Thinking about possible autism or ADHD?

Consider if an assessment is the best way to help the child or young person

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.

You can read more about waiting lists in our newsletters here.

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. 

Supporting the child or young person straight away

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

• The early years or school setting should begin by putting in place a support plan. As part of this 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.  

• Families should be made aware of the support available to them, without the need for a diagnosis (see section below called 'What help is available now?')

• For some children and young people this support plan may be sufficient to address the concerns. 

Before making the request, please refer to the relevant checklist below for guidance.

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

Families can receive support from their locally commissioned NHS service which supports families who have a child who has or may have autism and/or ADHD. The services provide a range of support including workshops to support with anger, emotional regulation and sleep difficulties. No referral is needed. 

To find out more and access support:

• Visit GEMS if you live in or have a GP in Bracknell, Windsor or Slough
• Visit Autism Berkshire if you live in or have a GP in Reading, Wokingham or West Berkshire

Visit the below pages to find out 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)

And for more information please see:

• Our ADHD Support and Advice pages.
• Our Autism Support and Advice pages.

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 you still feel an assessment would help, we ask families and the child’s school (or another professional who knows the child or young person well) to complete the appropriate additional information document together, then submit it with the online referral form. 

The additional information will give us all the information we need and will help us decide the best way to help. It will tell us:  

• if the concerns are likely to be linked to autism or ADHD 

• about the ongoing impact for the child or young person 

• how an assessment might help specifically with these concerns.  

The process of completing the additional information will also help families and schools to work together to understand where support might be needed and what can be accessed or put in place right now to support the child or young person.  

Please note: 

• Referrals must be made jointly by families and the early years setting or school. This helps us get a better understanding of the child or young person’s needs (if the chid is not in an early years setting or school, another professional such as health visitor, speech and language therapist or CAMHS clinician can help). 

• Together, the family and education setting should complete the relevant additional information document so that we receive all the information that we need, which means we can process the referral as quickly as possible.  

• Referrals should be made only after a robust support plan has been put in placeand 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 if I cannot access or use online systems?

Please speak with your child's school (or another professional that is involved with your child) to support you. If there is no one available to support you, please speak to the ADHD and Autism Triage Team who can help to provide support. 

CYPADHDandAutismTriage@berkshire.nhs.uk

0118 9046620 

The school do not see the same concerns, what should I do?

Arrange to meet the SENCO, to explain your concerns and discuss how the school can support your child. If other professionals are involved in supporting your child, make sure they are communicating with the school to share their observations and recommendations. If you feel that some aspects of the school day are difficult for your child (even if this is only apparent when they come home), explain what you think is affecting them and discuss what support can be put in place.  

Completing the form together will build a more complete picture of the young person across home and school. It may for example show where they are struggling with some parts of the school day but are hiding this in school, and that signs/behaviours of distress only happen at home.

My child 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. Arrange a meeting in school so that you can provide important information about sources of stress at school and share some ideas about what support can be put in place to reduce this.   

Read more about different behaviour in home and school.  

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).  

It would includes any support that has been offered at home, in school or by other services involved. It can include strategies that you have introduced at home as well as strategies recommended or put in place by professionals. Often relatively small changes can make a big difference. Please see our Strategies for supporting communication, sensory needs, emotions and behaviour and Strategies for supporting attention, activity, emotions and behaviour pages for more information.

What happens if a school does not put a support plan in place?

Generally schools will want to put support plans in place, recognising that early support can benefit all children and young people. The setting or school should use a graduated (stepped) approach based on a four part cycle of Assess, Plan, Do and Review, this will help the school to put in the right support and review how it is helping.    

Check that the school know that support can and should be needs-led regardless of diagnosis – no diagnosis is needed to put in place a support plan.  

Ask to meet with the class teacher and SENCo so you can explain the concerns you have about your child. This helps to make sure that school have a good understanding of the things that your child finds difficult – this is particularly important if your child is very different at home and at school.  

Having some clear specific examples of what your child finds difficult can help. It can also help to share your ideas of the kinds of things that would really support your child and what works well at home. Explain that it would be very helpful to pilot a support plan even if there are few concerns in school, as this will help reduce stress and distress for your child.  

You can also get free, confidential and impartial advice and support from your local Special Educational Needs & Disability Information Advice & Support Service (SENDIASS)  

West Berkshire SENDIASS 

Reading SENDIASS 

Wokingham SENDIASS  

Bracknell SENDIASS 

Slough SENDIASS 

Windsor & Maidenhead SENDIASS 

What if my child is not yet in nursery or school, or is educated somewhere other than at school?

The form can be completed by another professional who knows the young person well. This could be a health visitor, speech and language therapist, therapist, home tutor, family support worker or social worker. If you feel there is no one suitable to complete the form, please contact the ADHD and Autism Triage team: 

CYPADHDandAutismTriage@berkshire.nhs.uk

0118 9046620

Please note, a GP would not be able to provide this information as they would not know your child well enough. 

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

If there is anyone in the school that knows the child or young person, we still ask them to work with you as they will have important information including why the child or 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 you. 

What if it is during the school holidays?

Please wait for school to reopen and then ask them to complete the form with you. Young people spend so much of their time at school, so staff there are the best people to help us with key information.

Why do we need to wait six months before deciding if we can make a referral?

A six month period gives enough time to put in place a support plan for the child or young person. Some children or young people may not need a formal assessment after this, as their needs will already be met.

We ask you to work in partnership with the school. 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. 

What if I think an assessment is important to support my child's self-understanding and identity?

We understand that a diagnosis has multiple and important meaning for young people, and this can be very individual and personal to them.

We will continue to carry out assessments and diagnosis where it is clear this is needed, where there is ongoing impact, and the assessment will clearly add value.    

Referrals will be accepted for older children, where there is a high level of psychological distress for them which has not been improved by therapeutic intervention and which appears to be related to uncertainty about a potential diagnosis.   

If a child or young person has their needs identified, understood and met, we expect that distress and risk will reduce. 

Does my child need a diagnosis for me to apply for Disability Living Allowance?

Disability Living Allowance (DLA) is based on the care needs of a child or young person rather than a diagnosis. There is no need to wait for a diagnosis before making an application.  

An application can be made at any time if the care needs for the child or young person are significantly more than another child of the same age. This is based on what you have to do, how often you have to do it and how long it takes. This includes care during the day, during the night and care needed in and outside the home.  

I am 16-17 years old and want to refer myself, how do I do this?

Please ask your parent/guardian/foster carer and someone who knows you well at school to complete the form. Then either you or they can return the form and complete the online referral form. If there are any difficulties with this, please call us on 0118 904 6620 for help and advice.

Can I give feedback on the process?

Yes, we'll be collecting feedback with every referral so that we can find out what is working well and where we can improve the process.

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