Q My seven-year-old boy has just finished Senior Infants. He's a great little boy and is very sociable, but right from the start, the school has been telling me that his attention is poor and that he is not keeping pace with the rest of his class with learning. I can see that he hasn't grasped his numbers and letters like his older brothers and sisters did.
I had a meeting with his principal during the last week of term who felt my son needed to be assessed to see if he would qualify for resource teaching. Apparently he has to be diagnosed so that he can get resources.
I'm okay with this if he needs it, but I was told that he would have to wait 12-18 months for the assessment as they have access to only two assessments per year.
The principal told me I could go privately and he gave me the names of a psychiatrist and two psychologists who could do the assessment immediately. I phoned the various numbers but was stunned to find out that a psychology report would cost me €600-€800 and a report from a psychiatrist would cost about €400.
I'm not really sure about the difference between the two types of reports and which might be better. I really don't have this type of money and I'm wondering if there is any other option to get him assessed and diagnosed.
A It is very frustrating as a parent to know that your child has problems and needs in school, only then to be told that there is a long waiting list before they can even be considered for supports.
There is lot of emphasis on gaining a “diagnosis” in order to access supports, but even if your child does not meet any specific diagnosis, a good assessment will provide a clear outline of his strengths and weaknesses which can guide you and his school in the future.
Resource hours are awarded to a school when a child meets the criteria for one of a small number of "low incidence" disabilities set out by the Department of Education and Skills.
The allocation of resource hours is decided by the local Special Education Needs Organiser (SENO) based on reports supplied by relevant professionals, usually including a psychologist. The National Council for Special Education website (ncse.ie) provides information on resource hours and how they are allocated.
The three main options for accessing psychological assessments are the National Educational Psychological Service (NEPS), the HSE and the private route.
The National Educational Psychological Service (NEPS)
NEPS is linked to the Department of Education and Skills and employs educational psychologists who identify and support children with a range of educational difficulties.
They allocate a certain number of individual assessments to each school per year. Schools can suggest a private assessment when there is a long waiting list for NEPS.
HSE and allied services
The public
child disability
and mental health services are currently undergoing a massive overhaul and it is hoped that this will streamline the system. At the moment, different regional services can have different referral systems and criteria, and, depending on where you live, local child teams may not have a full complement of therapists.
Psychologists are in short supply which means there can be waiting lists for their services.
Any child born after June 1st, 2002 who may have a disability is entitled by law to a free Assessment of Needs (AON) through their local HSE services within a set time limit. Every Local Health Office has an assessment officer who can describe the service and guide you through the process (see hse.ie for further information).
However, while your assessment officer may direct that a child requires a psychological assessment, the HSE psychologist may review the case and decide that the issues are more education than disability-based and refer the child back to NEPS for assessment, leaving you back at square one.
Private assessments
The private route has the advantage of speeding things up but comes with its own issues. In some cases, the Department of Education and HSE will not accept a private diagnosis unless it has followed approved assessment and diagnostic guidelines.
This has put some parents in the difficult position of paying out for a private diagnosis only to find that it carries no weight and that the child has to be re-assessed within the public system before they can access services. You also need to ensure the person you employ is qualified and experienced.
The term “psychologist” is still unregulated in Ireland meaning that, in theory, anyone could call themselves a psychologist and advertise their services.
A child clinical or educational psychologist who is a full member of either the Psychological Society of Ireland (PSI) or the British Psychological Society (BPS) should be qualified to assess your child.
They will have completed a degree in psychology and a higher degree (a master’s or doctorate) in their specific field. Ask about their level of experience and get references and examples of previous work.
A good psychology report should be clear and concise, explain the tests and findings, and have a list of recommendations and resources. An assessment and report can take about 10 hours from start to finish, and €600-€800 is at the lower end in terms of price.
A psychiatrist is a medical doctor who has completed further specialist training in psychiatry. In your case, they should be registered as a specialist child and adolescent psychiatrist with the Medical Council; you can check this online.
They are qualified to diagnose the range of psychiatric conditions and, within the public service, will work closely with a team of therapists in arriving at that diagnosis or opinion.
A potential issue with all private assessments is that many cases are not straightforward and may require input or an opinion from another discipline such as occupational therapy, speech and language therapy or physiotherapy.
Most private psychiatrists and psychologists do not work as part of a multi-disciplinary team, and there can be issues with accessing and sourcing these services privately if they are needed.
So, while waiting lists for public services may sometimes be long, the team-based approach to assessment and intervention can prove to be more beneficial for a child in the long run.
Dr Sarah O’Doherty is a child clinical psychologist.
John Sharry is on leave.