General Principles of Assessment
What comprehensive neurodevelopmental assessment should include, who can diagnose, and what quality looks like.
A good assessment does more than provide a label. It should give you a deep understanding of your child - their unique profile of strengths and challenges, what support they need, and how to help them thrive.
Quality assessment takes time. Be wary of very quick diagnoses, but also of unnecessarily prolonged processes that delay support.
Core components of assessment
Should include:
- •Pregnancy, birth, and early milestones
- •Early temperament and behaviour patterns
- •Language development timeline
- •Social development and friendships
- •Family history of neurodevelopmental conditions
- •Medical history including sleep and eating
Why it matters:
Neurodevelopmental conditions are present from early childhood, even if not diagnosed until later. History helps distinguish developmental differences from acquired problems.
Should include:
- •Parent/carer observations and concerns
- •School or nursery reports and observations
- •Questionnaires from teachers and parents
- •Previous assessments or professional reports
- •Input from other involved professionals
Why it matters:
Children may present differently at home and school. For ADHD and autism, symptoms must cause impairment across settings.
Should include:
- •Standardised assessment tools (ADOS-2 for autism)
- •Cognitive or educational assessment if needed
- •Observation of behaviour and interaction
- •Play-based assessment for younger children
- •Interview or conversation with older children
Why it matters:
Direct observation allows the clinician to see your child's strengths and challenges first-hand, not just rely on reports.
Should include:
- •Ruling out medical causes (hearing, vision, thyroid)
- •Considering other developmental conditions
- •Assessing for co-occurring conditions
- •Evaluating environmental factors
- •Considering impact of trauma or adversity
Why it matters:
Symptoms can have multiple causes. Good assessment considers alternatives and doesn't assume diagnosis before evaluation.
Should include:
- •Clear diagnostic conclusion (or not)
- •Explanation of the reasoning
- •Understanding of your child's profile
- •Identification of strengths as well as challenges
- •Recommendations for support
Why it matters:
A diagnosis alone isn't helpful without understanding what it means for your specific child and what support they need.
Who can diagnose?
- Paediatrician (developmental or community)
- Child psychiatrist
- Clinical psychologist (specialist)
- Multidisciplinary team (gold standard)
NICE recommends multidisciplinary assessment for autism. In practice, experienced single clinicians may diagnose.
- Paediatrician
- Child psychiatrist
- Nurse prescriber (with appropriate training)
- Some specialist psychologists
NICE recommends specialist assessment. In England, Right to Choose allows private assessment.
Principles of good assessment
The assessment should focus on understanding your child as an individual, not just ticking diagnostic boxes.
Good assessment identifies what your child is good at, not just their difficulties.
Clinicians should understand how cultural background might affect presentation and interpretation.
Assessment should consider whether adversity or trauma might be contributing to difficulties.
Understanding is framed within what's typical for your child's age and developmental stage.
You and your child (where appropriate) should be partners in the process, not just subjects of assessment.
Timing considerations
| Factor | Consideration |
|---|---|
| Age | Some conditions are reliably diagnosed earlier (autism from age 2) while others require longer observation (ADHD typically from age 5-6). |
| Stability | Assessment during crisis or major life change may not reflect typical functioning. |
| Masking | Some children, especially girls, mask their difficulties. Longer observation or specialist expertise may be needed. |
| Co-occurring conditions | Multiple conditions can complicate assessment. May need staged assessment addressing one thing at a time. |
You are the expert on your child. Good clinicians recognise this and value your input.
Before assessment:
- • Gather developmental history information
- • Note specific examples of concerns
- • Collect school reports and observations
- • Write down questions you want to ask
During assessment:
- • Share your concerns honestly
- • Ask for clarification if needed
- • Provide real-world examples
- • Mention what you've already tried
Diagnosis is a means to understanding, not an end in itself. The goal of assessment is to understand your child better and identify what support they need. A label without this understanding isn't very helpful.
If you leave an assessment without a clear understanding of your child's profile and recommendations for support, something has been missed.