Advice on getting DS assessed

[EdPops]

The SENDCo at our nursery has asked that we have our DS (3y8m) assessed after observing various behavioural and developmental challenges over the last 6 months. It’s no great surprise unfortunately, ADHD and HFA run in the family but we were obviously hoping he would dodge the bullet.

I was just after some practical tips on finding the very best person to carry out an assessment. The SENDCo has asked that we do this urgently as he’s supposed to be starting reception in September.

We have private health insurance (BUPA) through work and we’re thinking this could be the best and quickest route?

So any advice on how best to approach this would be great.

Who’s help to seek out? I.e. are we looking for a child psychologist? A child psychiatrist? An educational therapist? A paediatrician that specialises in Neurodiversity?? I’m getting a bit lost in the terminology.

And any do’s and dont’s from your experiences of having your children assessed?

It depends on what type of assessment you want and what you want from the assessment?

Check the private health insurance, not all cover assessments such as ASD and ADHD assessments. Not many cover assessments like ed psych assessments.

The SENDCo has asked that we do this urgently as he’s supposed to be starting reception in September.

Support in schools is based on needs, not diagnosis. Have you considered whether you need to request an EHCNA?

As far as i understood from our conversation, the SENDCo wants to pursue an EHCNA in order to have an EHC plan in place before DS starts school and has suggested that – rather than rely solely on the nursery's own observations – we seek out an independent educational psychologist to carry out their own professional assessment of DS before moving forwards with anything. The urgency being that September is only round the corner so we need to move swiftly.

So in answer to your question, i believe we've been advised to seek a professional assessment of DS to see whether any signs of ADHD / Autism are present and if they are have the SENSCo at nursery move forward with an EHCNA to get a plan in place before he starts school.

Does this sound like the correct approach in our situation?

The EHCP process takes 20 weeks. Unless you apply very soon you will not have a plan in place by the time he starts school. If the nursery has six months of evidence that is enough and an educational psychologist assessment will be done as part of the process. Along side this the nursery can help with a referral for NHS ASD assessment, or you can opt for a private one. Assessments are usually done via a multidisciplinary approach involving a developmental paediatrician and speech & language therapist.

So really we should be asking the nursery SENDCo to just go ahead and begin the EHCP process based on their observations alone?

I believe they suggested we seek an independent adhd / autism diagnosis first in case we felt like we needed a professional 'second opinion' on the observations they'd made themselves, but really we don't have time for that and a proper adhd / autism assessment will be done as part of the EHCP process anyway, is that what you're saying?

Are there any risks in starting the EHCP process based solely on the nursery's assumptions and without a professional independent assessment? What if they've got it wrong? Will the process have any negative impact on DS if the assessment rules that he's fine?

They won’t assess for autism as part of the ECHP process but the EP will be able to see his difficulties.

Their observations are what they are. Have they completed paperwork for plan-do-review or similar over that time?

You can apply for an EHCNA yourself. On their website IPSEA has a model letter you can use. You are pushing it for time. As open stated EHCPs take 20 weeks if you don’t have to appeal. So you need to apply ASAP to have any chance. Sadly, many do have to appeal, some more than once. I would question why the nursery is only just raising this now.

You don’t need further assessments prior to applying for an EHCNA. The threshold is relatively low - a) has or may have SEN, and b) may need SEN provision to be made via an EHCP. If the nursery think this is urgent there should already be enough evidence to meet this threshold. If the LA agree to assess the EHCNA will include an EP assessment (which won’t diagnosis ASD or ADHD) and you can request assessments such as SALT, OT, psychiatrist, clinical psychologist. Although a diagnostic assessment for ASD/ADHD is unlikely.

You also don’t have time to seek independent assessments if you want to try to have an EHCP in place for September. Even independent EPs have waiting lists unless you are extremely lucky in a cancellation. And then you still need to allow time to receive their report. Waiting for independent assessments before applying just delays matters.

Unless money is no object I wouldn’t seek independent assessments before applying for an EHCNA anyway. They are expensive and if you get them now but e.g. the LA agree to assess but not issue and you appeal you may find they are out of date before you get to a hearing. They used to be considered up to date for around 2 years, but over the last few years SENDIST have considered reports much younger out of date. You also don’t know whether e.g. the LA EP assessment will be sufficient but you desperately need to prioritise funding an independent SALT either.

There’s no risks to not having a diagnosis and independent assessments before applying. There is a chance the LA will refuse to assess or refuse to issue, but that risk exists even with a diagnosis and independent reports.

There won’t be any negative effects if the nursery have ‘got it wrong’. Nursery may not know the precise diagnosis but if they think this is urgent I highly doubt they have got the need for significant SEN support incorrect.

I don't recall the term 'plan-do-review' being mentioned in our meeting but I can check. To be honest their whole approach to the meeting was a little heavy-handed, the SENDCo opened with the words 'your son is really going to struggle at school'^^ and proceeded to hand us a hand-scribbled list on a scrap of paper their 'collected observations' which included such blunt observations as:

Lack of empathy
No personal space awareness
Fails to make meaningful relationships
etc.

It was really upsetting the way they handled it. Anyway we are where we are. I'm just left feeling doubtful wether they're following the correct procedure with regards to what should happen next before DS starts school and wether we're wasting valuable time seeking an independent assessment before the EHCP process is started.

