Information for children, young people, families and schools
What we aim to offer families affected by ADHD
- To develop and improve our assessments of children and young people who might have ADHD, and to provide accessible and timely feedback about diagnosis (or not) to children, young people, families and schools.
- To enable clinicians to become more specialist in providing those ADHD assessments.
- To develop our workshops, trainings and interventions for families and schools who e supporting children with ADHD.
Our assessment processes
We follow NICE Guidelines (National Institute of Clinical Excellence informing health provision across the country) for supporting colleagues with assessments, and have focused on building on the training and development that has already taken place in the service over the past few years. We have developed a model of assessment that draws on information gathered from parents and teachers, developmental (early) history, detailed school observations and parent-child sessions. The clinicians leading on this assessment then go back to the Team (including Psychiatry, Family therapy, Occupational Therapy and Clinical Psychology) to formulate and make decisions. In situations where diagnosis is given, we then offer feedback sessions to parents, the child or young person and then the school.
We always work within a ‘strength-based approach’ to ADHD. This means we consider what ADHD might bring to a child and to a family, including abilities and resources as well as challenges. We are keen to consider what diagnosis might mean to children, families or schools at the point of assessment.
Over the past 18 months, we have focused initially on becoming clearer about our interventions (treatment options):
- Parent groups (for primary aged children)
- Individual work with children/young people and parents
- Support and ADHD training to schools
- Workshops or individual work with families making sense of diagnosis
We are keen to remain closely linked to the local ADHD parent support group (set up in July 2015 by families who had completed one of our parenting courses), and also to consult closely with parents themselves about what would be most useful for families.
We also plan to continue with our offer of age-appropriate training programmes for post-diagnostic work and management of ADHD, to be disseminated across the service in support of clinicians in all areas. We have worked closely with colleagues in schools, family support and social care in the development of appropriate training packages.
What the NICE Guidelines (updated in 2013) suggest for service delivery in support of ADHD
- Development of a specialist care pathway
- Integration of health, education and social care teams for understanding and intervention
- Good links with adult ADHD services, access to parent courses as first line of treatment (when diagnosis is suspected)
- Medication support
- Training for teaching staff
- Group parent trainings
- Individual interventions for those who would struggle to access a group (or those with more severe and complex presentations)
- Access to direct work for children themselves.
What is the process of assessment for possible ADHD or other conditons within Islington Community CAMHS?
Our assessments have the following intentions
- To listen to your concerns as parents or children/ young people, and teachers, and to consider the possibility of ADHD (Inattention, Hyperactivity and Impulsivity) in the context of other possible explanations of struggles your child might be experiencing (such as anxiety or sensory difficulties).
- To look out for strengths, resources, abilities and skills at home, school and any other activities.
- To assess the severity of possible ADHD features (sometimes referred to as symptoms). This means we look at the impact of inattention, hyperactivity or impulsivity on life at home and school.
- To consider whether there might be anything else going on for the child or young person (like anxiety, worry, low mood, tic or social/communication difficulties). This is sometimes referred to as looking for ‘co-morbidities’.
- To explore physical health and sensory integration – by asking about appetite, sleep, sensory issues (sensitivity to taste, touch, smell, movement, sound), and general physical well-being, and to take a full developmental history (from birth to present times). Usually, a doctor (Paediatrician or Psychiatrist) or Occupational Therapist is also involved in our assessments, either directly or as part of our team, to check-in with us about all of these questions.
How do we gather this information?
Our assessments for ADHD usually take five or six meetings, which might take place at our clinics or at school. Sometimes they take longer, because we might look more closely at learning (cognitive abilities). We tend to focus our assessments only on children of school age. If we start our assessments too young, it can be tricky to know what is happening, because children change and develop so much before the age of 5 or 6.
Pre-school children are naturally active, have short attention spans and are still learning how to hold onto their emotions, ideas and wishes. Because of this it can be hard to tease out what is typical for this stage and what might be early signs of ADHD. Assessment with pre-school children often involves some watching and waiting and monitoring of the child’s development over time; as the child matures and the demands of school increase. It can also involve parents and carers experimenting with different ways of parenting and seeing whether this helps the child be less active, pay better attention and react less and grow out of the pre-school phase.
We always have a general first assessment (Choice appointment) at home or school or clinic/health centre/children’s centre. Usually, the parent, child and sometimes a third person (like a Teacher or Family Support Worker) attends this first meeting, and we gather as much information as we can about family, school, early development and current strengths or needs. Sometimes, we meet once, and it doesn’t seem like ADHD, but we work with families to look at what might be going on.
We also look at
- Questionnaires about life at home or school
- Take a full history from a parent about the child’s development
- Meet with the child or young person to get to know him or her as much as we can
- We also do a school/nursery observation
Observations are easier to carry out discretely in primary school, but in secondary school we sometimes find it more helpful to contact a Teacher or Learning Support Assistant to gather information about life at school.
What happens next?
- We put all of our information together and discuss it with a small group of colleagues in our team meeting. We look at DSM V (the diagnostic criteria for ADHD) to help us to make decisions about whether ADHD looks likely or not.
- We then meet with you as families, or separately as parents and then children (whatever feels easiest) to feedback our assessments. If ADHD seems to be part of the picture, we talk about pros and cons of diagnosis and think about what would be most helpful to you.
- We provide two reports – one written for adults (parents, schools and GPs) and the other written for the child or young person.
- Finally, we offer a school meeting to feedback information, and to consider what might be the most helpful next steps in accessing the right support for learning at school.
If one of our Psychiatrists or Paediatricians have not been involved in the initial ADHD assessment, they can sometime also offer an appointment for families, jointly with the person who has completed your assessment, to discuss the range of treatment, or support options. These will include psychological interventions, parent workshops, groups and/or medication. We try to enable you to make informed decisions, so we discuss the evidence around risk versus benefits of medication. At the end of that discussion, we often provide printed information for you to read in your own time, so that you can make informed decisions.
If you have any questions about this process, please do not hesitate to contact me at Islington Community CAMHS:
Vicky Mattison (Clinical Psychologist)