Assessment & Diagnosis (identification)
Referral
I am happy to see children / young people up to their 18th birthday. If 18th birthday is coming up soon it may be advisable to see an adult specialist.
As well as ADHD, if you are very concerned regarding a mental health problem such as depression or your child has expressed suicidal or self-harm thoughts, then it would be advisable to see a Psychiatrist.
By accepting an appointment to see me, you have agreed that the focus of the consultation will be to decide if ADHD is the cause or contributing factor to your child's difficulties. Formal assessment for any conditions other than ADHD will require a separate appointment.
I apply a child focused and holistic approach to a detailed neurodevelopmental assessment that will consider
family/schooling/lifestyle factors including negative / adverse early life experiences.
medical problems and conditions that can be confused with ADHD
co-existing conditions (co-morbid) such as autism, dyspraxia, dyslexia, sensory processing difficulties as well as learning/emotional/mental health difficulties that if not causing may be contributing to the child's difficulties.
Part of the assessment process involves evaluating how much of a role, if any, these other factors play and attempting to identify and exclude these.
This is vitally important because, although getting a timely diagnosis of ADHD is important, it is also crucial that a child or young person isn’t wrongly diagnosed with ADHD.
As such, an ADHD assessment is not a simple or tick box exercise and should never be diagnosed on the basis of just a behavioural checklist even ones that claim to be validated.
Assessment
1. You will always see me. I follow NICE guidance as a minimum standard. How I work in private practice is how I work in the NHS. My holistic assessment is supported by objective scientific evidence using QbTesting for all children. Read further regarding QbTest LINK.
2. The first appointment is 90 minutes and F2F. I do not offer video consultation for the first appointment.
3. For the first appointment you will need to have completed my detailed parent (PAF) and teacher (TAF) assessment form and have had a QbTest.
4. During the appointment, I will ask lots of questions to clarify your concerns. An important part of the assessment is observing and talking to your child about their life, experiences and difficulties. This is an important part of my assessment and in my opinion best done F2F. This is why I do not offer online assessments. If indicated I will also complete a physical exam. This is important if ADHD medication is to be used.
5. As a large part of your child's day is spent in school, for my assessment, I will always require feedback from your child's teacher/s. Even if you feel the school do not share your concerns, their opinion is still an important part of my holistic approach. School feedback is one of many pieces of the jigsaw I will consider. If school feedback isn’t readily available for the first appointment (has left school or summer holidays) it will still be helpful if you can bring any school reports, learning plans etc. If your child attends out of school clubs / activities/ private tutor etc then it can be very helpful to get their feedback on your child’s behaviours.
6. Also, please bring any letters or reports from any therapists (e.g speech) or specialists your child has seen in the past. I like to have as much information as possible to get a full and holistic picture of your child's health and neurodevelopmental profile.
Diagnosis
1. Depending on evidence gathered and complexity, I aim to give my opinion on diagnosis i.e., does your child have ADHD or not, at the first appointment.
2. However, in some cases, if your child's difficulties are complex or the evidence collected is mixed or not strong ( e.g., child presents very differently at home and school) then further information / evidence will be needed. This may include arranging school observations (via a very experienced neurodevelopmental advanced nurse practitioner ANP that I work with) or I may recommend your child has other assessments before deciding regarding ADHD e.g., by psychology, psychiatry, speech/language therapist and occupational therapist.
3. It is important to note there are guidelines regarding how and when we can make a formal ADHD diagnosis. ADHD and how it presents can change over time but at any one time the behaviours or traits may not be ‘frequent or severe’ enough for a formal diagnosis. I understand how this can be frustrating. In these situations and in my report I do give an opinion on whether ADHD is likely or not and focus on ensuring your child receives the right support based on need, rather than waiting for a formal diagnosis, if there is one.
4. Otherwise, once assessment is completed and within 24 hours I will email a brief Diagnosis Confirmation letter which can be shared with school. This will allow you to quickly start discussions with school regarding extra support. Then, within 21 days, you will also receive a full detailed report outlining my findings/opinion/recommendations for parent/child/teacher. I will send a copy to your GP. The cost of this summary clinical report is included in your appointment fee. I keep this report brief and to the point, to minimise overall cost to you. One or two queries regarding the report I am more than happy to discuss via email, otherwise may require a further appointment (F2F or Video).
Support, Therapy, Treatment including Medication
1. Through a holistic approach, I view each patient as a whole rather than a single symptom to be treated.
2. I will discuss support/therapy options at the first or second appointment.
3. Not all children with ADHD require medication. If medication is the right choice for your child then it is important to note that medication is more likely to be effective if part of a multi-modal psycho-educational approach with school and home-based ADHD specific support and behavioural strategies. I will discuss some of these strategies during the first few appointments but for more detailed practical support I would recommend discussion with the school SENCO and the ADHD Foundation.
4. Further reading regarding ADHD Psychoeducation and Support / Training for Parents and Others: LINK1 LINK2 LINK3
5. Further information regarding Medication Titration
Other Neurodevelopmental Assessments
1. For autism, I can certainly do an assessment/autism screen and advice on whether it is likely but for a formal diagnosis this usually requires a team approach using standardised autism diagnostic tools. A young person may have autism and ADHD together. For appointment and likely costs please contact me.
2. For 'motor dyspraxia' (Developmental Coordination Disorder) I recommend an initial assessment by a Paediatric Occupational Therapist followed by a medical assessment by a Paediatrician. If the former is done then please contact me regarding likely costs.
3. For sensory processing difficulties ( I do not use the term disorder) you will need an assessment by a specialist paediatric occupational therapist.
4. General concerns regarding development and behaviour