ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
ASSESSMENT AND DIAGNOSIS FOR
CHILDREN & TEENAGERS
If you are concerned that your child or teenager may have Attention Deficit Hyperactivity Disorder (ADHD) and are interested in having an assessment, Questa is able to help. We have a multi-disciplinary team who are experts in assessing ADHD and other neurodevelopmental conditions and can offer valuable advice and guidance as well as signposting you to services that may be able to meet your on-going needs following the assessment.
Q. Will my child's school or college accept the outcome of an assessment conducted in the independent sector?
Many parents and carers may worry or may have heard that the assessment findings will not be accepted by their child's school or college because the assessment has not been conducted by clinicians working in the NHS. The issue is not whether your child has been assessed within the NHS or the private sector, but whether the assessment has been carried out by suitably trained, qualified and experienced clinicians and has followed NICE guidelines. All of the clinicians on our multi-disciplinary team (MDT) are fully trained and highly experienced in the assessment and diagnosis of neurodevelopmental conditions.
What is ADHD?
ADHD is usually first diagnosed in childhood and often lasts into adulthood. It cannot usually be diagnosed in children below the age of 6 years as the behaviour associated with ADHD is a normal part of early childhood. It should only be assessed if the child or young person is not thriving or reaching their potential because of the difficulties caused by their symptoms.
It is typical for children and young people to have trouble concentrating and behaving. However, children with ADHD do not just grow out of this behaviour and it can cause problems for them. ADHD can cause difficulties at school, at home, or with friends.
A child or young person with ADHD may:
daydream a lot
forget or lose things a lot
be very disorganised
seem not to listen to or process what is being said to them
squirm or fidget
talk too much
make careless mistakes
take unnecessary risks
act impulsively without apparent awareness of the consequences
have a hard time resisting temptation
have trouble taking turns
have difficulty getting along with others
leave tasks unfinished
find it difficult to know where to start with a task or assignment
have much more energy than would be expected and the need to move almost constantly
have difficulties getting to sleep and/or needing less sleep than same-age peers
Types of ADHD
There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:
Predominantly Inattentive Presentation: difficulty organising or finishing tasks, paying attention to details, following instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly Hyperactive-Impulsive Presentation: fidgeting and talking a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless or agitated and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
Combined Presentation: Symptoms of the above two types are equally present in the person.
Because symptoms can change over time, the presentation may change over time as well.
Does my Child Have ADHD?
You may be wondering if your child has ADHD because you or others have noticed that your child has behaviour often seen in children with ADHD. It is worth bearing in mind that a child without ADHD can sometimes present with ADHD, for example if they have learning difficulties, severe anxiety, experienced adverse childhood events or trauma, among other things. An assessment can help determine whether the behaviour is related to ADHD or if there is another possible cause.
What are the benefits of a diagnosis?
For many parents getting a timely and thorough assessment and diagnosis may be helpful because:
It provides a framework for understanding behaviour.
Getting the right diagnosis means accessing the right help or helping others understand their needs.
It means that school, colleges and universities can make reasonable adjustments for your child to make the environment more user-friendly.
A diagnosis can also help the young person make sense of their experiences.
It is up to you whether you decide to seek a diagnosis for your child; some people are happy to remain un-diagnosed. The only way to know for sure whether your child has ADHD is to have a formal diagnostic assessment.
The assessment process:
There are structured phases in the formal diagnostic process. Some of the diagnostic stages are carried out over video link, while some can be offered face-to-face:
1. Initial Assessment appointment:
You and your child will meet with one of our team members for an in-depth discussion of their history, development and behaviour. This lasts up to an hour and a half. You will also be asked to complete some questionnaires about your child prior to the appointment, and the answers will be explored by the clinician. At this point we discuss the assessment information gathered so far with you to decide whether a formal diagnostic assessment would be helpful. If there is not a clinical rationale for further assessment, our clinicians will make some recommendations for the next steps.*
This stage can either be carried out face-to-face or online.
It is advised that the child attends this appointment.
*If you are recommended both an autism and ADHD assessment, only one initial assessment is needed for the clinician to provide suitable recommendations about how to proceed. However, at Questa we do not carry out combined assessment but prefer to assess each diagnosis separately.
If the initial assessment indicates that a diagnostic assessment would be helpful, it is important that we gather observer reported information from other sources who also know your child. A member of staff at your child’s school or college are very often the best source of information and with your permission, we will send questionnaires for them to complete and return.
3. Detailed diagnostic interview Part 1:
The detailed diagnostic interview gathers further information from questionnaires and builds on the assessment information already gathered. The diagnostic process is split into three parts. Part 1 requires you to complete further questionnaires as well as attending an interview with a member of our multidisciplinary team.
This stage is carried out online via video link.
Note: Your child does not need to attend this appointment
4. Detailed diagnostic interview Part 2:
The second part can either be carried out at home or with our Assistant Psychologist. The child will be asked to complete a test called QbCheck. It is a web-based test with motion tracking which objectively measures the three core symptoms of ADHD: activity, attention, and impulsivity. It also measures the likelihood for ADHD. By providing quantitative measures of the child’s activity level, ability to pay attention, inhibit impulses and a likelihood of ADHD, QbCheck can aid our clinicians in the assessment process.
This stage can either be carried out face-to-face or online.
Note: Your child would need to attend this appointment.
5. Detailed diagnostic interview Part 3 (optional)
Our clinician may indicate that a school observation would be beneficial in assessing your child. If so, this would be carried out by our Assistant Psychologist at your child's school. *
6. A feedback session
We will go over the assessment with you and the outcome. A full report is produced, which includes detailed recommendations designed to meet your child’s needs, details of resources and other services that provide relevant support.
This stage is carried out online.
Note: Your child does not need to be present for this appointment.
*Further observations may be needed if there is any doubt about the observer reports.
If the assessment outcome was a diagnosis of ADHD, we can offer additional further post-assessment sessions to offer support, guidance and advice to address any on-going needs you may have. We can also offer consultation to schools, colleges and universities.
6. Therapy, Support and Coaching
We can also offer further therapeutic sessions to offer treatment for any behaviour or emotional concerns your child or teenager may be experiencing, such as difficulties with relationships, self harm, anxiety, depression, self esteem and emotion management.
Please see information under “Child and Adolescent Therapy”.
7. Further assessments
The assessment may highlight that additional assessment is needed or beneficial, for example a cognitive assessment to help clarify a learning profile and intellectual ability that can be of help to the child’s school or college. A behavioural analysis and expert advice and coaching to manage unhelpful behaviours in the family or at school can be of great help too.
Please note: For medication, you or your child will need a psychiatric consultation. That would include medical examination along with titration of medications. At Questa, we are a group of psychologists who can do the assessment and diagnosis. However, we do not have the resources to investigate how you, or your child will respond to medication or how long the titration process would be. We would therefore send all our reports to your psychiatrist for further assessment.