Consideration of diagnostic assessments for children
I receive a number of requests each year enquiring about whether I conduct diagnostic assessments for children. Whilst I am able to consider 16 – 18 year olds for diagnostic assessments, I predominantly only assess adults from 18 and upwards.
With regards treatment including psychological therapy, I only work with 18 year olds and above.
If you are considering a child assessment
If however you are considering an assessment for your child, then I’ve included some information below that may be of help:
Children of a younger age would need to be assessed by a multi-disciplinary team (MDT) as indicated in NICE Guidance (National Institute for Clinical Excellence). Typically the initial consideration is to be referred to a Community Paediatrician (for Primary / Junior School age) via your child’s GP, especially for very young children, unless there is a trust specific Autism and / or ADHD Team or the referral may go through the Child and Adolescent Mental Health Team (CAMHS) for children of Secondary School age. There are at times (area dependent) private teams who can conduct such assessments in addition to NHS services depending on what is available in your local area.
Although in the initial assessment process, it may be deemed that both Autism and ADHD are relevant, I have never known any clinicians who will assess both conditions at the same time concurrently as they require different assessment batteries. It is more likely for the focus to be on the most pressing difficulty, then move on to a second assessment if this is indicated. I’d also suggest it’s quite unlikely for anyone to accept an assessment without at least some face-to-face contact, though this has been considered a lot more throughout the COVD-19 lockdown period.
For a formal diagnosis to be achieved, in addition to an MDTs input, there typically needs to be input and forms completed by the child’s school, and typically school observations completed as well (so outside of the home environment). The parent’s views are also taken into consideration, though symptoms of ASD / ADHD need to be present and noted within two or more settings for a diagnosis to be valid.
It is potentially more difficult for an assessment to be carried out if the child doesn’t attend school (perhaps home schooled). The NICE guidance says children need to be observed in two different settings generally. I’d like to think this shouldn’t stop an assessment process if a child is not in school, but I’ve heard stories that suggest it can be very difficult.
As Neurodevelopmental diagnoses such as Autism and / or ADHD are life-long labels, great care must be taken to ensure the right outcome for any child. It is also worth considering the future impact on education and future jobs. I am aware that the Ministry of Defence for example, whilst having become more open to ADHD diagnoses, are still fixed on views that people with Autism (or who have been investigated for this) are not able to join the armed forces.
You may benefit from looking on the NAS website, or the ADDISS website for possible diagnostic services, I would urge parents to be careful that a private company’s procedures are in line with the latest NICE guidance for acceptable diagnostic thresholds so that the outcome is more likely to be formally recognised. If the assessment seems quite reasonably priced, be careful that it is sufficiently comprehensive. A full private assessment for a child with potential Autism is likely to be in excess of £1,500, and could be much more. A lone clinician like myself is NOT able to diagnose a child without the outcome being seriously questioned for it’s integrity. It will likely not be accepted by local authorities.
I’m very aware since I work in the NHS in addition to privately that some NHS diagnoses are more comprehensive than others and I strive to do this with mine to make the outcome as clear as I can.
For more information, please refer to the current NICE Guidance:
https://www.nice.org.uk/guidance/cg128/chapter/Recommendations#referring-children-and-young-people-to-the-autism-team
To access the National Autism Society directory of services where the list of teams that conduct child assessments:
https://www.autism.org.uk/services/autism-services-directory.aspx