I run an ADHD/ASD assessment service

[Trolleydolly123]

As the title says, curious to hear questions/thoughts.

What an interesting topic! Thank you for the insightful answers. Do you think if a person is AuDHD that the Au bit looks different from ASD without ADHD? My kiddo has DCD and ADHD. Also high intelligence. Very much of the old 'Aspergers' stereotype personality wise. ADHD meds just started and helping a lot in school. ASD comes up regularly. He has been assessed, but didn't meet the threshold, but close in a number of areas. School and ADHD prescribing psychiatrist think it may be present. I'm debating if it's worth going down the assessment route again, does it help anything. But also, could it be that ASD would present differently due to ADHD?

Yes I think the Au bit can look different with ADHD, but again so hard to generalise as one person AuADHD could have strengths and challenges in different areas and present differently to another. Also I think sometimes it shows up in different areas, ie masking etc. Some struggle at school, some dont but then unravel at uni or work.
In your shoes before joining a likely long wait list for assessment (which may not be funded if you had one on the NHS already, unless its 2nd opinion) I would think about what would a yes actually mean/change/provide that you dont already have, or cant adopt anyway - such as RAs etc. If it would be valuable/important,then worth considering yes. Again depends on area if a referral would be accepted without sound rationale.

They're not 'mental conditions'. 🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️🤦🏼‍♀️

The phone aspect is interesting.

I've got two older teens, one older diagnosed one with ADHD who has always been unbelievably forgetful and distraction-prone and one younger who I've always thought was the complete opposite with no issues at all.

Now more and more as the years go by the younger one can't seem to concentrate on school work. I can imagine if he was my oldest, I might wonder if this was ADHD. I reckon he would now tick a few boxes on a screening questionnaire.

I don't think it is ADHD though, I think it's his phone. He's always had some time restrictions and app blockers on all screens, even at 17, but it's not enough. It's like it's constantly pulling at his brain.

I wonder if phone use is wiring a lot of young people's brains in a way that looks like a sort of lite version of ADHD. Actually I'm pretty sure that's happening to some NT adults too (and I bet people with ADHD in the family will be more susceptible).

Have we set up a generation of young people to start their lives with a behavioural addiction to screens on a par with a gambling addiction? One that affects them a bit like ADHD, despite not being ADHD?

I get called disrespectful to the disabled on every thread about this but I really, really feel that the spike in diagnoses is masking negative changes in our environment which means we aren't fixing them.

People misunderstand my point as saying "just deal with it" / "who cares about your struggles" but I am saying there is something fundamentally wrong with a society structured around so much screen time replacing play and conversation, big institutional school classes stuck behind a desk from age 4/5, women expected to have steady full-time male-pattern careers through postpartum, peri and beyond...

Pregnancy isn't a disorder but women still take pregnancy tests.

You've phrased it more clearly than you have in the past and you may be correct. I've come to realise that, compared to my childhood, kids now grow up being bombarded with sensory input constantly (billboards are now backlit and move, for example) and in a panopticon where anyone could be filming you at any time and upload the footage to the internet, so the pressure to mask is constant.

A ND person who coped in the 80s is a lot less likely to cope now.

This is interesting. My ex was diagnosed a year ago in his late 40’s - he actually had a very minimal wait time in the NHS. I believe due to the other MH / addiction issues he was / is having. My sister is diagnosed EUPD but I have suspected ASD for sometime and the GP has suggested referral for her for that as well.

i have suspected ADHD for my youngest for about 6 years - she was referred to CAMHS in y4 but didn’t meet threshold. I left it as it didn’t affected her but now at 13 it’s causing a load of problems.

she has had a mini MH assesment. And it says ADHD likely.

She scored 20 on the SNAP IV 18 for inattention.
21 on the Qb and 33/35 on the self report for teenage girls. She got 13 on ASSQ.

This was all based on her / my info as school refused to complete forms.

is it likely the full assessment taking into account schools scoring would still come back positive (I’m not sure how significant they are (other then the self report one)

She has a lot of problems at school so she certainly won’t get a nothing going on report.

I think there is something in this. I'm not sure what but something.

I actually don't think it's to do with sensory overload but actually a lack of calming, sensory stimulation.

I managed quite well at school, but both my primary school and secondary school were quite relaxed, shabby environments with a fair amount of physical sensory stimulus, looking back. Think wooden floors, big Victorian windows with radiators we'd lean against to warm up, very draughty, plants everywhere, portocabins with gale force winds shaking them up, lots of shady corners under trees to sit in at break and lunch. I remember sitting on the grass with friends a lot and using sticks to draw in the dirt.

