What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects how people thinks, learns and processes information differently. People with ADHD can seem restless, may have trouble concentrating and may act on impulse.
Whilst the required medical terminology uses the word deficit, it is really important to note that lots of people do not see ADHD as a deficit.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school.
Most cases are diagnosed when children are under 12 years old, but sometimes it's diagnosed later in childhood.
Sometimes ADHD is not recognised when someone was a child, and they are diagnosed later as an adult.
The symptoms of ADHD may improve with age, but many adults who were diagnosed with the condition at a young age continue to experience differences in how they function day to day.
People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Getting help
Many children go through phases where they're restless or inattentive. This is often completely normal and does not necessarily mean they have ADHD.
But you should discuss your concerns with your child's teacher, their school's special educational needs co-ordinator (SENCO) or a GP if you think their behaviour may be different from most children their age.
Find out more here:
Parents' A-Z mental health guide - YoungMinds.org.uk
ADHD - NHS.uk
How is ADHD diagnosed in Bolton?
In Bolton, we have a new ADHD pathway for children and young people. Bolton’s ADHD diagnostic pathway is for children and young people registered with a Bolton GP from aged 5, up until a young person’s 18th birthday. The pathway starts at aged 5 as many of the assessment tools and medications can’t be used for those under this age. Young people will transition to an Adult ADHD service from aged 17&1/2 years who will continue to monitor and manage ADHD medication if this is required into adulthood.
The pathway focuses particularly on the importance of joint working among professionals when ADHD is suspected. The ADHD diagnostic pathway is split into five key areas: pre-assessment, assessment, treatment, post-diagnostic support and transition and is designed to help professionals follow a consistent process should concerns about disordered conduct and suspected ADHD be identified or raised. Most importantly, the pathway should allow children, young people and their parents/carers to understand how the various services will work together, with the aim of obtaining the best outcome as soon as possible.
As with any multiagency process, we expect the lead professional to gather the relevant information and initiate a referral to Child and Adolescent Mental Health Services (CAMHS) if they have concerns about possible ADHD, which impacts on the child in their daily life.
For children attending schools and colleges, this referral is typically made by the Special Educational Needs Co-ordinator (SENCO) or education professional.
For those not attending school but on role in a school, this should be coordinated by the SENCO (if they hold relevant information) with support from agencies with current involvement e.g., Public Health Nursing, GPs.
For those children and young people who are Electively Home Educated (EHE), responsibility sits with the EHE Officer at the Achievement, Cohesion and Integration Service (ACIS). If concerns about disordered conduct and suspected ADHD are raised, the professional should contact the Electively Home Educated Officer who will further liaise with appropriate professionals.
What is needed to make a referral?
All professionals in Bolton can access guidance around what the relevant information is that is required.
CAMHS are the responsible agency to assess ADHD. In making any diagnosis there needs to be robust evidence from the team around the child or young person about pervasive and severe impact on a child/young person’s day to day life. This means that the evidence should show how the difficulties affect the child in many areas of their life.
This evidence can include assessments, advice, interventions and strategies put in place via the early help process. This process forms part of the evidence gathering phase and helps settings identify through the graduated approach what might help in meeting a child’s needs. The lead professional may make referrals on to other agencies including Behaviour Support Services, Ladywood Outreach or Educational psychology to help gather the information. This phase also involves gathering the voice of the child, young person and their family.
There are a set of three screening tools which professionals can use to help decide whether a referral for an assessment of ADHD from CAMHS is needed. These are called:
- SNAP – IV Teacher and Parent Rating Scale
- TOAD: Classroom Observation
- Strengths and Difficulties Questionnaire
ADHD referrals are submitted directly to CAMHS to consider if a referral to the ADHD team is the right thing to do based on the information provided. If an assessment is needed this is conducted by Bolton Community CAMHS which is provided by Greater Manchester Mental Health NHS Foundation Trust (GMMH). The assessment is carried out by a multi-disciplinary team with expertise in the diagnosis and management of ADHD. The Bolton CAMHS ADHD Assessment Clinic is designed to provide assessment and care to children and young people, they follow national guidance and an evidence base of interventions. The assessment clinic is based upon a multi-disciplinary evidence-based assessment process. The assessment clinic process involves a wide range of information sources and includes, but is not limited to a neurodevelopmental history, structured observation, QB test, third party information review, school and academic progress, friends, family and social relationships, systematic review of other co-morbidities, questionnaires, MDT formulation and review of risk. Where possible this will happen in the fewest number of appointments.
Depending on the outcome of the assessment, the CAMHS team will offer a range of support options.
If the child or young person doesn’t get a diagnosis they will give advice to help meet their needs this may include advice, signposting and support which can be found at bekindtomymind.co.uk
For those children and young people who do get a diagnosis they will be offered a needs led approach to help. This might include behaviour strategies, parent-based interventions, learning and school support. Many children and young people with ADHD can manage in their setting with a range of reasonable adjustments. Learning more about what ADHD is can help the child and their family identify what helps them best.
Bolton CAMHS have clinicians who have expertise in initiating and managing medication. The choice of ADHD medication for children is an important decision to make. We ensure that parents/carers and child/young person are provided with the information needed to decide whether medication is the right choice for them. This includes weighing up both the pros and cons, and making a decision on what is best for each individual young person.
Further support can be found at:
Childrens' booklet - adhdfoundation.org.uk
A Teenagers' Guide to ADHD - adhdfoundation.org.uk
