I run an ADHD/ASD assessment service

[Trolleydolly123]

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

Yes thats entirely possible. Understanding (improved) and criteria (changed) for Adhd has also improved in the last 4 years. Would be worth reassessment of both, at least with adhd there is option of meds which 'can' help some, also if he doesnt have adhd, the meds wont do anything positive. Try private if you can given his age, its pretty time critical for alevels/uni.

@Trolleydolly123what do you think is behind the sudden urge in diagnosis?
I struggle with believing it’s just awareness. Yes some kids from the 80’s/ 90’s were missed but the rates of children now with quite significant traits of ADHD or autism who need EHCPs etc does not tally up with either what I saw in school or the amount of ‘statements’ that were issued.
Is it screen time?
Is it environmental?
Is it the school system?
Is it parenting?
Is it modern life being so tough?
I help parents whose children aren’t in school, usually due to anxiety/MH, and I find it interesting how this is nearly exclusively white and MC problem. Despite living in a very diverse area, black, Asian and other global majority children are not burning out and refusing school.
Also what do you think about the tests for autism based on eye reflexes which are seemingly very accurate?

As someone who has been repeatedly told she is ADHD and has reluctantly admitted it’s probably true (not going to go into details but I do realise that it’s really blighted my life), is there any point in looking for an official diagnosis?

I understand help for children at school but would there be any benefit to it as an adult?

Its really interesting, everyone in the 'industry' has theories but nobody actually knows. I think for example in a family if a child is diagnosed asd, mum/dad/wider family then start to look and go oh yes dad has eaten the same meal every day for 40 years, doesnt socialise and cant wear socks...maybe its asd, then seeks diagnosis and it snowballs across a family.
Adhd - i think its increased awareness, social media, its 'trendy', stimulant seeking behaviour. Also i think prevalence is genuinely much higher than we ever thought.
Agree re white MC, generally BME are under represented in MH full stop, could be many social and cultural factors.
I also think there is a link between social depivation, attachment, emotional neglect, poor diet, lack of meaningful activity across multi generations and screen time++(babies in prams with phones) which has caused kids to present with issue which LOOK LIKE nuerodiversity. Parents then parent 'down' rather than step it up and parent more to address how it manifests. An unpopular view but its shared within the industry 100%.

People get so irritated when diet is mentioned for conditions, but I genuinely believe diet plays such bigger part in our bodies than most people are willing to admit. I absolutely see a difference in my son when we are eating well vs when we’ve had a period of poorer choices.

I’m not saying diet could cause or cure conditions, but help with management for sure.

@Trolleydolly123absolutely! I hear this all the time ‘well my child has PDA so we do low demand parenting ’ like do you know how confusing this is for a child? To not be asked to take responsibility for anything? To not have to do what the rest of the family do? It’s actually really isolating and almost ableist. To be let to do whatever they like (actually saw a friend let her daughter eat five cupcakes in a row due to ‘low demand’) is not good for children. I have met children with PDA and it’s very very unusual to have a child in school who is ‘masking’ their PDA all day and a complete nightmare to their parents after school. That would suggest to me it’s parenting.

People asking about what is causing it, I have found it quite surprising over the years looking into why DD might do certain things and a lot of things point back to pregnancy and birth in our situation. A VERY traumatic pregnancy followed by a pretty traumatic birth. Also 3 weeks early so although not classed as premature still a significant amount of time compared to a 40 weeker.

PDA is not considered an actual.disorder within the medical.world, adult anyway, unsire about children.

How often do you find a parent who clearly has it when doing the assessment of their child.
I have 3 out of 4 with ADHD and I am certain I also have it.
I also think number 4 has it but at 17 masked very well up until recently.

It’s interesting as the school my eldest goes to is very strict with high expectations, very ambitious. Initially I was thinking it wouldn’t be suitable for my auadhd son, but after walking round and reflecting, realised that actually it was the best fit for him and what my son really thrives in is strong boundaries, knowing what’s expected of him and consequences. It’s how we parent also, definitely no ‘low demand’ parenting.

