Neurodiversity Assessments
Recognising your child experiences the world in a different way may feel very overwhelming and as a parent you may feel very concerned about your child, the way they do things, how they understand themselves and others. It can also be very empowering and insightful to learn about your child through the things they do.
Every child is very important, unique and has amazing individual attributes and every family’s experience is very different. Books, guidance, and research can provide valuable overviews, insights but it is equally important to gain as much understanding about your child on an individual level to make sense of and understand some of the challenges, difficulties and some of the things they do that are truly wonderful.
What is Neurodiversity?
The term neurodiversity is an overarching terminology that describes variation in all human brains, which is normal. Neurodivergence refers to those individuals whose brains differ from neurotypical standards.
There are conditions associated with neurodivergence such as autism, ADHD, dyspraxia, OCD, Tourette’s Syndrome and difficulties relating to literacy and numeracy.
At the children in mind service, we strongly celebrate all children. We believe all children have multiple strengths and think, understand and learn from all our contacts with a child, family and network supporting them. There are no two individuals the same, and individuals that are neurodivergent will not experience the world in the same way. We are strong advocates for children and families, we go the extra mile for children and families and want children to lead fulfilled, successful and enhanced lives and overcome challenges and difficulties.
We have undertaken various courses and trainings which equipe clinicians in the service to explore and think about all the challenges a child may experience with psychological and psychiatric methodology and practice at the forefront of our service. We want to see and understand people individually and we do not want to apply a general approach which is our pledge of how we operate that we take very seriously.
It is important to note that we deliver services with sensitivity and with enablement. We are aware of the impact that words and diagnoses can have on an individual, parent and community. We are very mindful of these things and always deliver a patient centred approach. Language and terminology must be relatable to an individual and have a positive impact. We understand the psychological aspects of assessment, treatment and onward services that could be required.
If you walk down a street or visit a busy place, there is every chance you will cross paths with a person who could be neurodivergent. People with neurodivergence do not have to have a restrictive life but may require support, adaptations and sensitive thinking to assist them at times. There are many people of all professions and backgrounds who are neurodivergent; including doctors, nurses, teachers, musicians, actors, engineers and many other professions. Pursuing ambitions is very important as they can be achieved.
Social Interaction
People with autism may find making and sustaining friendships very challenging. They may have daily routines which can be repetitive. They may like to abide by these as set routines and rules they must follow and could be undertaken in a specific order and sequence.
They may have certain ways of communicating, appear abrupt, direct or on the outside of friendships. They can notice and feel the sense of an injustice and they may have more of an association to objects or animals. They may have challenges with reading facial expressions, managing their own facial expressions, being in groups and understanding social cues. They may find it difficult to understand and express their emotions, find it hard taking turns, reciprocal communication may be tricky and they may have heightened sensitivities.
Communication
People with autism may need more time to process information, and eye contact and facial expressions can be challenging. They may have language delay, be non-verbal or have selective mutism. They may have a sophisticated vocabulary but may lack understanding which could be inconsistent.
They may have lots of knowledge and understanding of a group or particular interests and not have much interest in other things. They may use repetitive language, phrases and language. They may mimic others, imitate others and repeat certain sounds. This is commonly known as echolalia. They may perceive things literally and be unable to understand fluctuating communicating that have different aspects to it like humour and sarcasm. They may not seem very interested in situations or conversations they do not find interesting and choose to disengage very quickly. They may communicate with a direct response which could be seen as abrupt at times.
Executive Functioning
Executive functioning is a key aspect of how people organise, process and activate thoughts and actions to achieve desired aims and goals. The main aspects of executive functioning are impulse control, emotional control, flexible thinking, working memory, self-monitoring, planning & prioritisation, task initiation and organisation.
Challenges with executive functioning can be associated and be features of autism and ADHD. Stress and clarity can impact executive functioning along with other physical and mental health conditions. More common mental health difficulties that may be present in conjunction are anxiety and depression.
Change
People with autism may have challenges and may not respond very well to sudden or know upcoming changes. In the past this may have been associated to obsessional, rigid and literal thinking.
Here at children in mind we understand that these changes and upcoming changes could be the brain’s inability to think and respond to these changes with clarity which can overwhelm people with neurodivergence as these are major challenges to manage and overcome. These can be highly intensified experiences which can lead to enhanced overwhelming brain activity and significant exhaustion. This can be related to ‘burnout’ and the recovery process that is required from the significant spike in brain activity. For many of us, the regular routine and consistency of this is a familiar position and for people who are neurodivergent this can be unwanted, sudden and highly overwhelming.
