Im an Autism and ADHD Assessor - AMA

[magictits]

I get heaps of questions about this IRL so thought I would post here and answer any questions in case they are helpful to anyone.

My DD was assessed for autism 2 years ago. She had declined a CAHMS referral a couple of years before that. We went privately as we didn't think she would be referred again and needed a quicker route (university was looming). It was a NICE compliant assessment - 3 stages, MDT and we were interviewed at length for background information.
However I have wondered since if maybe it could also be AuADHD - can you get the additional assessment for ADHD done later?

What age was the trauma? We go by what was going on at age 4/5.

puberty and menopause definately exacerbate symptoms.

Absolutely. We do standalone Autism or ADHD assessments. As well as combined.

He was around 6.

So then in the ADI-R they would be asking about age 4/5 and currently. So what was happening prior to the trauma would be captured.

I suspect my 7.5yr old son has ADHD (inattentive/combined) I’m diagnosed.

When he starts a learning task e.g maths worksheet that the teacher sent home - he immediately starts yawning. I remember being the same in school!

is there anything I can do to help him?

Thank you

@FuzzyWolfdo you have the name of the Facebook group please

@magictits
Hi, have been given a list from GP of companies through RTC for ADHD & autism assessments. There are 9 that do both.
I really want an accurate, in person, in depth assessment not a quick one over zoom.
DD has a diagnosis of anx/depression so it needs to take that into account and make sure her problems aren’t solely down to that.
I looked at private but even then how do i know its accurate? I don’t want to spend upto 3.5K and it’s wrong!
What should I be asking the company when deciding which to go with?
Which companies on the RTC lost are the best?
Then theres meds, GP won’t do shared care even from RTC which is ridiculous if the NHS are funding the assessment they must believe these companies are accurate but won’t take their word for it on needing meds its crazy, if we can’t afford private meds is it worth getting a private assessment?
Any advice much appreciated especially which companies are better than others.
Thanks

@magictitsthank you for this, really appreciate it

How old is your DD?

You don't need in-person to be thorough. Ours are incredibly thorough and they are completely remote.

We are private and don't do shared care or get involved with medication so can't comment on RTC or shared care.

Im in a rush as got to go to work, so forgive the rushed notes but I hope this is helpful to people. Its just my opinion (before people come at me).

If it were me or my child, if I decided to go private I would be asking the following -

1. Are the clinicians specifically trained and experienced in female autism and adhd? Do they have lived and professional experience? If the provider isn't then women and girls just get missed as typically the knowledge just isn't there right now.
2. Do they use ACIA or DISCO, ADI-R, ADOS, DIVA-5 and Qbtest? You want to make sure they do all those elements. Some firms simply do one hour with a psychologist which you do not want, and the report won't stand up to scrutiny.
3. How long are their reports? Ours are around 55 pages long and the client leaves with a full neurodevelopmental profile, confirmed diagnosis or not. A 2 pager with basically just the diagnosis is really common though and you don't want that.
4. Do they include functional impacts and detailed recommendations for reasonable adjustments and funding requests? This is important, because going forward people need those things to be worded properly to help gain the right supports. (which is why social workers are best placed to be involved)
5. How many clinicians are involved? How many actually sign-off? You don't want a report that is just signed off 'The Autism Group' or something like that (i made that name up). You want actual registered professionals (SWE or HCPC) who sign the report. Ideally three. And always including at least one registered psychologist. This is important. NICE recommend two, we do three at least. You also want to check that it isn't one clinician doing everything (eg a nurse) and a psychologist just takes a once over and signs off. You want it to be that different clinicians do different parts of the assessment. Eg, one does the ADI-R, a different one does the ADOS. And you want to make sure that those people are highly qualified. We recently redid one for someone where the entire assessment and report was done by a trainee nurse, and was just skimmed and signed off by a psychologist. The trainee had no experience or training in the field. This was RTC too!
6. Is there an MDT, and who is involved and what are their qualifications and experience? You want that to be a mix of psychologists, social workers, mental health nurses, occupational health - and all registered. Titles such as 'neurodevelopmental specialist' are meaningless as people may have done a quick course on autism. It shouldn't make them qualified to be part of an MDT.
7. Will they do a follow up feedback session? This is to discuss in detail the report. That's important because the report can be confusing and confronting and clients want to understand so you want that.
8. Is the report neurodiversity-affirming? This is important because a report full of what someone can't do, their 'deficits' 'struggles' etc can really damage a persons self worth. A report that focuses on neurodiversity as a difference, not a disorder, and where those differences can create challenges and suggestions for 'scaffolding' to help the person is more productive.