Where I didn't cope particularly well was in a modern, climate-controlled office environment where, for instance, it was impossible to open the windows. It was too bright, too sanitised and lacking in the kind of sensory stimulus I think I needed to function optimally. Many schools, secondary schools especially, are built and designed to mimic offices nowadays and I think that does many children a disservice.

But isn’t Amber’s post querying the idea of ‘neurodiversity’ altogether by saying it’s not about a brain difference, but environmental differences and their impact upon people?

A young actress from Game of Thrones was diagnosed autistic recently and said something along the lines of ‘now i know why i find things hard that everyone else finds so easy!’. It made me want to scream. 99% of people do not find life easy. Virtually everyone I know has some kind of significant struggle but, like her, assumes they’re the only one. It’s like the Emperor’s New Clothes but in reverse.

I don’t think it’s surprising as neurodiversity, in the form it takes now, is still incredibly recent in medicine. The average person hadn’t even heard of it 10 years ago, and maybe even 5. Autism has been around for yonks of course but in a very defined and small number. Now we have hundreds of thousands of diagnoses in 5 years alone. It is no surprise that treatment plans and healthcare has not yet caught up.

No. You've misunderstood Amber's post. We are both talking about modern life making the effects of a ND condition worse, not causing it.

Analogy time. Asthma is real and no one in 2025 disputes this. An asthmatic person who can cope with minimal medication in rural Iowa might die in Beijing where the air pollution is much worse. That person doesn't stop having asthma just because they live in Iowa. The entire population of Beijing might struggle with respiratory infections and similar from the polluted air there, but that doesn't make them asthmatic.

I have always been autistic. The behavioural signs were noted on school reports. Modern life makes it harder for me to cope with being autistic. It's probably harder for NT people too, but in different ways.

I read it this way too. Modern life makes it more difficult for ND people to cope, especially children. Too many demands, too sanitised, too much pressure, too much "zero tolerance", too much polyester. Too little rolling in dirt or climbing on stuff.

Do you shower regularly? Or does the idea of water hitting you and keep some areas of you warm and others cold creep you out? Do you struggle to brush your teeth because of the discomfort of ‘nippy’ toothpaste? Do you find it easy to perform self care habits like it. Do you need to remind yourself how to act normal and parrot small talk? Do you have to remind yourself to give eye contact as to not l appear rude?

That is just a small example of the easy stuff neurodivergent people refer to. Social interactions need practicing and script forming to perform it. Personal care is struggle - for various reasons. Executive dysfunction affects work and home life, and any task initiation or completion.

Life is easier for those who don’t have additional struggles in their brain function. It is like not having glasses, when we need them. Neurodivergence IS a disability and it makes our lived experience harder. Neurotypical life is easy by comparison.

it is not to say life is all dancing on roses for them either but the little stuff the majority don’t even notice can be big hurdles for those in the ND community.

Pregnancy isn't just a neutral difference; it is a physical condition that can be very risky so needs medical monitoring and/or intervention. It makes sense to test for it in order to guide treatment.
If ADHD/AUD are just differences, and the idea is just understanding, not treatment, then what is the point of expensive diagnosis and labelling?
If the point of diagnosis is to prescribe meds or other treatment, then they are medical conditions. Nothing pejorative about that.

So to answer some of the Qs about attachment etc, ill share what I have seen in previous roles with childrens services. A lady who was a teacher asked something around this.

A typical situation could look like this:
Mum experiences adversity in her life for any number of reasons, this can impact on baby brain development in utero (epigenetics). Baby is born and mum (for a host of reasons) struggles or cant form secure attachment to baby, baby does not receive responsive attuned care. Mum cant co-regulate babies distress. This could look like baby being put in front of TV+++, not being responded to when crying, spending lots if time indoors, lack of real world experiences, late weaning, lack of exposure to varied taste and texture. Developmental milestone delay. Baby starts nursery and is way overstimulated due to its world being so small previously, lack of attachement observed (reduced eye contact, sensory seeking etc) concerns noted.

Child starts school and these increase, mum also notices difficuties in managing childs behaviour, mum herself experiences maladaptive coping, increased high expressed emotion, poor communication. Child cannot regulate and spends lots +++ of time on screens (often viewed as 'the only thing that works') and dysregulates when its taken away, has very limited diet and sensory issues, which all compund mums view its ND.

This then manifests as home and school both notice issues and child can go down the asd assessment route. Attachment disruption can present with many similar symptoms.

Of course in this there will be children who have ASD regardless of experience or environment, but I have seen the above play out again and again and again.

This is based on families i have worked with, and only work with due to them having a range of other concerns, so I dont see the 'average' family, I am not suggesting parents are to 'blame' for ND AT ALL, but its important to consider the overlap with differential diagnosis.