This is very interesting. I’m a teacher too. And it makes sense now reading your response, that one little one in my class who I’m a bit concerned about, I think his mummy has an attachment issue. Interesting. If you have time, can you explain a bit more.

Thank you so much for your reply. According to the Autism Clinic, his ADHD ‘file’ remains open, so given that and what you have said here, at least I can be hopeful. I honestly never even thought of medication. At the time we had him assessed for ADHD he was doing really well academically and it was more about trying to get answers in other areas where he was very obviously struggling. He’s all over the place now though, with regard to schoolwork/exams😬 Thanks again.

Hmm its very very very common to have an autistic child who "masks" at school and "explodes" in the evening (Google coke can effect) and also very common for parents to get the blame and sent to parenting courses...

Dr Naomi Fisher (linked with Not Fine In School) and Eliza Fricker talk about low demand parenting as a way to support a child who is suffering trauma/pda/ burnt out and not in school. I've attending one of their seminars and it "made sense" tbh for their context. I keep meaning to read their books.

There's a huge number of ND kids who are struggling in school. I have wondered if this is part of it. Kids who in the past would have gone under the radar because a kindly TA would have "sent them to get something from room x" or been able to diffuse a situation and now that TA isn't there. The option to "just take the kids on the field" or listen to the teacher read when everyone is overstimulated isn't there. The curriculum is so jam packed and in accessible for so many. Secondary schools in particular in our area at least have become zero tolerance on every little rule and that's been one of the things I'm hearing has been a tipping point for some kids that perhaps could have coped in a slightly more supportive setting.

For many of these inbetween kids who haven't got significant LD I think the environment is what is making it difficult and therefore the need to seek diagnosis and support in order to sort school when in a different setting they might not struggle so much.

I've not explained myself well but I think there's a clear link in stricter school practices/less funding/teaching crisis/ teaching by numbers and kids out of school.

I do think it's also increased awareness.

I would love it if when kids were diagnosed their parents were given the option too!

Ive been trying to get my DC (2) assessed for ASD for a few months. I noticed he was slightly different from as early as 1 YO.
he walks on his tip toes, flaps his hands, doesn’t stop jumping, delayed speech (still doesn’t speak), doesn’t like textured foods, doesn’t sleep (really struggles), grinds his teeth, I could go on and and and on.

I’ve also been told he has sensory processing disorder (HV) and when I took him to hospital as I thought he had a food allergy, the paeds doctor said I think it’s more important you get him assessed for ASD as I can see he has a lot of traits for this (from viewing him for 10 mins). All of this said, I’ve been refused twice now for ASD assessment.

anyway, my point is, help! What do I do? Are you a GP or do you work for a private business? I also wonder if he has ADHD but not sure if it’s traits of autism. He never sits still, constantly jumping and running. Can’t sit still ever.

would love advice from you or ANYONE. I was actually going to post on this as I posted on the neurodivergent section and got no replies and just wanted to help my LO as much as possibLe.

I have some experience in that one of my DC has been diagnosed ASD and one of my close family was a specialist teacher in a school for children with ASD.

I am curious about the number of people I know well who really struggle with life ( in a way that reminds me a lot of ASD) but don't pursue a diagnosis because "I don't want the label". I know one person who was told by several professionals to explore an ASD diagnosis but they didn't because - they didn't want a label.

Why do you think this fear of labelling exists. To my mind gaining an understanding of how their mind work compared to the minds of others would help them.

@Trolleydolly123 I posted above. Can I just ask, in my shoes, should I request a review of the original assessment given the ADHD component was borderline, or is that out of order? We can’t afford to get it completely done again by another provider…

@GoldfinchesInTheTreemy entirely NT son also does this. Home from school, agressively bouncing on the trampoline for two hours, shouting, refusing to stop gaming or even really talk to me. It’s because school these days is bloody boring (in my opinion). He’s a bright lad and just does endless worksheets all day. Yes I could say ‘oh it’s ADHD’ but looking at the bigger picture, it’s much more likely environmental (boring curriculum and distracted mum trying to work and parent, no dad, limited income and my own lax boundaries). People have forgotten that parenting is hard, modern life is hard, NT children are also difficult at times.

