Frequently Asked Questions

Is a remote autism assessment as accurate as an in-person one?

Yes, research shows that remote autism assessments can be just as accurate as in-person assessments when carried out by an experienced professional.

A study by the National Autistic Society found that the move to remote assessments during the pandemic didn't affect the accuracy of diagnoses. In fact, a study published in the Archives of Disease in Childhood showed that remote assessments not only maintain diagnostic accuracy but also have high levels of parental satisfaction.

For remote assessments, we use an adapted observation that draws on the Autism Diagnostic Observation Schedule (ADOS). This is the same adapted observation that our children who are seen face to face complete for consistency in assessment.

Does the order of the parent interview and child observation make a difference?

The order of the parent interview and the child observation are not important, and won't affect the outcome or the quality of the assessment of your child.

What will my assessor ask me in my parent interview?

The assessor and parent appointment will cover your child's strengths, needs, preferences, dislikes, and developmental history, particularly focusing on your child's early years.

What do I need to prepare for my child's observation appointment?

The child observation appointment is between your child and one of our assessors who will observe your child's behaviours and mannerisms.

For our in-person appointments, there is nothing you need to bring.

For remote appointments, it is important that you join the call on a laptop or desktop computer, or on a tablet with a 10 inch screen or greater, and bring five small hand held objects. Two of them need to have a clear purpose, e.g. a pen, and three need to be able to be used in different ways, e.g. a block. Please ensure none of these objects are characters or action figures.

Please do not join a remote appointment on a mobile phone, or on a tablet with a screen smaller than 10 inches, as it will not be possible to continue the appointment.

Does a Paloma Health autism assessment screen for PDA?

We do not assess for PDA as it is not a recognised diagnosis in the DSM-5 diagnostic criteria. We do not use any measures that specifically screen for 'demand avoidance'. However, where demand avoidance is described (a persistent and marked resistance to the demands of everyday life, which may include essential activities such as eating or sleeping as well as expected demands such as school or work) we will record these characteristics and signpost to resources.

Resources will include those provided by the National Autistic Society and PDA Society UK.

What if the assessors don't observe the same behaviours I do?

Our assessors are experienced in, and trained on, recognising the diverse ways autism can present.

Our assessments are carefully designed to identify more subtle traits and symptoms, how autism can present differently in females, and potential masking and camouflaging.

What if my child is very anxious in the assessment?

Our team is highly experienced in working with young people and understand that sometimes an assessment can be a stressful experience for the family.

As experts in the field and trained in working with children, our assessors will do their very best to put your child (and the whole family) at ease and engage even the most shy and anxious children.

When will I receive my outcome appointment and outcome report?

After your two appointments are completed (the parent interview and child observation), we will send you an outcome appointment date which is typically within two to three weeks.

We aim for your outcome report to be available before your outcome appointment. You will receive an email notification when your report is ready, and you can access it in your Paloma Portal (you login to this when your child is first referred to Paloma).

Will my GP get my outcome report?

The NHS GP that referred your child to us will receive the assessment outcome report within a few days of your outcome appointment. They should ensure the report is included in your child's NHS medical record. As an NHS Right to Choose provider, our assessments should be accepted by any Local Authority, as we meet the standards of the NHS.

What happens if my child is not diagnosed with autism?

Behaviours seen in autism can also be seen in other neurodevelopmental or mental health conditions. And, a child's experience can affect how they develop and sometimes this can look like autism.

We will consider all these factors in your child's assessment and provide you with our understanding of what the possible causes of your child's difficulties are, so the best support and understanding can be offered.

All children assessed will receive recommendations and a strengths and needs profile, whether they get an autism diagnosis or not.

Is the outcome report compliant with NHS and local authority standards?

Yes, the outcome reports are in line with all guidance set out by the NHS and NICE.

We are a Right to Choose provider of the NHS. That means that the NHS appointed (commissioned) us to assess children and young people for autism.

To become a Right to Choose provider, we were assessed to meet high standards, including that our assessments are compliant with NICE guidelines and the NHS England Operational Framework.

An example of these guidelines is that all assessments are done by trained and experienced professionals, and include all criteria as set out by guidelines of NICE called "CG128: Autism spectrum disorder in under 19s". These guidelines focus on recognition, referral and diagnosis.

