What is a ‘thorough assessment’ of neurodiversity (or SpLD)?

For those who don’t know, I am Dr Nancy Doyle, registered Occupational Psychologist, working in UK and USA. Assessment standards are rife with acronyms!  Let me explain mine:

I am a committee member for the British Psychological Society’s  (BPS) Committee for Testing Standards (CTS) the SpLD Assessments Standards Committee, who regulate HE assessments (SASC).  I am a professional registered with the Health and Care Professionals Council (HCPC).  I pioneered positive assessment a co-created the docuseries #TheEmployables airing in the USA right now and the UK in 2016 and 2017 as #EmployableMe. I have lived and breathed this stuff for many years and have been frequently aghast at what passes for ‘thorough assessment’.

There are three types of assessment:

  1.  An in-person, face-to-face assessment of individual history (medical, psychiatric, social, emotional, family, educational and occupational) combined with relevant psychometric tests that you must be qualified (HCPC registered or equivalent) to interpret, or under supervision of a consultant clinician if still in training.
  2. An online assessment of cognitive function (2A), which may collect basic background data AND/OR An online assessment of functional performance or reported need (2B).
  3. a screening tool, asking 10-20 questions related to a specific condition (such as dyslexia).

Let me be 100% clear:  Only number 1 should be considered a thorough assessment of neurodiversity. 

No trained professional or competent assessor would claim that an online assessment is thorough. Indicative, yes. Useful for recommending basic levels of support, yes.  A good first pass from which adjustments can follow, yes.

There are no conditions under which an online assessment only can be considered sufficiently thorough for diagnosis or comprehensive assessment of SpLD/Neurodiversity.  None. 

This is because:

  1. Clinicians are trained and experienced in spotting anomalies that an algorithm cannot – such as the effects of fatigue and anxiety on test performance, small give aways that might indicate a false response to background information and need further probing.
  2. A human being needs a human interaction in order to manage a diagnosis, the information that can arise might be emotional or traumatic and needs to be managed.  Delivering assessments electronically only with no support is unethical and may cause safeguarding issues.
  3. There are a lot of coexisting symptoms that must be contextualised with observation of physical presentation and might lead to tangents that cannot captured effectively electronically – for example a thyroid condition may lead to the same symptoms as ADHD, but you would see hairloss, changes to the eyes and weight loss / gain.

An online assessment of functional cognitive skills is plausible as an assessment of adjustment need, but presenting cognitive assessment only as a thorough assessment is deeply misleading, as people receiving this information may need help contextualising.

From my twenty years of professional experience, and my considered research and policy development around the topic I would like to state the following recommendation:

Assess functional performance first (2b).  This means assessment of presenting difficulties such as memory/concentration organisational skills and time management, which research shows us are the most typical difficulties associated with neurodiversity in a workplace or advanced education setting.  Because, to be honest, what flavour of diagnosis people receive is irrelevant.  The Equality Act is predicated on functional performance, not clinical condition.  For this very reason, we have a FREE functional assessment questionnaire on this site.  We also recommend the Do-IT profiler, which assesses functional, background and some cognitive skills and can be well contextualised if you have someone with some basic training to go through results with the clients.  Our questionnaire has the 48 most common issues paired with the 48 most common strategies.  Our internal data shows that providing this for free means that 15% of people don’t need any other interaction after taking it and so reduces the cost of assessment.

If assessing functional performance online doesn’t solve the problem, escalate.

You can escalate to a psychologist’s phone call debrief, who can then triage.  It might still only need a few pointers at this stage, or direct to assistive technology, rather than a full assessment. Again, our data indicate that a further 10 to 15% of people don’t need anything further after this.  ka-ching!  Savings of cash, time, effort and good will.

A phone call exploration with a psychologist after the online questionnaire enables us to unpick the reasons for the challenges and make recommendations for what support will be required. An online assessment, coupled with Psychologist input then becomes a ‘thorough enough’ description of support needs to access funding such as the Additional Learner Support (ALS) funding from the ESFA for apprentices. Without this telephone interview, the online part on it’s own is not enough. We have compared this process with a cohort of 100 people that went on to get a full cognitive diagnostic assessment and have tracked the tipping points where neurodiversity is most likely to be present and require additional support. We have seen many online profilers claiming to assess – however the danger here is that the tests can take a long time to complete, and if the person is neurodiverse they may get bored and just click buttons to get to the end! A psychologist is needed to unpick the reasons for results and to formulate an individual plan to meet needs that will work.

A full, face to face assessment should be the last thing you do in the workplace or on an apprenticeship because it takes a long time and is expensive.

It’s better to get the adjustments in without assessment, you don’t need to to any cognitive assessment to decide what adjustments might work, just functional.

Do full assessments when situations are contentious, when the individual needs catharsis or when you are really unclear what the situation might be.  Save them for the tricky cases but for goodness’ sake don’t think that by doing something online you are negating the need for a trained clinician.  Oh, and make sure they are positive, providing reports that are easily read by the client and consistent with the standards in place. These standards should apply to ALL cognitive assessments provided by ALL psychologists – neuropsychologists, occupational etc.

Cutting corners on diagnosis isn’t a cost efficiency, its a distraction.

If you are running an employment inclusion programme, an apprenticeship or vocational education programme, employability, criminal justice choose wisely.  Don’t be blinded by big words, fancy graphics or big data – there are no statistics sophisticated enough to help if we are asking the wrong questions and there is no thorough assessment without contextualisation.

The right questions are:

  1. Does this person have a functional performance issue and if so, what adjustments might help?
  2. Does this person require more intervention?
  3. If this still hasn’t helped, can we ‘reasonably’ provide more, adjust role / assessment or is it time to outplace?

But full, thorough cognitive assessments are expensive, and can take valuable time to put in place. By combining an online assessment with a further conversation with a trained, experienced clinician (in our case an Occupational Psychologist), an assessment that whilst not truly thorough, is ‘thorough enough’ for the big funding agencies. It ALSO provides a clear plan of what support is required to meet needs immediately – meaning access to further funding such as Access to Work or ALS which saves everyone time and money and bridges the gap between inadequate online testing and full, face to face, £500+ diagnostic assessments.

You can find out more about our ‘Genius Screening’ here and our full Assessments here

If you’d like to discuss anything we’ve said in this post, please contact us at the office and ask for Nancy, I only to happy to explain this further!

 

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