Assessment & Diagnosis (identification)

Referral

AYC Psychology referrals. The team will have completed a detailed screening assessment including a QbTest. If ADHD was suspected and you wanted this confirming or discussing further, then the team will have referred you to me. So welcome!

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 serious mental health problem such as severe depression or your child has expressed recent suicidal or self-harm thoughts / actions, then it would be advisable to see a Psychiatrist. 

Although you may have come to see me regarding possibility of ADHD, I apply a child focused, trauma-informed and a broad and holistic approach to a detailed neurodevelopmental assessment that will consider not just ADHD but:

  • family/schooling/lifestyle factors including negative / adverse early life experiences. The latter can include exposure to alcohol or substances during pregnancy. I have experience in FASD assessments and understand the role alcohol and substances can have on developing brain and future health.

  • medical problems and conditions that can be confused with ADHD as well as considering any genetic or medical causes for delayed development. This can only be assessed by a Paediatrician.

  • 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 as well as understanding your child’s full spectrum of strengths and needs.

This is vitally important because, although getting a timely diagnosis of ADHD is important, it is also crucial that child or young person isn’t wrongly diagnosed with ADHD or other factors ignored. 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. 

For all of the reasons in my opinion the person conducting an assessment (and diagnosis, if there is one) needs not just knowledge and experience in child development (physical, language, social and emotional) but also medical expertise.

As an experienced Paediatrician I offer a one stop full assessment of need. If medication is indicated then I initiate this and provide on-going supervision myself. I don’t out source.

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 although I finally have more time! In the NHS my new appointments had to be no longer than 1 hr. This was never enough. My appointments are now 2 hrs. My holistic assessment is supported by objective scientific evidence using QbTesting for all children. The first appointment is 120 minutes and F2F. I do not offer video consultation for the first appointment.

2. For the first appointment you will need to have completed my detailed parent (PAF) and teacher (TAF) assessment forms, online Connors questionnaires and have had a QbTest. The PAF booklet will ask questions about how your child has grown and changed over time. It will give you a chance to tell me about any worries or concerns you have about your child, past and present. The PAF will give me essential information I need to assess your child. The PAF is very long and can take several hours to complete, so please don’t try to do it all at once, take your time and do it over several sessions.

3. I will always recommend a QbTest to be done as part of my assessment. A QbTest provides objective, computer-based data on your child’s attention, impulsivity, and hyperactivity, and compares it to age-matched peers. I use it alongside traditional assessments tools such as interview, observations and behaviour rating scales and school reports etc. QbTest has to be done in a clinic setting so that the results are accurate and reliable. It is a lot more detailed. It is different to a QbCheck which can be done online from home or school. QbTest is the only digital test recommended by NICE. See how a QbTest is performed Video LINK

4. Connors behaviour rating scales / questionnaires are probably the best psychometric tools to collect information about a person's behaviour across multiple settings. They are standardised meaning they compare an individual's results to a normative sample of the same age and gender, reducing interpretation bias. Connors are expensive to use (I have to pay for each test) and they are included in the assessment fee. There are other types of questionnaires that can be used that are free but for me Connors is the best. It is the only rating scale mentioned in the NICE guidelines.

5. I do not just rely on questionnaires and QbTest. They are just some pieces of the jigsaw. The PAF and TAF forms collect lots of information about your child at home and school and covers development, learning, emotional wellbeing, general screening for autism and learning difficulties, relevant family and social factors and health. During the appointment, I will then clarify any points within the completed forms, and ask lots of questions to clarify your concerns. Also, 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.

6. 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.

7. 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. But my ‘diagnosis’ is broader than just ADHD. I will also discuss any other findings of need that will be important to address. This may include sleep, motor or speech / language, sensory, social communication, emotional health.

3. 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.

4. 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 emphasise on ensuring your child receives the right support based on need, rather than waiting for a formal diagnosis, if there is one.

5. 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 28 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. I strongly believe in the principle of connection rather than correction of behaviour. Research in neuroscience, developmental psychology, and trauma studies shows that brains grow and develop (neuroplasticity) through connection, not shame or correction. Safe relationships, co-regulation, and sensory-friendly environments enable these brain changes that support behavioural shifts, emotional regulation, and learning. This is why we need to move away from "correcting" behaviour and toward creating safety and connection. Because connection is what enables neuroplasticity. Understanding neuroplasticity then hopefully leads to changing the focus from seeking ways to correct specific behaviours to considering how to establish environments that support optimal brain development.

2. 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 holistic approach with school and home-based ADHD specific support and behavioural strategies. Depending on time I will discuss some of these strategies during the first appointment but for more detailed practical support I would recommend discussion with the school SENCO and attending ADHD specific parent skills-building or ADHD coaching program. Older children can also find this helpful. This can be done 1: 1 or in groups and face to face or online.

3. For some children with ADHD, it is other issues that are causing or contributing to their difficulties. This can include trauma, sensory issues, other neurodivergent traits or conditions such as autism or a learning difficulty. For some the focus will be on prioritising getting the right and support for these issues or along with any ADHD related interventions or treatment.

4. I would emphasise that if ADHD is diagnosed that there is an evidence based approach to treatment options and time is not wasted pursuing treatments or interventions that are not working. This involves having an honest and pragmatic discussion with you as a parent and your child to agree what is important to you.

5. Please be aware that medication will only be issued if parent has watched any of the ADHD Parent Workshop Videos (LINK1 or Link2) and Explaining ADHD Medication video LINK. Dr Nawaz will have discussed this with you in clinic.

6. 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’ and interpreted by an experienced and neuroinclusive clinical team. For private diagnostic assessments you can contact me for recommendations. For screening assessment 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.