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.

We do meet NICE guidelines - you are misinterpreting them.

When I started this thread we had a nurse prescriber working for us as part of the MDT - not to prescribe but for her input on assessments as she had mental health nursing experience and ADHD and autism experience. We didn't use her to prescribe, she just happened to be qualified in that which is why i mentioned it.

You can think its a medical scandal if you wish. I think your model isn't ideal as ive said. I was open to hearing your views but you have given me nothing to persuade me that a single clinician face to face assessment with a psychiatrist (with no autism/adhd training) is preferable to what we provide.

So your service diagnoses ADHD but doesn't prescribe medication for it? That's quite odd as that's what most people seeking a diagnosis are looking for

Its not odd. Its pretty typical actually. We offer combined assessments. We don't prescribe and we don't do shared care.

You literally said this, on this post.

You have a nurse prescriber for ADHD meds on your team!

Might want to recheck your OWN POSTS before lying to try and twist the narrative.

I would advice anyone reading this thread to disregard anything OP says. What I have said is accurate and follows the NICE giidance

so now we've established that you were lying about that, can we assume it's because you have realised that the service you work for is negligent and dangerous?

Perhaps you should bring this up with them tomorrow. At least that way no more children will be put in danger. You can choose to do the right thing. If a child dies, you have blood on your hands

This is also a wonderful example of: just because someone is speaking with complete confidence, doesn't mean they are right

Look at the date? It is now March!

Not that it is any of your business, but we made a business decision way back when to not get involved in medicating. She was employed as a nurse prescriber and then we decided not to use her for that.

As with most AMA when someone is just trying to help people, somebody always ruins it. So 'Im out' now as Alan Sugar would say. Ive probably said everything I needed to say anyway. If anyone wants to PM me questions thats fine, happy to help. But Im going to leave this thread now.

I will leave you in the capable hands of hobbiestwriter who seems to know it all, so I suggest you direct your questions to her going forward.

My (NHS) pathway does have community pediatricians as affiliated professionals , and they get referred any child with dysmorphic features, girls with particular patterns of regression, children with cafe au lait spots etc. They are more active on under 5 pathway as those children often have learning disabilities. It's not a routine part of the assessment but the capability is there. Last one I referred was a child with very low set ears.

I know that they do heart and blood pressure checks with meds for ADHD. I had a child with a small hole in their heart picked up that way.

That's reassuring, that the NHS pathway is doing proper clinical assessments that consider the wider picture, not just a list of alphabet quizes.
How long is the waiting list in your area? I hope the long waits are sorted soon. every child deserves a decent assessment, it makes me want to cry how vulnerable children and their families have been preyed upon

3 years for over 5s.

Thank you, no Iv not received anything yet. It’s care adhd. Do you know what one they use?

My husband presents with what I think is a very female-coded presentation of autism - he has OCD, people pleases, masks a lot, struggles maintaining friendships, highly anxious, low social battery, routines, hyperfocus, struggles to switch off, quite visibly physically anxious with foot tapping and some verbal repetition - comes across as the nicest, gentlest, sweetest man but his is burning out from masking the high levels of anxiety he has. Would a dx pick up this type of presentation?

But she’s saying here that physical assessments aren’t the standard for autism assessments. They are referred only when required. Which is what you challenged earlier.

No, someone's doing a physical assessment then referring on to a paediatrician if they have concerns, like dysmorphic features or cafe au lait spots. So an initial one, then a specialist one

Well that never happened with any of mine - all NHS. It’s not a medical condition afterall.

https://www.england.nhs.uk/publication/what-clinicians-tell-us-about-using-telehealth-for-autism-diagnostic-assessments-during-the-covid-19-pandemic/

Thank you very much for explaining about that. I didn't know any of that. Would you be able to recommend something that I could read to find out what the health part of the EHCP can cover? We have nothing in that section and a lot of unmet health need. We have private psychology input on the EHCP weekly already so it sounds as though that would not fit with CAMHS anyway. Thanks for explaining.

@NotReallyNotOftenAnyway Health care provision (section G) can be anything that is health provision related. This would include more general psychiatry input, for example.

