ADHD is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
Symptoms of ADHD tend to be noticed at an early age and might become more obvious when your child's circumstances change, such as when they start school.
The symptoms, usually noticed before the age of six, are categorised into two types of behavioural problems:
Most people with ADHD have problems that fall into both these categories, but this isn't always the case. For example, some might have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD).
ADD can sometimes go unnoticed because the symptoms might be less obvious. It’s thought that girls more commonly present with ADD, which is why they’re less likely to get a diagnosis than boys.
Whilst children with ADHD will show the core symptoms of inattention, hyperactivity and impulsiveness (or inattention only with ADD) there are a lot of other reasons why children and young people may present as hyperactive, inattentive or restless and impulsive. These include sensory processing and 'proprioception' difficulties (hypermobility and difficulties with posture), learning difficulties, anxiety, depression, and reaction to stressful or difficult life experiences.
Children who show signs of inattentiveness might have a short attention span and be easily distracted. They might have difficulty organising themselves, they can make careless mistakes such as in their schoolwork, and they can appear forgetful and/or lose things. They might have difficulty sticking at tasks that are tedious or time-consuming, and constantly change tasks and activities. They might also have difficulty listening to or carrying out instructions.
Children who are hyperactive can have difficulty sitting still and concentrating, especially in calm or quiet surroundings. They might want to move excessively, fidget constantly, talk more than necessary and find it difficult to wait and take their turn.
Impulsive behaviours can include acting without thinking, interrupting conversations and appearing to have little or no sense of danger.
Although not always the case, some children might also have other problems or conditions alongside their ADHD. These include anxiety disorders, oppositional defiant disorder (ODD), conduct disorder, depression, sleep problems, autistic spectrum condition (ASC), epilepsy, Tourette’s syndrome and learning difficulties, such as dyslexia.
We’re an experienced multi-disciplinary team made up of consultant psychiatrists, speciality doctors, clinical nurse specialists, non-medical prescribers, assistant psychologists, and children's wellbeing practitioners.
An assessment usually takes place over two appointments. One appointment is to complete a computer-based task which takes around 15-20 minutes to complete. The other is an appointment with an ADHD clinician which takes around 1 ½ hours. Before the assessment we will also gather some additional information from home and from school which will help streamline the assessment process and mean that we can make a decision as quickly as possible.
Not everyone referred will get a diagnosis of ADHD. Some things which may look like ADHD can often be due to other things and the clinician will consider any other support the young person may need.
When we make a diagnosis of ADHD we will offer recommendations on how to support the young person with their ADHD. This will include a discussion about whether a trial of medication might be appropriate. However, medication will not be suitable for all and would be considered for moderate to severe impact of ADHD. Generally other forms of support should be in place first at school and at home before medication is trialled.
We will discuss the outcome of the assessment with both you and your parent/carer. You may receive individual support to help you manage difficult feelings or behaviours. It may be that your parent/carer finds behavioural support in the form of parenting interventions helpful. This may vary according to your local authority.
If it is felt appropriate you may be offered a trial of medication. This may help young people with severe ADHD concentrate, focus, and think about things before doing them. There are different types of medication, with different effects and strengths. We will discuss these with you and your parent/carer to make sure they are the best fit for you. Once we have found a helpful routine of medication, a clinician from our team will check how you are getting on every six months.
Interventions depend on the findings of the assessment and level of impact on the child or young persons life.
They will usually include:
You are still entitled to free NHS care if you choose to pay for additional private care and this will not affect your position on the NHS waiting list.
We recommend that you research private providers and ask them if their ADHD assessment is in line with NICE Guidance (National Institute for Health and Care Excellence). NICE guidelines are evidence-based recommendations for health and care in England. We would also advise a full discussion about the costs, including the costs for ADHD treatment should this be started by the private provider.
You may want to check with your GP whether they would accept a shared care agreement with your private provider. A shared care agreement means that your child’s care and treatment will be shared by your private provider and your GP. Your GP would take over prescribing although you would still need to pay for any review appointments needed with the private provider up until the time we can offer an appointment and take over care. If your GP will not accept a shared care agreement with a private provider then you will need to continue to pay privately for the medication as well as for the medication reviews.