Masking
Common descriptions of people with neurodivergence can be they use masking. This is essentially pretending not to be neurodivergent and to appear that they can manage and function in certain situation and settings. This can lead to enormous amounts of emotional work, intensity, negative/critical thoughts, anxiety/low mood and social phobia. This can be associated to high functioning, low functioning, severe and mild terms being used to describe this method of managing and coping.
At the children in mind service, we explore these aspects of neurodivergence ways of masking as requiring low or high needs of support and to think of the way they may cope and manage in certain situation whilst identifying the impact this can cause. At the children in mind service, we encourage and identify the how and why and the challenges this can cause. We provide additional services to support, and we advocate this for children where required. The children in mind service enables hope and optimism for the future masking and doing certain things in certain situations may not be a coping or managing strategy that happens throughout their lives and learning, understanding, thinking and adapting can mobilise different methods of coping.
It may be challenging to know whether an assessment is needed when your child could be presenting in ways they are coping due to masking. They could be putting vast amounts of energy into manging social situations which could be exhausting. At times people may not realise they are performing or masking until someone notices. When masking becomes the way of managing, people may end up not knowing who they are or knowing their sense of self. At times people can manage in certain situations like attending school but when at home you may see heightened stress, exhaustion, anxiety, depression, burnout with negative associations towards themselves. Diagnosis can enable people and others to understand them with more clarity and insight.
Justice, Injustice – Not Lacking Empathy
People with neurodivergence can be highly caring, kind and deeply compassionate. Sometimes how this is described can be understood, for example when communications and responses to things they may dislike can be abrupt and direct. Individuals that are neurodivergent may process and understand emotions in a different way from people who are neurotypical.
They can often experience themselves and the world as fragile, vulnerable, and emotions can often be highly overpowering and overwhelming. When the intensity of emotions is felt, the individual may feel this psychologically and physically but they may experience different responses, such as anxiety, masking, being seen as not being empathic when they could be experiencing acute emotional responses to the situation. People who are neurotypical can equally struggle and find this challenging.
Being On Their Own - In Their Own World
People with neurodivergence have a wide range of interests and personalities, just like those who are neurotypical. People can be introverted and extroverted which can be seen in people who are neurodivergent. People with neurodivergence may have sensitivities to bright lights, busy places, noises which they may respond to quickly. In people who are neurotypical this can also occur. In these moments our brains may signal we do not like this, and we may respond to minimise the response to the situation.
A person with neurodivergence may have far quicker responses to this; they may withdraw from eye contact and may have other instant reactions. They may want to leave the place very quickly or avoid certain places. People with neurodivergence may prefer smaller social gatherings, specific places and may choose to be with other people who are aware of their sensitivities and with whom they share focused and similar interests. This can be seen as a hyper focus, fixation, rigid thinking and being in their own world, and is a response to finding something highly overwhelming and incredibly emotionally charged.
Creativity, Imagination & Play
People with neurodivergence learn in different ways; they could be focussed on a specific topic or subject, they may gather information and be very knowledgeable on the topic and subject matter. This could be seen as a routine, area of fixation, repetitive, ritualistic which could be obsessive. The children in mind service explore and think about the needs for some of the hyper-focus topics, what can be learnt and understand and how these could also be a relaxing and soothing experience.
Body Movements
People with neurodivergence may experience body movements and sensations. This can be identified as stimming, mannerisms, flapping, walking on tip toes, repetitive movements, rocking, wriggling, sounds and tastes. This is not an exhaustive list. Body movement can be a communication and the brain signalling to our body the need to regulate our emotions. It can be hard to make sense and understand some emotional communications which can be both conscious and unconscious. These can be communicated and enacted through kinetic activities. At the children in mind service, we understand these as necessary actions, gathering further insights into the why and how, and the frequency may enable people to redirect these responses with progressed understanding and reasoning for doing them.
Attention Deficit Hyperactivity Disorder (ADHD)
People who have ADHD have challenges managing and regulating their attention, impulsivity and hyperactivity. This can impact concentration, focus, managing work/tasks, peer relationships and organisation.
This not an exhaustive list but some of the features. These difficulties occur due to the chemicals are released and transferred within the brain. Children can be labelled as disruptive or poorly behaved children. They may be seen as deliberately not following the rules, not being able to undertake tasks and requiring additional support.
