Can we better understand the experience and outcome of complex neurodevelopmental assessment by considering the perspectives of both parents and clinicians?

This study aims to examine the lived experiences of four parents accompanying their child in a complex neurodevelopmental assessment. It attempts to understand what the parents experienced in the assessment particularly in relation to the clinicians and why, and how this might contribute to the outcome of the assessment. Free Association Narrative Interview (FANI) method and Interpretative Phenomenological Analysis (IPA) was used. FANI is designed to work with defended subjects, and IPA aids the researcher to identify themes that may not be apparent at first. As well as interviewing parents, the staff group of assessing clinicians were interviewed within a focus group. This aimed at understanding their counter-transferential responses to the parents in the assessment situation. This had the goal of understanding the parents' unconscious communications and motivations within assessment to further inform on the parent’s experience. It is hoped that this additional data will inform on the outcome and feedback aspects of the assessment by enlightening why clinicians might make decisions or process the assessment in particular ways. The following themes are described, with the first three belonging to the parents and a further three belonging to the clinicians: 1. Parental trauma and the role in the child’s difficulties. 2. Difficulty, uncertainty and the development of epistemic trust. 3. A persecuted state of mind: how assessment effects parental sense of self and clinician. 1. The clinicians’ experience of knowledge and power. 2. The presence and management of parental trauma in the assessment framework. 3. The need for time in processing conflict and coming to a conclusion. These themes are examined in relation to current research as well as psychoanalytic literature of internal processes. There are conclusive remarks around the presence of defensive states in parents as well as in clinicians which hinder the understanding of the child’s difficulties and there is discussion around why this may be. Recommendations for coping with the increasing demand for neurodevelopmental assessment are made by way of linking what parents want to what it appears they might need.