ND Assessment & Diagnosis

Overview of the ND Assessment & Diagnosis Process

Alder Hey’s Neurodevelopmental Service provides assessment and diagnosis for children and young people with suspected Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD). The service has recently integrated ASD and ADHD pathways into a single ND pathway to streamline care, reduce waiting times, and improve patient experience.

Referrals

If you’re looking to make a referral for an ASD or ADHD diagnosis, our online referral platform is the quickest and easiest way to do this. You will also be able to track the progress of your referral. Click the button below to find out more.

Conditions Assessed

• Autism: Ages 2–18 years.
• ADHD: Ages 6–18 years (children under 6 are not assessed for ADHD as traits may reflect typical development).

Referral Process

• Referrals must be completed by professionals (e.g., GP, school SENCO) and cannot be self-referrals.
• Parental/legal guardian consent is required before assessment begins.
• Referral forms include demographic details and consent for information sharing with relevant agencies.
• The health visitor, nursery staff or school staff will complete a referral form and send it into our service. As part of the referral, you may be asked some questions about your child or young person. These questions will be about the types of behaviour your child or young person is showing.

Rejected referrals

A referral can be rejected or refused because:

• There is not enough information to make a decision
• Lack of evidence of graduated response
• It is not the right service for the questions being asked
• If your referral is rejected, don’t worry. There are still services you can access whilst a decision is being made.

Accepted referrals

When your referral has been accepted, you will be placed onto a waiting list for an assessment. You will be sent a letter confirming your accepted referral with some information on what you can expect from your appointment.

Stages of the Assessment

1. Pre-Diagnosis Support
   • Drop-in sessions with an ND practitioner and psychologist (typically Tuesday mornings).
   • Allocation of a peer support worker for ongoing support and signposting.
2. Assessment Process
   • Forms & Questionnaires: Sent to parents and schools to gather behavioural and developmental information.
   • Face-to-Face Appointments – some of the following may be required as part of the face-to-face appointments:
     • Neurodevelopmental history.
     • Clinical assessment by paediatrician.
     • Speech & Language Therapy input.
     • Clinical Psychology assessment.
     • School observation.
     • Autism Diagnostic Observation Schedule (ADOS) for ASD cases.
     • Qb Test
3. Outcome & Feedback
   • Diagnostic Panel Review: Multidisciplinary team evaluates findings.
   • Feedback session offered to parents/carers to discuss results.
   • Written report summarising assessment and diagnosis provided.
   • If diagnosis confirmed, families are signposted to post-diagnostic support services.

Who you will see & speak to

As part of the assessment process, your child may need multiple assessments from specialist professionals and services. This is a completely normal part of the process. It helps us to get more information about your child or young person.

You may speak to:

Peer Support Worker

The role of a PSW is to offer emotional, social and practical support to neurodivergent CYP’s and their families, by helping them to navigate through the assessment process. This is through planning and preparation for appointments; advocacy support within appointments, help completing ND forms and also creating and providing visual supports for both parents and CYP if needed.

Nurses

Nurses play a central and highly skilled role within the ND assessment pathway. As key members of the multidisciplinary team, they contribute clinical expertise, coordinated care, and supportive engagement with children, young people (CYP) and their families throughout the assessment journey.

Clinical Role in the Assessment Stage

During the assessment phase, nurses focus on gathering highquality clinical information to help determine whether a CYP meets the criteria for a neurodevelopmental diagnosis. This includes:

• Clinical conversations and structured observations designed to understand the CYP’s strengths, needs, communication style, and behaviour patterns. These observations contribute to the evidence base used by the clinical team when considering a diagnosis.
• Collaborating with other clinicians to ensure that assessment findings are consistent, holistic, and reflective of the CYP’s daytoday experiences across settings such as school and home.

• Providing clinical insight into cooccurring factors that may influence assessment outcomes, helping families navigate next steps.

Paediatricians

Paediatricians assess and diagnose children with ADHD and autism. They work with education professionals and other professionals to support children with additional needs in education.

Psychologists

Psychologists are specialists in understanding the emotional, behavioural, and cognitive development of children and young people. Psychologists help identify underlying factors that may affect learning, social interaction, or mental health, and provide recommendations for support, intervention, or further assessment as needed. Their work may include conducting interviews, administering psychological tests, and collaborating with families and other professionals to gain a holistic view of the child’s strengths and challenges.

Occupational Therapists

Occupational therapists support children in gaining skills and independence for everyday activities, such as eating, self-care, and play. Their approach is tailored to each child’s individual needs and may involve teaching new techniques, suggesting alternative methods for tasks, modifying environments, or recommending equipment to enhance daily functioning.

Speech and Language Therapists

Speech and language therapists are experts in evaluating speech, language, and communication abilities. They focus on neurodivergent children and young people, carefully observing aspects like play, creativity, flexible thinking, social interaction, and patterns of behaviour or interests that may be repetitive or restrictive.

