Professionals - guidance to our request for help process

ADHD

• We can offer ADHD assessments for children and young people aged 6–17 years.
• We do not offer assesments for children under 6.
• For young people aged 18 and above, please visit our Adult ADHD service. 
• We can consider medication for children and young people who already have a diagnosis of ADHD.
• If the young person already has a diagnosis of ADHD and already takes medication and you are asking us to take over their care: please fill in the additional information document found here and attach it with the online referral form.
• The child or young person must be registered with a GP in Berkshire.

Autism

• We can offer autism assessments for children/young people aged 2 ½ to 17 ½ years of age. 
• For requests to consider autism assessment for young people aged 17 ½ years or older: please visit our adult autism assessment team. 

• The child or young person must be registered with a GP in Berkshire.

The most important thing is to put support in place straight away – this can happen without diagnosis, assessment or referral.  

Begin by putting in place a support plan, and advise families what support they can access straight away. As part of the support plan, think about the child or young person’s needs at home as well as a school. Remember that the child may present very differently: for some children and young people their distress may only really be apparent at home. Some changes in school could make life much less stressful for the young person. For some children and young people this support plan may be sufficient to address the concerns.  

There are many things that might look like possible autism or ADHD but are not. This can include things like hearing, speech and language difficulties, learning difficulties, depression and anxiety, bullying and emotional worries. It’s important, therefore, to carefully consider these possibilities before thinking about requesting an autism/ADHD assessment. 

In Berkshire, we are fortunate that in many or most cases you can get exactly the same support without an assessment (or referral) as you would get after a diagnosis. This means the child or young person can receive support as early as possible based on their needs, without needing to rely on or wait for an assessment to happen first. 

A young person’s needs will be the same on the day after the assessment as they were the day before the assessment. It is very likely that the child or young person will still require support whether or not they receive a formal diagnosis.  So having the right support in place as early as possible is more important and more meaningful than being added to a long waiting list.

There is a range of support available immediately which can often mean a young person does not need an assessment.

Visit the below pages to advise families about all the support available now:

• Getting help now: ADHD. You can also download this as a PDF to print off: ADHD (opens PDF)
• Getting help now: autism. You can also download this as a PDF to print off: Autism (opens PDF)

There are lots of strategies that parents and carers can put in place to help a child or young person, which you can find here:

• Strategies for supporting attention, activity, emotions and behaviour
• Strategies for supporting communication, sensory needs, emotions and behaviour

Support plans can take different forms. They should be based on a careful consideration of individual needs and helpful strategies, with a plan to review and adapt the plan as needed. Often relatively small changes can make a big difference. Flexibility is key when thinking about how to make adaptations to support the child or young person.  

Support plans should:  

• Focus on tailored support based on the identified challenges/needs/difficulties, while also factoring in strengths and what the child or young person enjoys.  

• Consider the reasonable adjustments that the school can make to support the child or young person and the ways that the environment can be adapted (eg considering sensory differences/sensitivities).  

• Identify and provide support for aspects of the school day that might cause stress or distress for the young person, even when this is not directly observed in school.  

• Include the less structured parts of the school day (break, lunch and after school clubs or activities).  

As part of the support plan, please make sure that families also know where they can access advice, support and courses. 

If school have access to a profiling tool, this will be extremely helpful in understanding the profile of needs and strengths and informing strategies to support the child or young person.  

Please see the checklists below for help in putting a support plan in place. You can also find more information on strategies for supporting attention, activity , emotions and behaviour and strategies for supporting communication, sensory needs, emotions and behaviour.

Possible ADHD support plan checklist: Primary school 

Possible ADHD support plan checklist: Secondary school

Possible autism support plan checklist: primary school

Possible autism support plan checklist: Secondary school

All of the below need to apply.

Where they apply, the below are also needed.

All of the below need to apply.

Where they apply, the below are also needed.

All of the below need to apply.

Where they apply, the below are also needed.

This is for a request to consider starting ADHD medication when an ADHD diagnosis has already been made.

All of the below need to apply.

Where they apply, the below are also needed.

If, after following all of this advice and following the support plan for at least six months, you and the family still feel an assessment would help, we ask you to work with the family to complete the appropriate additional information document together, then submit it with the online referral form. Making referrals jointly with the family helps us get a better understanding of the child or young person’s needs, and means we can process the referral as quickly as possible. 

Referrals should be made only after a robust support plan has been put in place and reviewed for at least six months or two school terms.

What to do now

Please visit this page to download the relevant additional information document and follow the instructions there.

Please note you will not be able to submit the online referral form unless you have the completed and attached the additional information document.

The information will be reviewed and a decision made about the best way to help the child or young person. Because of the number of referrals we receive, this can take some time and we please ask for your patience.

As soon as the review (known as triage) is complete, we'll reach out to share our decision with you. To help our team focus on reviewing all requests, we kindly ask that you refrain from calling the service for updates. Thank you for your understanding and patience.

What about parents and carers that cannot access or use online systems?

Working in partnership with the school (or other involved professional) means that they can support the use of IT systems. Where there is no one available to support the young person, bespoke support can be provided by the service. 

What if the school or professional is concerned, but the family is not?

Arrange to meet the parent/carer and explain your concern. Discuss with them how the school can support the child and what support is available to the family. Make sure an effective support plan is in place (this should be based on identified need and does not require referral/assessment/diagnosis). Arrange to meet regularly to evaluate the child's progress.

If you feel the child needs a specific provision or service that can ONLY be accessed with a specific diagnosis, please share this with the family. 

