To push for a camhs referral?

[hibbledibble]

Reposted from SN due to no replies.

Dd aged 4 is due to start reception in September.

Her nursery flagged up a speech and language delay in January, and we are still waiting to see a SALT, which may not happen until July or August. The resources in our area are very stretched! Her speech is difficult for people outside the family to understand, with poor grammar.

In addition we have had behavioural issues with her. She can have temper tantrums that last over 2 hours. She is especially violent with me, and bites, hits and kicks me.

At nursery she hasn't been violent for some time which I am happy with. They do however comment frequently how she finds it difficult to engage in adult led activities, finds it difficult to stay still, is very impulsive, etc. This is more so than other children her age.

I believe she is bright, as she is very good at problem solving when she can see a reward for herself! She however has very little interest in mark making other than scribbling, and learning numbers and letters. Nursery have commented how she is behind with this.

Now the start of school is looming, I'm wondering what to do to prepare her and ensure the relevant support is in place. I do feel that I have failed to an extent.

Any advice? I'm wondering if I should be seeking a CAMHS referral?

[PeppermintCrayon]

Have you tried asking for an occupational therapy referral?

[mappemonde]

It doesn't sound as though CAMHS is the right service - they are for children with problems of an psychiatric nature. It sounds more like a community paed would be more helpful. Have you contacted your HV? They could carry out an assessment of her development and advise and refer to the most appropriate service in your area. Some areas have child development 'hubs' where multi-agency ie paid/SALT/Physio can all assess together, and some have asd assessment teams etc.

Try your gp and hv if you haven't already and ask for nursery to roo code a written report of their observations and concerns. HTH.

[hibbledibble]

No, but very happy for advice peppermint Why do you think occupational therapy would be helpful?

[hibbledibble]

Thank you mappe

Her nursery is hopelessly disorganised, but they are good in other aspects, and she doesn't have long left before starting school so we are sticking with them. I will arrange another meeting and ask about a report but I don't think they will be much help.

I haven't spoken to a HV, there are so few in our area that they are mostly restricted to child protection, but I will try to make an appointment.

[hibbledibble]

need I have and they were rather unhelpful, just said to get nursery to make salt referral. I didn't talk about camhs though. TBH I am pretty clueless about what to do, but feel that something ha something has been amiss for a long time, and don't know how to go about getting the right help.

[Elecare]

Go for a private Educational
psychologist assessment. It'll cost you around £400 but it will be money well spent. O

[LeChien]

I would ask for a referral to a developmental paed, who can then ask the appropriate questions and decide on the best course of action.
In some areas CAMHS is the right place for this, but your gp should know.

A SALT referral through nursery could be helpful as the SALT should spot any issues and know what to do next.

An occupational therapist could be good and help with identifying some issues, but IME they don't diagnose but can offer therapy that can help (this might just be my area though)

[Goldmandra]

CAMHS would be an appropriate route to getting a neurodevelopmental assessment in our area.

Your GP can tell you the referral process in your area, it may be through a community paediatrician.

A neurodevelopmental assessment should include reports from an OT plus SALT, nursery, and other professionals as appropriate. They should also take a full developmental history from you and talk to you about how she presents at home.

[WasWildatHeart]

Do ask your HV for a developmental assessment to get a proper understanding of her abilites compared to children of the same age. From this the HV will know if she needs a referral to OT/CAMHS/Community Paediatrician. You should wait a max of 18 weeks from the referral to the SALT assessment so compain to the service or the PALS service in the NHS Trust about your anxiety if it drags on. Hope you get some help soon.

[MisForMumNotMaid]

My DD also starts school in September. She's had speech and language sessions, they've visited at nursery and shes under a consultant at the family centre. We've also had a CAMH's referal and refaral for support assessment for starting school.

Different areas work in different ways but the health visitor seams to be the key in the four counties (two England, two Wales) I've lived with my DC.

Here the health visitor did an assessment and DD was accepted as a complex case then under the consultant and six weeks speach and language, then speach and language in nursery assessment followed by more consultant, now in nursery learning needs support assessment for starting school and CAMHs for anxiety (probably Autism linked anxiety as my eldest is Autistic).

The doctors receptionist put me onto the health visitor and told me what to ask for and who to get hold of to discuss my concerns so they visited at home with the right forms to fill in.

Nursery should be able to call in the Educational Psychologist who can produce a report on your DD and make recomendations for support that would assist her - anything official in writing is key to getting support it would appear.

