Who diagnoses ADHD in the NHS? (ASD already assessed and not ASD)

[lookingforadvice12]

DD9 (Year 5) was assessed for ASD during lockdown years in 2021. Findings were: not autistic (but low self esteem, possibly some receptive language issues).

Two years later, social / friendship issues (one friend only, with ASD) / social confidence / communication issues continue, along with poor empathy, difficulty managing emotions, some lack of focus.

I have always suspected ADD (not ASD). Happy with not-autism diagnosis.

School SENCO agreed to refer for ADHD, but thought general paediatric referral the way forward, as social issues persist (she thought ASD, though knew about the previous assessment).

We have just had the referral turned down by local authority (they rung me and sent email) who say assessment already made and to return to GP for referral to complex neuro-disability clinic for 'second opinion'. I am not after a second opinion re ASD, only an ADHD one. But I don't know the way forward.

Please could any experienced soul out there help me out?! ☺️ I will go back to the SENCO but want to be informed, as it has been a slow process and it seems she went the slightly wrong route in July.

Who diagnoses ADHD in the NHS? Is it CAMHs? Another service? Not the autism clinic that I was referred to for a second time, it seems. I know waiting lists will be long.

If I get a private assessment, will the NHS accept it? If I do so, any recommendations of where to go in London? We also probably need an Ed Psych to consider slow processing, etc, too, perhaps, but I assumed those would be different assessments.

Any help or advice gratefully received. Thank you so much.

It depends on the area. In some areas it is CAMHS, in others paeds, and in some it depends on the age of the child.

Are you sure it was the autism clinic you were re-referred to and not the neurodevelopmental clinic? In some areas the neurodevelopmental clinic assesses for both ASD and ADHD. The complex neuro-disability clinic may also assess for ADHD so don’t necessarily rule it out.

The NHS is less likely to question a private diagnosis if the assessment is undertaken by someone who also carries out NHS work or has previously done so. Some GPs are reluctant to have shared care, so if you would want medication and paying for ongoing private scripts would be an issue it is worth speaking to your GP.

Thank you so much @OvertakenByLego, that is incredibly helpful.

We were referred to the general paediatric assessment service in July, I think. It was the guy on the phone who said, 'you see, you were referred to the autism clinic, and that is not the appropriate one for your DD'. But he was not a clinical member of staff as he said - just reading from the notes, he said.

So maybe yes, should I do as they suggest and ask GP for a referral - 'Complex neurodevelopmental disabilities service referrals' was the link I've been given.

Does that sound about right? I guess the SENCO will also know if I pick it up with her again. Happy to go down that route if it is the right one for Southwark.

I've just actually looked up the clinic and it seems as though it would probably be the correct assessment... from their website:

The Newcomen neurodevelopmental service We are a regional and national service for the assessment, diagnosis and management of children and young people with neurodevelopmental differences. These are conditions such as:  autism  attention deficit hyperactivity disorder (ADHD)  language disorder  co-ordination difficulties  epilepsy  genetic conditions

So I am sure you are right and thank you so much for steering me back in the right direction!

CAMHS assess for ADHD in Southwark. The complex neuro-disability clinic may refuse a referral for an ADHD assessment unless CAMHS has first assessed for ADHD. Given the option I would go with the complex neuro-disability clinic as their assessment is likely to be more comprehensive and they are more specialist, but you may not get the choice.

Ah, thank you very much. I will see what the GP / Senco says. But useful to know that it IS CAMHS in Southwark. So helpful to understand that now. Thank you.

Hello.

We had son diagnosed with ADHD privately and Southwark CAMHS / the NHS took on his diagnosis.

The NHS uses a certain diagnostic method (I can't remember what it's called but you can google it I think) involving certain standard forms and criteria. I just checked that the specialist who diagnosed privately used the same assessment methods and the NHS / CAMHS were quite sensible in terms of looking at what had been done and saying there was no point them re-doing the exact same process.

The doctor we used also practices in the NHS, many pediatric psychiatrists work privately and in the NHS so again if you can get one who does both they will know how the NHS process works.

Following on from the diagnosis being 'accepted' all medication and so on is now managed by CAMHS with the GP helping for prescriptions.

Hi there @KingsHeath53. Sorry for belated reply, but thank you very much for your input. That is really helpful to know. Were you already on a waiting list at Southwark CAMHS when you went private for the assessment? Did that original referral go via your GP or a Senco, if you don't mind me asking? Thank you so much.

Hello @lookingforadvice12

We were on the waiting list anyway. But we'd been waiting a year or so and were getting desperate. When our place came up maybe another 9 months after we had the private diagnosis (so 21 months or so of having been on the waiting list) they called and asked us to come for an assessment, I shared paperwork and spoke to the NHS psychiatrist on the phone and she was really reasonable. It helped that she knew personally the private psych who had diagnosed my son and could see from the paperwork he'd done exactly the assessments she would have done so didn't see the point in re-doing it. Surprisingly pragmatic!

Original referral was by GP for an overall developmental assessment with a pediatrician. This was then my son was about 4 and it was clear something was off with him, but none of the big red flags for autism so GP thought best to have a full MOT. We had wondered if there might be something like hearing problems.

We did the overall developmental assessment, the pediatrician did a massive report but ruled out a lot of stuff like hearing problems and then SHE referred onwards for ADHD and autism assessments.

Sorry long answer but I wish to be precise.