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.

Thanks for the thread op. I am in Scotland and have been told by my GP the waiting list for assessment for ADHD is well over 3 years. She advised me to go private but specifically said I won’t get any ongoing prescriptions on the NHS if I haven’t had the assessment done by a consultant psychiatrist. My GP practice will not recognise prescriptions from anyone not a consultant psychiatrist. I am assuming Scotland is different to England (and that you are in England?) Any comments on this?

Thank you for this.

I’m pretty sure my tween son is autistic - his paternal uncle is level 1.

It presents in friendships (he doesn’t have many friends… doesn’t seem bothered about that), is super bright, very articulate, no behavioural issues, normal eye contact, walks on toes. Not at all sporty. Loves gaming. Is a germaphobe, hates rule breaking, and is very particular about which fabrics he wears.

To me it’s a slam-dunk, but I’m not an expert. He may just have a lot of traits but not meet the diagnostic threshold.

I want to get him tested just so he knows (I think this is important for future mental health, and thst’s my priority here). My husband is adamant he’s not autistic and says labels aren’t helpful.

How can I get him on side? Could he be right?

As part of the assessment is mother’s alcohol use during pregnancy explored, to determine whether the presentation is FASD rather than ADHD or ASD. If so do you think honest answers are given?

That’s interesting. I think it must be either practice or health board specific maybe. I was privately diagnosed with ADHD by a consultant psychiatrist and my GP won’t even acknowledge it let alone prescribe for it. Just as well I don’t want meds…

Yes. Others input is always good, but not necessary for assessment.

An EHCP is difficult to get throughout the country. They are given by the LA after evidence is put forward by schools and their own experts (usually an EP and maybe a SALT and OT). Parents have very little input into them because the LA ignore them (and they ignore the law). Perhaps more middle class parents are prepared to appeal and go to a tribunal but in all honesty the whole process is exhausting and difficult enough as it is.

Given you have so many contacts in education it’s disappointing that you’ve either been given an impression that EHCPs can be bought or that those you know genuinely think that.

If there is no evidence from childhood then I would have thought you don’t have ADHD. I understand the concept of masking but surely people don’t mask from themselves? Like you would have noticed your struggles even if others didn’t.

Sometimes, ‘masking’ seems a convenient way of diagnosing people when the evidence isn’t actually there.

You mentioned up thread that you are walking contradiction because you have both ADHD and Autism. Can you explain to me in what ways you believe Autism and ADHD to be contradictory?

Hobbiestwriter

Thank you for your contribution millionsofmonkeys . Sounds like you have a practice much like ours.

Hobbiestwriter I am afraid you are very very wrong. You seem to think psychiatrists are the be all and end all of assessments, and they can and should do it alone. Couldn't be further from the truth. As millionsofmonkeys informed you, an MDT team is ideal - I agree with her that a single clinician for an assessment, no matter what their qualifications is a very bad idea and NICE would agree with me there. Autism and ADHD are not a medical condition, nor should they be under a mental health condition in my eyes. It is a neurological difference - NOT a disability.

So in my case I am the lead assessor, and every assessment has an MDT review. I do all the information gathering, family assessment and history, ADOS-2 assessment etc, and I make a diagnosis but we have a discussion about that in the MDT meeting. Each case is different though so for example I will ask more of the SLT if its a non-verbal child or more of the psychologist if its a middle aged woman with a Bi-polar diagnosis.

Also remember the members of that team ALL need to have extensive experience and training working with people with autism and adhd. Just being a psychiatrist is not enough.

You seem to think purely being a psychiatrist makes you qualified to do an assessment - better qualified than me or psychologist with vast experience with autism. You couldn't be more wrong. You are entitled to your opinion of course, but your views are not at all considered best practice.

Ive not written this for your benefit as you seem hellbent on rubbishing our professions here, but for people reading. Please also remember that people like me and millionsofmonkeys are giving our time and advice freely in order to help others, and comments like yours could put people off doing that.

A really interesting and helpful thread, thank you so much for sharing your expertise

My pleasure. I know how stressful navigating the journey to assessment can be. So I wanted to help where I can.

I've received been diagnosed with ADHD after a referral through RTC by my GP. From referral to diagnosis was 5 months, and the assessment and diagnosis was done by a Psychiatrist (PhyschiatryUK).
However I was extremely surprised (and disappointed!) in the lack of thoroughness and time spent my the Psychiatrist in my appointment - the whole thing lasted about 45 minutes and the resulting report was literally just a transcribe of what I had said, with no analysis or comment. Is this usual practice?

The most recent government statistics from January 2025 show 43.8% of pupils with an EHCP were eligible for FSM. That compares to 39.3% of pupils with school level SEN support who were eligible for FSM and 22.2% of all pupils in schools without SEN.

LAs don’t issue EHCPs if the legal test for an EHCP is not met. Neither does SENDIST Order LAs to issue when the legal test isn’t met.