However, health care provision that educates and trains is actually deemed to be special educational provision. Therefore belongs in section F of the EHCP (special educational provision) rather than section G. This is stated in section 21(5) of the Children and Families Act 2014. There is a fair bit of case law around this too. The Noddy guide is a good starting point for a summary of the law and some of the case law and links to some of the judgements. This includes things like OT, physio, clinical psychology, SALT, etc. The benefit of having the provision in F is that it is easier to enforce than G.

More general optometry input would be in G, but some provision for visual problems can be in F. Similarly, more general dietetic input would be in G, but some therapies and other provision for difficulties eating can be in F.

Psychology input via the EHCP wouldn’t necessarily be a barrier to all CAMHS involvement even if it is commissioned privately.

In our area NHS are doing a lot of online assessments rather than face to face. I think it’s unfair to accuse a service that is being carried out privately of not carrying out legitimate assessments when the NHS are often carrying out lesser services and seriously lacking in capacity.

I'm very interested to know what area this is. Could you name the trust? Or general area?

It’s Birmingham, I was told Shropshire too

Exactly my thoughts on this. Waiting lists are years people don’t want to wait, so do rtc, get a diagnosis within weeks and want it back on the NHS, passed back to the Gp for shared cares and then kick off at the surgery. CERTAIN AREAS ARE NOT COMMISSIONED TO TAKE ON SHARED CARES FROM A PRIVATE PROVIDER! I don’t know how many times we have to say this until either the patients or the rtc clinics understand this!!

DD2 was assessed face to face. ADOS and 3Di plus home and school questionnaires.

DD1 was assessed face to face with ADOS and then I had a remote interview with the psychologist.

DD3 was assessed completely remotely, still using ADOS and interview.

The only difference I could see is that DD3 didn't have a physical interaction with the assessor. I remember in DD2's assessment that the assessor held back some shapes and there was a really awkward spell while DD2 tried to work out how to get the shapes to finish the puzzle without asking for them.

I was assessed remotely via questionnaires and virtual interview with a lead assessor and an observer.

DH was also assessed remotely but I believe his non-diagnosis is a huge error. He's clearly autistic (his current boss asked if he was autistic on day 3 of his job, having clocked it within hours) but they asked if he enjoyed going to parties as a child ('yes') and didn't ask any follow up (which would have revealed he only went to one).

DD3 was assessed for ADHD in person by a psychiatrist who also used the QBcheck.

I was assessed for ADHD by a single assessor. He wouldn't ask me direct questions but asked me to tell him why I thought I had ADHD and just gave me themes for discussion as guidance. He said afterwards that it was because he spends much of his day telling people that the TikTok video they watched isn't actually a good guide to ADHD.

I agree with people who say that being in a ND house makes it hard to know that what you do is ND. I remember a support worker saying 'you explain yourself so much to your kids.' Well, they asked the question...'

I taught DD2 eye contact when we crossed the road to school when she was 4. 'We look at the lollipop lady, we smile, then we can look away.'

@Lougle I found DD2 and DS3’s responses to the puzzle task interesting, too.

DD2 is articulate, but when she needed the remaining pieces, she didn’t ask for them even when the HCP repeatedly moved them out of her reach.

DS3 didn’t ask for the remaining puzzle pieces, either. He tried to get them himself a few times. When the assessor put her hand on them so he couldn’t get them, DS3 sighed loudly and exclaimed, “How do you expect me to finish if you won’t give me the last pieces?”

It's quite fascinating, isn't it? For DD1, we were at a library and we got there before the assessors. When they wandered in with their Costa Coffee frappes, DD1 glared at them and said 'You're late. I don't like being kept waiting!' I've often wondered if they were deliberately late.

With DD2, the assessor tried so hard to pique her curiosity. She had asked what her favourite animal was - 'dogs'. Then she said 'I've got a dog and he was so naughty at the weekend.... 'mhmm'. 'I couldn't believe he was so naughty....' 'mhmm.' 'I've never known a dog to be sooo naughty.... 'mmm' I almost snapped 'Just tell her what he did because she's not going to ask you!'

When they asked her why people got married she shrugged and said 'so they don't get lonely. But I'm going to live with my husky dogs because they don't have a list of demands like humans.'

@Lougle it is fascinating. I was surprised what they picked up during mine and DC’s ADOS testing, including things I thought were subtle.

DD2 was shown a picture of a man and a woman hugging and asked why they were hugging. She stated she didn’t know because there wasn’t enough information and reeled off over a dozen possible reasons.