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.

You say here you make a diagnosis.

It's also key, I feel, to point out that a face to face assessment is mandatory in the under 18s as per NICE. I'm not sure where you have got under 12s from, but that is ominous.

Which provider do you work for?

Its very obvious that I am saying I make the diagnosis I think then I discuss with the team and we reach a conclusion. We often agree, disagree, or are unsure and discuss. The overall diagnosis has to be agreed by three clinicians. I think that is pretty clear.

Im not going to tell you who I work for obviously.

Just to clarify, NICE guidance does not state that autism assessments for under-18s must be conducted face-to-face. The relevant guideline is NICE CG128, which outlines the components of a comprehensive diagnostic assessment (developmental history, information from parents/carers and school, and direct observation of behaviour), but it does not prescribe the format of the assessment.

If you’re aware of a specific NICE paragraph stating that face-to-face assessment is mandatory for under-18s, I’d be very interested to see it, as I haven’t seen that anywhere in the guidance.

If you are happy paying privately for psychiatry, I doubt there is much point. If at some point you may want the NHS to take over, it is worth getting on the list.

Something to be aware of is CAMHS refuse input if you are receiving private input at the same time.

BTW, if OT and physio are needed, they should be in the EHCP. That way DS isn’t limited to the NHS offer and he doesn’t need to sit on the normal waiting lists. Similarly for the clinical psychologist input rather than you paying privately for that.

Just to clarify a few points about the NICE guidance for others reading.

NICE does not state that autism assessments must be psychiatrist-led. The guidance emphasises that assessments should be carried out by appropriately trained professionals with expertise in autism, which can include psychologists, psychiatrists, speech and language therapists, occupational therapists, and other qualified clinicians such as social workers who have specialist training and experience in autism assessment. Being a psychiatrist does not automatically confer specialist expertise in autism, just as other professions can develop substantial expertise through training and clinical experience.

NICE also recommends that assessments are multidisciplinary, meaning input from more than one clinician with relevant expertise. In practice, this often involves different clinicians completing different elements of the assessment – for example a developmental history (often using tools such as the ADI-R), observational assessment (such as the ADOS-2), and joint diagnostic formulation.

It’s also worth noting that NICE does not mandate specific tools. Instruments such as the ADOS-2 are widely used and recommended in many services, but they are not a requirement under NICE; clinical judgement, developmental history, observation and collateral information remain central to the diagnostic process.

In my own practice, whilst I follow NICE guidance, I have also developed my pathway in ways that I personally consider clinically robust. For example, I routinely include an ADOS as part of the assessment process, I do not conduct remote assessments for children under 12, and I ensure that different clinicians are involved in different parts of the assessment. None of those elements are mandated by NICE, but they are standards I have chosen to implement within my own service.

https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#diagnosis

Here you are. A diagnostic assessment should include a full assessment of physical health. Which cannot be done over xoom.

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Do your 'nurse prescribers' listen to the patient's heart sounds and exclude a murmur in every single person they prescribe for? That's the expected (none-negligent) standard of care

@magictitsif a child was diagnosed with ASD at 4, and ADHD at 6 via NHS would you say they’re at the more “severe” end of the spectrum

Hi, I’m due my adhd assessment soon but have no idea what to expect. Are u able to advise? It’s being done through RTC

We don't prescribe.

That link doesn't say anything about face to face. Requesting information about a patients physical and mental health prior to assessment is normal. We always get their medical records and get them to do detailed questionnaires prior as all services do. NHS face to face don't do a physical examination prior to assessment either.

I think you are on the wind up tbh. I would remind you that there are a lot of worried anxious parents here who are after some good advice, so this is a serious subject. You are entitled to your views of course, but you can't substantiate them and Im getting a bit sick of defending myself.

For others, my advice is to please read the NICE guidelines, and look for providers who fit that criteria.

Happy to. I have they sent you any information? Do you know the assessment tool they are using? We use DIVA-5 and Qbtest. I can tell you about them if that is what they use.

And here, in the autism NICE guidance.

https://www.nice.org.uk/guidance/cg128/chapter/Recommendations

Include in EVERY assessment a physical examination. So it can't be done by zoom, and meet Nice criteria. Using tools instead of robust clinical history also discouraged.

Very, very worrying you don't already know this. Not surprised you don't want to identify the provider

Not necessarily. Depends on the provider and how thorough they were.

My dd's main symptom in primary school was anxiety.

Her psychiatrist said untreated adhd can show up as anxiety.
The adhd meds are so effective for her, I don't think anyone could doubt her diagnosis.

They absolutely do a physical assessment, and it is mandatory. Read the nice guidance. Are you on the wind up? ADHD medications can have serious cardiovascular effects and cause sudden death if people have an underlying heart condition.

'That link' I provided is the NICE Guidelines

You’re misinterpreting that section of the guideline. NICE lists “physical examination” as something that should be considered within the overall diagnostic pathway, but it does not state that the autism assessor themselves must perform the examination or that the diagnostic appointment must therefore be face-to-face.

In practice, autism diagnostic teams — including NHS services — do not routinely carry out physical examinations themselves. Physical health is reviewed through medical history and existing care, with GPs or paediatricians involved if a physical assessment is required.

I think you know this though.

Here you say you have nurse providers as part of your team.

You are constantly changing your story. I imagine because you are realising that the provider you work for and the assessments you are part of are inadequate.

Why don't you give the rationale for doing assessments over zoom with a none doctor, that isn't about making it easy to do from the other side of the country and rake in as much money as you can? How is it safer for the patient?

We don't medicate.

Autism assessment teams do NOT do physical assessments as part of the assessment. I have never heard of anyone having one, including myself.

It says every autism
assessment MUST include a physical assessment in children. This is in part to identify other conditions, which doctors should also be aware of

Why did you say you had nurse prescribers working for your team? What is their role, then?

That's the Nice guidance for children. Were you diagnosed as a child?

I quote it verbatim:

include in EVERY autism diagnostic assessment a physical examination. You can read it yourself.

If you are wondering why your service doesn't, then good. You should be

We did have a qualified nurse prescriber who was also a mental health nurse with lots of expertise in autism/adhd on our team who doesn't prescribe for us. She does other things for us.

We do have several doctors on our team. And there is always one psychologist involved in each assessment.

I have already explained our model in great detail.

Where have I changed my story? I am more than happy with the way our team works. I think we exceed NICE guidelines and Im really proud and happy with the way we do assessments.

You think we are money grabbing snake oil merchants and Im fine with that. You have said nothing whatsoever that has made me second guess or doubt our service and the way it operates. Quite the opposite.

How can you exceed NICe guidelines if you don't meet them.

you referred to nurse prescribers, I suspect, because they are the one's prescribing the ADHD medications, without ever physically seeing the patient. Appalling.

As I said, this is the next big medical scandal, and I hope there is some accountability for all those involved