Specialist Assessments
Specialist Assessments
EPIC’s assessment of children, young people and young adults always starts with a consultant or senior clinician initial appointment to take a holistic view of the concerns and advise regarding specialist assessments to further understand any underlying differences or areas of difficulty. Recommendations can then be made for adaptations, support, interventions and therapeutic approaches.
Below are our most popular assessment pathways within the broad areas of neurodevelopmental difference, education difficulties, trauma and attachment disruption and eating behaviours that lead to nutritional risk. Our assessment pathways may be adapted or combined to provide bespoke pathways according to individual needs.
Information on the individual components of pathways and what to expect is available from our administration team on request.
Neurodevelopmental Difference
EPIC offer a range of assessments for different profiles of neurodevelopmental difference. Understanding these differences may help to explain emotional, behavioural and educational difficulties. All of the below include feedback to discuss the findings, either with the practitioner undertaking the assessment or with the consultant/senior clinician providing overview of the specialist assessment pathway. A full report with recommendations is provided for support and adaptations.
Autism (ASD)
Autism is a neurodevelopmental condition that is often referred to as a spectrum as it impacts everyone differently. Autism is characterised by difficulties with social interaction and communication, with restricted or repetitive thinking patterns or behaviours. Autistic individuals may communicate, behave, learn, relate, and interact in different ways.
Our ASD assessment consists of a Cognitive Assessment, an ADOS (Autism Diagnostic Observation) and a Developmental History, also questionnaires completed by parents/carers and the school/education setting.
Pathological Demand Avoidance (PDA)
PDA is understood to be a profile on the autism spectrum, with high levels of anxiety and avoidance of everyday demands, including the use of 'social' strategies. The presentation can therefore look different to more typical autism. Understanding this profile can be important to inform the most appropriate support strategies.
Our ASD assessments can be extended to include a Coventry Grid assessment and demand avoidance questionnaires to identify a PDA profile.
Attention Deficit (Hyperactivity) Disorder (ADHD/ADD)
ADHD/ADD are neurodevelopmental disorders characterised by struggles with inattention, hyperactivity, and impulsivity. ADHD/ADD presents differently in individuals and impacts negatively on learning, behaviours and emotions. ADHD/ADD is rarely diagnosed under the age of 6 years.
Our ADHD assessment is thorough and includes face to face components to be sure we can identify where there other explanations for ADHD like behaviours. Assessment consists of a Cognitive Assessment, a Developmental History and either a computerised test (for older children) or a school observation (for younger children), also questionnaires completed by parents/carers and the school/education setting.
Developmental Language Disorder (DLD)
Developmental Language Disorder (DLD) is a life-long neurodevelopmental condition characterised by differences with understanding and/or using spoken language. DLD can present in a variety of ways with features that can appear similar to ASD, ADHD or learning difficulties. EPIC have unique expertise in the assessment of complex language disorders and aphantasia (the inability to visualise mental images)
There are different levels of assessment that may be advised either as stand alone assessments or as part of a specialist assessment pathway. The Clinical Evaluation of Language Fundamentals (CELF 5 UK) assesses core receptive and expressive language skills, particularly related to learning. A range of further assessments of higher order language are used by our specialist speech and language therapist to explore the use, processing and interpretation of language, particularly for social communication and the impact of any difficulties on emotions and behaviours.
Fetal Alcohol Spectrum Disorder (FASD)
FASD is a complex neurodevelopmental disorder that can occur following exposure of the developing brain to alcohol during pregnancy. FASD can present with physical problems and/or problems with development, emotions, behaviour and learning. The presentation varies between individuals but understanding an individual FASD profile of strengths and difficulties is essential to providing appropriate life long support.
Assessment involves a paediatric review of in utero risk factors, all areas of difficulty, past medical, family and developmental history and a physical examination. Our paediatrician will review any previous professional reports that may contribute towards the overall assessment.
An individualised plan of further assessments is then made to ensure an understanding of strengths and difficulties across ten domains of brain functioning which include cognition, attention, executive functioning, language, motor skills, social skills and adaptive functioning, memory, affect regulation, academic attainment and neuroanatomy/neurophysiology.
