You and your child may refer yourselves to our team, or you may be referred by your consultant Paediatrician, Psychologist, Psychiatrist or Educator. For self-referral, you can email our practice management on referrals@neurodiversitycentre.co.za, with a brief outline of the reason for referral, your child's name and age (if it is for a child), and which of our centres you would prefer to attend (Durbanville, Paarl, Worcester or Somerset West). Professionals who wish to refer can also email us directly, or make use of our referral form, available here .

The most suitable clinician will then be allocated to your care, and one of our Practice Administrators will contact you to set up a first appointment. Once a first appointment has been confirmed, we will send you some paperwork to complete prior to the first appointment. After the first appointment, the clinician will be able to advise and discuss with you what further assessments may be required, and can also give you some indication of the various pathways to intervention that may apply.

If you have any questions or concerns, please do not hesitate to contact referrals@neurodiversitycentre.co.za, or you can phone our office closest to you.

Assessment at the NDC is intended to be as comprehensive as possible, and is grounded in the unique presenting needs of each and every individual attending our service. Assessment may well be required across many developmental dimensions and settings; and may require both formal and informal assessments, in the home, the school (or creche) and the Centre. Diagnostic and psychometric assessment are just two facets of the assessment process that may be implemented. In order to most appropriately attend to each individual's needs, cases may be reviewed in the MDT meetings, and a key-working professional will be assigned. This professional's adjunct role will be to guide your (or your child`s) engagement with services. Importantly, assessment needs may change and evolve over time - and children and individual's diagnostic presentations may change over time.

What are the intake screening forms used for? The intake screening forms assist us in having as much information as possible about you or your child when we meet your child, and it is also a way to ensure that you can inform us about all of your concerns in as much detail as possible. We use four primary screening questionnaires:

• The ESSENCE Q is a short questionnaire that assists us in assessing whether a child (at any age, but particularly very young children) may have difficulties that would fall under the ESSENCE 'umbrella'.
• The Relationship Problems Questionnaire (RPQ) is a short questionnaire which is used to screen for any potential concerns in five areas of your child's behaviour, namely emotional or conduct problems, hyperactivity, problems with peer relationships and prosocial behaviour. This assists us in being able to capture your concerns or concerns that may have been brought to your attention.
• The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire for children and adolescents of all ages. It considers five dimensions: emotional problems, conduct problems, hyperactivity or inattention, peer-based social difficulties and prosocial behaviour.
• The A-TAC (Autism-Tics, ADHD and other comorbidities) is a telephone interview also developed by Prof Gillberg and his team to allow for proxy identification of many of the conditions that are considered under the ESSENCE framework, such as the autisms, ADHD, DCD and similar. It is not a diagnostic procedure, it is an aide to our work with you and your child. This will usually be conducted telephonically.

Why are school and/or home observations conducted?
We find that being able to observe your child in both a peer and school setting gives us extremely valuable information about the quality of your child's social communication and interaction, and it gives us general information about your child's progress in many other developmental areas - ranging from speech and language development, as well as motor and coordination development, to your child's ability to flexibly tolerate all of the varied demands of the classroom as well as many other areas of early development. Similarly, at home we are able to observe your child in her/his most familiar setting, where he or she is most comfortable. Here we are able to learn about how your child engages her/himself in what she or he likes to do; and is most comfortable and content in doing. We also learn about how your child experiences her/his environment.

Do we use specialist instruments to assist in diagnostic assessments?
There are no specific diagnostic tests that 'diagnose' neurodevelopmental conditions such as conditions on the Autism spectrum. There are however specialist instruments that help a clinician in the process of making a clinical diagnosis. This is important, as a comprehensive diagnostic assessment does take time. Collateral from other clinicians, the school / creche and similar should be collected and considered. Other assessments, considering the child's sensory processing, developmental coordination, cognitive areas of strength and weakness, self-care and emotional and behavioural needs may also be required. Some of the instruments that we at the NDC utilise and are trained in using, include the following:

• DISCO
• ADOS
• ADI-R
• 3Di
• Griffiths

Although precise diagnosis of your or your child's needs is extremely important, it is also useful to remember (as the GNC reminds us) that diagnosis of just one condition is often likely to prove inadequate, and re-assessment may be required over time in most cases. The important factor is that for some 'diagnoses' there are clear and very well proven intervention programmes that can be implemented, such as is the case for Developmental Coordination Disorder, for example. In the context of other diagnoses, such as for many of the autisms, intervention should be environmentally focussed, assisting and supporting the individual's experience of the world, and both increasing and capacitating the individuals working around the child.

Again, for many children with one of the autism conditions (for example), it may be the impact of other ESSENCE conditions that is most impacting their developmental progress or quality of life. A core factor in the success of applied interventions is the extent to which the family, school and team can work together around the child or individual. Interventions may be multi-faceted, and in some cases, more traditional; and the intervention needs may change and evolve over time - or when the developmental or environmental needs of the individual change. Each of the neurodevelopmental and neuropsychiatric needs may require individualised and appropriate attention, and there are limits to what interventions have been found to be valid and appropriate for each of these.