They can frequently require moving around and may be easily distracted. Where there is ADHD, it can be incredibly helpful to pursue a diagnosis as this can enable people to look deeper into the behaviours and how children may not know why they do the things they do. Children can be supported to enable them to concentrate and organise themselves.
The stigma of being a challenging or badly behaved child changes with further understanding and with sensitivity. Children may need different levels of help and support as they progress through their educational journey and are highly capable of achieving their ambitions with the right help and support.
A diagnosis could be helpful and other interventions of psychological support and medical therapy interventions can be provided. The emotional well-being of the child must be monitored, and exploration of additional services should be provided. Some people may have obtained injuries, be identified as having conduct, oppositional and defiant features and may have had contact with the criminal justice system.
They could be trying to self-manage their symptoms with risky behaviour and substance misuse. Some people are highly vulnerable which should be considered and they may feel unable to speak out about difficulties/challenges. It is vital that people see beyond the behaviour.
Inattention
People can make careless mistakes; they can often lose or misplace items and avoid activities that require a lot of concentration. They can have difficulty organising themselves and they may not appear to listen when spoken to directly. They may not follow direct, step by step and complex instructions and be easily distracted.
Impulsivity
Individuals may blurt out the answer before the question has finished. They can be accident prone and have difficulty waiting, often appearing irritable and frustrated. They may not be able to think ahead of potential impacts, consequences, risk issues and be oblivious to this. They may not connect their actions to difficulties that occurred with understanding and clarity or with reflective functioning. They may interrupt and speak over people, they may answer back without thinking and could get into conflict with others and authority.
Hyperactivity
Fidgets with items, restless and constantly moving as if driven by a motor. May play with pens, fidget gadgets, ricking in chair etc. May talk excessively and often at a louder volume than other people. Runs, climbs in situations which are not appropriate. Has challenges engaging in activities and tasks quietly. Can be intrusive to other people and where the actions to not fit with the settings. Long term rewards or instant rewards do not appear to work, modify or change behaviour.
Autism
Autism is a life-long neurological condition that impacts how people can communicate and interact with themselves and others. People with autism see, hear and associate to the world differently. Autism is individual and what one person may struggle with may not be the same for another individual. People with autism can have many strengths and this has been identified as high functioning to low functioning.
There can be some misconception of the condition and at the children in mind we understand this on an individual basis and do not make assumptions. There can be varying challenges as some people may excel at certain things, e.g., music, learning and have some highly focused interests. These could be their preferred strengths, but they may have certain challenges with organisation, communication and interaction.
Autism in Girls
Girls and boys are assessed in the same way for autism. At times it may be more difficult to identify some of the traits and features of autism in girls which can also be present in boys. Sometimes girls are referred for assessments slightly later in age than boys.
Some girls can manage certain aspects of their lives through masking and other methods. Girls who have more complex needs may be identified earlier but girls who are able to manage mainstream education may not be so easily identified as having autism.
Girls may not have as many repetitive interests, and they may be quieter about them to others and some of their particular interests may be seen as being very common or typical for girls. Girls can sometimes be better at controlling their behaviours in public and may learn how to respond to people, like making eye contact and using facial expressions.
These can make subtle differences that can be challenging to detect. On the surface they may appear to be managing and not displaying features of autism. When girls go without diagnosis this can lead to increased amounts of intensive masking which can lead to significant challenges. Gaining access to the right help and support is vital to enable people to cope.
There four times as many boys diagnosed with autism than girls. Many girls do not fit the stereotype and either get late diagnosed or misdiagnosed where symptoms are interpreted as something else. Girls may receive other diagnoses of anxiety and depression, and it is important to undertake full holistic assessment which can identify, understand and rule in and out potential underlying autism.
Misdiagnosis can lead to people having to work extremely hard to fit in and they may be left wondering but not knowing the reason behind their difficulties/challenges, resulting in them feeling exhausted and misunderstood.
Some of the traits/features in girls are they may rely heavily on others to speak for them, have passionate restricted interests, hypersensitive, limited topics of conversation and interests, hard to moderate and modify responses to frustration, anxiety, depression and changeable moods, difficulty making and sustaining friendships, can be described as quiet and shy, can be passive about some things and reactive to other things and challenges with social communication and interaction. This is not an exhaustive list but things for consideration.
ADHD In Girls
Girls and boys are assessed in the same way for ADHD. Girls can present with symptoms of daydreaming and disorganisation. Hyperactivity can be more common in boys than girls which can make it challenging to gather and understand ADHD symptoms in girls.
