FAQs – Neurodevelopmental Assessment Service

Our first appointment will generally be a video consultation with parents or carers to take a developmental history, discuss the assessment process, and answer any questions you may have. The assessment with the child or young person will usually take place face-to-face in our clinic in Norwich city centre.

Waiting times for assessments may vary, but we endeavour to offer appointments within six–eight weeks of your referral.

Because there are different costs associated with different types of assessment, after we receive your initial enquiry we will  be in touch with our recommendations regarding the assessment we believe to be most appropriate for you or your child alongside the associated costs.

We can assess children who are not in school, but we would need to speak to someone who knows your child well outside your network of friends and family. This may be a sports coach, music teacher, private tutor, and so on.

No, you do not need a GP referral to be assessed at PCEA, though we do sometimes receive referrals from GPs. We also receive referrals from Local Authorities and schools.

If an assessment adheres to NICE Guidelines, as our neurodevelopmental assessments always do, it would be difficult for an NHS health professional to question a diagnosis if it is made. In many cases, our assessment processes are more comprehensive than those offered by NHS services.

If a health professional does reject a diagnosis following a PCEA assessment, they would need to provide written evidence regarding their rationale for rejection – this is incredibly rare. Our clinicians are always happy to liaise with NHS professionals to resolve any concerns that may arise.

Video consultation with parents or guardians will take place a week or two before the assessment itself. The face-to-face assessment will usually be conducted in one day, however, if it benefits the child to conduct the assessment over two or more days, we are always happy to accommodate. On occasion, clinician availability may mean that your assessment could be completed sooner if split across two days. In all cases, we will let you know and arrange assessments to suit your needs and availability.

Wherever possible, we like to liaise with a child’s school to receive further information about how they present in this environment. We will ask your permission to do this and for the most appropriate person to speak to within the school. We may also ask your child’s teacher to complete standardised questionnaires about their behaviour in school.

Our clinicians have years of experience in working with children with all manner of behavioural and emotional challenges, including those who are very anxious. We will do everything we can to help your child to feel at ease on the day and will adapt our methods accordingly should the need arise. To help ease any anxieties before their visit, you may wish to show them a picture of the clinician they are seeing.

We prefer to assess children on a one-to-one basis if we can. If this is not possible however, we can accommodate a parent or carer being in the room but will require them to remain quiet and out of sight during the assessment process to minimise distraction.

We understand that children can present very differently with new people and in an unfamiliar location. We also know that some children with ASD or ADHD ‘mask’ their difficulties, particularly when they are anxious or trying to make a good impression. We collect information from both schools and family members for this very reason—to ensure we get a reliable picture of their general behaviour.

We aim to have reports completed and sent out within four weeks of assessment.

Following receipt of our report, we offer a follow-up video consultation to go over the results, answer any questions and discuss any next steps recommended for your child.

Fetal Alcohol Spectrum Disorder (FASD) is a life-long neurodevelopmental disorder caused by exposure to alcohol during pregnancy. Not all alcohol-exposed pregnancies result in a baby being born with FASD, but the risk is significant and there is no safe amount of alcohol to consume during pregnancy. It is therefore recommended by the World Health Organisation that alcohol be avoided entirely during the pregnancy, including when planning for a pregnancy.

There are, nonetheless, many reasons why some women have alcohol-exposed pregnancies. This may include not realising they are pregnant until later in the pregnancy, not understanding the risks involved, or for some, having a dependency upon alcohol, making abstinence difficult. If you are currently pregnant, and there has been some alcohol exposure, it is important to discuss this with the medical team looking after you, who will provide advice and support. You may also wish to visit the National Organisation for FASD for further information.

If a child is diagnosed with FASD, they may have a range of physical, neurodevelopmental, and cognitive difficulties. Children who have FASD often also have ADHD and/or ASD as part of their condition. They generally have what are described as ‘spiky’ cognitive profiles, with significant weaknesses in some areas, and relative strengths in others. A very small number of children have what are known as sentinel facial features associated with prenatal alcohol exposure, but most do not. Some children also have non-specific physical manifestations of alcohol exposure, such as problems with their sight, hearing, heart, or kidneys.

If you believe your child may have FASD, or has previously been diagnosed, there are professionals available to support you, so please do not be afraid to reach out to us.

FASD continues to be a poorly understood condition for many who live with it. Research suggests that a diagnosis made as early as possible in a child’s life will have a positive impact upon their prognosis. Children who receive a timely diagnosis are more likely to receive appropriate understanding and support both in their education and at home, which reduces some of the risks associated with FASD, such as exclusion from education and social vulnerability. Furthermore, if a child or young person understands their condition and receives the right support, they are less likely to feel isolated and to suffer from low self-esteem.

Many of the children we have previously seen for diagnosis return for updating neuropsychological assessments at key transition points, such as beginning secondary school or planning for independence in late adolescence.

Repeating a neuropsychological assessment at intervals during childhood can be important because the trajectory of FASD tends to mean the developmental gap between an affected child and their peers often widens over the course of childhood, resulting in their needs and vulnerabilities also changing. This is particularly pertinent when ascertaining whether a young person is likely to be able to live independently as an adult or whether they will require a degree of ongoing support to protect them.

Updating neuropsychological assessments can inform EHCP reviews by providing a detailed account of an individual’s strengths and challenges in relation to their diagnosis and how this should translate into the educational and social support they require.

Diagnostic assessments for FASD must follow SIGN 156. This is a national clinical guideline detailing the prenatal exposure of children and young people to alcohol and provides more detailed information about the assessment process.

To confirm a diagnosis of FASD, an individual must have had a genetic screen completed (CGH microarray) to rule out the small possibility of there being a chromosomal cause for some or all of their presenting problems. We can provide further information about this during the assessment process.

Assessment of FASD is centred around ascertaining whether a child or young person who has been prenatally exposed to alcohol has significant impairments in at least three of a possible ten neurodevelopmental domains, as cited in SIGN156. To do this, a thorough neuropsychological and neurodevelopmental assessment is required, which also ideally includes screening for ASD and ADHD.

FASD is a diagnosis of exclusion. We must always ensure there are no other possible causes of the difficulties seen before making a decision.

There are a number of excellent services offering support and advice to families affected by FASD. One such organisation is FASD South West.

The National Organisation for FASD also provides a wealth of information, including where to access further support.

Children and young people with FASD may wish to access ‘Me & My FASD’, a website dedicated to helping them understand FASD specifically.

Dr Cassie Jackson offers individual parent consultation sessions to families who are struggling with behavioural, education, or other issues relating to their child or young person’s diagnosis. You can request a one-off consultation with Dr Jackson by completing this form.

We follow NICE Guidelines for the diagnosis of autistic spectrum disorder (ASD), which must involve at least two qualified health professionals who are registered (such as with HCPC) and with appropriate levels of expertise and experience.

At our clinic, children are generally seen by a chartered clinical psychologist and a speech and language therapist, who conduct different aspects of the assessment and then confer their results. If possible, we also request information from parents and from a child’s school to ascertain the pervasiveness of symptoms in different environments. We then collate this information to inform diagnostic decision-making.

PDA stands for Pathological Demand Avoidance and continues to be a much-debated topic in the ASD world. At PCEA, consistent with most NHS services, we recognise that some children with ASD present with a profile consistent with PDA symptoms. We do not recognise PDA as a standalone diagnosis but as a profile observable in some children who have autism. When we see this profile, we make appropriate recommendations for onward support following diagnosis.

There is no single test for diagnosing ADHD, although certain tools are frequently used to look at certain symptoms.

Reliable assessment of ADHD must be conducted according to NICE Guidelines by qualified health care professionals with expertise in ADHD, such as paediatricians, psychiatrists or clinical psychologists. Assessment generally involves taking a detailed developmental history, observing the child, collecting information from different environments such as home and school and use of standardised questionnaires from different environments.

Direct assessment of the child is also important, which may include neuropsychological assessment to investigate different domains of intellectual functioning and a direct assessment of inattention, hyperactivity and impulsivity symptoms. It is also very important to rule out any other possible reasons for a child’s symptoms. This is because some other conditions can look very much like ADHD to the untrained eye.

ADHD cannot be considered as a possible diagnosis until a child is six years old or above.