National Guidance
The NHS follow a guidance called NICE – National Institute of Health and Care Excellence when assessing for conditions such as Autism and ADHD (Attention Deficit Hyperactivity Disorder). NICE is an executive non-departmental public body, sponsored by the Department of Health and Social Care. This alongside the DSM-5; The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, supports clinicians and researchers define and classify mental disorders, which can improve diagnoses, treatment, and research.
All private clinics should also follow the NICE guidance when carrying out assessments. It is at the parents discretion to ascertain whether the clinic they are attending are following this guidance.
Why is this so important?
If you want your child’s diagnosis and report recognised in the NHS, it must follow NICE guidance. The NHS team will look at the report and decide whether they are going to accept it, or not. They will look at who has carried out the assessment (are they appropriately qualified) and whether or not NICE guidance was followed.
Failure to follow NICE guidance, may mean that first and foremost your child’s assessment may be inaccurate. ADHD and Autism are lifelong conditions and it is fundamental to your child that these assessments have been carried out appropriately and in line with processes. It may also mean that if your child’s report is not accepted in the NHS, you may have to fund a second assessment elsewhere, or wait for another NHS assessment in order to receive treatment.
We appreciate that when paying for a private assessment it can be very difficult for families to know whether or not the assessment they are funding meets NICE guidance. The NICE guidance is available for the public and all parents can access this.
At The Children’s Wellness Centre we strictly follow NICE guidance, and have been told by many NHS professionals that we go above and beyond to ensure this. We are sharing the NICE guidance on this page, for ease, for families to understand further.
ADHD Assessments
The full NICE guidance document can be accessed here. Please review this if you are considering a private ADHD assessment for your child. Equipping yourself with this knowledge, means you can then be certain that the clinic you are choosing to book with is following this
In line with NICE guidance, we carry out the following processes in all of our ADHD assessments:
- Full Clinical Assessment (face to face)
- Developmental and Family History
- Mental Health Assessment
- Formal ‘Conners’ Rating Scales (home and school)
- School Interviews
- School Observation
For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:
- Cause at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings and
- Be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings
This is why (unless a child does not attend a school) we carry out school observations and teacher interviews for every single assessment we do, in order to meet the above criteria from NICE. This is imperative, not only for best practice, but to ensure we have in-person school observations of a child who may have developed the skill of ‘masking‘ at school. i.e., suppressing or changing ADHD traits and behaviors at school in order to blend in with neurotypical peers, or just to get by in a neurotypical world.
For any child that does not attend school, in order to ensure we have sufficient evidence, we use a computerised QbCheck in place of this.
Autism Assessments
The full guidance document can be accessed here. Please review this if you are considering a private Autism assessment for your child. Equipping yourself with this knowledge, means you can then be certain that the clinic you are choosing to book with is following this.
An Autism assessment is a complex assessment, and in line with NICE, MUST be carried out by a multidisciplinary team (known as an MDT).
NICE guidance is quoted below.
In each area a multidisciplinary group (the autism team) should be set up. The core membership should include a:
- Paediatrician and/or child and adolescent psychiatrist
- Speech and language therapist
- Psychologist with training and experience in working with autistic children and young people.
In every single Autism assessment at The Children’s Wellness Centre, we have 3 clinicians on the team; a Clinical Psychologist, a specialised Speech and Language Therapist and a Paediatrician.
Include in every autism diagnostic assessment:
- Detailed questions about parent's or carer's concerns and, if appropriate, the child's or young person's concerns
- Details of the child's or young person's experiences of home life, education and social care
- A developmental history, focusing on developmental and behavioural features consistent with ICD-11 or DSM-5 criteria (consider using an autism-specific tool to gather this information)
- Assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours, focusing on features consistent with ICD-11 or DSM-5 criteria (consider using an autism-specific tool to gather this information)
- A medical history, including prenatal, perinatal and family history, and past and current health conditions
- A physical examination
- Consideration of the differential diagnosis (see recommendation 1.5.7)
We follow all of the above guidance in every Autism Assessment, and our assessment is a lengthy process, involving 4 appointments and home and school formal screening, using autism-assessment tools. We do not diagnose Autism in a day.
Please note, in accordance with the quoted guidance ‘consideration of the differential diagnosis’ this explains further why we carry out a Step 1 Mental Health Assessment in all our Autism assessments. This is an additional meeting with child and Psychologist to determine this, rather than just carrying out the ADOS and ADI-R as a stand alone assessment. This is a fundamental part of the Autism assessment, to ensure that there is not another difficulty present that better explains the behaviours. An ADOS and an ADI-R (parent interview, without the child present) alone, cannot determine this.
Please note, in accordance with the quoted guidance ‘include in every Autism diagnostic assessment a physical examination’ this explains further why we have a paediatrician involved in all of our assessments (in addition to the NICE guidance on who must be in a core Autism assessment team).
Please note, in accordance with the quoted guidance, Autism must never be diagnosed by one tool alone; for example, the ADOS alone must never singly diagnose Autism.
Do not rely on any autism-specific diagnostic tool alone to diagnose autism
We hope by understanding they have public access to the NICE guidance, and the quotes we have shared, families can feel more equipped in understanding the assessment process and knowing what must be included, for best practice, in every ADHD and Autism assessment, in the best interests of their child. Having a diagnosis of ADHD or Autism will remain with your child for life; the assessment process is therefore fundamental to ensure this is an accurate diagnosis.
Having a diagnosis of ADHD or Autism will remain with your child for life; the assessment process is therefore fundamental to ensure this is an accurate diagnosis.
For more information on our ADHD & Autism processes please click below: