Pre 6 years Assessment Team

All children under the age of six years will need to be seen by our Community Paediatrics Team first and if appropriate your child’s paediatrician will then refer you to the Neurodevelopmental Service for further assessment. This is to ensure a thorough medical assessment is completed and is available to NDS staff when they meet with you.

When we are considering if an assessment of possible autism is required, we are looking for further information within the following domains at both home and school which cannot be explained by other needs:

• Restrictive and repetitive behaviours
• Sensory needs
• Difficulties with social communication and social reciprocity
• Ability to use non-verbal communication and eye contact
• Tone of voice
• Peer relationships
• Adjustments to new environments and management of unstructured environments or use of routine
• Areas of particular interests

When we are considering if an assessment for possible attention deficit hyperactivity disorder (ADHD) is required, we are looking for the following symptoms across settings which cannot be explained by other needs:

• Levels of motor restlessness (e.g. whether the child or young person taps or fidgets and how these energy levels come out or are expressed)
• Ability to turn take (e.g. when playing a game, in conversation or queuing for something)
• Organisational skills (e.g. remembering belongings, planning their time or diaries or for younger children how they plan out games or interactions with peers; ability to keep room tidy)
• Attentional ability (e.g. how long they are able to read for, how long they remain on tasks that they like and those they don't like, how well they can sit through a movie and recall events afterwards, whether or not they can be asked to do things and if reminders are required)
• Levels of impulsivity (e.g. safety crossing the road, managing money (for older young people), putting hands up in class, thinking about what they say in conversation, level of interruption in conversations)

Questionnaires

Please complete the following questionnaires and take them to your appointment with the paediatrician. 

If your child is not yet in nursery, is home-schooled or out of school, detailed information from parents (plus any other information from other professionals relating to neurodevelopmental difficulties/differences) will be considered.

Teacher Observation Questionnaire (TOQ) for NDS Referral

Parent Observation Questionnaire (POQ) for NDS Referral

If you have any queries about completing the questionnaire please call us on 01553 668712 or email nds@nchc.nhs.uk

Once a referral has been accepted, a consent form will be sent home for someone with parental responsibility to sign.

Who has parental responsibility?

Mother: automatic

Father: if married to the mother either when baby is born or since

Unmarried father: if name appears on birth certificate (since 1/12/03) or legally acquired

Young person: if over the age of 16 years*

Others: if parental responsibility is legally acquired

Parental Responsibility Agreement: signed, properly witnessed and sent for registration to Principle Registry or the Family Division (High Court)

Residence Order: granted by the Court

*Please note that young people under the age of 16 can give or refuse consent for assessment if considered competent to do so by clinicians with the Neurodevelopmental Service

As part of the assessment, members of the team will spend time with you discussing your child’s early life and development. This may be a clinic appointment, a home visit or a video call.

Team members will spend time playing with and observing your child to learn about their strengths and needs. This may happen at home, or in nursery/school and may include an assessment at one of our clinics.

We have clinics in the Children’s Centre at Norwich Community Hospital (NCH), Thorpe Health Centre, West Pottergate Medical Practice and St James Clinic in King’s Lynn. 

You can find more information about the clinics in which we carry out assessments, including travel and parking information, on our location and travel information page.

Appointments will be child friendly and we will work as flexibly as possible around you and your family.

All observations are made in line with the Diagnostic and Statistical Manual of mental Disorders – Fifth Edition (DSM-5) and diagnostic discussions are based on these criteria. The decision is a team decision and is not made by one professional alone. You can find the DSM-5 criteria for autism here and for ADHD here 

Every child will be discussed at a multi-professional panel meeting throughout their assessment and when a final conclusion is made, you will be offered a feedback appointment with a paediatrician or a member of the NDS team.

You will receive written information including NDS reports following the feedback appointment.

How long will I have to wait for my child’s assessment?

For children 6 years plus, the overall assessment period could take four to five years.

For children pre 6 years, the overall assessment period could take around three years.

What age can my child be assessed for ADHD?

A diagnosis of ADHD can be considered in young children but would not usually be confirmed until a child is at least 6 years of age and is settled in school. This is because it is common for children to be highly active, especially at younger ages. 

Can my child be assessed for Pathological Demand Avoidance (PDA)?

There have been lots of questions and discussion regarding Pathological Demand Avoidance (PDA). PDA does not appear as a separate diagnostic condition in nationally or internationally recognised diagnostic manuals such as DSM-5 or ICD-10. This has meant that children and young people have not received a separate "diagnosis" of PDA and in the past, it may have felt that PDA was not recognised or understood.

Professionals in Norfolk recognise and understand that there are a group of autistic children and young people who present with a PDA profile and we understand this within the umbrella term of autism spectrum disorder. We may use language such as "autism spectrum disorder with a PDA profile".

We understand each individual child’s unique way of seeing the world.

Can my child be diagnosed with a Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is not included in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5). Sensory differences are considered a symptom rather than a diagnosis. The Royal College of Occupational Therapy do not therefore, support the use of SPD as a diagnostic label. Within the Neurodevelopmental Service, assessment for sensory processing differences may be considered as part of a diagnostic assessment for autism spectrum disorder (ASD or Autism) or attention deficit hyperactivity disorder (ADHD).

What if my child is too anxious to be assessed?

All assessments are child focused and adapted to individual needs. Just seeing your child in their own environment can often give us a lot of information which adds to our assessment.

A diagnostic decision comprises many parts and is not just based on one assessment alone. If your child does not engage for one part of the assessment, we can still use information from other sources such as questionnaires and nursery/school observations.

