Before the day
Most services send forms out before the appointment: questionnaires for you, often a separate set for someone who knew you as a child or knows you well now (the “informant”), and for children, a questionnaire for school. These are a large part of the evidence. Fill them in fully, in the frame of mind of a hard week rather than a good one, and send them back on time.
If the service asks for an informant and nobody is available, say so. It does not stop an assessment. Clinicians are used to it, and old documents such as school reports and letters can stand in.
An ADHD assessment
An adult ADHD assessment is usually a long clinical interview, often between one and two hours and sometimes longer, with a psychiatrist, a specialist nurse or a psychologist. Expect questions about childhood and school, work, relationships, mood, sleep, alcohol and drugs, and physical health. The clinician is building a picture of a lifelong pattern and ruling other explanations in or out.
Alongside the interview, services use standardised rating scales. Names you may see include the Conners scales, the DIVA (a structured interview for adults), and for children the SNAP-IV or Vanderbilt questionnaires. Some services add a computer-based task, often the QbTest, which measures attention, impulsivity and movement over about twenty minutes. It supports the assessment; it does not decide it.
For children, the assessment usually involves a parent interview, information from school, and time with the child, sometimes across more than one appointment.
The outcome is often discussed on the day, or in a follow-up appointment or letter.
An autism assessment
An autism assessment is often spread over more than one appointment and involves more than one professional. A “multidisciplinary” team might include a psychologist, a psychiatrist, a speech and language therapist or an occupational therapist. It usually has three parts.
- A developmental history: an interview with a parent or someone who knew you young, using a structured tool such as the ADI-R or the 3Di. It covers early speech, play, friendships, routines and sensory experiences.
- A structured observation, most often the ADOS-2: a series of activities and conversation with a clinician. It is not a test you pass or fail. It gives the clinician a standard way of seeing how you communicate and interact.
- Questionnaires and other information: from you, from a relative or partner, and for children, from school. Some assessments add a school observation or speech and language input.
The diagnosis is usually discussed at a separate feedback appointment once the team has met.
What they are looking for
Across both conditions, clinicians look for a pattern that has been there since childhood, shows up in more than one setting and affects daily life, while considering what else could explain it. You do not need to perform or to prove anything. Be honest about the hard days, not just the good ones, and about the things you have learned to hide.
The possible outcomes
- A diagnosis, with an explanation of what it is based on and recommendations for what happens next.
- No diagnosis, with an explanation. Sometimes the picture fits another condition better; sometimes there are traits that do not reach the threshold the guidelines use.
- A recommendation for further assessment, for something that came up during the process.
A “no” is not a verdict that nothing is wrong. Ask what the clinician thinks is going on and what help exists for it. If you believe something important was missed, you can ask your GP about a second opinion.
The report
You should receive a written report. It usually sets out your history, what the assessment found, the diagnosis (or why not) against the criteria used, and recommendations. Ask when it will arrive, read it carefully, and tell the service about factual errors. The report follows you to your GP, an employer, a university or a school, so it is worth getting right. Keep a copy somewhere safe.
Questions worth asking on the day
- What is the diagnosis based on, and how confident are you?
- What are the next steps, and who arranges them?
- If medication is an option, who prescribes it, and will my GP take over?
- What support exists locally after this appointment?
- When will I get the report, and who else will see it?
- Who do I contact if something changes, or if I have questions later?
The assessment is an opinion built from evidence. Your job on the day is to make sure the evidence is complete.