CAMHS

Child and adolescent mental health service (CAMHS) – specialists that support difficult feelings like anger sadness, etc.

Clinicians

For more information about the different clinicians you might meet as part of the assessment process, please visit the About Services section of our referral portal.

Virtual tour

Main hospital

You can now access a 360 virtual tour of the main hospital.

If you feel your child may need additional support to attend their appointment, please contact the team to discuss this. You can also find more information on what support is available on our additional needs page.

Catkin Centre

The Catkin Centre is located on our Children’s Health Campus, next to our main hospital building. Before you visit, you can explore the Catkin Centre, and any other part of Alder Hey, using our 360 virtual map. Click on the button below to explore now!

Next steps

Whatever the outcome of the assessment process, it’s important to celebrate your child or young person for who they are. This is only one part of the journey for your child or young person.

Make sure to celebrate their strengths and what makes them unique.

We have worked with neurodivergent children, young people and their families to help them focus on their unique qualities.

Private Diagnoses and NHS Ratification

Autism Spectrum Disorder (ASD)

If your child has received a private diagnosis of Autism Spectrum Disorder (ASD) and you would like this diagnosis to be ratified by the NHS, the diagnosis must be reviewed by our service.

To allow us to do this, you will need to provide:

• A full diagnostic report from the private provider
• Any additional information that was provided to the private clinician by your child’s school (for example, school reports or questionnaires)

All diagnoses are reviewed to ensure they have been made in line with NICE guidance.
If, following review, we find that the diagnosis was not made in accordance with NICE standards, we may offer further assessments through our service to determine whether the diagnosis can be ratified.

Attention Deficit Hyperactivity Disorder (ADHD)

If your child has a private diagnosis of ADHD and you wish to commence medication, the diagnosis must be ratified by our service before medication can be started or taken over by Alder Hey. This ensures the diagnosis is NICE compliant and that medication can be prescribed safely and appropriately.

To allow us to review and ratify the diagnosis, you must provide:

• A copy of the ADHD diagnostic report
• Assessment documents completed by both home and school
• Rating scales and scores used as part of the assessment process
• QB test results, if these were performed
• Additional evidence from school or other settings, where used
• Evidence of observation of the child or young person during the assessment process
• A clear clinical rationale explaining how the diagnosis was made

Right to choose

There has been an increase in requests to GP’s for a Right to Choose referral as an alternative to an NHS pathway.

Before you request a Right to Choose referral, the following things must be considered:

• There is a high level of demand for Right to Choose referrals so assessment may not necessarily be any quicker than an NHS referral
• There are quality concerns with some Right to Choose providers. Not all assessments meet NICE guidance or have proper documentation in place.
  • Some providers are not regulated by the Care Quality Commission (CQC).
  • Assessments can lack essential things like school input or clear clinical evidence.
  • Some providers only offered remote appointments, with no face-to-face option.
• For children being assessed for ADHD, some Right to Choose providers offer only an assessment/diagnosis with no follow-up if ADHD medication is required.
• Not all Right to Choose providers have a NHS contract with Cheshire and Merseyside ICB. This is needed for shared care arrangements with your GP or other locally commissioned service if needed.
• As a result of the challenges above, NHS services may be unwilling to offer follow up support, including entering into shared care arrangements with Right to Choose providers. This can delay access to medication for young people diagnosed with ADHD and families can be left struggling to find help.

Cheshire and Merseyside ‘Knowing Me‘ profiling Tool

What is it?

The Cheshire and Merseyside Neurodevelopment Pathway for Children and Young People was launched in June 2025 and is in the process of being rolled out across Cheshire and Merseyside.

Under this new pathway, the aim is that all children and young people with neurodiversity will be supported, through their educational setting and/or key professional, to access an early help offer using the Cheshire and Merseyside Knowing Me tool.

The focus of the new pathway will focus on meeting needs first without waiting for a diagnostic assessment. Not all children will meet thresholds for an individual neurodevelopmental diagnosis.

What will it do/ how it works?

Work on the new pathway means that your child’s needs can be identified earlier and support put in place quicker and more effectively.

The profiling tool will be completed by your child’s school, nursery or college (educational setting) and/or by a person who knows your child really well (key professional).These people and settings will work with you and your child so that everyone understands your child’s needs and strengths across 10 areas. The ten areas are:

• Self
• Emotion
• Energy
• Coordination
• Sensory
• Attention
• Communication
• Flexibility
• Impulsivity
• Future

When you do the profiling tool, a review date should be set with you and your child/young person; it should be set dependent on the child or young person’s needs.

The Knowing Me tool, once rolled out, will form part of the referral process for diagnosis if needed.

Community support will continue to be offered throughout the pathway, whether children are referred for diagnostic assessment or not.

The link below will take you to the Cheshire and Merseyside pathway page where you can find more information as well as frequently asked questions.