What are my rights if my Local Authority is challenging my outcome report?

You have the following rights if your Local Authority is challenging an outcome report.

Request clarity: you can write to them and ask them to explain their challenge. File a complaint: if you're dissatisfied with their response, you have the right to file a formal complaint. Escalate: if their response is unsatisfactory, you could take the complaint to the Local Government Ombudsman and to your local MP. Appeal: if the challenge to a report influences the EHCP decision process, you may have a case to appeal.

What happens if my Local Authority needs more information on my outcome report?

If this happens, you can ask them to contact us. Our assessor team will work with them to ensure a swift resolution.

What does a child ADHD assessment involve?

Our ADHD assessments are thorough and evidence-based, strictly adhering to NICE and NHS guidelines. The process involves a social context questionnaire as well as a detailed discussion in an appointment with the assessor, the parent, and the young person.

Can my child be assessed for both ADHD and autism at the same time?

Yes. It is very common for ADHD and autism to co-occur. If you or your GP suspect your child shows traits of both conditions, they can refer your child to both an autism and ADHD assessment through the referral form on our website.

What happens if my child is diagnosed with ADHD? What are the next steps?

If your child receives an ADHD diagnosis, you will receive a comprehensive report detailing their strengths, challenges, and tailored recommendations for school and home. We will also discuss evidence-based management options, which may include psychoeducation, behavioural strategies, lifestyle adjustments, and medication if it is recommended.

Do you provide ADHD medication titration under Right to Choose?

Yes, we offer medication to children who have received an ADHD diagnosis from us, as it is one of the most common and effective ways to treat the condition. If medication is recommended, there will be an eligibility screening followed by a clinically led "titration" process to find the right type and dose. We will continue to support your child's prescription and medication moving forward, even after they turn 18 if needed.

What is the process for the ADHD medication service?

If your child is eligible for ADHD medication, our NHS medication service includes a six-week titration period alongside regular monitoring by a qualified prescriber. Throughout titration and monitoring, you, your child, and their school will be asked for regular feedback on how the medication is working, ensuring it effectively supports your young person.

Is medication my child's only option for ADHD treatment?

No, medication is not the only option for managing ADHD and should never be used in isolation. Lifestyle adaptations, behavioural strategies, and academic adjustments are all effective ways to support young people with ADHD. It is essential that these supportive tools continue to be used alongside any medication treatment.

How do I know if my child is eligible for medication?

If your child receives an ADHD diagnosis through Paloma Health, medication options will be discussed during their outcome appointment. If the assessor determines that medication is clinically suitable and you agree to proceed, your child will be referred to our NHS medication service.

Can my child be referred directly to the ADHD medication service?

We are not currently accepting direct referrals solely for our NHS ADHD medication service.

Is medication free or covered by the NHS?

In England, NHS prescriptions are free for children up to and including age 15, as well as for 16–18-year-olds in full-time education. Once a young person turns 19 (or turns 18 and is no longer in full-time education), standard NHS prescription charges will apply unless they qualify for an exemption.

How do I know if ADHD medication is the right choice for my child?

Every child with ADHD is unique, and what works for one person may not work for another. If you have already tried implementing lifestyle adaptations, behavioural strategies, and school support, but ADHD symptoms are still significantly impacting your child's daily life, you can discuss medication options with the assessor during your outcome appointment.

Is ADHD medication safe for children and young people?

Yes. When prescribed at the correct dosage, administered properly, and regularly monitored by a qualified prescriber, ADHD medication is safe and effective for children and young people. Routine check-ins ensure your child's growth, overall health, and progress are safely tracked throughout treatment.

What are the most common side effects of ADHD medication?

Most side effects are mild, temporary, and improve as the body adjusts or with small dosage tweaks. The most common side effects include decreased appetite, difficulty sleeping or falling asleep, mild stomachaches or headaches, and dry mouth or slight irritability as the medication wears off.

Regular monitoring ensures these are managed effectively. It is essential to discuss any side effects with your child's prescriber during your titration or monitoring appointments so they can adjust the dose or timing as needed.

What is NHS Right to Choose (RtC)?

Right to Choose is a legal framework that allows you to select your preferred healthcare provider for specialist consultations and mental health assessments.

