultimately dictates what Licensing Boards can do/regulate.

SO…

• • What is regulated regarding diagnosis in general?
  • What is LEGAL and ethical within our defined scope of practice as advised by our governmental bodies and regulatory boards?
    AND
  • Are there any specific restrictions on Diagnosis (RE: ADHD & Autism), Scope of Practice and testing, assessment or evaluation?

The process of attempting to answer these questions surprised me. It helped me understand why so many therapists are confused.

These are WILDLY difficult questions to answer.

For each state and each licensing board, this required an independent search (via Google and other search engines) and combing through a wide variety of sources, from individual opinions (blogs run by therapists or group practices), to professional associations claiming (without reference or citation) the scope of their members.

I decided my search needed parameters. I only wanted to include what I could reference as legal fact. So the source had to come from a Government publication or Government managed website. And with this as a requirement/parameter, the research only got more complex.

Governments are not known for tidy, accessible websites.

Many state governments link PDFs rather than maintain a complex directory and occasionally the PDF Hyperlink is inaccurate or outdated. Often, you sort through pages upon pages of referendums, meeting notes and complex legal jargon, to find the law, statute or administrative code which actually describes what it means to “Practice Mental Health Counseling” OR “Practice Clinical Social Work”.

Once you’ve found the correct Law, Statute or Code which describes the state & boards *current* definition of practice within the field you’re investigating, it goes one of two ways.

It either says and describes what it means to Diagnose. OR it doesn’t. In scenario one, I usually sigh a big sigh of relief. I grab the information & enter it, grateful that in recent history some lobbying body and/or professional board used dollars to insist that Diagnosis or Diagnostic Privilege is a protected part of a therapist’s job.

Amazing! System Level Change Happened and I can see the benefit!

In scenario two, where the Law, Statute or Code does not utilize the word “Diagnose” or “Diagnosis”… it often occurs to me that I have, in my relatively new but prolific teaching career, ALREADY encountered a therapist with that license, from that state, for whom’s STATE JOB involves assessing and diagnosing clients. SO…. The specific action of “diagnosing” isn’t an officially legally protected part of their scope of practice. HOWEVER the government is paying them money to do it.

What does this mean? CAN that person diagnose or not? The best answer I have is *PROBABLY* (since it IS happening in practice and it is often being offered by the government and/or governmentally funded community mental health agencies). I then look for any legal evidence that may indicate this as within a therapist’s scope of practice, even with the omission of the word Diagnose.

Often times, what I’ve found is that for whatever reason (maybe no lobbying group took on the challenge of changing the law), while the word has been omitted from the definition of the practice, the word diagnose/diagnosis IS in the requirements for education and/or post-masters supervision. Meaning that clinicians MUST learn about and be trained in the action. Implying that it is a part of their scope, even if it isn’t defined. Other times, some states will utilize words and phrases like:

“Utilize Counseling interventions and psychotherapeutic techniques to identify and remediate”.

Essentially describing diagnosis without using the word. In these states, I can’t help but wonder what political toes the counseling, social work or MFT boards & lobbying groups are worried about stepping on. Sometimes Masters Level Licensing Boards / Associations are fighting each other! (SEE New York LMHC’s vs. Social Work).

To summarize, finding and interpreting ALL of this information is deeply INACCESSIBLE.

One of the CORE values of NeuroAbundant and the education we hope to offer is Accessibility. Masters Level Therapists (of all different fields) need an easier way to understand their own scope of practice. Especially if they are hoping to fill a MASSIVE gap in needed mental health support in this country. That gap includes access to accurate, ethical and neurodiversity affirming Assessment, Evaluation and Diagnosis of ADHD & Autism for individuals who seek that support.

That is the aim of my independent research presented as an interactive map. This research has been conducted without pay and with our professional bias/opinion expressed transparently. But let’s break those down so that it is ‘Abundantly’ clear.

NeuroAbundant values accessibility on all levels

• We want it to be easier for therapists to understand their profession, professional role, scope of practice and competence.
• We want to increase access for clients who desire necessary and often life-changing information regarding their neurotype.
• We want it to be easier for people in general to understand both the possible benefits and potential harm of an official clinical diagnosis of their own identity & experiences.

Common Misconceptions

I can’t diagnose ADHD/Autism because it’s in the Neurodevelopmental Disorder section of the DSM.

Please let me know if you come across a board rule that explicity prohibits this!

ADHD and Autism REQUIRE Full Neurosychological Testing to diagnose.

Again, PLEASE point me to a law, code, statute or board  which states this is a requirement.

• Lots of emerging research and “Best Practices” indicate that for ADHD at least, a clinical interview (in combination with ruling out alternative mental health causes/explainations) is the best method for determining whether ADHD is an accurate diagnosis.
• Many times, an ethical and lawful evaluation offered by a masters level clinican with LIVED EXPERIENCE is going to be more accurate and neurodiversity affriming than an evaluation done by a neurotypical or Allistic/Non-ADHD psychologist.

Okay, so I technically *can* Diagnose ADHD/Autism. Will my Diagnosis “Count”?

Can I put this diagnosis in the chart and be reimbursed for a 90791?
Does my diagnosis ‘count’ as an official diagnosis in the eyes of the client?
Will the client be able to get school or work accommodations based on my diagnosis?
Will the client be able to access ADHD medication based on my diagnosis?
How can I write-up my findings in such a way that other professionals in other fields take my work seriously?

THESE are the questions we explore in our Neurodiversity Affirming ADHD Evaluation Course!

We offer this course every few months and should have an on demand offering option available PLUS an expanded ADHD/Autism Evaluation class available in 2025!

Learn more HERE: http://www.neuroabundant.com/courses