Psychoeducation and Parent Guidance
In the case of most ESSENCE disorders, a practical and empathic understanding of the child or individual's needs - and their experience of the world - is key. An example of this is understanding - for example for a child with a condition on the spectrum of Autism - the inherent qualitative impairments in the social aspects of communication, interaction and imagination, and associated inflexible patterns of thought. If a supporting teacher, facilitator or parent is able to understand these needs more effectively (amongst all the other areas of need and challenge), they are more equipped to support and assist the child or individual. Your NDC keyworker will plan with you where the most appropriate psychoeducation and parent guidance is required. Your NDC keyworker will also need to work with you an relevant school staff to remove barriers to active inclusion in the classroom setting, and make adaptations that take your child's learning style and needs into consideration.

Psychological Therapy
At the NDC we provide a variety of appropriate therapies - where these are consistent with available international best practice - which should ideally be consistent with the unique needs of each and every individual attending our service. Importantly, each developmental transition (such as puberty) brings unique challenges for individuals with ESSENCE needs. It is imperative that therapy is planned with a primary mindfulness of the child or individual's needs at that point in time. Various therapies are one facet of intervention, and may well not be suitable or appropriate in all cases. This should be discussed in detail with your keyworker. There may often also be 'interactions' between the various therapies or interventions, such as changing school or medication, or attempting a particularly challenging aspect of a social training programme. This must be carefully considered, so that the most effective decision-making around therapy can take place.

Support and Intervention Groups
Across the three NDC offices we offer support and intervention groups. A flagship programme is Bridges in Social Understanding. This is an online-based social skills programme which may be accessed individually, but which we will also be offering in facilitated groups at certain schools and at the NDC. We will also be running goal-directed support groups for certain groups in our communities, varying from groups for adult women with conditions on the spectrum of Autism, to groups for parents of children with Pathological / Extreme Demand Avoidance (PDA/EDA). Information on these groups is updated regularly on our Facebook page and on our website throughout the year. If you have specific needs that you believe should be attended to in a group setting, please do let us know. We rely heavily on the input of our families.

Most relevant and recent research is clear as to the implications of any child presenting with any form of speech and language delay or difficulty at the age of two and a half. Many of these children may later present with one or other form of neurodevelopmental challenge. The onus is therefore on comprehensive assessment and support across all developmental areas, with appropriate early identification as soon as possible.

In the context of describing the interwoven nature of neurodevelopmental symptoms and needs as they present in children, Professor Christopher Gillberg formally coined the acronym ESSENCE in 2010. ESSENCE refers to Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations; and is a term that continues to garner widespread support and use throughout the world. As described on the website of the Gillberg Neuropsychiatry Centre (GNC), the term ESSENCE refers to the whole group of neurodevelopmental/neuropsychiatric disorders that present with impairing symptoms in early childhood and includes AD(H)D, Autism Spectrum Disorders, Developmental Coordination disorder, Intellectual Developmental Disorder, Specific Language Impairment, Tourette syndrome, early onset bipolar disorder, behaviour phenotype syndromes, and a variety of neurological and seizure disorders presenting with major behavioural/cognitive problems at an early age. A primary factor that cannot be discounted in considering these diagnoses, is the fact that their symptoms are often co-morbid or interwoven with one another, and may be difficult to distinguish from one another in initial diagnostic assessments. This is precisely because they often present in similar ways - with similar symptoms, and they share genes and environmental risk factors. In this way, as described by the GNC, symptoms of each disorder can overlap with those of another disorder within the group and diagnostic criteria may be met for one or two of them at one age, and for a third or fourth of them at another age.

This term 'ESSENCE' that the NDC have adopted is not a diagnosis, rather it is a means of thinking about the broad and varied ways in which early-onset neurodevelopmental challenges present. As demonstrated in other contexts by Gillberg and his collaborators, ESSENCE challenges affect approximately one in ten individuals. In our context the NDC team is committed towards providing a high quality neurodevelopmental service for individuals with ESSENCE needs, and to collaborate as broadly and extensively as possible with the families in our services.

Across the three NDC offices we offer support and intervention groups. A flagship programme is Bridges in Social Understanding. This is an online-based social skills programme which may be accessed individually, but which we will also be offering in facilitated groups at certain schools and at the NDC. We will also be running goal-directed support groups for certain groups in our communities, varying from groups for adult women with conditions on the spectrum of Autism, to groups for parents of children with Pathological / Extreme Demand Avoidance (PDA/EDA). Information on these groups is updated regularly on our Facebook page and on our website throughout the year. If you have specific needs that you believe should be attended to in a group setting, please do let us know. We rely heavily on the input of our families.