The child/young person presents very differently at school and at home, what guidance can you offer?

This can often happen and it may be for a number of different reasons. A young person may work very hard to manage the school day, although this may not be apparent in the school setting. This may only be seen at home where the young person may, for example, have meltdowns or shutdowns. The effort to manage the school day can leave young people exhausted and with no energy or coping resources left by the time they get home. This can particularly affect young people who mask or camouflage, and work very hard to fit in. 

While the distress may only be seen at home, the underlying triggers or reasons are often things that happen at school. It is very important to understand that, although a child may appear to cope at school, they may be feeling very stressed and distressed, even if they do not show this at school. Talking to the young person and their family will usually provide important information about sources of stress at school and ideas about what support can be put in place to reduce this.  

What if the child or young person is on the school roll but is not currently attending due to anxiety or other needs?

If there is someone in school that knows the child or young person, we still ask them to work with the family as they will have important information including why the young person is not in the school setting. Where a child or young person is not known to school staff, then generally another professional who has direct knowledge of the young person will partner with the family. 

Why do we need to wait six months before deciding whether a referral is needed?

Six months will give enough time to implement and evaluate a robust support plan based on the child or young person ’s needs. Some children or young people may not need a formal assessment after this, as their needs will now have been met. 

We ask you to work in partnership with the parents and carers. Information needs to be gathered by looking back over a minimum period of two terms or six months. This is so we can fully understand the child/young person’s needs, the strategies put in place and the impact these strategies have had.  This is referred to as a ‘graduated response’ to meet a child/young person’s needs. 

Will the requirements for a support plan put additional pressures on school staff? 

The updates to the process are intended to reflect the graduated response and ordinarily available provision and what is already happening in schools. Our assumption is that where there are concerns sufficient enough to warrant referral for a specialist assessment, these will also be triggering a support plan in school.  

All children/young people will need a fully completed form and supporting evidence before we can accept for assessment as it is the only way to gather the depth of information required. We cannot properly triage the referral and make decisions we have all the information required. 

Will completing the additional information form create additional work for schools?

We would like to reassure you that the additional information forms have been designed to reduce the burden for those completing them when compared to the previous process. For example the combined autism and ADHD form replaces a total of 9 separate questionnaires previously sent out to families and schools. The forms have been designed to streamline the process, reduce duplication and the reliance on referrers providing a great deal of narrative text or description. Very similar additional information forms have been in place in Oxford for over a year and in Buckinghamshire for several months and are working well. 

By making the forms available to download and asking for the form and support plan to be uploaded with the referral form, we are eliminating delays and issues with sending and receiving documentation that has held the process up for many families. We are already seeing that triage under the updated process is taking much less time to complete.  

Can I give feedback on the process?

Yes, we will collect feedback from families and schools with every referral to help us evaluate, refine and improve the process. We want to make sure the system adapts to meet the needs of children and young people effectively. 

What do we mean by a support plan? 

This is the support in place that is above and beyond what would be typical to support a child/young person at this stage of development. A support plan is expected to include areas of need we would typically associate with possible autism and/or possible ADHD. For example for possible autism this would include needs with communication and social interaction, flexibility of thought and behaviour and sensory needs (three key areas of difference).  

When completing a referral we ask for you to demonstrate that a ‘graduated response’ has been put in place for at least six months ortwo terms prior to referral. This includes any support that has been offered at home, in school or by other services involved. It can include strategies that parents have introduced at home as well as strategies recommended or put in place by professionals. 

Why do we think a support plan is so important? 

When we look at the process overall (in terms of referrals that are not accepted and referrals for children who do not go on to get a diagnosis) it is clear that there are  children and young people whose needs can be met without referral for a specialist assessment. It is also very important that we do not add children to a long waiting list without knowing that they have support in place.  For ADHD we have always asked that support is in place first (previously for 10 weeks) and a copy of the school support plan is provided.  

What if the referral process isn't clear for some families or schools?

We are providing detailed guidance on our website and will be available to answer any questions. We encourage families and schools to spend some time on the website reviewing all of the information as this is likely to answer their questions. If not they can contact us for advice. 

CYP Autism and ADHD triage team
CYPADHDandAutismTriage@berkshire.nhs.uk 
0118 9046620

What support is available for schools?

There is a range of resources and free training to help schools with supporting children and young people. This includes:  

• Psychological Perspectives in Education and Primary Care  or PPEPCare Training: Flexible and free training for EYS/schools delivered by Berkshire Healthcare, with a total of 17 modules covering autism, ADHD and a wide range of common concerns and mental health difficulties   
• Mental and Emotional Health advice  

• ADHD and Autism (Neurodiversity) advice  

• Health and Development advice   

• Sensory processing advice
• Information on our online Sensory Processing, Early Language Development and Handwriting workshops

• What does inclusivity in schools look like? 

• NHSE info re Children and Young People including PINS: A national pilot coordinated by the Department for Education, Department of Health and Social Care, NHS England. Currently in primary schools in Reading, Bracknell, Royal Borough of Windsor and Maidenhead. The pilot will focus on early support and intervention for neurodivergent children in the mainstream primary setting. It will achieve this by bringing together health, the local parent carer forum, the local authority, and education staff to help shape whole school SEND provision , provide early interventions at a school level , upskill school staff, and support strengthening of partnerships between schools and parent carers.  

• LEANS Learning about Neurodiversity at Schools 

• Belonging in School  A guide to developing an inclusion policy for schools  

• Person Centred profiling tool from Bracknell Forest