I hope that helps.

Any provider that assesses children over zoom and provides medication is seriously clinically negligent and needs reporting to the GMC and CQC. These service will likely be prosecuted in the future for the appallingly dangerous care they have given, and the NHS money they have fraudulently taken after giving inadequate assessments.

https://www.theguardian.com/society/2026/feb/28/poorly-regulated-clinics-putting-children-adhd-risk-warn-doctors

Shared Care is opt in for GPs, so they do 't have to do it at all. With the likely upcoming scandal regarding ADHd meds, I would be amazed if any GP did shared care for them.

The NHS would not take over prescribing a private prescription either, so unless you want to keep paying, don't go private.

Look to your local NHS provider or a RTC provider that does a face to face robust assessment with a doctor. Zoom, non doctors, saying your GP will take over prescribing after the first prescription are all massive red flags

Hi,

Thank you very much for doing this AMA. It's really good of you to give your time.

I wondered if I could ask a question about NHS services versus private?

My DC is privately diagnosed level 1 ASD with medical trauma PTSD. There was a large amount of distressing material in the secondary school teaching and he stopped being able to attend at age 13 because of anxiety.

We got an EHCP EOTAS package and dc has been schooling at home for two years. The EHCP provides weekly therapy which has been great, and we see a private paediatric clinical psychologist and paediatric psychiatrist periodically for advice.

I just wondered if you think there is any benefit from a CAMHS referral in this situation? We saw an NHS paediatrician recently and are now being pressured to see CAMHS. Our private therapist, our GP and many friends have advised strongly against it. I worry a little about doing it because it would be a whole extra set of professional relationships that I would have to manage on top of everything else, and so many people seem to say that CAMHS can be problematic.

I just wondered if you think there would be any concrete advantage in a CAMHS referral in this situation? I think if they were likely to be good then it might help, but everyone says it is very risky to try to engage with CAMHS because so many people have bad experiences.

Dc has recently had four gp appointments and did well with those, and has managed a blood test. He also has referrals to NHS OT, physio, optometry and dietician. It seems like enough to me.

We have a new school for exams and bits of tutoring and that has been going well.

We're a bit isolated by dc's anxiety, but i'm not sure that yet another MH assessment is going to help with that when therapy is already in progress and going well.

Thanks so much for the reply, really really helpful info

Thats the problem though, the NHS list is a 3 yr wait, RTC are all zoom from what I have looked at so far. I really need an assessment of all of thr issues to decide how much is anxiety of if something else could be happening

What percentage of children referred, actually get a diagnosis of something?

I’d have thought a high percentage of people assessed will get a diagnosis, but that doesn’t mean the process isn’t rigorous enough.
There are a lot of administrative hoops to jump through to get as far as an assessment, and admin is already (statistically) harder for ND people than for NT people. Therefore, the people arriving for assessment aren’t a random selection from across the community.
If you’ve spent months wondering if you might be ND, taking the online tests every day just to see if the results change, and putting yourself through a frankly humiliating process to explore with a stranger all the ways you’re weird and all the social interaction you messed up in your life, then you’re much more likely than not to be ND.
It’s like asking how many of the people assessed for cataract surgery actually need cataracts removed, the process of getting as far as asking removes the negative answers.

I agree with hobbieswriter that it is not ideal to do remote for children under 12. Over 12 is fine though.

I do agree there should be one doctor (as in a psychologist) involved in the assessment. I know she disagrees that this should be a psychiatrist, but I disagree.
I also disagree that just one doctor makes it robust. I think it needs to be three clinicians at least, with each one doing a different element of the assessment and then an MDT panel review.

I think hobbieswriters view on what makes a 'robust assessment' is very different from mine. I dont know what her qualifications are for her to have that strong opinion as I don't believe she has shared it.

I dont believe that zoom assessments for under 12s are a medical scandal however - they aren't ideal though. I wont do them under 12 although Im trained for 2 years plus. I do think that the way women and girls are unsupported for autism and adhd assessments is a medical scandal or medical neglect though but thats something else.

