By Amy Ford, PsyD, ABSNP
What Changed in Washington in 2026
If you've wondered whether you have ADHD or autism, you may have noticed more therapists offering assessments lately. Psychologists, psychiatrists, and other medical providers have long diagnosed both conditions in Washington. In 2026, the Washington State Department of Health (DOH), the state agency that licenses health care providers, posted a notice about who can diagnose these conditions.
The notice says four types of master's-level providers may now assess and diagnose ADHD and autism:
- Licensed Mental Health Counselors (LMHCs), therapists with a master's degree in counseling
- Licensed Marriage and Family Therapists (LMFTs), therapists trained to work with couples and families
- Licensed Independent Clinical Social Workers (LICSWs), social workers licensed to provide therapy on their own
- Licensed Advanced Social Workers (LASWs), social workers with a master's degree and an advanced Washington license
However, the DOH attached a condition to this change. These providers may diagnose ADHD and autism only when they have the "training, experience, and competence required to meet the standard of care." The standard of care means the level of care a trained, careful provider in that field would give. In other words, a license alone doesn't qualify someone to do these evaluations.
Since the notice went up, many private practice therapists have started advertising ADHD and autism assessments on social media. That gives you more options, but it also means you'll want to choose your provider carefully, because not every provider runs these evaluations the same way.
What the DOH Says a Good Evaluation Includes
The DOH spelled out what meeting the standard of care looks like. A provider who diagnoses ADHD or autism should have:
- Enough education and training to do this kind of evaluation well
- Tests that researchers have studied and proven to work, called validated assessment tools
- A careful check of other conditions that can look similar, called differential diagnosis
- A plan to refer you to a different specialist when your case goes beyond their training
The state didn't create a new training program or exam for this. Each provider decides for themselves whether they're qualified, and the DOH says the legal and professional responsibility stays with them.
The Upsides and Risks of the New Rule for You
Like any change, this one comes with upsides and risks for you. Knowing both can help you decide where to go for an evaluation.
The upsides
- More providers can now offer evaluations. That may mean a shorter wait for an appointment and a lower cost for your evaluation.
- You may be able to get evaluated by a therapist who already knows you. If you're already in therapy, your therapist knows your history and may have noticed patterns to look into.
The risks
- Providers decide for themselves whether they're qualified. The DOH didn't add a required training program or exam, so training in assessment can vary a lot from one provider to the next.
- Some evaluations may rely mostly on a screener. A screener is a short questionnaire about your symptoms, so the result depends almost entirely on how you describe what you're going through. If you report trouble with attention and concentration, you might get an ADHD diagnosis even when anxiety or poor sleep is behind it. That raises the chance of a false positive, meaning a diagnosis you don't actually have.
- A wrong diagnosis can lead to the wrong treatment. You might start ADHD medication, for example, when anxiety is what's holding you back.
Where Your Diagnosis May Not Be Accepted
A diagnosis from a master's-level provider, or from an evaluation that relied on a screener, could run into problems in a few places:
- Washington's Developmental Disabilities Administration (DDA) accepts an autism diagnosis only from certain providers, such as a licensed psychologist or psychiatrist. Master's-level therapists aren't on that list.
- The DOH's own notice warns that some insurance companies have their own rules about which credentials or tests they'll accept for an ADHD or autism diagnosis. Check with your insurer before you book, since a master's-level diagnosis may not meet those rules.
- Most colleges want a written diagnosis from a physician or psychologist before they approve accommodations like extra exam time. That diagnosis also needs to explain how your condition affects your schoolwork, such as reading or taking tests. Each college sets its own rules, but many want documentation from roughly the last three years.
- Employers may ask for a written report that shows how your condition affects your work before they approve accommodations, such as a quieter workspace. A screener-only evaluation may not give you that much detail.
- Your prescriber or primary care doctor may want to know your evaluation ruled out other causes, like anxiety or poor sleep, before starting ADHD medication. A screener-only evaluation would not be able to help provide this information.
If your diagnosis isn’t being accepted in one of these places, you may end up having to pay for a second evaluation.
Why ADHD and Autism Can Be Hard to Sort Out in Adults
A common sign of ADHD is trouble focusing, and a common sign of autism is feeling drained after social time. However, these same signs can also come from other conditions and life changes, including:
- Anxiety or social anxiety
- Depression
- Trauma
- Giftedness
- Perimenopause
- Cognitive decline, meaning changes in memory and thinking
- Poor sleep
A screener can't tell these causes apart, because it only asks whether you have certain symptoms, not why you have them.
A psychologist trained in assessment looks at the bigger picture. They test your thinking skills and memory. They look at your executive functioning, the brain skills that help you plan and manage your time. They also consider your emotional health and what's happening around you at home and at work. Then they sort out what's contributing to what. Sometimes that's ADHD, and sometimes it's anxiety or something else.
To diagnose ADHD or autism, a provider needs to see that your signs started when you were a child. That's why a good evaluation looks back at your early years and gathers input from more than one person who knows you well, such as a parent or partner. They may remember details from your childhood that you don't, or notice patterns you can't see in yourself.
A master's-level provider may skip some of these steps, especially if they rely mostly on a screener. The DOH leaves it to each provider to decide whether they're qualified, so ask how they'll handle each step before you book.
Questions to Ask Before You Book an Evaluation
To make sure you get a thorough evaluation and a diagnosis you can use, ask these questions before you schedule with any provider. The answers will show you how the provider tests and who makes the final call:
- Who will give me the tests, and who makes the final diagnosis?
- Which tests will you use, and have they been studied on adults?
- Will you look at my childhood, and can a parent or someone who knew me as a kid answer questions?
- How will you check whether anxiety or another condition explains what I'm going through?
- Will I get a written report I can share with my doctor or employer?
- Can I use my diagnosis for workplace or school accommodations?
- Will my prescriber or primary care doctor accept your diagnosis?
- What happens if my case needs a different kind of specialist?
A provider who does full evaluations should answer each of these clearly. If you get vague answers, the provider may not know the evaluation process well, so you may want to keep looking.
What an Adult Evaluation at Dayspring Looks Like
At DaySpring, licensed clinical psychologists oversee every adult evaluation. Our assessment team includes licensed psychologists, postdoctoral fellows, and psychometrists. Postdoctoral fellows have finished a doctorate in psychology and are completing supervised training before licensure. Psychometrists are specialists trained to give and score tests.
The licensed psychologist on your case chooses your tests, determines your diagnosis, and approves your final report. Your evaluation takes three appointments:
- An intake appointment of about one hour. You talk about your history and what's bothering you, and you share contacts for people who know you well so your provider can consult with them.
- A testing appointment of 3 to 5 hours. You complete a set of tests your case psychologist chose for your concerns.
- A feedback appointment of about one hour. You go over your results and next steps, and you receive a written report.
You can meet with us in person at our Issaquah or Kirkland office, or by telehealth when it fits your needs. If your results point to ADHD, our medication management team can talk with you about treatment options. If anxiety or another condition explains your symptoms, our counseling team can help you work on it.
Get Answers That Hold Up at Work and With Your Doctor
If you think you may have ADHD or autism, you deserve a diagnosis that holds up wherever you need it. Learn more about adult evaluations at Dayspring, or contact our scheduling team. A member of our team will reach out to talk through your concerns and find a time that works for you.