We can provide your child with support prior to the appointment if this would be helpful, for example by sending a photo of the clinician they are seeing or of the room they will be going into. We can also send a letter to your child to explain the tasks that they will be doing.

Please contact us on 01553 668712 or by emailing nds@nchc.nhs.uk to talk through any worries that you have.

Will I get written reports following my child’s assessment?

You will receive a written report regarding each assessment that the Neurodevelopmental Service has carried out at the end of your child’s assessment regarding the diagnostic decision.

The reason we send reports together at the end of the process is that each report is a small part of the bigger picture. It is only when all reports are viewed that the whole picture can be seen and a final diagnostic decision can be reached.

Can my child’s assessment be sped up?

The criteria for an assessment with the Neurodevelopmental Service to be expedited are:

• Looked After Children (this is a child or young person that might be looked after with their parents’ consent or by a court order. They might live with foster carers, in a children’s home, with family members or connected people (such as friends or neighbours) or sometimes even with their birth parents.
• If the assessment process has started in a different area — including military families — you will be added to the waiting list with your original referral date.

Unfortunately, we are not able to speed up assessments for any other children.

Can my child access support while the assessment is taking place?

The Neurodevelopmental Service is an assessment-only team; we only provide a small amount of short-term post-diagnosis support. Receiving a diagnosis of a neurodevelopmental disorder does not resolve any difficulties/differences that your child/young person may be experiencing and therefore alternative support needs to be explored regardless of whether a diagnosis is given. Norfolk is working towards a needs-led culture rather than a diagnosis-led culture. Just being accepted for an neurodevelopmental assessment is sufficient to request reasonable adjustments within your education setting.

Some examples of the kinds of reasonable adjustments an education setting might offer for a child awaiting diagnostic assessment for neurodevelopmental disorders include:

• Provide a clear agenda for planned activities, using visual timetables or diaries.
• Keep verbal communications clear and concise, giving precise, specific instructions rather than general ones.
• Give individuals more time to process information and formulate responses.
• Break down instructions into manageable chunks and offer repetition as needed.
• Provide information in visual format wherever possible.
• Minimise distractions and try to ensure quiet environments for focused work.
• Allow breaks after activities that require focused attention or are highly demanding, or when feeling overwhelmed.
• Allow the use of fiddle toys, stress balls, and movement breaks to help manage hyperactivity and impulsivity.
• Encourage individuals to ask for help, offer praise and rewards for completed work, and boost self-esteem through working towards goals.
• Provide a quiet place to escape if the environment becomes too overwhelming.
• Encourage regular exercise as part of a supportive environment.

Please visit this webpage for information about other services that can be accessed for support.

Does my child need a neurodevelopmental diagnosis before they can be considered for an Education and Health Care Plan (EHCP)?

You do not need to have a formal diagnosis when applying for an EHCP (please see the N. But to apply for an EHCP, your child will need to have identified additional needs (please see the Norfolk SENDIASS website for more information).

A child can be on a waiting list or may not even be referred into the service before an application for an EHCP is made. Some young people start their assessment having already been in receipt of an EHCP.

A diagnosis also does not necessarily mean that a young person will need an EHCP. 

What if my child is offered an appointment in school time?

If your appointment with the team is within school hours, you should speak to your child's headteacher so they can authorise your child/young person’s absence. Norfolk County Council recommend that you try to minimise disruption to your child's/young person’s school day if possible. Norfolk County Council provide further information about absences from school for medical appointments.

What happens if I move out of area before the assessment starts?

Please do let us know if you move out of Norfolk. If you move area before your child’s assessment has started you will be transferred to the team responsible for neurodevelopmental assessments in your new area. Some teams will honour the original referral date but other teams will not.

If you are not happy with the waiting time for your child’s assessment, you can use the ‘Right to Choose’ to choose another healthcare provider to carry out the assessment.

What if I want a private provider to carry out my/my child’s neurodevelopmental assessment?

We would ask that you let the Neurodevelopmental Service know that you/your child has received a diagnosis once the assessment has taken place so we can take you off our waiting list. There is no need to have an NHS assessment once you have had a private assessment, as a private diagnosis is recognised the same as an NHS one, provided it meets the same criteria. Advice about choosing a private provider and the criteria to consider is available here.

Assistant Practitioners

Adele Davison, Assistant Practitioner

"I’m Adele, I like puzzles and walking."

Susan Plumb, Assistant Practitioner

"I’m Susan and I like to read books and play word games."

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Nursing team

Occupational Therapists

Psychology team

Lisa Howell, Assistant Psychologist

"I’m Lisa and I like baking cakes and going to the theatre."

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Speech & Language Therapists

Administrative and support staff

Bobbi-Jane Holden, Administration Assistant

“My name is Bobbi, I like walking my dog and going to the gym. I absolutely love the beach and a good sunset.”

Emma Mutton, Administration Assistant

“I'm Emma, I love long country and beach walks and exploring new places and holidays, my 2 cats and a really good slice of cake and a cup of fresh coffee.”

Lisa Hart, NDS Coordinator

"I’m Lisa, I like baking and sightseeing."

The NDS is a diagnostic assessment-only service. Following a diagnosis, you will be provided with a pack containing information about autism and/or ADHD, as well as information about the additional resources and support services available.

NDS clinicians also support the delivery of 'Puffins', a 4-week information group coordinated by Family Action and designed for caregivers of autistic children/young people. For more information about Puffins, please click here.

We are currently developing a 2-session information group for caregivers of children/young people with ADHD.

If a diagnosis is not given, the NDS will feedback the reasons and factors that have influenced this decision. You will still be provided with the assessment reports and a summary explaining the non-diagnosis. We are currently developing an information pack for young people who have not received a diagnosis.