Overview of what I do when parent’s request
On parent’s request, Dr Kukendrarajah sees the parent first without the young person, depending on the age of the child, since young children can distract parents and the questioning is very in–depth. It will be the benefit to older children not hearing them being discussed in their presence. While during a diagnostic interview, she also observes the child attention and listening skills, communication, social and play skills, and any other behaviour. Moving on she assesses the child in the parent company then see the child for a ‘medical examination’. This way, she will get a very good idea of how they relate socially, how they interpret what she says during the examination, and so it is more than just a physical assessment of their body and brain.
She is happy to accept a self-referral from parents who have concerns but it is often helpful for a child to be referred by the family’s GP or another specialist such as a general paediatrician, psychologist, speech & language therapist, occupational therapist or educational professional. This is because health insurance companies often require a doctor’s referral and because background professional information about the child is often essential. The child’s GP plays a key role in the overall care, and if needed onward referral and continuing medical treatment. GP involvement at the outset often results in better after-care.
Developmental disorders, such as autism spectrum conditions, ADHD and DCD (dyspraxia), are collections of overlapping and interrelated problems. The vast majority of children will have a mixed picture of strengths and needs and many will have two or three additional problems.
She requests a nursery or school report and questionnaires from teachers and parents or carers, as well as reports from previous assessments (such as those from psychologists or therapists). It’s not an easy situation for the parents to involve the child school, however, it is important to receive information on the child’s profile in a different environment.It might be difficult to arrive at a firm diagnosis on the first appointment.
She will aim to give my expert opinion as a senior clinician as to the diagnosis and appropriate options for helping. My assessment is based on asking a large number of structured questions in a fairly straightforward conversational way. She usually sees child and parents together so if they feel comfortable, the child can contribute and she can unobtrusively observe them at play or interaction over an extended time. Parents are understandably wary of talking about their child’s problem in front of them but she finds that in general, children and young people can offer valuable insight and find the process helpful and positive. It may be helpful to explain to your child that she is a doctor who will try to find out why they are having difficulties and how we can together to improve things better. There will be no tests or needles involved!
She rarely asks for blood tests, EEGs or brain scans. In complex cases, sometimes she recommends another professional assessment to help with a diagnosis such as a psychological or speech and language therapist assessment.
Detailed report on your child’s assessment will be prepared by Dr Kukendrarajahand given to you. You may share the report with other professional involved in their care at your own discretion. If medication is required, then she will manage with shared care with GP initially until things are stable.