February 3, 2025

For many families, seeking a psychological evaluation for their child is an important step toward getting the right support, whether for ADHD, autism, or learning challenges. Unfortunately, a growing crisis in mental health services has led to extremely long waitlists for these crucial assessments, particularly at large hospital-based clinics.

In many cases, families are left waiting six months to two years for an evaluation—an agonizing delay when early intervention is key. During this time, children may continue struggling in school, at home, and socially, without the accommodations or interventions they desperately need.

So, what are the pros and cons of waiting for a hospital-based evaluation? What are the potential consequences of delaying testing? And most importantly, are there faster alternatives to getting answers?

The Reality of Long Waitlists

Large hospital systems and academic medical centers are often the first places parents turn when they suspect their child has ADHD, autism, or a learning disability. These institutions are trusted, well-known, and may even be recommended by pediatricians, teachers, or school psychologists.

However, due to high demand, a shortage of specialists, and systemic inefficiencies, these clinics often have waitlists that extend well beyond a year—and in some cases, beyond two years for a full neurodevelopmental evaluation.

Why Are the Waitlists So Long?

Several factors contribute to these excessive delays:

  • Increased Awareness & Demand – More parents, educators, and medical professionals recognize the importance of early diagnosis, leading to a surge in referrals for evaluations.
  • Limited Number of Specialists – There simply aren’t enough clinical psychologists, neuropsychologists, and developmental specialists to meet the demand.
  • Systemic Inefficiencies – Large institutions often have cumbersome scheduling systems, bureaucratic processes, and insurance requirements that slow things down.
  • Multi-Step Processes – Some hospital-based evaluations require separate appointments with multiple specialists, which extends the overall timeline.
  • COVID-19 Backlog – The pandemic caused massive disruptions in healthcare services, creating a backlog that many clinics are still struggling to clear.

While waiting, parents are left in limbo, unable to get a diagnosis or access the necessary accommodations at school, therapy, or medication options.

So, is it worth sticking it out on a long waitlist, or are there better alternatives?

The Pros and Cons of Waiting for a Large Hospital-Based Evaluation

Potential Benefits of Waiting

While long waitlists are frustrating, some families feel that waiting for a hospital-based evaluation is worth it. Here’s why:

1. Access to Multidisciplinary Teams

One advantage of hospital-based clinics is their access to teams of specialists who can collaborate on complex cases. These teams may include:

  • Clinical psychologists & neuropsychologists (for cognitive and emotional assessments)
  • Speech-language pathologists (for communication and language concerns)
  • Occupational therapists (for sensory and motor issues)
  • Developmental pediatricians (for medical and genetic evaluations)

For children with severe medical conditions, such as those with suspected seizure disorders, genetic syndromes, or complex medical histories, a hospital-based evaluation may be beneficial because they can coordinate medical tests (like EEGs or MRIs) alongside psychological testing.

2. Specialized Research-Based Clinics

Some hospital-based programs participate in ongoing clinical research, which may give families access to experimental treatments, clinical trials, or research-driven interventions that aren’t yet widely available. These programs are typically focused on specific diagnoses or rare conditions, meaning they may not be the best fit for children with more common concerns like ADHD or general learning difficulties.

3. Connections to Hospital-Based Services

If a child receives a diagnosis through a hospital system, they may have easier access to hospital-affiliated therapy programs, medication management, and intervention services. This can be particularly useful for families who plan to pursue ongoing treatment within the same system.

3. Connections to Hospital-Based Services

If a child receives a diagnosis through a hospital system, they may have easier access to hospital-affiliated therapy programs, medication management, and intervention services. This can be particularly useful for families who plan to pursue ongoing treatment within the same system.

The Downsides of Long Waitlists

Despite these advantages, waiting for an extended period without a diagnosis comes with significant risks.

1. Critical Delays in Intervention

The earlier a child receives support, the better the outcomes. Studies show that early intervention is key for children with:

  • ADHD – Untreated attention and executive functioning challenges can lead to academic struggles, frustration, and low self-esteem.
  • Autism – Without early intervention, children may miss out on critical social, communication, and behavioral supports.
  • Learning Disabilities – A lack of proper accommodations can cause children to fall further behind in school, making it harder to catch up later.

Without a diagnosis, many schools won’t offer accommodations, leaving kids without the tools they need to succeed.

2. Increased Family Stress

The waiting period can be extremely stressful for families. Parents often feel helpless watching their child struggle but are unable to take action without a formal evaluation. This can lead to:

  • Emotional exhaustion
  • Increased conflict at home
  • Anxiety about the future

Additionally, navigating insurance approvals, school requests, and medical referrals during this time can feel overwhelming.

3. Potential Worsening of Symptoms

Children who struggle without support may develop secondary issues, such as:

  • Anxiety & Depression – Feeling “different” without understanding why can lead to mental health struggles.
  • Behavioral Problems – Frustration from unrecognized challenges can lead to acting out at home or school.
  • Low Self-Esteem – Repeated failures or negative feedback can damage confidence and motivation.

These secondary issues often persist even after a child finally gets a diagnosis, making treatment even more complicated.

4. Rigid Evaluation Processes

While hospital-based evaluations are often high-quality, they may not always be flexible or individualized. Some programs follow strict protocols and do not allow parents to tailor the evaluation to their specific concerns.

For example, some hospital clinics only diagnose autism but won’t assess for ADHD or learning disabilities in the same evaluation, requiring separate waitlists for each concern.

Are There Alternatives to the Long Waitlists?

Yes! Many private practices and independent psychological testing providers  offer high-quality, comprehensive evaluations without the extended wait times.

The Benefits of Private Psychological Testing:

✅ Faster Access to Answers – Many private practices can complete an evaluation within weeks rather than months or years.

✅ Personalized & Flexible Testing – Independent psychologists can customize assessments based on the child’s unique concerns rather than following a one-size-fits-all model.

✅ Immediate School & Treatment Planning – A quicker diagnosis means that schools, therapists, and doctors can act sooner, getting a child the support they need when they need it.

✅ More Availability for Follow-Up – Some hospital-based clinics provide assessments but offer limited follow-up guidance, whereas private providers can be more accessible for ongoing questions and recommendations.

The Bottom Line

If your child is facing significant challenges and you’re stuck on a months- or years-long waitlist, it’s worth considering other options. While hospital-based evaluations have their place—especially for complex, multidisciplinary cases—the reality is that most children don’t need to wait that long to receive high-quality psychological testing.

Seeking a private evaluation can mean the difference between waiting years for answers or getting the support your child needs now. If you’re concerned about your child’s development, exploring alternatives may be the best step forward.

—Dr. David Butman, Psy.D. is a licensed clinical psychologist and founder of Keystone Psychological Testing & Consulting, a private assessment practice in Doylestown, PA. He specializes in the assessment of ADHD, Autism, learning difficulties, emotional and behavioral challenges, executive functioning, attention, and giftedness.