I hope that helps you. I imagine it must feel very confusing.

If you want a thorough, in depth assessment that is reliable and conducted properly by a Psychiatrist then it sounds like you need to go through local NHS services, sadly. It sounds like the RTC are able to provide an assessment so soon as they are doing them by a social worker via zoom. It's not reliable, not appropriate and sometimes outright dangerous.

I suspect in the future any diagnosis done via zoom or by a random mdt member will be declared invalid and will need to join the NHS waiting list to be reassessed. Hopefully the NHS will be able to claw back some of this money, fraudulently stolen by snake-oil salesmen.

Well in my service we make a big fuss about saying they are paying for an assessment not a diagnosis - they have to sign something to that affect. Some really don't come away with one, and they get very very upset. I have seen firms have endless arguments with clients afterwards, furious and going through the report bit by bit, challenging it and insisting on refunds. It hasn't happened to me yet (yet!) but Im sure it will. Most often my assessments are combined and we usually find something. Even if its not ND but a differential dx (last one was PTSD), but nevertheless clients can get very upset and have a lot of mixed feelings after a dx. We do a lot of followup for that reason. We don't want to just diagnose - or not - and run. Its a long, laborious, stressful process and people need time to grieve, accept, and then hopefully embrace what they have learnt about themselves. But yeh, some people very much do leave without a diagnosis of anything other than maybe anxiety.

Interesting that you don't believe that prescribing for under 12s via zoom is a scandal, as opposed to the guardian and the eminent paediatrician mentioned in the article I shared.

No assessment via zoom is adequate or appropriate. That's why the local NHS services don't do them, even as they became snowed under by demand.

I work in this area but don't want to share exactly what. But I can say with confidence OP that I doubt you will still be assessing people via zoom using NHS money in 3 years time

Well, if you don't believe bad parenting exists, then i can categorically say you are massively over-diagnosing!

There are lots of similarities with the trans movement and the issues that caused.

For a while the trans movement gained momentum, and the bar to being trans was simply what you identified as. Any kind of slight challenge to this was seen as an aggression, and due to this children were inappropriately prescribed powerful drugs with long term consequences, and anyone who identified as trans achieved a powerful position where they couldn't be questioned or challenged.

The neurodiversity issue is more complicated as it certainly has been under diagnosed for a long time. But again, it became fashionable and a 'movement', people could opt into it by identifying as adhd without any further assessment or rigor, and those in the movement acted aggressively to anyone not 'neuroaffirming', leading to long term consequences for people misdiagnosed or prescribed inappropriate medications.

In the medical world it would have been unthinkable for a social worker to be diagnosing people via zoom 10 years ago, in the same way it would have been unthinkable to remove a 15 year olds breasts because of what they had seen in tiktok. These social contagion come and go, but the consequences are felt for years after.

Bot saying that people who think they may have ASD or ADHD should not seek an assessment, of course they should! But it is a wild west out there and they are being massively failed, in part by seek to profit.

Yes I dont agree with them.

As I said, I do believe zoom assessments are adequate and appropriate for over 12s.

The NHS do zoom assessments under RTC.

I wont be taking any NHS money because Im private.

I DONT KNOW HOW MANY TIMES I CAN SAY IT. I DONT DIAGNOSE PEOPLE!!! I am part of the MDT team.

Trans is completely different to ND. For a start trans is nonsense (I'm gender critical), and ND very much exists.

You've already described what you consider the perfect model for assessment (a psychiatrist with no specific training other than the fact they are a psychiatrist, and face to face- and thats it). Ive said why I consider that to not be ideal, and I have described in depth what I consider the perfect model in depth. I am doing that only to help others. I get nothing from it because I am not touting for business on here. I believe the information you are providing is incorrect and may lead to people getting a poor assessment. The model you describe is the one followed by Psychiatry UK and I dont believe it is robust enough. It is a typical one hour with a psychiatrist and thats it. You consider that the gold standard, I very very much do not. NICE guidelines recommend a developmental interview, an informant interview (using ADI-R), and ADOS-2, and at least two clinicians. So your idea of the perfect model is not supported by NICE.

We clearly aren't going to agree.