DD's future school have been very good. I've been in and discussed her with the school SENCO (Special Educational Needs Coordinator). She's having extra settling in sessions, meeting just the teacher on a one to one then visiting the empty classroom and building to seeing it as a class environment. They're effort things on the schools part rather than high cost like additional staff as budgets are very stretched but its effort for my DD that will make the difference. I see school for her as sink or swim.

Its possible your DD's school senco will be better able to signpost you as its in their interests to have the right support in place. They may even be able to point nursery in the right direction for getting the Ed Psyc in.

Good luck.

[hibbledibble]

Thank you all.

I will make an appointment with HV.

From what I have described, would this meet the threshold for an assessment? I keep hearing about how scarce the resources are in out area.

[ElleBellyBeeblebrox]

CAMHS are no longer commissioned in our area to support with behaviour, I would advise as others have to take her to the GP for consideration of a community paediatrician referral. Go with as much info from home and nursery as you can.
Has she had her hearing tested? If she was struggling to hear it might explain her speech and language difficulties and engagement in nursery. Good luck x

[chocnomorechoc]

I would go to GP and request a referral to a developmental paed. I have a DD with severe ASD and HVs have let us down badly. I would avoid them and go through GP.

she is too young for camhs.

[MisForMumNotMaid]

Resources are stretched but if you feel your DD needs extra support then you need to push for it. You just need to focus on her. Its up to the professionals to slot her into the system.

I said go to the health visitor in my earlier post but as we're approaching the last half term to starting school now I'd say as others go to the GP as well and ask for a community paed refferal. You may get a double referal, but better that than no referal.

Would you consider making a SENCO appointment and going into her school too?

I've found keeping a little behaviours notebook helps. A sort of diary of unusual behaviours because when you're asked for examples its so easy to really struggle to come up with many, then as soon as you leave the appointment you think of loads. Ask for examples from nursery and quote other people in your record.

[Goldmandra]

she is too young for camhs

It depends on how services are commissioned in your area. I know a 3YO who has been accepted for assessment by our CAMHS.

I second keeping a diary. It's very easy for each individual aspect of a child's behaviour to be considered normal, especially by professionals who are looking to deflect the referral. A diary demonstrates clearly the frequency, range and severity of the behaviours much more effectively than plucking a few examples out of the air.

[chocnomorechoc]

Didbnot know that gold. In my area 4 year olds fall under dev paeds

[hibbledibble]

Its interesting to hear that area makes such a difference.

I will start keeping a diary.

Sometimes I'm not sure whether she needs assessing or not, but I see the difference between her and her peers increasing as time passes.

[Goldmandra]

Sometimes I'm not sure whether she needs assessing or not, but I see the difference between her and her peers increasing as time passes.

If she has ASD, this difference is likely to continue to increase.

Your concerns and the nursery's are quite enough reason for her to be assessed. Early intervention, if it is warranted, makes a difference and it's important to get the right support in place for when they start school if possible.

[hibbledibble]

gold I have never thought it possible she has ASD. She is very confident and sociable, and has lots of friends. There are lots of issues, but I'm not sure what to make of them. My experience of ASD is admittedly limited.

[Tangerineandturquoise]

I think a diary is a good idea- and if nursery could get on board with the diary that would be helpful especially as it may show how she manages emotionally and speech wise in different situations

My experience of this is about 5 years ago but our child was accepted at three by CAMHs, we had been asking since about 2.5 years though, it isn't easy to get a referral and it takes time.

We had HV on board- I admit some are more stellar than others, but if you can get one on side then they can be REALLY helpful.
GP was helpful as well
We weren't using a nursery but did you know you can ask for an assessment yourself for SEN provision? There are some useful letter templates here www.ipsea.org.uk/what-you-need-to-know/model-letters

Have the nursery triggered an Early Years Action Plan? Where they set and review targets, with extra support if necessary, have they talked about bringing in the Education Psychologist or a SALT worker?

Sometimes it can be helpful to push for everyone to see her, a) so that someone will and b) so that she can be referred on by the person who sees her.

[Goldmandra]

Sorry hibble I shouldn't have mentioned ASD. I was thinking more of any neurodevelopmental difficulties. I had just read another thread where the parent was talking about ASD. I should have been more careful

[hibbledibble]

That's fine gold, thank you for all your advice.