When is it worth asking for an assessment?

Every child is distractible, restless or socially awkward at times, and a move abroad can make any child look unsettled for a while. So how do you know when to ask for more than reassurance? Guidelines give some useful clues. The American Academy of Pediatrics (AAP) 2019 guideline says clinicians should start an ADHD evaluation for any child or adolescent aged 4 up to their 18th birthday who presents with academic or behavioural problems together with symptoms of inattention, hyperactivity or impulsivity.

For parents, the practical question is usually whether the difficulty shows up in more than one place, lasts beyond the settling-in period, and gets in the way of learning, friendships or family life. You do not need to be sure. You only need enough concern to ask a professional to look properly.

What a thorough assessment actually includes

The single most useful thing to know is that neither ADHD nor autism is diagnosed with one test. The US Centers for Disease Control and Prevention (CDC) says there is no single test to diagnose ADHD, and that there is no medical test, such as a blood test, to diagnose autism. Both are diagnosed by clinicians who gather information from several sources and use their judgement. Knowing what the guidelines expect lets you judge whether a clinic abroad is offering a full assessment or a quick screen.

ADHD

NICE guideline NG87 (UK) says a diagnosis should be made only by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in ADHD. It should be based on a full clinical and psychosocial assessment, including discussion of behaviour and symptoms in different settings, a full developmental and psychiatric history, observer reports and an assessment of the child’s mental state. NICE is explicit that a diagnosis should not be made solely on the basis of rating scale or observational data, and that symptoms should cause at least moderate impairment and be present in two or more important settings.

The AAP guideline says the clinician should confirm that DSM-5 criteria are met, with information obtained primarily from parents or guardians, teachers, other school staff and mental health clinicians involved in the child’s care. It also says the evaluation should at least screen for other conditions, including anxiety, depression, learning and language disorders, autism, tics and sleep apnoea. The CDC adds that the process can include a medical examination with hearing and vision tests.

Autism

NICE guideline CG128 (autism in under-19s) lists what a diagnostic assessment should include: detailed questions about the parents’ concerns, a developmental history, assessment of social and communication skills, a medical history, a physical examination, consideration of other possible explanations, assessment of coexisting conditions, and a profile of the child’s strengths, skills, impairments and needs. It says not to rely on any autism-specific diagnostic tool alone. The NHS describes the same picture from a parent’s view: one or more appointments with a team, questions about development such as when your child started talking, tasks to see how your child communicates and thinks, watching how they play and interact with you, and reading reports from school.

One point matters especially for families: ADHD and autism can occur together. The World Health Organization notes that autistic people often have co-occurring conditions including ADHD, anxiety and depression, and both NICE CG128 and the AAP guideline ask clinicians to consider the other condition. If you suspect both, say so at the start.

Who can diagnose, and why it varies by country

This is where living abroad gets confusing. Job titles, training and legal rights to diagnose differ between countries, and even between the guidelines themselves. Here is what the sources we checked say.

In practice, the professionals you are most likely to meet are developmental paediatricians, child and adolescent psychiatrists and clinical psychologists. Educational psychologists often assess learning, attention and cognitive skills and can be very helpful for school planning; whether they can give a formal medical diagnosis depends on the country and their registration, so ask directly. Speech and language therapists and occupational therapists usually contribute to autism assessments as part of a team.

How to find an English-speaking clinician abroad

There is no global directory of English-speaking child assessors, so most families combine several routes. We do not name private clinics here; availability and quality change, and we cannot vouch for any individual provider.

Online assessments by clinicians in another country are sometimes offered. If you consider one, ask how they will observe your child, gather school information and handle a physical examination, which both NICE CG128 and the CDC’s ADHD guidance include. Also ask whether they are allowed to practise across borders and who will provide follow-up care where you live.

What to prepare before the first appointment

Because assessments rely so much on history and school input, preparation saves time and money, and it matters even more when your child’s early records are in another country or language.

The NHS notes that there may be forms to fill in before the appointment or as part of an ADHD assessment. Ask the clinic what it needs, in which language, and how teachers should return their forms. If your child has changed schools often, a short timeline of moves is useful: clinicians will want to know what was happening when difficulties appeared.

It is worth telling your child, in simple words, what will happen. Something like “We’re going to meet someone who helps work out how your brain learns best, so school can be easier” is usually more reassuring than silence.

Assessing a child who lives in two or more languages

Many expat children speak one language at home and learn in another at school. That can blur the picture. A child who seems not to follow instructions may be struggling with attention, or may simply be missing some of the English.

The guidelines are clear that language should neither explain everything away nor be ignored. NICE CG128 asks professionals to ask about the child’s use and understanding of their first language, and warns not to assume that language delay is explained just because English is not the family’s first language. The American Speech-Language-Hearing Association (ASHA) says that being multilingual is not a communication disorder, that language samples should be collected in all the languages a child uses, and that standardised test scores are not valid for a child who is not reflected in the test’s normative sample. ASHA also describes working with an interpreter where necessary.

You may find that the best clinician for your child is not the one who speaks English, but the one who speaks your home language or has experience with multilingual children. It is reasonable to ask for a report in English even if the assessment itself used another language.

Costs, insurance and waiting times

We have not included prices, because they vary widely by country, provider and what is included, and any figure we gave would quickly be out of date or wrong for your city. What you can do is ask the same questions of every provider so you can compare like with like. The US State Department advises travellers to make sure they understand what their health insurance covers outside their home country; the same applies to families living abroad.

If the wait is long, you do not have to put everything on hold. You can share your concerns with the school now and ask what adjustments are possible while you wait.

After the assessment: the report and your child’s school

NICE CG128 says findings should be discussed with parents in person and without delay, with the reasons for the conclusions explained even if autism is not diagnosed, and that parents should be given a written report. It also says the child’s profile can be shared with professionals in education, with consent, so that it can contribute to planning. Whatever the outcome, ask for the report in writing and for time to ask questions.

Sharing is your decision. Some families share the full report; others share a summary or a letter focused on what helps. A diagnosis is not required for a school to make reasonable adjustments, but a clear report often makes the conversation easier.

When you meet the school, bring two or three specific requests drawn from the report, such as seating, breaks, instructions given in writing, or extra time. Ask who will be your contact, how teachers will be told, and when you will review how it is going. Ask too how the information will be stored and who will see it, especially if the school’s data rules differ from what you are used to.

Where your child learns next: an honest comparison

An assessment may confirm that your child’s current school can work well with some changes. Or it may show that the setting itself is part of the problem: very large classes, lots of transitions, or little adult time. Here is how common options compare in general. None is right for every child.

Online learning brings its own challenges for some children with attention difficulties, such as screen time and self-organisation, so it is worth discussing with the clinician who assessed your child. Whatever you choose, the assessment report is most useful when the adults around your child actually read it and act on it.

A small-class online option: NIJIN GLOBAL ACADEMY

NIJIN GLOBAL ACADEMY (NGA) is an online international school for ages 6–18, run by NIJIN, the company behind this site. We mention it as one option for families who feel a smaller, steadier group might suit their child. It is not a clinical service and does not replace an assessment or specialist support.

Frequently asked questions

Sources used for this article

Looking for a calmer, smaller class?

If you are exploring settings where your child can be known by name, NIJIN GLOBAL ACADEMY offers live online classes of eight with bilingual mentors and no rankings. Tuition is yet to be announced, and the school opens in September 2027.

Visit NIJIN GLOBAL ACADEMY