An independent provider in the Kirklees area

3. Mrs O complains about an NHS funded neurodevelopmental autism assessment which the clinic completed for her daughter, Miss H in January 2025.

4. She complains the assessment did not fully consider Miss H’s symptoms and her request for a second opinion has been inappropriately refused.

5. Mrs O says the assessment should have resulted in a diagnosis but did not due to lack of consideration to Miss H’s symptoms. The refusal for a second opinion will impact her life and in particular her education as the referral process will take another 2 to 3 years.

6. As a result of bringing this complaint to us, Mrs O is seeking for the clinic to reconsider reviewing its assessment decision and level 2/3 financial remedy.

7. Mrs O's daughter, Miss H is 12 years old and was diagnosed with Dyslexia in June 2022. Mrs O has suspected her daughter has autism for a long time due to her sensory issues around clothes, shoes, food and her struggles with communicating.

8. Mrs O requested an assessment in March 2023.

9. Miss H's Autism assessment with the clinic took place in January 2025.

10. The assessment concluded Miss H has sensory issues and anxiety but did not give an autism diagnosis.

11. Mrs O complained to the clinic on 28 February 2025. The clinic sent its final response on 10 March 2025. Mrs O brought the complaint to us on 28 April 2025.

15. Mrs O says she has suspected her daughter Miss H has autism for a long time and she requested an assessment because of her sensory issues around clothing, shoes, food and her struggles with communicating. She says she hoped the assessment would provide clarity and an explanation for Miss H’s issues, but she did not get this.

16. She says Miss A masks symptoms, and they do not seem to have considered this at all. She feels the report is very generic and could have been written about any child. She says not receiving any diagnosis has meant she has been left without the relevant support in place to help her and she felt disappointed that the assessment report felt ‘very copy and paste style’ rather than specifically about her daughter.

17. She says lack of consideration to her daughter’s symptoms and the refusal for a second opinion will impact her life and in particular her education as the referral process will take another 2 to 3 years.

18. The records show Miss H underwent an Autism Diagnostic Observation Schedule (ADOS) assessment with the clinic in January 2025. The clinic reported the results in February 2025 via its ‘Neurodevelopmental Assessment Report’.

19. The assessment concluded Miss H has sensory issues and anxiety but did not give an autism diagnosis as Mrs O anticipated. In her complaint to the clinic, Mrs O raised concerns about limited observation times and settings as well as saying she felt Miss H’s masking and anxiety were overlooked and her symptoms minimised.

20. In its response to Mrs O’s complaint and request for further re assessment, the clinic summarised the assessment and what was reviewed. The clinic explained to Mrs O all of the concerns she raised were considered in the context of the assessment and it was agreed after an extensive and in-depth assessment that these were not attributed to Autism and better explained by Miss H’s anxiety. It says it is satisfied that enough information was collected and reviewed to provide an in-depth assessment of Miss H’s needs and to enable its specialist clinical professionals to reach a diagnostic decision and there is no indication of any need for further assessment.

21. The clinic says if the team had felt more information was needed to make a final decision, then they would have requested a further appointment with Miss H or asked for further supporting information. It says as part of the assessment process with the clinic, all clients are screened for differential diagnosis and if further assessment was deemed clinically appropriate such as for ADHD, then this would have been provided.

22.It said there was no indication of ADHD symptoms seen or reported either at the screening stage, pre-assessment stage or during the assessment process (as per the DSM-5 diagnostic criteria for ADHD) and therefore no need for further assessment. It says in relation to ADHD, it would offer an additional assessment when this is deemed clinically appropriate. It recommended Miss H continued to receive support for her anxiety.

23. We reviewed Miss H’s records with the help of our clinical advisor and. asked our advisor how a Neurodevelopmental assessment should be carried out and if this was done appropriately in Miss H’s case.

24. The NICE and National Autistic Society’s guidance says ‘there should be a gathering of developmental history, current functioning, and concerns from multiple sources (parents, teachers, friends etc). It also confirms the need to use standard diagnostic criteria (eg., DSM-5, ICD-11) and evidence-based tools and checklists.

25. NHS England’s guidance says the assessment should not rely solely on one clinician’s opinion; it should usually involve a team or multi-disciplinary service (paediatrician/child psychiatrist, clinical psychologist, speech and language therapy, occupational therapy) especially for children.