Thank you, it's not Camhs who are assessing him, I think they call themselves the Neuro development pathway. Camhs saw him once when he took an overdose aged 12 but he had a meltdown every time they tried to talk to him so they discharged him. I would have been more assertive but I was struggling with lock down and I was still in shock.

I asked about how we could avoid running out of time but they said this is inevitable when assessing someone of his age because of the amount of information they need.

This describes me. I function, i have a family and a job. Outwardly i appeared to be coping but that's because nobody ever saw my regular periods of burnout resulting from being undiagnosed. Now I'm diagnosed I've learned all the ways it affects me and adjusted my life to account for it and i am far more settled and experience far less burnout than i did before. It's a shame you seem to think people should end up in prison before they're able to access information about their health. I wasn't ever going to end up in prison but i was bordering on suicidal at times.

What changed for me post diagnosis was letting go of decades of self hatred for struggling so much with living a "normal" life, and feeling like an alien amongst neurotypicals but never knowing why. I've also now been able to get reasonable adjustments at work which has made it far easier for me to cope at work.

It's a shame that you run an assessment service but haven't ever given any thought to why someone who appears to be coping might want to be diagnosed.

Ah thats good, it might be useful to clarify they continue post-18 (and maybe you have) but it would be awful to get this far and not get over the line! The flip side to it taking so long is at least its very thorough, which is reassuring that its robust and reliable. Good luck.

Thanks for this thread OP.
I was dx at age 60 following my adult DD being dx at 25. She, like I did, is excelling in her career. I am trying to formulate my question without writing a detailed essay but I can't find the words yet.
But essentially I think they made a mistake with me. I will come back if I can formulate my question without writing my life story. Please don't go away!

I dont think people need to end up in prison first. I absolutely agree the life changing outcomes you have described are so so valuable. However there is not unlimited resource, and the rates of people requesting assessment, for reasons ranging from what you have described and beyond, to curiousity, have escalated beyond all capacity. The current rates are not sustainable, and this means people will be waiting years and years. The adverse outcome is that people who would really really benefit are waiting longer than they should, and the only way to change this is to make criteria which means those who most need it are seen. But nobody will want to be in the group considered not at 'most need' and how do we measure this. There is no more staffing provision available, so something needs to shift one way or the other.

So to everyone on this thread who feels the current level of people receiving a diagnosis is accurate, do you really believe that this amount of people or more (I heard someone say they believe 50%) are ND and should receive medication, reasonable adjustments, EHCPs if at school, special passes for theme parks, museums etc? Or not be able to work or claim carers or DLA? The world world literally not function.
Almost all of my friends believe they’re ND and it is bonkers!!
Shouldn’t we get rid of diagnosis all together and base all resources on needs? For example, yes your child may have autism but do they need to skip the queue in the theme park? My daughter is roughly 3 years behind her years and has an EHCP, she still queues!

I think there probably that many people who are ND, yes. However not all of them will need that much support. My DS1 has autism and gets PIP but he managed with some small reasonable adjustments at school, no ehcp. He is now working, almost full time in a zero hours contract. Work is a 20 minute walk from our house which is great as he struggles with public transport. He is allowed to say he is not available on certain days etc no questions asked and his work are really good with him. He works really hard too and doesn't easily get distracted. His boss just gives him a list at the beginning of the shift and he plods through it.

There are a lot of people with autism and other ND conditions who are non verbal and need a lot of support or those like my 10 year old who need ehcp and a teaching assistant with them all the time. But there are also a lot who can work and don't need much support.

@elliejjtinybut even those small adjustments, if every other person had them, would have a huge impact. And I don’t trust people to just claim what they need. Take DLA, I don’t claim as honestly my DD doesn’t cost me anymore than any other child. But most do. And the SEN forums are an echo chamber of ‘you should give up work!’ ‘You should homeschool’ ‘school is traumatic for autistic and ADHD kids’ etc.

@HistoryisadiscardedVHSas I commented on a post earlier in this thread I have suspected my daughter was adhd since she was 7. It didn’t affect her too much so I didn’t pursue it. She is now 13 and it’s massively affecting her and has been for last 18 months. She is at the stage of getting suspended from school regularly and her education is suffering. She was self harming last year as well.

her dad is massively screwed up as an adult - it was recognised when he was in primary but his parents didn’t want to pursue it. He’s now on meds at nearly 50 and he said it has transformed his head. My sister was diagnosed EUPD probably in her 30’s. She has now been referred for an ASD assesment. She again is completely messed up. I have found her unconscious multiple times she was resuscitated after after managing to strangle herself in a secure unit.

this is why for me it’s critical for me that I fight for my daughter to get a diagnosis and hopefully meds to reduce the risk of her having addiction issues and self medicating. It also will help her understand why she is like she is.