About The Fife Neurodevelopmental Questionnaire (F-NDQ) - for Professionals

The copyright to the F-NDQ is owned by NHS Fife, and it was developed by Dr Joshua Muggleton, a Clinical Psychologist with NHS Fife, in collaboration with multiple different health professionals, specialities, and with feedback from service users, staff, and multiple health boards. The F-NDQ was designed for neurodevelopmental assessment pathways, but it is also used in related services, for example Paediatrics, Speech and Language Therapy, Mental Health Services, Psychiatry, and Clinical Psychology, when there are questions about a person’s development and more information is needed

“Neurodevelopmental disorders are behaviour and cognitive disorders that arise during the developmental period that involve significant difficulties in the acquisition and execution of specific intellectual, motor, language or social function.” (ICD-11, WHO). These include Intellectual Disability (ID), Speech and Language Disorders, Dyslexia, Dysgraphia, Dyscalculia, Developmental Coordination Disorder, Autism, Attention Deficit Hyperactivity Disorder (ADHD), Foetal Alcohol Spectrum Disorders, Tic Disorders, and Stereotyped Movement Disorder. These conditions show significant overlap between each other (Gillberg, 2010; Hunt and Craig, 2015; Thapar, Cooper and Rutter, 2017), making assessment challenging. Gillberg (2010) estimates the total combined prevalence (accounting for overlap) at 7-10%, although this figure does not include Foetal Alcohol Spectrum Disorders.

Assessment of Neurodevelopmental conditions “requires specialists from a range of disciplines (e.g child psychiatrist, psychologist, paediatrician, speech and language therapist and occupation therapist) and agencies (e.g health care and education)” (p340. Thapar, et al, 2017; SIGN 145, NICE CG128, NICE NG87, SIGN 156). Although essential, multidisciplinary assessment often means one child has multiple appointments with different professionals for one assessment. Siklos and Kerns (2007) found that for an autism assessment, parents saw on average 4.46 (S.D 2.42) professionals. Further, assessment services are often condition-specific (Gillberg, 2010, Hunt et al, 2015; Thapar, et al), meaning that if a presentation is unclear, or indicates comorbidities, multiple assessments with different teams may be required, leading to replication of information gathering (Kerry, 2017).

Recently, there has been a move towards ‘neurodevelopmental assessment pathways’. The Scottish Government’s National Neurodevelopmental Specification (Scottish Government, 2021) sets out that children and young people may require a neurodevelopmental assessment which takes into account their environment, experiences, and multiple areas of development (such as communication, attention, intellect, and movement). This allows those around the child to develop a shared formulation and understanding of a child or young person’s development, their difficulties, and how they can be supported to fulfil their potential. It also highlights the need for multidisciplinary team working, and the possibility that as part of the neurodevelopmental assessment a child or young person may receive multiple overlapping diagnoses.

Guidelines and clinicians highlight the importance of a “structured discussion including a formal developmental history spanning preconception to present” (Hunt et al, 2015, p114; SIGN 145, NICE CG128, NICE NG87, SIGN 156) for neurodevelopmental conditions. Several structured developmental history tools exist for specific conditions, such as the Autism Diagnostic Interview (Lord et al, 2000). These validated diagnostic tools predominantly gather evidence for or against a single diagnosis, and are therefore confirmatory assessments. While these are ideal for answering the question “does this child have this condition?”, they are less helpful in earlier stages of joined-up neurodevelopmental pathways where the initial questions are “what is contributing to this child’s presentation?” and “what further assessment does this child need?”, particularly in the context of mixed, complex, or inconsistent presentations. 

Despite its importance, there is currently no quality standard or tool for developmental history taking for neurodevelopmental conditions more broadly. The Fife Neurodevelopmental Questionnaire (F-NDQ) is an exploratory tool which considers bio-psycho-social factors within a child’s development. This tool provides the necessary clinical history items to provide a basis for a comprehensive formulation of a child’s difficulties, and aid planning for future assessment or interventions as appropriate. It also supports clinicians who may be specialist in one neurodevelopmental condition to ask relevant questions about other possible conditions, and ensure evidence of absence is not confused with absence of evidence. For example, it is easy to assume that other clinicians have asked about alcohol use during pregnancy, and so one may assume that no mention of alcohol means there was none, when in fact nobody asked (indeed, a survey of Australian paediatricians indicated only 23.3% routinely asked about alcohol use during pregnancy; Elliot, Payne, Haan and Bower, 2006).

The Fife Neurodevelopmental Questionnaire (F-NDQ) is a tool to support integrated neurodevelopmental assessment pathways. It aim is to produce a single, exploratory, multidisciplinary neurodevelopmental history which:

• Identifies the priorities for child and family
• Gathers information about a child’s development across multiple domains
• Considers multiple bio-psycho-social factors which may contribute to a child’s presentation
• Allows information key to different professions to be gathered at once in a core neurodevelopmental history, reducing the need for a similar history to be repeated by a different profession
• Allows professionals who are not specialists in neurodevelopmental conditions to gather relevant information to inform their judgement on referral to specialist services.

The F-NDQ can be used as a structured interview, as a form for service users to fill in then bring to their first appointment for discussion, or as a form for service users to fill in and send back ahead of their first appointment. While anyone can help service users complete the F-NDQ, it should always be reviewed by an appropriately qualified, registered and supervised health professional before being considered completed.

Further details about how to use the F-NDQ are in the Guidance Materials, available along with the F-NDQ here. Please read the Terms and Conditions here, before downloading the F-NDQ and guidance materials