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Referral
ADHD - RDUH Northern & Eastern Community Paediatric Team
Key Messages
The Community Paediatric Team at the Royal Devon University Healthcare NHS Trust provide specialist assessment, diagnosis, and support for children with neurodevelopmental disorders including ADHD.
Provision of support for a child or young person should be according to need, not diagnosis, and can be accessed through the local offer as part of the Graduated Response, and Early Help.
In Devon other services contributing to understanding and supporting a child’s needs include: Public Health Nursing (Health Visitors and School Nurses), Children and Family Health Devon, Vranch House, Special Educational Needs and Disability (SEND) and Social Care.
It is often appropriate for a family to first access support from one these services prior to a referral to specialist paediatrics.
Scope
Age: 6-17 years old
(ADHD is not considered in young people under the age of 6 because the behaviours noted to diagnose ADHD are developmentally appropriate at that age)
Conditions in scope:
- Attention Deficit Hyperactivity Disorder without co-morbid mental health need (see ‘Out of Scope’).
Out of Scope
- Attention Deficit Hyperactivity Disorder with co-morbid mental health need.
If there are concerns about associated significant mental health issues alongside ADHD, then the referral should be sent to CFHD CAMHS Single Point of Access (SPA).
Please see further information on referral criteria for CAMHS, and details of conditions in scope / significant mental health issues also found at: Children and Family Health Devon
Examples of mental health conditions that Specialist CAMHS will consider are:
- Depression
- Anxiety impacting on functioning
- Self-harming or suicidal ideation
- Impact of trauma including developmental trauma
- Disrupted attachment
Community Paediatric ADHD assessment summary:
Pre-referral
- There should be evidence that the educational setting have used a 'graduated response' based on needs, before a referral is made for ADHD for assessment.
- Parents/carers to be supported to access behaviour management advice / parenting programmes through BisNet or other local programmes.
- Educational settings should monitor the response to these strategies and if significant ADHD symptoms persist then liaise with health professional (GP and/or school Nurse) re referral for specialist assessment.
Referral
- As per NICE guidelines, a referral for specialist ADHD assessment requires evidence of significant ADHD symptoms (inattention, hyperactivity and impulsivity), presenting across at least two settings, e.g. home and school.
- Note: Only children over 6 will be considered for an ADHD specialist assessment.
Assessment
- The assessment process will involve a semi-structured clinical interview, the use of validated rating scales and assessments, examination, and observational information from school or other setting.
Management
- If ADHD diagnosis confirmed clinical management in accordance with NICE guideline.
- If alternative diagnosis and / or co-morbidities identified appropriate referral and or management initiated.
- Shared care guidelines with Primary Care are in place re overview of medication review if prescribed, including monitoring of side effects.
Transition
- Transition to adult services - multiagency and adult health services.
- Discharge to Primary Care.
- Referral on to alternative services (eg: CAMHS) as indicated by needs.
Please see below additional supporting information regarding referral for ADHD assessment:
At present, it is not possible for education settings to refer directly to this service. This is something that may be possible in the future. In the interim, primary care are required to make these referrals – this is in line with NICE guidance and provides primary care with the opportunity to share additional information when relevant. The specialty teams and the LMC have worked together to make the system as efficient as possible, keeping primary care involvement to a minimum.
Mandated requirements for referral:
1) Primary Care Clinical Summary
This should include a list of read-coded medical problems and an up-to-date medical history
If primary care has any additional knowledge of any wider issues relevant to assessment that is not included in the patient’s clinical summary, please could this be shared in a short covering letter e.g., safeguarding history, family history, developmental trauma.
2) A completed copy of the ‘Parent / Carer Information Gathering Form’
This form can be found on MyHealth-Devon here
3) A completed copy of the ‘Education Setting Supporting Information Form’
GPs should ask parents to request the form be completed by the most appropriate person i.e., this can be completed by a tutor or a parent if they are responsible for providing the only educational element to the young person.
This form can be found on MyHealth-Devon here
TO AVOID REFERRALS NEEDING TO BE RETURNED, PLEASE ENSURE THAT BOTH FORMS ARE FULLY COMPLETED (or comments are added e.g., N/A, unknown)
GPs to refer:
1) RDUH Eastern to Community Paediatric Team:
a) Via Advice & Guidance (A&G):
Referring via the A&G route allows the service an efficient way to communicate with the referrer (without having to cancel the original referral):
- When referrer is specifically asking for advice (e.g., if unsure regarding patient eligibility)
- When additional information is required (e.g., incomplete referral form)
Referrals via A&G on e-RS will only be returned to the referrer if:
i. the referrer has specifically asked for advice
ii. additional information is required/missing forms.
All A&G requests will be triaged within 5 working days.
OR
b) Routine referral to Community Paediatrics on e-RS
2) RDUH Northern to Community Paediatric Team:
a) Routine referral to Community Paediatrics on e-RS
There is currently no A&G service in North Devon for the Community Paediatric Team. If requesting A&G, please make this clear in the reason for referral.
This guidance has been agreed by….. and based on ‘Attention deficit hyperactivity disorder: diagnosis and management’, NICE guideline [NG87]Published: 14 March 2018 Last updated: 13 September 2019.
This guideline has been signed off on behalf of NHS Devon.
Publication date: October 2023