If your child receives a diagnosis privately, and you would like us to consider taking over medication at a later stage then we will review the assessment report. For us to prescribe without needing to complete further assessment there is certain information we need, to ensure we provide safe and effective care for your child. You can find more information on what is required here and would recommend you share this with your private provider.
If this is the case, please update us and we can discharge the referral.
If this is the case, please update us and we can discharge the referral. If you would like us to add the diagnosis to your child’s records, please send us a copy of the report.
If your child has received an ADHD diagnosis and at a later stage you want to consider medication, please make a parent/GP/school referral online here (opens in new window), explaining that your child has a private diagnosis of ADHD. Please include a copy of the report (if this has not been sent previously) and state that you would like to consider medication.
The team will review the assessment report to ensure it contains the information we need to be able to start medication if it is appropriate.
Unfortunately, we are not able to prioritise on the basis of a private assessment and appointments are allocated based on those who have waited the longest and those with the highest level of clinical need. This means that a referral to the team after a private assessment would in theory have the same wait as any other new referral – although sometimes we are able to offer an appointment to discuss medication sooner than an assessment appointment.
If the report does not contain the information required, then we will consider the best way forward. We may be able to obtain the additional information required from the private provider or we may offer some further assessment. We will always do our best to avoid repeating any parts of the assessment and will only do this when essential.
You can return to the NHS for ongoing care once your child has been stabilised on medication, a process known as titration. Titration is the process of safely stabilising a person on medication to establish the most suitable medication and the dose which has maximum benefits with minimal side effects.
Unfortunately, we are not able to prioritise appointments on the basis of a private provider having started ADHD medication. When a private provider initiates medication, the responsibility for monitoring and reviewing this remains with them until we can see the child or young person.
Our team will review the assessment report and medication letters to make sure they contain the information we need to be able to take over the monitoring and review of medication that has been prescribed. If this is the case, we will write to your GP to confirm we have accepted the referral and ask them to kindly take over prescribing the medication for your child.
If the report/letters do not contain the required information or we have any concerns about the type of medication prescribed, then we will not be able to ask the GP to take over prescribing. This does not happen often, and we will always contact you to discuss this and the way forward. Please note that we are unable to take over review of medication during the stabilisation period (titration).
We have a shared care agreement with GPs, which means that GPs will prescribe medication if this has been started by a specialist in our team and the right dose has been established (known as titration completed). Treatment within our team is in line with recommended medicines and we recommend you discuss this with a private provider if you might want to transfer back to the NHS. We recommend that your private provider considers this and refers to the guidance below. This will mean more consistency in treatment.
Bracknell, Slough, Windsor and Maidenhead medication guidance (opens in new window)
Newbury, Reading, Wokingham medication guidance (opens in new window)
Please note that this is a shared care agreement with our team and GPs, so private providers are not covered by this; although some GPs will take over prescribing (when asked to do so by a private provider) and/or when our team asks them to and we have confirmed that we have reviewed the assessment and treatment.
You can read the guidance from the NHS here (opens in new window)
If you decide to look into paying for an assessment in the private sector this is what we require if you wish to return to the NHS:
+ Appropriate professional with experience in assessing for ADHD
+ Adequate history including persistence & pervasiveness of symptoms
+ Family history Information gathered from two or more environments
+ Mental state
+ Observer report of child
+ Diagnostic criteria including standard evidence screening tools
+ Monitoring on medications
+ All information handed over including
+ Allergies and adverse reactions
If you are thinking about possible ADHD please visit our information here on how to request help.
About your referral to the ADHD team
Getting help now
Waiting times
ADHD and autism support service (Bracknell, Slough, Windsor and Maidenhead)
ADHD and autism support service (Newbury, Reading, Wokingham)
ADDiSS
ADHD Foundation
The Association for Child and Adolescent Mental Health
Family Lives
GEMS
Mind Ed
Parenting Special Children
Young Minds