Assess, plan, do, review cycles are called different things in different places. If the nursery think an EHCNA is urgently needed it would be remiss of them not to have already undertaken this in some form.

As soon as you know what school you have been offered you should speak to their SENCO.

You only have 22 weeks until the start of term (?). I don’t think that is enough time for a private assessment to take place and the EHCP process to be completed (with a final plan issued) following that. That’s even assuming they don’t refuse to assess for the EHCP (a common delay tactic) and you don’t have to appeal.

As a PP said, you don’t need a diagnosis to get an EHCP issued. Not all children with EHCP’s are asd/adhd. The nursery staff are not qualified to say if he has asd/adhd though they can spot red flags and recommend that he be seen by a professional for formal evaluation, their opinion will add weight to this. What they should be able to say is that ds has (mild/moderate/severe) difficulties with x/y/z, these are the strategies we put in place, this did/didn’t work. Based on that they can make recommendations that can input into a support plan.

Have you heard about a school place yet? Have you discussed his needs with the school yet?

Crossed post with FloatingBean

An assess (thank you) plan do review type approach is standard in settings when SEN is suspected. I think you would know if they had done this though as the paperwork and targets have to be approved by you formally each time - at least they certainly used to be (my ds is 9 now).

Is it recommended that we apply for the EHCNA ourselves or will it be better coming from the nursery SENDCo? Given the delays we've experienced I'm worried the nursery might not complete the application quick enough.

Personally, I would do it yourself, so you know it is submitted ASAP.

What happens if we miss the deadline and an EHCP isn't in place by the time he starts school? Will the plan simply come into effect once it's ready a number of weeks later or do we have to wait for a new term or a new school year before an assessment can be done and a plan put in place?

The reason i ask is that my DH is extremely reluctant to start the EHCP process without having an independent assessment of our DS done first as DH feels the nursery can't be trusted following the way they handled the meeting (i also suspect a large part of it is denial and not wanting to believe DS has anything).

I'm at a loss as to what to do as i'm worried if we don't act now we'll miss the boat in terms of having a plan in place for him if he needs one.

The plan will come into effect as soon as it’s ready. If it’s later, obviously that means specific support will not be in place for when he starts school. This is why I think it’s important to discuss his needs with the school before then.

Ideally you want the EHCNA to happen before the summer holidays if his nursery is term time only. Lots of educational psychologists only work term time too.

Maybe it will help your dh to separate out the asd/adhd assessment and the needs assessment. Whether or not he’s neurodiverse he has some issues that the nursery say are going to have an impact on his school experience. These issues need to be identified and measures put in place to support him so that he achieves the best possible outcome. If he is then diagnosed as ND then that is additional information to help support him going forward.

Everyone above is right - you don't need to and shouldn't wait for assessment before applying for an EHCNA. Even if referred, you'd be waiting years for an NHS diagnostic assessment. and quite probably months for a private one. Good private EPs are booked up many months in advance most of the time. And they cost well over a thousand.

I do have some sympathy with your DH though. We went through a similar process with nursery and it was handled far better. Apart from the unprofessionalism of a scribbled bit of paper, talking of '
Lack of empathy
No personal space awareness
Fails to make meaningful relationships
etc.'
shows a worrying lack of understanding of neurodivergence and rather an ableist perspective. Lack of empathy has bugger all to do with autism. Difficulty in reading others' emotions, difficulty in understanding how to react to them - sure. Not lack of empathy. Similarly - it's not as simple as saying he is failing to make meaningful relationships - others are failing to make relationships with him.

Similar situation.

DS has had a assessment already, 6 month review due soon.

We applied for EHCP and have been refused for assessment. Currently in the appeal stage.
So ours won't be done in time for reception either.

Do your nursery do a handover to school staff? We are meeting with his teacher (once known) and going through everything then so he/she are aware of his needs until/if we manage to get a EHCP.

They were more interested in what the EP has to say than the peads consultant so having a diagnosis etc doesn't make a difference

My DH is worried that if we start the EHCP process now relying purely on the nursery's observations (and not those of a professional psychologist) then DS might be unfairly stigmatised in the eyes of the LA and the school we end up with.

Is there any danger of this happening?

The EHCP is about his needs, not a diagnosis. It’s that simple. A child can be autistic and need very little support, or they could not be autistic and require a high level of support. They are two separate things but a diagnosis might help inform the EHCP, which it can do later if appropriate as each EHCP is reviewed annually. The worse scenario is for him to start school with no support and be labelled as ‘difficult’ or ‘naughty’.

I agree with Open, there are 2 parts of your situation. One about any potential diagnosis. The other looking at support in school and an EHCNA which is based on needs, not diagnosis. If DS needs support in school he will need this regardless of whether he is diagnosed or not. The majority of nurseries pass on their observations to the school anyway whether going through the EHCP process or not.

If an EHCP isn’t finalised by September you won’t have to wait for a new term or year. The EHCP process doesn’t work like that. An EHCNA can be applied for at any time, and the statutory timescales apply. If the LA are going to issue an EHCP they must do so within 20 weeks (with a few limited exceptions).

DS will start school as normal (or not if you decide to defer). Even without an EHCP the school must make their best endeavours to meet a pupil’s SEN. However if the nursery are suggesting an EHCNA you really should listen, imo.