26. The National Autistic Society’s guidance says;

‘the assessor must evaluate : (a) developmental history (early childhood milestones, social communication, behaviour, sensory differences) (b) current presentation (social interaction, communication, repetitive behaviours, restricted interests) (c) how the difficulties impact daily living and functioning in multiple contexts (home, school, leisure) (d) exclude or co-consider other conditions (learning disability, ADHD, mental health, sensory impairments) and identify strengths and support needs.

27. It also says collateral information is important, including reports or input from teachers, school, family and previous services.

28. In relation to the diagnostic decision and feedback, the NICE and NHS England guidance says at the end of the assessment, a written report should be produced that clearly states whether the criteria for autism (or other neurodevelopmental condition) are met, giving reasons, stating the evidence, summarising strengths and difficulties, specifying recommended support and next steps. The person (and/or parent) should be given feedback, have opportunity to ask questions, and be provided with information about support and post-diagnostic pathways.

29. It says for children, the assessment needs to look at social communication, interaction, imagination, repetitive behaviours across contexts (home and school).

30. We can see from the records there is clear evidence the clinic gathered full developmental history including early years, school, social functioning, communication and sensory issues. Information regarding Miss H’s functioning was considered in multiple environments (home, school/education, peer relations) and these were taken from a number of sources. These sources included parents, direct observation, one to one assessment and information from Miss H’s schools. Miss H’s pre-existing dyslexia diagnosis was factored into the decision making. Our advisor says the clinic used the DSM-5 Autism diagnostic tool and there is clear reference to this throughout.

31. In line with the NHS England guidance, the assessment was appropriately overseen by a qualified psychologist, with specialist input from an assistant psychologist, a speech and language therapist and specialist educational needs consultant. It also included a professionals meeting as per the NHS England guidance mentioned above.

32. In relation to the assessment decision making, our advisor says the report was comprehensive and it clearly documented the decision and reasons why the clinic felt the criteria were not met for a diagnosis of autism. Its report suggested actions linked to Miss H’s dyslexia and how the school could support this more. The decision was verbally communicated to Mrs O with a written report to follow.

33. Differential diagnosis including ADHD was considered however it was felt there was no consistent differences in inattention or hyperactivity that would indicate further formal assessment was needed.

34. We asked our advisor whether the clinic gave appropriate consideration to Miss H’s symptoms. Our advisor says there is clear evidence throughout the detailed report and relevant notes including the complaint response that all Miss H’s symptoms were considered as part of the assessment. Our adviser says the clinic used the DSM-5 appropriately and referred to this at every point throughout the assessment. This included developmental history, current difficulties in social communication, interaction and restricted/repetitive behaviours (or sensory differences) in multiple settings. It also considered functional impact of the symptoms and how these symptoms cause impairments or support needs, rather than just listing traits.

35. The clinic also explored alternative explanations for symptoms (in this case social anxiety and dyslexia) as well as considering school reports, teacher observations and family observations.

36. The Patients Association guidance says parents can ask for a second opinion if they have concerns about the diagnosis or the assessment process.

37. However, our adviser said many neurodevelopmental services such as the Clinic’s autism diagnostic service set out local criteria for when they will offer a second opinion. For example, the Clinic’s policy is that a second opinion will only be offered if new or compelling information is available that was not part of the original assessment. This means it is therefore not an automatic right to a second opinion.

38. In Miss H’s case, the assessment was funded by the local Integrated Care Board (ICB) and at this time the ICB did not fund second opinions. Therefore, it was not the clinic’s decision about whether a second opinion could have been offered.

39. Taking into account all of the evidence we can see the assessment was carried out based on the correct diagnostic tools and in line with the NHS England, NICE, and National Autistic Society guidance. The second opinion/reassessment request was rejected based on the fact that the ICB did not fund second opinions at that time. We have seen no indications of maladministration and will not consider Mrs O’s complaint any further.

40. We recognise it has been a difficult and distressing time for Mrs O and her daughter, Miss H and we were sorry to hear of this. We hope Mrs O is reassured by our investigation and understands the reasons we are taking no further action on her complaint.

1. We have carefully considered Mrs O’s complaint about the private mental health clinic (the clinic). We were sorry to hear about the circumstances of her complaint and the ongoing difficulties she and her daughter face.

2. We have not seen any indications of failings in relation to the autism assessment process. This is because we have seen the clinic carried out the assessment and responded to her appeal in line with guidance. We have explained the reasons for our decision below.