Islington Community Paediatrics: Pathway for children with ADHD

Email for referrals: whh-tr.islchildrensreferrals@nhs.net

Who is this care pathway for?

This care pathway has been written primarily for families and carers of a child where there are concerns about possible Attention Deficit Hyperactivity Disorder (ADHD) and there is a request for a diagnostic assessment and then follow up for on-going management.

The information on this page is also likely to be of interest and helpful for professionals as well.

Who do we see?

We see children where there is an emerging or identified with ADHD, who have an Islington GP or attend a school in Islington.

How to use this tool

When you scroll down you will see the information provided in this care pathway is set out in the following sections:

Who we see?
Who can refer and how?
Care Pathway: gives a flow-diagram type overview of the pathway
Detailed actions: sets out in more detail what is involved in the different parts of pathway
Associated documents: more for use by professionals
Resources: these are links to relevant web sites
Quality standards: this is a list of the quality standards that we report on annually on this web site and these are designated by QS where they appear in the text

Who can refer and how?

We accept referrals from any professional. If you are concerned about your child, please discuss your worries with your GP, health visitor or other professional who is working with you and your child, as they can make a referral.

While we do not accept referrals directly from families, the referral must include acknowledgement that you have consented to the referral.

A referral form is included in the Associated Documents section of this web page for use by your professional.

Care Pathway

Detailed Actions to be Completed

Referral Made	Please note that in our service: We use an electronic patient record to hold our clinical notes and documents. This in turn is accessible by other professionals who work for Whittington Health and helps greatly with our information sharing At the end of the initial assessment which may take several appointments and an observation of your child in school, we will write a report that is sent to you with an agreed plan and copy list of all relevant professionals. We aim to send this out 90% of our reports within 2 weeks of the final assessment appointment (QS-1) We welcome and actively seek, and act on feedback from all who use our services (QS-2)
Referral Triaged	All referrals are triaged by a consultant paediatrician - if accepted the child will be seen in our specialist paediatric ADHD clinic.
Assessment Appointments	It may take several appointments to complete the diagnostic assessment and to get all the results and questionnaires back (e.g. parent and teacher Conner's questionnaires). For most children there will also be a school observation and discussion with school staff to get a first-hand description of the child or young person�s profile of strengths and difficulties.
Diagnostic Feedback Appointment	At the giving of the diagnosis (or no diagnosis if one cannot be made) the paediatrician will discuss with you: Your child�s areas of strength and difficulties, and from these strategies to impact positively on the child�s behaviour, and if additional input from Child and Adolescent Mental Health Service (CAMHS) would be recommended The parents of all children who receive a diagnosis of ADHD will be offered support through an ADHD parenting group run by CAMHS Advice regarding managing ADHD in school with be given to staff at your child�s school The option of medication will be discussed with you and your child
Follow-up Appointments	If your child goes onto medication you will be seen for follow up to monitor their response to the medication and what side effects that they may experience (e.g. poor sleep, loss of appetite). This will also involve a dialogue with the school and intermittent repeat Conner's questionnaires.
Discharge or Transition to Adult Services	The majority of young people will have come off medication and be discharged from follow up before their adult years. However there are some who remain on medication into their adult years and they will be referred onto the Camden and Islington Mental Health Trust Adult ADHD Clinic for on-going monitoring of their medication.

Associated Documents

Additional Needs and Disability Service (Islington) Referral Form

Resources Table

Useful links
NHS Choices - ADHD	Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
NICE - Attention Deficit Hyperactivity Disorder	This is the NICE guideline on Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (Published date: July 2012, a decision was taken in February 2015 to review this guidance).
Centre 404	Centre 404 is a voluntary sector organisation that offers a range of high quality services to assist children and adults with a learning disability and their family carers. These include: direct support, information, respite, activities, advocacy, help with personal budgets and form filling, and access to social groups and other local networks.
Islington Council - Disabled Children's Team	The London Borough of Islington Disabled Children's Team (DCT) provides services for children with disabilities and their families. Their aim is to provide a quality, child-centred service for disabled children and young people (and their families or carers) who live in Islington.
Islington Council - Local Offer	The summaries the LBI Local Offer of all the help there is in the Islington area for children and young people aged 0-25 with special educational needs and disabilities.
Disability Living Allowance (DLA) for children	Disability Living Allowance (DLA) for children may help with the extra costs of looking after a child who is under 16 AND has difficulties walking or needs more looking after than a child of the same age who doesn�t have a disability.
Children with Complex Needs	When a child has exceptional need for education, health and social care support that cannot be met from resources/assessments/interventions normally available, they will need an Education, Health and Care Plan (EHCP).

Quality Standards Table

QS-1	We will send out our clinic letters within 2 weeks of the appointment
QS-2	We welcome, actively seek and act on feedback from all who use our services