This post is based on a real conversation we had with a mother during the early days of building NVOX. She sounded exhausted but determined.
“I have a smart, sensitive, incredibly curious kid,” she told us. “But lately, something just hasn’t felt right. At home he’s quick to explode over the smallest things, can’t calm down, forgets stuff, and has a hard time starting his homework. At school, they keep telling me he’s not focused and always daydreaming.”
She said she spent months going back and forth, wondering if it was just a phase or something more serious. Eventually, she booked an appointment with her pediatrician. The visit lasted maybe 15 minutes. He asked a few general questions about school, about his behavior at home and then looked at her and said, “Sounds like ADHD.” No questionnaires, no tests, no observation. He didn’t ask to speak with the teacher or meet the child. He gave a diagnosis on the spot and suggested starting medication.
“I was shocked,” she said. “On one hand, I was relieved someone was finally listening. But it also felt way too fast. Like we went from question to prescription without really understanding what was going on.”
A few days later, she approached the school counselor and asked about accommodations. “I thought that if we had a diagnosis from a doctor, that would be enough. It’s in his medical file, and we were already considering medication.”
But the counselor gently looked over the document and said, “It’s great that you have a medical diagnosis, that’s important, especially if you’re considering treatment. But in order for us to provide accommodations at school, things like extended time, modified exams, or learning support – we need a comprehensive evaluation. One that’s done by a licensed psychologist or educational diagnostician, including testing and a clear picture of how he functions in a learning environment.”
“I didn’t understand how that wasn’t enough,” she told us. “A family doctor isn’t just anyone, and he clearly said it’s ADHD. But then I found out it simply doesn’t meet the school’s criteria.”
She tried looking into her options. She contacted a few private evaluation centers in the San Francisco area, and every quote started at $2,000 and went well over $5,000. When she called the school district to ask about getting tested through the public system, they told her the wait time could be over a year.
“He’s my kid,” she said. “I can’t just sit around and wait. He’s already struggling now. Every day without support just makes things harder.”
She was one of the many parents we interviewed in the early stages of developing our system. We spoke with dozens of families from different backgrounds and regions to understand what the real journey looks like – from the first signs of concern to the moment a child actually gets the help they need.
Her story repeated itself again and again. Suspicion builds. A quick medical diagnosis. And then – a wall.Instead of support, bureaucracy. Instead of answers, delays. Instead of accommodations, unaffordable requirements.
So what’s the actual difference?
Many parents ask the same question:
Why can a family doctor, psychiatrist, or even a neurologist diagnose ADHD, but that’s not enough for schools, universities, or professional exams like the SAT, LSAT, MCAT, or Bar exams? The answer lies in the purpose of the evaluation and the type of report that’s generated.
- A quick medical diagnosis (pediatrician, psychiatrist, or neurologist)
This type of evaluation is intended purely for medical purposes, like starting medication or referring to therapy.
It typically includes:
- A conversation with the parent (and sometimes the child)
- A basic medical history review
- General clinical impression
If the doctor feels there’s a clear pattern, they may diagnose ADHD in just one or two short visits.
There are no cognitive tests, no academic assessments, and no age-norm comparisons.
This is a valid medical diagnosis, but in most cases, it’s not sufficient for receiving educational accommodations.
- A psychoeducational or neuropsychological evaluation
This is a comprehensive assessment focused on how the condition impacts learning and school performance.
A comprehensive ADHD evaluation, especially one designed for use in academic or professional settings, typically includes several key components, even when delivered online or remotely:
Cognitive testing – Structured attention tasks, such as Distractor-based Continuous Performance Tests (d-CPT), are commonly used to assess impulsivity, sustained attention, and response inhibition. These tasks often include both visual and auditory distractors designed to mimic real-world conditions, making it easier to detect attention difficulties that might not surface in more controlled or distraction-free environments.
Basic academic skill screening – While full academic testing may not always be included, short reading assessments that focus on fluency and decoding accuracy are commonly used to identify reading-related challenges. (Note: reading comprehension is not always evaluated.)
Parent and teacher questionnaires – Standardized behavior rating forms are typically completed by both parents and teachers to help capture how symptoms present across different settings, such as home and school. This multi-informant approach provides a more comprehensive view of the child’s daily functioning.
Behavioral and emotional indicators – In addition to cognitive tasks and questionnaires, some modern evaluations incorporate passive voice analysis, monitoring tone, rhythm, and speech patterns during the assessment. These subtle vocal cues can offer insight into potential emotional states — such as anxiety or frustration — especially when considered alongside performance data.
Summary and diagnostic impressions – A final report is prepared by a licensed psychologist or educational diagnostician. It typically includes a clear diagnostic conclusion (if appropriate), an explanation of how the observed symptoms affect learning or daily functioning, and recommendations that may support eligibility for accommodations such as extended time, reduced-distraction settings, or periodic breaks during exams.
This is the type of evaluation schools, universities, and testing boards require for 504 Plans, IEPs, and exam accommodations
What about cost?
Here’s where the challenge becomes more serious:
- A medical diagnosis through a doctor is usually covered by insurance (e.g. HMO), or may cost a few hundred dollars
- A full psychoeducational or neuropsychological evaluation:
- In the San Francisco area, ranges between $2,000 and $5,000
- In other parts of the U.S., costs may be slightly lower, but still significant
And just as important – getting evaluated through the public school system can take many months, often up to three years. In the meantime, the child is left without proper support.
Bottom line
If you already have a diagnosis from a doctor, that’s a great first step. It may help with treatment and open the door for conversations at school. But when it comes to official documentation for learning accommodations, most schools and institutions require a comprehensive evaluation conducted by a qualified psychologist.
We know how frustrating this is. The costs are high. The wait times can stretch into years. And the system isn’t always easy to navigate. But within this mess, understanding the difference between the types of evaluations can give you the clarity and confidence to advocate for what your child really needs.
That’s exactly why we created NVOX. Not just as a product, but as a mission. We believe every child deserves access to a serious, thoughtful evaluation – without waiting years or breaking the bank. This is personal for us, and we’re here to change the system from the inside out.
A quick note: In some cases, especially in more flexible schools or districts, a medical diagnosis may be enough for basic classroom adjustments. But when it comes to formal accommodations under a 504 Plan, IEP, or for high-stakes exams, most institutions still require a comprehensive evaluation by a licensed psychologist.
