Red Flags in Assessment
Warning signs that an assessment may not be thorough or reliable, and what to do if you have concerns about your child's diagnosis.
Poor-quality assessment can lead to wrong diagnoses - either missing a condition that's present, or diagnosing one that isn't. Both have significant consequences.
A missed diagnosis means delayed support. A wrong diagnosis can lead to inappropriate treatment, misunderstanding, and missed exploration of the actual cause.
Major red flags
Quality assessment takes time. For autism, expect several hours minimum. ADHD should also involve thorough history-taking.
What to expect instead: Full assessment typically involves 2+ hours of clinical time, often across multiple sessions.
NICE guidelines explicitly require multi-setting evidence for both ADHD and autism. School observations are essential.
What to expect instead: Clinician should request questionnaires, reports, or direct contact with school.
No single test diagnoses ADHD or autism. Tools like ADOS-2 or rating scales are part of assessment, not the whole assessment.
What to expect instead: Multiple sources of information should be integrated.
Neurodevelopmental conditions are present from early childhood. History is crucial for accurate diagnosis.
What to expect instead: Expect detailed questions about early years, development, and family history.
Assessment should be open-minded. The clinician should gather information before forming conclusions.
What to expect instead: Questions should explore possibilities, not confirm predetermined conclusions.
Good assessment considers differential diagnosis. Other conditions can look similar.
What to expect instead: Expect discussion of whether symptoms might be explained by other conditions.
Other concerns to watch for
No written report provided
Without documentation, you can't get support from schools or services.
Report is vague or generic
Should contain specific observations and reasoning, not just general statements.
No recommendations given
Diagnosis without support recommendations misses the point.
Pressured to accept diagnosis
You should have space to ask questions and process information.
Charged for report as extra
Written report should be standard part of assessment.
Diagnosis given over video call alone
Some observations benefit from in-person assessment, especially for autism.
No opportunity to ask questions
Feedback should include time to discuss and clarify.
Immediate medication prescription without monitoring plan
ADHD medication requires proper titration and monitoring.
Questions that reveal quality
These questions can help you assess whether an assessment was thorough.
Good answer
References multiple sources: parent interview, school input, observation, history.
Concerning
Only mentions one source or is vague about evidence.
Good answer
Names specific alternatives considered and explains why ruled out.
Concerning
Didn't consider alternatives or can't explain the reasoning.
Good answer
Clear explanation of the distinguishing features observed.
Concerning
Unable to differentiate or dismissive of the question.
Good answer
Specific recommendations tailored to your child's profile.
Concerning
Generic advice or no recommendations.
What to do if you have concerns
- Ask about the reasoning behind the conclusion
- Ask what alternatives were considered
- Request time to process before deciding next steps
- Ask for a written report if not offered
- Request a copy of the full report
- Ask for clarification of anything unclear
- Discuss concerns with your GP
- Consider a second opinion if significant doubts
- You have the right to seek a second opinion
- Can request NHS re-assessment (may face waiting lists)
- Private assessment is an option (ensure quality)
- Take all previous reports to new clinician
Choosing private assessment
Private assessment can offer shorter waits, but quality varies. Check for:
Clinician is appropriately qualified
Registered with appropriate professional body (GMC, HCPC, NMC). Check registration.
Experience with the condition
Specialist experience in ADHD/autism, ideally in children.
Clear about what's included
Know upfront what the fee covers - school contact? Report? Follow-up?
Multi-source information
Should still require school/teacher input. Be wary if this is skipped.
Uses standard tools
Should use recognised assessment tools, not just clinical opinion.
Written report included
Comprehensive report should be part of the package, not an extra fee.
Will be accepted by NHS
Check if NHS will accept the diagnosis for ongoing care.
You have the right to question and understand. A diagnosis that affects your child's life should be explainable. Good clinicians welcome questions and can clearly explain their reasoning.
Trust your instincts. If something feels rushed, incomplete, or doesn't match your knowledge of your child, it's okay to ask questions or seek a second opinion.