Children and Young People’s ASD and ADHD (Wakefield) Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • ASD (Autism Spectrum Disorder) diagnostic pathways
  • ADHD (Attention Deficit and Hyperactivity Disorder) Assessment

This guidance does not cover:

  • Individuals aged 18 or over (please see Adult ASD, LD AND Mental Health Pathways)
  • Children and Young People with Mental Health, emotional health and well-being concerns (See CAMHS Pathway)
  • Children and Young People with a suspected eating disorder (See CAMHS Pathway)

Assessment

Signs and Symptoms

Signs & Symptoms of ASD in pre-school children

Spoken language:

  • delayed speech development (for example, speaking less than 50 different words by the age of two), or not speaking at all
  • frequent repetition of set words and phrases
  • speech that sounds very monotonous or flat
  • preferring to communicate using single words, despite being able to speak in sentences

Responding to others:

  • not responding to their name being called, despite having normal hearing
  • rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
  • reacting unusually negatively when asked to do something by someone else

Interacting with others:

  • not being aware of other people's personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age
  • not enjoying situations that most children of their age like, such as birthday parties
  • preferring to play alone, rather than asking others to play with them
  • rarely using gestures or facial expressions when communicating
  • avoiding eye contact

Behaviour:

  • having repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something
  • preferring to have a familiar routine and getting very upset if there are changes to this routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately
Signs and symptoms of ASD in school-age children

Spoken language:

  • preferring to avoid using spoken language
  • speech that sounds very monotonous or flat
  • speaking in pre-learned phrases, rather than putting together individual words to form new sentences
  • seeming to talk "at" people, rather than sharing a two-way conversation

Responding to others:

  • taking people's speech literally and being unable to understand sarcasm, metaphors or figures of speech
  • reacting unusually negatively when asked to do something by someone else

Interacting with others:

  • not being aware of other people's personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age, or having few close friends, despite attempts to form friendships
  • not understanding how people normally interact socially, such as greeting people or wishing them farewell
  • being unable to adapt the tone and content of their speech to different social situations – for example, speaking very formally at a party and then speaking to total strangers in a familiar way
  • not enjoying situations and activities that most children of their age enjoy
  • rarely using gestures or facial expressions when communicating
  • avoiding eye contact

Behaviour:

  • repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing in a repetitive and unimaginative way, often preferring to play with objects rather than people
  • developing a highly specific interest in a particular subject or activity
  • preferring to have a familiar routine and getting very upset if there are changes to their normal routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately
Signs & Symptoms of ADHD

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into two types of behavioural problems.

These categories are:

  • inattentiveness
  • hyperactivity and impulsiveness

Most people with ADHD have problems that fall into both these categories, but this isn't always the case.

For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.

Signs & Symptoms of ADHD in children and teenagers

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and at school.

The main signs of each behavioural problem are detailed below.

Inattentiveness:

The main signs of inattentiveness are:

  • having a short attention span and being easily distracted
  • making careless mistakes – for example, in schoolwork
  • appearing forgetful or losing things
  • being unable to stick at tasks that are tedious or time-consuming
  • appearing to be unable to listen to or carry out instructions
  • constantly changing activity or task
  • having difficulty organising tasks

Hyperactivity and impulsiveness:

The main signs of hyperactivity and impulsiveness are:

  • being unable to sit still, especially in calm or quiet surroundings
  • constantly fidgeting
  • being unable to concentrate on tasks
  • excessive physical movement
  • excessive talking
  • being unable to wait their turn
  • acting without thinking
  • interrupting conversations
  • little or no sense of danger

These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

Diagnostic Pathways

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • a young person is having a breakdown in their mental health and behaviour is presenting harm to themselves or others

Referral

Referral Criteria

  • There are presentation specific referral forms (see links below) that should be completed by professionals working with the child, and include the input of the parent / carer.
For Pre-School Age Children:
  • For pre-school children the lead professional completing the referral form would be the health visitor, but would also include input from:
    • Childcare provider
    • Early Help Hub
    • Special Educational Needs Teams
    • Other Health professionals working with the family
For School Age Children (up to their 14th Birthday):
  • For school-age children the lead professional completing the referral form would be the school, supported by the school nurse, but would also include input from:
    • School staff
    • Early Help Hub
    • Special Educational Needs Teams
    • Educational Psychology
    • Other Health professionals working with the family
For Children over 14 and over (up to their 18th Birthday):
  • Referral is via the CAMHS SPA (single point of access): 01977 465865

Referral Forms (with guidance)

Supporting information

Shared Decision Making

  • Young people have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation. For young people they may also include family members and those working with them to ensure a shared understanding of the options available

Patient information/Public Health/Self Care

Evidence/Supporting Information

Assurance & Governance

  • This guidance was developed on: 07.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 07.2017
  • Publication Date: 07.2017
  • Review Date: 07.2019
  • Ref No: MH5 - 07.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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