Attention Deficit conditions, including ADHD, are developmental disorders; it’s believed that they can’t develop in adults without first appearing during childhood. ADHD is the UK’s most common behavioural disorder affecting 2-5% of school children and young people.
In order to be appropriately diagnosed, signs and symptoms must start before the age of 7 and are primarily characterized by inattention, distractibility, and impulsiveness. The Healthcare On Demand team will normally assess children from the age of 5 years old. That’s because many pre-school children have some ADHD symptoms in various situations. In addition, children change very rapidly during the pre-school years
There are strict criteria that need to be fulfilled before a diagnosis of ADHD can be made. The National Institute of Health and Care Excellence (NICE) has published guidelines on diagnosis and treatment of ADHD for the NHS.
There is no single test for ADHD; a specialist doctor can diagnose ADHD with the help of standard guideline and initial screening can be carried out by a psychologist using a range of well recognised tools and approaches.
The screening and diagnosis of Attention Deficit conditions such as ADHD requires several steps and involves gathering a lot of information from multiple sources. You, your child, your child’s school, and other carers should be involved in assessing your child’s behaviour.
Options for Attention Deficit Assessment – Specifically for Children and Young People
Healthcare on Demand is committed to ensuring that individuals and families do not pay for services that they do not need, or that they could access freely from the NHS. Following the preliminary screening, clinician recommendations can be provided via the Clinic Coordinator. Therefore, you will receive appropriate guidance on the correct next steps for you.
Step 1: Preliminary Screening
If you are not sure what your child’s difficulties may be, or even whether an attention deficit/ADHD assessment is indicated, you may request a preliminary screening step, at a modest cost, before deciding whether to proceed with a full assessment.
We accept referrals from GPs, other healthcare professionals, also parents and families may self-refer, as wished. Our preference is always to work in close collaboration with GPs and others, as this is the best practice, and is the approach most likely to ensure you get optimal care, particularly if a positive diagnosis is made, and treatment with prescribed medicines is recommended, you may well need your GP’s co-operation in order to access ongoing prescriptions.
Therefore, please consider seeking a referral from your GP to the HoD clinic, if at all possible.
It is in your best interests to do so, however we will not turn you away if this is not possible, for whatever reason. The practitioner(s) you consult may well seek your consent to keeping your GP informed of any diagnoses or treatment being undertaken, whether you enter the service via a GP or self referral.
Immediately Prior to, and During the Assessment
Information is gathered from parents and/or carers and others who know the child using a range of standard clinical tools/questionnaires, and information is elicited from the school where appropriate.
Some forms will need to be completed and returned to the Clinic Coordinator prior to the appointment.
The psychologist will review the material provided and invite you to attend a face-to-face consultation. This may include using some other assessment tools, not already sent out before the meeting.
The whole range of measures used to screen, both before and during the screening appointment with input from the parents and the school is likely to include:
- Parental questionnaire including an abbreviated Developmental History Questionnaire
- SDQ (Strengths and Difficulties Questionnaire, age specific version)
- SNAP-IV (Swanson, Nolan and Pelham Questionnaire), including the SKAMP (Swanson, Kotkin, Agler, M-Flynn and Pelham Scale)
- We will request a paragraph from school re difficulties seen in the school setting, normally written by class teacher
What Happens During the Step 1 Consultation
The teacher who knows the child best completes all the forms before the appointment and sends them back to us by post or email (the appointment confirmation is conditional on its receipt)
- The consultation will include a discussion on the difficulties that make you or your child think an attention deficit condition may be present, including anything in the history that may be significant. The family history may also be thought to be relevant, as will your education, medical and social history and information provided by the school/other educational environment.
- The Psychologist will have a general discussion with you as a parent, and the child, in an age appropriate way. He/she will summarise the nature and range of difficulties experienced.
- The questionnaires will also be reviewed or administered, as appropriate and can be scored during the consultation to give you a preliminary indication of potential findings.
- After the session, the Psychologist will write up the report, including all items addressed plus the formal SDQ, SNAP-IV and SKAMP results, and will give recommendations as to whether you should consider progressing to a full Attention Deficit Dignostic Assessment.
The cost for Option 1 – Screening Consultation for children/adolescents, including written report provision is £250.
It is important to note that the screening step provides important indicators for your consideration, but it is not in itself the full diagnostic process. It gives you an indication of whether it is likely that you may meet the thresholds for diagnosis. You need to progress to Step 2 – if appropriate and wished – to establish a full, positive diagnosis.
It is in Step 2, a longer, more detailed and complex set of assessments with a specialist doctor that the firm diagnosis is established, and further recommendations on treatment and other forms of support can be made.
Please note, if you do go on to Step 2, this is may well require the completion of further forms by you and your child’s school, in order to gain the optimum insights and a solid basis for a diagnostic decision.