We dont assess children but if a parent joins the adult child for their part of the process, we often suspect it.

I agree school is difficult for a lot of children ( I don't teach in one anymore...) and I would like to see huge changes to the school system. So many teachers are leaving it's not sustainable and it's the kids that are losing out.

But that doesn't negate that many ND kids will mask during the day. It's a bit of an old fashioned idea that only those with a more "external" presentation of autusm/adhd get picked up on school (becuase they find the behaviour difficult) and therefore get diagnosed.

Its one of the theories as to why so many boys were diagnosed... It could be not that it's more prevalent amongst boys but that boys are more likely to have an external presentation and girls internal. (although of course both can present in either way.)

The Autistic Girls Network is very very good and has a lot of good resources.

That's really interesting. I certainly only noticed mine after my kids were on the pathway.... It explained a lot and tbh the adhd drugs have been life changing.

I suspect I would be one of the ones that people above mock as being okay on the outside... Oh the little they know...

Also; how would you describe someone with autism? What’s it like in their head, What’s going on?

@Trolleydolly123 DH was assessed recently. It was online and he wasn't allowed anyone in the room with him. He has very clear ASD traits and it's quite debilitating, but also has clear ADHD traits.

The assessors asked him questions and he answered them very literally. So, for example, they said 'did you enjoy going to parties when you were younger?' DH said yes, he did. What he didn't say (because he never elaborates) was that he was only invited to one party when he was young. Later, when I asked him about it, he said 'they asked if I enjoyed it and I did'.

When they asked about social occasions, he said 'he was happy to sit and listen' which implies he is comfortable. The reality is that he sits silently because he can't join in, and unless there is food available to focus on, he just waits until he can go home.

He is completely regimented in his routine and gets absolutely startled if we interrupt it. So, for example, if I have a headache and go downstairs to get painkillers at 05.30, he completely stops what he's doing until I go back upstairs again, because I'm interrupting his routine.

He once carried on cleaning DD1's teeth when DD2 had split her lip open, because he 'wasn't finished'. I once collapsed in the hallway and mumbled to 'just give me a pillow'. He did, and went to bed.

His boss asked him on his third day at work if he was autistic.

In the end, they didn't diagnose him, but suggested that he got assessed for ADHD.

What can we do to get a second opinion?

This is quite a nice overview of "demand avoidance" from the National Autistic Society for anyone interested explaining from lived experience but also the debates around it.

https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance

OP - I heard someone recently tell me that they were told they couldn't be autistic as they could make eye contact and had empathy.... These are outdated views now in adult diagnosis aren't they?

Oh I think this is a huge problem with the questions. I saw a "funny" shirt video where someone is asked if they have a problem with insert sensory issue here and they can reply they don't have a problem. What they say is they don't have a problem because they have coping strategies galore....

I think I was like this initially and similarly would have replied about parties. I like them... I like quiet ones with board games or housewarming ones of (likely ND looking back) friends with different rooms so you can chat and mingle but on your own terms and with stuff to play with (lego!). I have avoided so many "discos" and can't cope with weddings and don't do what I realise other people might be thinking of when they say parties...

I was really impressed with the assessors I've had so far who have unpicked this but I think as an adult we've had years of compensating so it doesn't always show. I needed my colleague to reinterpret the initial questions for me to see what they were actually asking in order to give the right response...

Yes, and that's the problem. They were asking DH those questions, and for him it's not a problem that he can only do one task, that he needs a strict routine, that he can't meet the emotional needs of his children because he can't see things from his point of view, that he has such a strict routine that he gets his cereal ready the night before...