All referrals for assessments where there is a new area of concern, including those for ADHD and Autism, will be offered an initial assessment.
Initial assessment
All children will be seen for an assessment with a doctor or an advanced clinical practitioner (ACP). Children being referred for behavioural difficulties and assessments for ADHD will have an initial video assessment with a nurse to gain a history of the symptoms and severity of difficulties and signpost to support. This will make access to the service quicker and support the first appointment with the doctor/ ACP. This pathway is demonstrated below:
| ADHD timeline for referrals |
|---|
| Accepted for assessment |
| Online nurse-led appointment |
| Parent support online |
| Invite for Qb test (if clinically indicated) |
| Initial assessment |
| Plan of care agreed |
In all appointments you and your child will be invited to participate in a discussion about any concerns and challenges and the nurse/doctor/ACP will ask questions about your child’s development, health and learning.
The face-to-face appointment with the doctor/ ACP will vary depending on why your child has been referred to the service and how old you child is, for instance a very young child will have a review of their development using a play-based assessment whereas an older child will have a discussion on home and school life. Your child will have their weight and height measured. Children referred for ADHD will have their blood pressure taken and the doctor will listen to their heart and ask questions about family cardiac medical history.
Waiting times
The average waiting time is eight months but some children may wait up to 14 months. Children are booked in order of the date the referral was received unless there is a statutory/ clinical requirement to see children sooner (children of families in the Armed forces, children that are looked after/ being adopted, children where there is a specific clinical need as determined by an appropriate clinical practitioner).
Next steps
The plan of care will be individual to your child. Some children may be diagnosed with ADHD at the first face to face appointment or a decision made that your child does not have ADHD, for others further assessment may be required. For Autism, a very small number may be diagnosed at the first appointment. A decision may be made that your child does not have Autism or a decision would be made that further assessment is required and they are added to the pathway as below.
Autism pathway
All children are different and therefore require different approaches to their assessments. It will depend on what assessments a child has already received including clinical observations taken from the initial assessment, their age and the information received from education and/ or screening questionnaires. A doctor/Advanced Clinical Practitioner (ACP) will decide which pathway is needed for your child.
*A small number of children may receive a diagnosis of Autism at the initial assessment or within the first year of being on the pathway. This will be for children that are already under multiple services who, inline with NICE guidance, can support diagnostic assessments for Autism. There would need to be clear supporting evidence over a period of time to allow this to happen.
| Autism | |
|---|---|
| Decision: Single 24 months | |
| Single assessment | |
| Paediatrician follow-up (virtual) | |
| Autism diagnosed | Autism not diagnosed |
| Discharge with information | Discharge to GP |
*a small number of children may be discussed at a multidisciplinary panel to help make a clinical decision for your child and further information may be sought. You will be advised of this and timings, if this is needed for your child.
| Autism | |
|---|---|
| Decision: Joint | |
| 56 months | |
| Joint assessment | |
| Autism diagnosed | Autism not diagnosed |
| Discharge with information | Discharge to GP |
| Autism | |
|---|---|
| Decision: Inconclusive | |
| We aim to offer a review in 12 months or refer to another service |
Autism pathway descriptions
Single assessment
Your child will be invited to an appointment with either a nurse, ACP, speech and language therapist or occupational therapist that have been specially trained to undertake an ADOS assessment (Autism Diagnostic Observation Schedule).
You will then have an appointment with a doctor on a different day which may be a virtual call or a face to face appointment depending on when and how your child was last seen. The doctor/ACP will complete their assessment and discuss the outcome with you and your child.
Joint assessment
Your child will be invited to an appointment with either a nurse, ACP, speech and language therapist (SLT) or occupational therapist (OT) and a doctor/ACP at the same time. The nurse/ OT/ SLT will undertake an ADOS assessment (Autism Diagnostic Observation Schedule). The doctor may observe the ADOS assessment or speak to you whilst your child is playing to complete their assessment. You and your child will have the outcome of the assessments provided at this appointment.
ADOS assessment (Autism Diagnostic Observation Schedule)
ADOS is a semi-structured, standardised assessment of communication, social skills, play and restricted and repetitive behaviours. During the assessment the clinician will play some games with younger children or carry out activities including questions about school, friendships and feelings with older children. By watching the way your child communicates, interacts, plays and behaves during the games and activities it helps us to understand if there are signs of autism.
ADHD pathway
| ADHD | |
|---|---|
| ADHD confirmed | |
| Medication to be discussed at appointment | |
| Parent support group available should further information on medication be required | |
| Medication decision | |
| Yes | No |
| Three months | |
| ADHD clinic | Discharge to GP |
| ADHD | |
|---|---|
| Not ADHD | |
| Discharge to GP |
| ADHD | |||
|---|---|---|---|
| Inconclusive | |||
| Six months | |||
| Qb Test | |||
| Diagnosis of ADHD | No diagnosis | Qb unable to be completed/ inconclusive | |
| Further information required | |||
| Follows ADHD confirmed pathway | Discharge to GP | Follows ADHD confirmed pathway | Discharge to GP |
| ADHD confirmed | ADHD confirmed | ||
ADHD pathway descriptions
Parent Support Group
You will be invited to an online group for parents and carers. Attendance at this group is needed before a child can be considered for ADHD medication. This is because behavioural strategies need to be tried before medication. Your child’s school may be able to support you to attend this if you do not have access to a computer at home. If you are finding it difficult to gain online access, we invite you to contact the service to discuss further. A nurse will lead the session and discuss what ADHD is, how it may affect your child and what you can do to support your child. The use of medication to help control ADHD symptoms will be discussed.
After the session, you will be contacted to see what you would like to do for your child. There will be three choices
- Continue to try behavioural strategies. You will be discharged from the ADHD pathway, however, you will continue to be given easy access to the service for 12 months.
- Start medication for your child and proceed to an appointment.
- Consider medication but want more information, we will invite you to a further online group specifically discussing what ADHD medication is and how it works. You can then decide to follow either choice 1 or 2.
Qb Test
Your child may require a Qb test if further information is needed to consider a diagnosis of ADHD for your child. The Qb test is a diagnostic screening tool which provides objective information to aid the assessment of Attention Deficit Hyperactivity Disorder (ADHD), this includes ADHD – predominantly inattentive presentation (previously called attention deficit disorder) and ADHD – predominantly hyperactive/impulsive presentation.
The test uses age and gender matched comparisons to assess a child’s ability to concentrate, their movement and impulsivity. The Qb test is carried out in clinic and your child will be asked to sit in front of a computer screen and wear a soft, flexible head band with a reflective ball which measures their movements. Your child will hold a responder button and click in response to shapes they see on screen. Full information will be sent to you to prepare for this appointment.