Girls may internalise their symptoms which could be seen as anxiety, low self-esteem and low mood. Girls can struggle to follow instructions and complete tasks. They may be disorganised and forgetful. Girls may doodle or be observed lost in thought. They may require additional help and support during potential stressful events, exams and social events.
They can sometimes not hand in homework; it may look rushed, not fully completed, variation in standard and capability or they may spend excessive time completing homework and other tasks.
They need time to recover from stressful events. Girls may be less likely to be aggressive towards others and be seen as a chatterbox. They may not want to wait their turn, become easily frustrated and could be good at some things and not so good at other things. They may engage in risky behaviours and could have challenges with menstrual cycles and puberty. They can find making and sustaining friendships difficult, can be socially withdrawn and may use masking to cope.
They may experience bullying. There can be cultural challenges and expectations where they may work very hard to please others but could be overwhelmed and exhausted.
With Children in Mind Cheltenham, families gain not just professional support but also guidance, strategies, and confidence to help their children thrive in every aspect of life.
Assessment Process
At the children in mind service, we follow NICE guidelines and ensure the assessments are the equivalent to the NHS. Our assessments have been accepted by the local authority although it is helpful to explore this prior to proceeding with an assessment. The initial meeting is always undertaken face-to-face, and the service can provide other consultations remotely. For autism assessments, the service uses the ADOS-2 (autism diagnostic observational schedule) assessment and uses instruments approved to validate and to ensure credible assessments have been undertaken in line with NICE guidelines and assessment criteria.
The assessment is carried out by a multi-disciplinary team and undertaken over 2-3 meetings. The assessments are detailed, thorough, and examine not only the neurodivergence but as a standard approach the service undertakes a general psychiatric assessment. This will examine other conditions such as anxiety, depression, OCD etc. This is to ensure that we can rule in and rule out other conditions and in certain circumstances the service can conclude generic disorders and neurodiversity simultaneously.
At times we may advise on certain assessments that meet the needs of your child. The service undertakes an assessment pre-screening to ensure initial impressions are gathered. The service does not suggest you have multiple assessments at different times as we are aware that additional costs for assessments can be expensive.
We are child and family focused and will undertake and provide reviews, clarifications on presenting difficulties and are able to monitor and observe a child on an ongoing basis. The service operates a value base on quality and being child centred rather than excessive and unnecessary assessments.
The assessments are of a ‘gold standard’ and as a service we are very approachable and will provide prompt responses to queries. As a service we want people to feel comfortable and be able to raise and understand any concerns or queries they have. These can be made at the time of the appointments or afterwards. The service does not charge for queries as we identify this as an aspect of the assessment process. The service can manage and support the ‘whole pathway’ of treatment and interventions.
The assessments are undertaken by professionals who are highly experienced in neurodivergence and other child mental health challenges. Clinicians in the service have a wide variety of experience, knowledge and experience and have all led CAMHS services as clinical leads and heads of departments. The service has a diverse skill mix backgrounds where we can provide psychological and medical interventions on an individual basis and can provide network and parent/carer support.
The assessments are overseen by a consultant CAMHS psychiatrist and a consultant (clinical director) child & adolescent psychoanalytic psychotherapist (service manager and point of contact). Both these trainings are intensive trainings which have taken over 7 years to achieve.
Clinicians have enhanced DBS checks, are registered with governing bodies and have curriculum vitae that can be shared prior to engagement. All clinicians have active NHS CAMHS services employment and experience.
All diagnosis is undertaken in line with diagnostic and statistical manual of mental health disorders (DSM 5th edition). The service will write, inform and consult with other services with your consent to enquire whether they can support and assist with prescribing and onward referrals.
FAQS
How do I know if my child needs a neurodiversity assessment?
You may consider an assessment if your child shows persistent challenges with attention, communication, social interaction, learning, or emotional regulation. Early understanding helps access the right support and strategies at home and school.
What happens during the neurodiversity assessment process?
Our assessments follow NICE guidelines and are carried out by a multi-disciplinary team. The process usually involves parent consultations, child observations, standardised assessments (like ADOS-2 for autism), and teacher input. This ensures a holistic understanding of your child’s strengths and challenges.
Will the assessment identify autism, ADHD, and other conditions?
Yes. Our clinicians are trained to assess for multiple neurodevelopmental conditions. This helps identify whether your child’s difficulties are linked to one or several conditions, ensuring a full and accurate understanding.
Do you offer therapy online as well as in person?
Yes, we provide both in-person sessions at our Bristol location and secure online therapy for convenience.