If your GP agrees that your child is showing signs of autism or ADHD and is willing to make a referral to an NHS assessment service, you have the legal right to choose which NHS provider you are referred to. You must explicitly choose Paloma Health to be referred to our service.

My GP says they can only refer to a local list. Is that right?

If your GP refers you for elective care or mental health treatment in England, you have a legal right under the NHS Constitution to choose your provider. That right is not limited to a local list — you can choose any provider holding an NHS contract with any ICB in England, including independent sector providers.

Some ICBs are telling patients and GPs that choice is restricted to a local approved list. It is not.

What you can say to your GP: "Under the NHS Choice Framework and the NHS Constitution, patients in England have the right to choose any provider holding an NHS standard contract with any ICB in England for the service they need. This applies to elective referrals and mental health services. Choice cannot be restricted to an ICB-approved list."

If the GP still refuses, the next step is to make a complaint to your GP Practice Manager.

Can my child be referred to you if we are already on a local NHS waiting list?

Yes. If your child is currently on a waiting list with another NHS autism or ADHD service and has been waiting longer than 18 weeks (or if you have been told the wait will exceed this), you have a legal right to switch your NHS provider. Speak to your NHS GP about transferring your referral to us.

Who carries out the assessments?

Our ADHD and autism assessments are carried out by a multidisciplinary team of qualified healthcare professionals.

Assessments are carried out by GMC registered consultant child and adolescent psychiatrists, consultant paediatricians, or medical doctors; HCPC registered practitioner psychologists, speech and language therapists, occupational therapists, and NMC registered nurses.

Our assessments are NICE-compliant, and all diagnoses are made against DSM-5 criteria following a full diagnostic interview, not a screening questionnaire alone.

What happens if a patient is assessed and it isn't ADHD or autism?

We do not diagnose by default. Where the clinical picture doesn't meet diagnostic threshold, or symptoms are better explained by another condition, this is stated clearly in the report back to the referring GP, along with recommended next steps. We're happy to share anonymised outcome data on this if it would be useful for your practice.

How do you triage urgent or higher-risk cases?

During the safeguarding and triage review process, we evaluate the case for indicators of physical aggression (e.g. biting, kicking, throwing objects). Additionally, at referral, high case complexity and high risk are identified early through specific steps in the onboarding process. Risk and safeguarding are critical components that are actively monitored throughout the pathway, with any risk flags being identified as part of the appointment risk screen.

Do Right to Choose providers have a higher diagnosis rate than typical NHS community services?

A few factors explain this without implying we diagnose everyone referred.

Referral population is self-selected: patients who pursue a Right to Choose referral have usually already researched their symptoms, often completed screening tools, and are choosing to seek assessment specifically because they suspect a diagnosable condition. This is a different starting population to a general community mental health referral.

Our current positive diagnosis rate is approximately 75%: this means roughly 1 in 4 patients we assess do not receive a diagnosis. Assessment is a genuine clinical filter, not a formality. As an NHS ICB-commissioned provider, our diagnostic rates are actively monitored as part of our contractual reporting, specifically to guard against overdiagnosis.

We do not accept referral as pre-confirming a diagnosis. Assessment can and does conclude that symptoms are better explained by anxiety, depression, trauma etc. and in those cases we refer back to the GP with recommendations.

Isn't Right to Choose contributing to over-medicalisation of normal experience?

We take this concern seriously. Our position is that we apply the same diagnostic thresholds as NHS services; a diagnosis is only given where full criteria, including functional impairment across multiple settings, are met. We're not able to comment on demand trends across the sector as a whole, but we can confirm our own assessments require evidence of impairment in education, relationships, and daily functioning, not symptom presence alone.

Which ICBs can refer to you, and are there any current waiting restrictions?

We accept referrals from patients across all England ICBs for assessment. Some ICBs currently have commissioning or funding restrictions in place, which may mean a capped number of Right to Choose referrals accepted per period, or a wait until a specified future date before assessment can begin.

If your ICB is affected, we'll confirm the current position and expected timescale at the point of referral so you and your patient have accurate information before proceeding.

Do you feed back to referring GPs, and can we query a report?

Yes. GPs can contact us directly with questions about a specific patient's assessment or report. If a GP has clinical concerns about a diagnosis or its basis, we're happy to discuss this directly rather than only through the patient.