EPIC’s multidisciplinary team will review all findings and agree whether the diagnostic criteria for FASD are met
Global Developmental Delay (GDD)
GDD refers to a child's development milestones being significantly behind what is considered typical for their age and usually affecting multiple areas of development, including physical, cognitive, communication, social and functional skills. Early intervention and support can help children with GDD make progress and reach their developmental goals.
Assessment will start with our consultant paediatrician to consider all areas of difficulty, past medical, family and developmental history and a physical examination. Our allied health professionals including physiotherapist, speech and language therapist, occupational therapist and clinical psychologist will be involved as needed to assess areas of development and provide recommendations for intervention and support.
Developmental Coordination Disorder (DCD/Dyspraxia)
DCD, also known as dyspraxia, is a disorder affecting gross and/or fine motor skills and coordination which negatively impacts on everyday functioning including educational and recreational activities.
Assessment involves a paediatric review of all areas of difficulty, past medical and developmental history and a physical examination. Our Occupational Therapist will then perform a Movement Assessment Battery for Children (Movement ABC) and a Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). If required our Physiotherapist will also provide assessment of core strength and mobility.
Our Paediatrician will confirm the diagnosis if appropriate and a full report with recommendations is provided.
Sensory Processing Difficulties
Sensory processing difficulties are where the brain struggles to process sensory information, causing over or under sensitivity, including visual, auditory, tactile, movement, oral and interoception. Difficulties often coexist with neurodevelopmental disorders and can contribute to challenges with anxiety, emotional regulation, attention, social interaction and self help skills.
Our Occupational Therapists offer standard face to face assessments with observation during play based activities, and caregiver questionnaires. A full report with a sensory diet and/or goal based practical recommendations is provided. They can also offer enhanced assessments over two sessions where recommendations for EHCP are needed and/or consideration for Sensory Integration Therapy.
Educational Difficulties
EPIC offer a range of assessments that can be done individually or as part of specialist assessment pathways to address educational difficulties in nursery/school/college/university. All of the below include feedback to discuss the findings, either with the practitioner undertaking the assessment or with the consultant/senior clinician providing overview of the specialist assessment pathway. A full report with recommendations is provided for interventions that would be helpful in the education setting.
Cognitive Assessment
A cognitive assessment is a standard part of most of our assessment pathways to identify any learning needs that may be contributing to the presenting difficulties. The cognitive assessment used is dependent on age, these include the WPPSI (Wechsler Preschool and Primary Scale of Intelligence), WISC-V (Wechsler Intelligence Scale for Children Fifth Edition) and WAIS-IV (Wechsler Adult Intelligence Scale Fourth Edition).
In children or young people identified with significant learning needs, or who may struggle to complete a cognitive assessment, we may advise a Vineland Adaptive Behaviour assessment to further explore whether the criteria are met for intellectual or learning disability.
Dyslexia Assessment
Dyslexia is a specific learning difficulty that causes problems with certain aspects of learning such as reading and writing. It is not related to intelligence. We can offer a dyslexia screening test (TODS) or our full dyslexia assessment which consists of a cognitive assessment, specific dyslexia assessment, developmental history and screening questionnaires completed by parents/carers and school/education setting.
School Observation
School Observation by one of our specialist practitioners can help to identify difficulties in the school environment with attention, language, social communication, sensory processing, emotional regulation and behaviour. This is usually done as part of an assessment pathway but can be done as a stand alone to inform further assessment and provide guidance to schools.
Functional Assessments
Our Occupational Therapists can offer a range of functional assessments relevant to educational difficulties. These include for motor and coordination difficulties (DCD/Dyspraxia) and sensory processing differences. They can also do specific handwriting assessments which include the DASH (detailed assessment of speed of handwriting).
Neuropsychological Assessments
EPIC’s Clinical Psychologists offer a range of other neuropsychological assessments that can be done individually but are more often part of specialist assessment pathways. These include for Executive Functioning and Memory (BRIEF, D-KEFS, NEPSY).
Education Support Adviser
EPIC have an Education Support Adviser who can provide a ‘bridging support’ package to help communicate the findings and recommendations from our assessments through meetings with schools/colleges and advise regarding adaptations and supportive strategies.