Many parents have to appeal to secure EHCPs/good EHCPs. That isn’t unique to certain areas of London. In fact, some of the most difficult to deal with LAs are outside London. Parents can gather evidence to meet the legal test without a diagnostic report. EHCPs are based on needs. And if parents have to appeal, if they are eligible for legal aid, that can fund reports. If they aren’t eligible for legal aid, there are charities who can help.

I was in my 40s before I even recognised I had struggled. There is no way I could have identified that as a child. My autism absolutely overshadowed and hid the ADHD. Back then nobody questioned the quiet children, we were accepted as ‘good‘ - I was broken in the inside, but i certainly did not know it.

For me - degree, Msc in social work, dip in counselling, ADOS-2, DIVA-5 training and lots of other training, heaps of experience working in disability services in social care, MA in autism, and regular CPD around autism in women and girls. Its my special interest (Im autistic and adhd myself) so its very much my passion.
Others have different paths though.

Every provider is different. If he were with me, then he would very much have a choice and I would accommodate his needs (eg lots of breaks, support person present etc).

We would see that though. Part of interviewing the family isnt just about the answers, its about observing the parents. The amount of times I have a clearly adhd child with dad in the corner twitching away and looking like he wants to jump out of his seat, lol. You haven't failed, the assessor will have noticed your ND behaviour Im sure and that would be an indicator.

That is quite some path!
My DD, 15, has recently been diagnosed, but has known for sometime that she is autistic. And autism is now definitely her main special interest. I asked her if it would fade as some of her other interests have, and she said: well, I am always going to be autistic!
She is considering studying psychology for A Levels and possibly at university. I hope one day she can be of as much help to fellow autistic people as you are!

Has the diagnostic criteria for autism changed?
I ask as I work with adults with learning disabilities. 1 guy is 27 years old and his parents were telling me how hard it was to get his diagnosis as a child, yet he clearly absolutely obviously has ASD. They had to battle for assessment.

So his parents are shocked to hear how easy it is to get a diagnosis nowadays. I couldn't answer that.

I very much believe so. It certainly was for me, and many of my clients say the same. I think it helps you to understand yourself, get reasonable adjustments in work/study, help loved ones understand you more - and most of all help you to be patient with yourself. Many people on the spectrum have anxiety, depression and low self-esteem because of always masking and feeling like we dont fit in.
For example, I used to feel like why am I so 'clever' in the usual sense, but (in my mind) absolutely stupid in others. So im book smart yes, but I can't follow a recipe to save my life (I get so distracted and overwhelmed), I can't park (zero spacial awareness or road sense), cant change a duvet cover, love socialising, Im the life and soul, but am absolutely pollaxed afterwards for days on end with a 'social hangover' - I could go on here, but my point is, like many on the spectrum I felt weird and incompetent and 'stupid'. But knowing that my executive functioning is so poor with a diagnosis I have been able to access support and gain skills to manage those things better. And I dont feel stupid or weird anymore, I feel empowered and that with my gifts (hyperfocus, ability to see the world differently etc), comes some challenges that with the right scaffolding I can thrive in - and now I do. Ive set up my life now so I minimise my overwhelm (eg, ready meals, timers, big spacing between socialising, avoiding crowds, etc) and my anxiety and depression radically reduced.

In your experience, how often does ADHD medication, in particular Atomoxetine, help with other ADHD symptoms but not impulsive and risk taking behaviour (think things like climbing on a roof to get a football)?

God no. I do a screening first which isn't infallible but its a good indicator. Sometimes I wont go ahead if they score low, and people can get very angry about that but I don't think its ethical to take their money or their time.

Also going through 4 hours of assessment, plus all the paperwork for a client is a lot to put on someone I feel. Not everyone gets a diagnosis, and some people are very very unhappy about that. Especially when they are paying. Some seem to feel they are paying for a diagnosis - not an assessment. But sometimes it really is something else, usually trauma-related, and I will refer them onto a psych eg for bi-polar/bpd assessment.

The hardest is those parents who are crushed by a positive dx. I always give them lots of time to go through the report afterwards and follow up. For some, its like grief, and can get quite anxious and depressed themselves, so I think its vital to tread carefully and do follow ups. Interestingly its the dads that tend to take it the hardest, or simply will not accept it. So some couple counselling afterwards I often advise in these cases.

I agree with you. I don't like the medical model. I follow the social model of disability. But then I would wouldn't I being a social worker! 😁

Huh? anyone with a phd can call themselves a Dr. The term 'psych' means psychologist, psychiatrist, ed psych, clinical psychologist - all of those.

No psychologists can't prescribe, but so what? Most people take their assessment to then get meds if they want via GP. Or we have a nurse prescriber on our books for ADHD meds.

You clearly don't work in this field so please stop talking nonsense, its not fair on people who are getting really good advice here.

Thank you for starting this thread, it is very much welcomed & fascinating. Autism and ADHD in women is one of my special interests. I'd love to know more about the connections between trauma and autism/adhd, and how/if they can be separated. I have experienced significant trauma both in childhood and adulthood & have a late diagnosis of AuDHD (plus OCD, anxiety, depression).

Edited to add that I am hopeful your answers on the thread can dispell some ignorance; it's incredibly frustrating how far we still need to go.