The decision to seek a diagnosis is a very personal one. Some individuals may seek a diagnosis because they have a suspicion about their strengths and weaknesses and would like confirmation. Some may be aware that they are struggling and be looking for clarification. Some may have a diagnosis suggested to them by their colleagues or friends. Others may be seeking a way to gain the support an official diagnosis can offer in terms of reasonable adjustments and protection from discrimination.
The Practicalities
Diagnoses of neurodiversity are made by specialist diagnostic teams, and how to access these differs depending on the condition. In the East of England, the Professional Support and Wellbeing Service offers screening for neurodivergence which can take place after either self-referral, or a referral by an individual's Educational Supervisor (with their consent). If the screening result is indicative of likely neurodivergence, the PSW may recommend and fund a confidential cognitive assessment via a service such as Genius Within. This results in a cognitive assessment report provided to the individual, and a workplace report containing less personal history which can be given by the indiviudal to their place of work to allow support to be put in place. Some screening centres including Genius Within also offer individual or workplace coaching sessions to provide strategies based on the strengths and weaknesses of an individual and their workplace requirements.
Unfortunately, dyslexia is currently the only condition which can be formally diagnosed in this way in the East of England. If the confidential cognitive assessment demonstrates a likelihood of another type of neurodivergence, the report is still generated but will instead state that there is a high likelihood of a diagnosis and recommend further testing. Follow up coaching is still offered, and this report can be used to demonstrate the need for a GP referral to diagnostic centre. It can also be used to access certain reasonable adjustments in the workplace. For the FRCA and faculty exams, a cognitive assessment result and a cover letter are usually sufficient to apply for reasonable adjustments according to the HEE EOE Education Lead TPD and deputy Regional Advisor. Candidates who struggle to obtain reasonable adjustments using these methods are encouraged to reach out to a mentor or to their TPD.
Challenges Around Diagnosis
The challenges individuals face when considering or undergoing diagnosis may be related to the decision to seek a diagnosis, the practical realities of getting a diagnosis, the emotional challenges of the assessment and how to come to terms with the outcome of the assessment:
Diagnosis on the NHS is a lengthy process, with some areas reporting an anticipated wait time of up to five years. Some areas are outsourcing diagnostic processes to private centres to reduce these wait times. This can be challenging for indiviudals waiting for a diagnosis, and discussions are ongoing with the PSW about whether diagnosis is something that can be facilitated for resident doctors.
Individuals seeking diagnosis should be aware that a comprehensive cognitive assessment may include questions about their childhood experiences and their perceptions of their strengths and weaknesses, which can feel challenging. It also includes a childhood history of symptoms and signs. Where at all possible an assessment also includes speaking to family members or those who knew the individual as a child. While not strictly mandatory for a diagnosis, it is encouraged and this can be difficult for certain individuals.
Once the report is received, individuals may feel worried that the result is not what they expected or hoped for. This may particularly be the case where individuals have strong feelings about a diagnosis eg. social or cultural stigma, diagnosis was suggested to them by a trainer rather than being something they had questioned themselves. For some individuals, a negative result may also be challenging, if they were hoping to be able to access specific support or if they felt a diagnosis fit them well (bear in mind that it is always an option to seek a second opinion). It may be worth putting time into thinking about what support one might access in this circumstance. It can also be challenging, even if the result is expected, to read a diagnostic report which often details strengths, weaknesses and specific character traits. It can feel quite personal and it is not uncommon for individuals to feel defensive about these reports when they are read.
Advantages of a Diagnosis
A diagnosis of neurodiversity can be very freeing. It can increase an individual's understanding of themselves, and can also support them to be more compassionate towards themselves and have more confidence. It can provide direction for further self improvement and it can open doors to external support.
As one individual said "my diagnosis meant that I knew myself better. I was never going to stop trying to improve, but it means that when I struggle with something I can frame it in terms of how far I've come, rather than how badly I'm doing".
This author even mentioned her diagnosis in her registrar interviews as a strength - and someone must have liked it as she got a job!