Good quality assessments for autism and ADHD

The mental health world seems to have exploded with awareness of neurodevelopmental conditions including ADHD and autism.  Social media is replete with multiple daily posts, reels and articles related to these conditions and ND voices are increasingly loudly shouting from the rooftops about more recognition, assessments and support for people who are neurodivergent.

Sadly, since the Covid pandemic, with soaring referral rates, and seemingly diminishing resources available in the NHS, getting an assessment through the National Health Service is proving more and more challenging.  I recently screened a 16 year old young woman whose parents were reluctant to refer her into the NHS as they were conscious, she would never be seen before turning 18, then have to start all over again as waiting times do not transfer to adult services.

Having worked in both private as well as NHS, I understand both perspectives, that it is not okay when seeing a good quality assessment for either autism or ADHD that you have to wait as long as you do, or to pay privately.  Costs for private assessments range from a few hundred pounds to thousands, but cost does not necessarily equate to, or guarantee quality.

Having been an NHS Consultant Psychologist heading up an NHS specialist team, we have seen a range of reports being submitted, from half a page to more than 60 pages, and sadly, as this is all we have to go on, it can be very hard to determine whether a good quality assessment process was followed.  In collaboration with colleagues, at times we have rejected around half of the assessments due to the report not detailing a clear and comprehensive assessment process.

One of the issues is that some companies are aiming for an approximately hour-long online assessment, especially where ADHD is concerned.  These individuals are often using the DIVA-5, but in its own guidance, the DIVA stipulates it takes around 90 minutes to administer, but most be done in the context of a wider mental health assessment rather than just on its own.

Neurodevelopmental conditions are ‘conditions of exclusion,’ so that one must consider other potential causes for a person’s issues, and rule these out as either not relevant, or also relevant, before ADHD or autism can be confirmed.

NICE Guidance, the Autism Act, and NHS England have suggested what may constitute a good quality assessment, but I have seen services that do not seem to feel the need to adhere to standard practice, though to be fair, this is not mandatory or sufficiently regulated at all.

People have asked me on a few occasions which companies I would recommend for private assessments, aside from my own, and when working in the NHS, it was a conflict of interest to recommend my own service.  I have found that very few companies are perfect, and that often it is down to which diagnostician has carried out the assessment.

What I would like to see is a governing body that stipulates the minimum standard for a good quality ADHD or Autism assessment, and that these standards must be adhered to, or the outcome will not be recognised.  I would also like to see better regulation of companies and justification as to how they charge what they charge.

I would never say my assessment processes are the gold standard, but I strive to maintain excellent quality levels, to use industry recognised assessment tools including the Adult Autism Assessment, DISCO, ACIA, ADOS, Brown’s ADD Scales, TEA, and the DIVA-5, and to ensure that as much evidence is gathered to cross a reasonable threshold.  Then I aim to write a clear and detailed report that has value both to the process, and justifying the outcome, but more, and most importantly, to make sense to the person I am assessing, and have value to them in understanding their differences through the lens of neurodiversity.

I then offer what I believe to be high quality assessment processes to clients according to how long it takes me, not compared to other companies, and not striving for as much as I can charge.  I believe I can defend my practice, processes, prices and the way I work, as it is backed by strong values and principles, as well as what best practice recommends.

My assessments are not cheap, but they are good value, high quality, have value and are meaningful.  That’s what it’s all about isn’t it?