If you think your child may have ADHD, finding the right assessment can feel confusing. There are NHS and private routes, services of very different kinds, and a lot of advertising. This guide explains what a good assessment involves and what to ask, so you can decide with confidence.
Why the assessment matters
An ADHD diagnosis influences the support a child receives at school, whether medication is considered, and how they and their family understand their difficulties. Getting it right matters as much as getting it quickly.
Who can diagnose ADHD?
NICE, which sets clinical guidance in England, says ADHD should only be diagnosed by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD. What matters most is the specific training and experience of the person you see, and how thorough the assessment is.
What a thorough assessment includes
NICE says the diagnosis should be based on a full clinical and psychosocial assessment, a full developmental and psychiatric history, reports from people who know the child, and an assessment of the child’s mental state. In practice you can expect:
a detailed conversation with parents or carers about your child’s development, strengths and difficulties
time with your child, so their own view is heard
information from school or nursery
questionnaires, which add helpful structure
consideration of other explanations and of conditions that can occur with ADHD
attention to your child’s physical health
Questionnaires and tests are aids, not answers
Rating scales can add useful information, but NICE says a diagnosis should not be made solely on rating scale or observational data. For children aged 6 to 17, NICE also lists a computer-based test (QbTest) as an option to help the diagnosis, alongside a full clinical assessment. Be cautious about any service that offers a diagnosis from a questionnaire alone, or that seems to promise an outcome before it has met your child.
Other conditions matter
The diagnostic process should include an assessment of your child’s needs, any coexisting conditions, their social, family and educational circumstances, and their physical health. This matters because the signs of ADHD can overlap with anxiety, low mood, the effects of stress or trauma, sleep difficulties, autism and learning differences, and these often occur alongside ADHD. NICE also says that having autism shouldn’t automatically rule out an ADHD diagnosis, so the two can be considered together.
Different professionals, different expertise
Every professional works within the limits of their training and registration. Psychiatrists are doctors with specialist postgraduate training, which allows them to consider physical health, medication effects and other psychiatric conditions alongside ADHD. Psychologists, occupational therapists, speech and language therapists and nurses bring different and equally valuable expertise, and good care often draws on several of them.
Medication
If medication might help, ask who will prescribe it and who will monitor it. NICE says GPs and other primary care practitioners should not make the initial diagnosis or start medication in children, and that ADHD medication should only be started by a professional with training and expertise in diagnosing and managing ADHD. Before medication starts there should be a baseline check of your child’s physical health, including height, weight, pulse and blood pressure, and medication should be reviewed at least once a year. After the dose is settled, prescribing is usually continued by the GP under a shared care agreement. Whether a GP agrees is their decision, so it’s sensible to talk to your GP before the assessment, particularly if you’re using a private service.
After the diagnosis
A diagnosis is the start of support, not the end. With your consent, a good service will contact your child’s school to explain the diagnosis and recommend adjustments, and will point you to local and national sources of support.
Will my GP and school accept the diagnosis?
It depends on the GP, the school and the local arrangements, and no provider can promise it. A report that explains clearly how the diagnosis was reached, and that follows NICE guidance, gives you the best chance. Ask to see what the report will contain.
Questions to ask before you book
Is the assessor a psychiatrist, paediatrician or other professional with specific training in diagnosing ADHD?
Does the assessment include a full developmental and psychiatric history, and not only questionnaires or a computer test?
Will other explanations and coexisting conditions be considered?
Will information from school be included?
Will my child’s physical health be checked before any medication?
Who will review and prescribe medication, and who will monitor it?
Will the report follow NICE guidance, so my GP can rely on it?
What are the total costs, including reports and follow-up?
Checking credentials
You can check clinicians on the public registers: the General Medical Council for doctors, the Health and Care Professions Council for psychologists, occupational therapists and speech and language therapists, and the Nursing and Midwifery Council for nurses. You can also check whether a service is registered with the Care Quality Commission.
A final thought
A good assessment should leave you with a clear explanation, a report you can understand and use, and a plan for what happens next. It should respect your child as an individual and take your observations seriously.
Source: NICE guideline NG87, Attention deficit hyperactivity disorder: diagnosis and management (nice.org.uk/guidance/ng87), recommendations 1.2.9, 1.3.1 to 1.3.4, 1.4.12, 1.7.2, 1.7.4, 1.7.29 and 1.10.1.