Step 2: Medical Diagnostic Review
If you have undertaken the screening process, and have been advised, or decided independently that you wish to proceed with a full assessment for a potential Attention Deficit Condition, the process is as shown below:
What Happens During a full Diagnostic Assessment?
A full Attention Deficit(ADD)/ADHD assessment is made up of several elements including:
Clinical examination aims to identify the presence of other illnesses with symptoms that overlap with those of ADHD.
- This typically involves inspections for vision or hearing impairments, neurodevelopmental immaturity in relation to gross and fine motor functions and motor or vocal tics, and retardation
- A general examination of patient’s physical health may also be performed to highlight any evidence of a congenital disorder
- Clinicians may also look for evidence of comorbidities which are often found in patients with ADHD.
A healthcare professional will interview the person with suspected ADHD along with any relevant family members or carers and draw on input from teachers and others to ascertain:
- Perceptions of the child with suspected ADHD about their own symptoms, behaviour, functioning, self-esteem or emotions
- Observations of symptoms/behaviours in different settings
- Developmental, medical and psychiatric history
- Associated family functional difficulties/issues
- Presence of any comorbidities
- Patterns of ADHD or related comorbidities present in the family.
This will usually have been established in the Stpe 1 process.
Additional questionnarires/ assessment in the Medical Diagnostic step may include:
- Child Behaviour Checklist (CBCL), which is for children ages 6 to 18
- Conners-Wells’ Adolescent Self-Report Scale, which is for teenagers
- National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, which is for children ages 6 to 12
- Conners Comprehensive Behaviour Rating Scale (CBRS), which is for children ages 6 to 18
Therefore, even if you have already been through Step 1, please be prepared to complete further questionnaires for this next set of diagnostic investigations. This may be requested of you and your child’s school.
Behavioural observations may be useful to confirm symptoms reported in interview.
In children and adolescents, teachers in particular may be especially well placed to identify symptoms of ADHD in children and support symptom reports from parents.
- Reports from teachers are recognised as one of the optimal sources of information related to problems with behaviour or developmental/social functioning in children and adolescents, with standardised questionnaires considered a useful tool to obtain such information
- Classroom observations by an educational psychologist may also be useful for diagnosing children and adolescents where warranted and if feasible
All assessments culminate in the production of a detailed report, outlining the information gathered and explaining the conclusions that have been drawn. Where possible, alternative explanations for a person’s difficulties will be provided where an Attention Deficit Condition is not identified.
The final report will also contain recommendations for home and education environments where appropriate.
How Do I Book an Assessment?
You request an appointment directly with the practitioners you would like to consult.
You can choose from the Consultant Child and Adolescent Psychiatrists who provide the Attention Deficit assessments:
The cost of this “Step 2” element, (i.e. when Step 1 has already been carried out) is £450, takes 90 minutes and includes the first prescription, where applicable..
Additional controlled drug prescriptions are chargeable at £15 per prescription.
Just click on the clinicians’ names to be taken to their profile pages, where you can see their qualifications, experience,and can even book an appointment by clicking on the Request an Appointment button (the green button below the individual practitioner’s photograph).
The practitioner will then contact you to discuss any questions you may have, prior to the assessment consultation.
What Happens After the Assessment?
A detailed report will be prepared summarising the child’s developmental history and describing their current presentation in each of the key areas important in Attention Deficit states, along with the diagnostic conclusion and any recommendations for treatment/management and further assessment.
For some children and young people, with a more complex presentation, additional assessments may be recommended.
This may include optional additional assessments, at additional cost, of:
For some individuals, a cognitive assessment may be helpful.
The assessment typically consists of a series of tasks designed to establish a person’s level of ability in certain key areas including working memory, speed of mental processing, visuo-spatial skills and the understanding and use of language. These assessments are ‘standardised’ – they have been developed through extensive research and allow the examiner to compare a person’s scores against the average that would be expected for their age group.
These assessments are used to help establish whether underlying difficulties in one or more key area of cognitive functioning could be influencing a person’s difficulties in everyday life. They can also be used to identify educational/ employment difficulties, and subsequently allow professionals to make recommendations to schools and other educational establishments or employers regarding the individual.
In terms of Attention Deficit states, cognitive assessments can differentiate other difficulties seen in children with attention problems. They can also identify cognitive issues that may lead to patterns of functioning similar to Attention Deficit States.
Attention Deficit conditions can affect a child in many different ways. A child’s difficulties are normally be evident across all settings, although they may vary a little in intensity and the extent to which they impact on successful functioning. A nursery, school, or college assessment can be invaluable in confirming a diagnosis, or by highlighting inconsistencies that then inform an alternative formulation of a child’s underlying difficulties.
Interested in exploring the Assessment Options further? Please contact us by emailing info@HealthcareOnDemand.org.uk