It can be very upsetting to suspect that your child has ASD and as NHS clinicians, we understand that the wait for a diagnosis can be prolonged and often enhance the anxiety and confusion. Noticing a great need for a specialist diagnostic service in Scotland, The Edinburgh Practice decided to create its own 'gold-standard' service, ensuring that families can access fast and convenient ASD assessments for their children.
You may choose to have a private assessment because you have noticed some of the features and behaviour of ASD in your young child. Or, certain behaviours may have been pointed out by a teacher or educational psychologist when your child started school. Most parents find that getting a diagnosis; be it positive or negative; is a constructive step, as it helps them to learn more about their child and access the most appropriate services and support for their needs.
The Assessment Process: What to Expect
ASD is diagnosed by gathering evidence from a child, their family and by completing a clinical assessment. Currently, there is no blood test or brain scan that can test for ASD. It is a bit like a jigsaw, gathering pieces of information from different sources to see if the picture looks like ASD or if the symptoms can be better explained by something else, for example, anxiety or learning difficulties. Our child and adolescent team is multidisciplinary, and comprised of two senior clinical psychologists and a specialist speech and language therapist. In order to provide a 'gold-standard' service, we have chosen to use a range of clinically recognised tools. Below is a guide of how our assessments typically proceed:
Stage 1: Initial Consultation with Parents/Guardians
The first stage of our assessment process involves an initial consultation with one of our senior clinical psychologists. The purpose of this consultation is to give you the opportunity to meet with a member of our team to discuss your concerns about your child and provide some details about your child's developmental history. Where applicable, both parents or guardians should attend this meeting which will last approximately one hour. At the end of the meeting we will provide you with a questionnaire to give to your child's nursery/school to fill out and return to us. We will also need to contact the school/nursery to verify information. This information is vital to the diagnostic process and is essential for us to have prior to us meeting your child.
Stage 2: The Core Assessment
For the main part of your child's assessment, you and your child will be invited to attend a morning or afternoon session at The Edinburgh Practice. You will be welcomed by the clinical team and the assessment process will be explained. There will be an opportunity to ask any questions and discuss any concerns at this time. Over approximately three hours, a variety of assessments will be carried out:
As parents/guardians, you will meet with one member of our team to complete the ADI-R. This is a standardized interview which includes in-depth questioning relating to your child's early years and developmental history and has been proven to be highly useful for diagnosing and supporting individuals with ASD. It is a gold standard assessment tool and is recommended in current national guidelines.
While the developmental interview is being carried out, your child will meet with another member of the team to complete some tasks from a cognitive assessment. This assesses cognitive skills, such as language and problem solving. It will highlight a child’s strengths and weaknesses and can help to identify whether there are any difficulties with learning.
Following this, your child will be invited to complete the ADOS-2 assessment for ASD. This is a semi structured, standardised assessment which is designed to identify behaviours that are typically related to a diagnosis of ASD. This is also a gold standard instrument recommended in current national guidelines. This play-based observational assessment involves your child playing with specific toys and undertaking various tasks with a member of the team, whilst their interaction is being observed by another team member.
Stage 3: Diagnosis, Report & Recommendations
Once these assessments are complete our team will meet to discuss the assessment results (this will take approximately 30 minutes). Following this discussion, two team members will meet with you to share our findings. In the majority of cases we will be able to tell you whether we think your child meets the diagnostic criteria for ASD at this time. In some cases, further assessment may be required if it is determined that further clarification and observation would be useful to the assessment process. Examples include a nursery/school observation, an additional speech and language assessment, or a review by a paediatrician or child psychiatrist. If this is the case then the rationale and timing for the further assessment will be discussed. Following completion of our assessments a written diagnostic report will be completed. We will aim to have this report finalised 14 days after completion of our assessment.
Stage 4: Post-Assessment Support Meeting
Whether or not your child received an ASD diagnosis, we understand that the whole process and outcome will have been challenging for you as a family. Receiving a positive ASD diagnosis for a child can feel overwhelming, and each individual will have differing emotions following the diagnosis. Equally, parents of children who do not receive a diagnosis and where the origin of their child's difficulties appear to point elsewhere can also feel overwhelmed and helpless as to what to do moving forwards. For this reason, we have structured in a 'follow-up' meeting, approximately one month after your child's assessment. This meeting allows you the opportunity to go through the report again if necessary and get clarity on any outstanding queries. Whatever the outcome of the diagnostic assessment, you will be provided with practical resources and recommendations for local services and support groups that may be helpful for you and your family.