Trauma and Attachment disruption
Attachment Disorders and/or Developmental Trauma can present as complex emotional and/or behavioural difficulties as a result of disrupted attachments to primary care givers in the early years of childhood and/or adverse experiences or specific traumatic events during different stages of development. EPIC offer a range of assessments that can be done individually or as part of specialist assessment pathways to explore children and young people’s experiences of trauma and attachment disruption. All of the below include feedback to discuss the findings, either with the practitioner undertaking the assessment or with the consultant/senior clinician providing overview of the assessment pathway. A full report with recommendations is provided for understanding, support and therapeutic interventions.
Trauma and Attachment
Our specialist mental health nurse uses a range of assessments that explore experiences of attachment and trauma including the Coventry Grid Assessment, Story Stem Assessment, Child Attachment Interview, Trauma Symptom Checklist for Children and the Marshak Interaction Method (MIM) specific to the theraplay model. These are explained in our information sheets.
These will be discussed in the initial assessment and used as appropriate for each individual child or young person to provide a greater understanding of their experiences and difficulties.
MOSAIC Assessment
Where there is uncertainty in young children as to whether difficulties might be explained by life experiences or neurodivergence we offer a MOSAIC assessment that includes the DAWBA (Development and Well-Being Assessment), Coventry Grid Assessment and school information gathering. The outcomes will inform the most appropriate onward pathways.
Therapeutic Support
The assessments above will inform the most appropriate therapeutic support. This might include Trauma Focused Therapies (including EMDR), NVR (non violent resolution), Child Psychodynamic Psychotherapy, Systemic (Family) Therapy, Theraplay, Dyadic Developmental Psychotherapy (DDP).
EPIC have dedicated spaces to provide Creative Therapies (play, art, drama) and Sensory Integration Therapy.
Eating Behaviours of Nutritional Risk
EPIC offer a range of assessments, support and therapeutic interventions for eating patterns and behaviours that lead to nutritional risk. This includes over or under weight, physical health complications, and/or nutritional deficiencies. Full reports will be provided outlining risks and recommendations for support and therapeutic interventions. Where physical risks are high referrals will be recommended to NHS hospital based services.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is an eating disorder characterised by avoidance of certain foods and/or having a restricted intake in terms of overall amount eaten. This may be due to a combination of sensitivity to the taste, texture, smell, or appearance of food, a distressing experience associated with eating, or a poor appetite and low interest in eating. ARFID often coexists with neurodevelopmental differences, particularly autism. There may be associated physical health concerns regarding weight, growth or nutritional deficiencies.
Assessment is with our Consultant Paediatrician and/or Specialist Dietitian. Where indicated a full nutritional analysis +/- blood testing will be needed to inform recommendations for dietary supplementation. A support plan to achieve the dietary recommendations will be individualised according to need and may include input from our Clinical Psychologists, Psychiatrists, Occupational Therapist and Speech and Language Therapist.
Eating Disorders/Disordered Eating
Anorexic/Bulimic eating disorders, unlike ARFID, are related to distorted beliefs around body image and weight. The restricted eating patterns are with the intent to lose weight or change body shape. Compensatory behaviours may also occur such as induced or excessive exercise. There can be other drivers for changes in eating patterns including beliefs around health, fitness, need for control, punishment.
EPIC offer proactive assessment and early intervention where there are concerns that an eating disorder may be developing. Our Paediatrician provides physical assessment and advice regarding risk to physical health. Our specialist dietitian provides assessment, dietary analysis and a food plan.
EPIC’s team of clinical psychologists and mental health practitioners can offer a range of eating disorder therapies according to individual need including family based support and CBT-E. Our Psychiatrists will provide input if needed.
EPIC may decline our input and recommend NHS eating disorder services where physical risk is high and the access to hospital investigations and inpatient services is essential for safe management.
Binge Eating Disorder
Binge eating disorder is characterized by frequent and recurrent episodes of loss of control and excessive eating. It can be associated with compensatory eating disorder behaviours, obesity, and mental health difficulties such as anxiety, depression, and other compulsive behaviours.
EPIC’s binge eating assessment is led by our consultant child and adolescent psychiatrist supported by physical health assessment with our consultant paediatrician and nutritional assessment with our specialist dietitian. A care plan will include individualised therapeutic interventions with our clinical psychologists or other mental health practitioners, and medication for low moody/anxiety if appropriate.
Where young people are significantly overweight with health complications we may recommend medications or injections, within license, alongside physical monitoring and mental health support.