Step 1: concerns about possible autism and / or ADHD

If you think you may be autistic or have ADHD, talk to your GP, primary care team, or mental health team about any lifelong symptoms and how these impact on your daily life (such as difficulties managing your home, relationships, work or education). If a formal assessment is needed, your GP or healthcare professional can refer you to the Neurodevelopmental Specialist Service.

Step 2: concerns about possible intellectual disability or mental health problems.

If you have intellectual disability (also known as learning disability) – you will need to be referred to the Intellectual Disability Service. If you are currently struggling with your mental health, it may be appropriate to refer you to your local mental health team. Your GP can make this referral for you.

Step 3: autism and / or ADHD diagnostic assessment.

Once your GP or healthcare professional has made a referral, this will be screened by the clinical team at the Neurodevelopmental Specialist Service. If it is accepted, you will be put on a waiting list.

While you are waiting for your assessment, you can find mental health, social care, education and employment specific support through the following organisations:

• Nottinghamshire County Council
• Nottingham City Council
• Autistic Nottingham
• Video: Making sense of autism
• Nottinghamshire Healthcare Trust
• Nottingham ADHD support group

Step 4: if an autism and / or ADHD assessment is not appropriate for you.

If your GP or healthcare professional does not feel a neurodevelopmental assessment is appropriate, they will talk to you about other support that is available. If after referral to the Neurodevelopmental Specialist Service, you have not been accepted onto the waiting list for a neurodevelopmental assessment, you can talk to your GP or healthcare professional about other support that is available.

Step 1: for concerns regarding significant developmental delays, medial conditions or medical reviews

Contact your GP for advice and support. Your GP may refer your child to the Community Paediatrician for an assessment.

Step 2: for indications of autism and / or ADHD – graduated response

If you do not have any of the concerns mentioned above at step 1, you may wish to make a referral to the Behavioural and Emotional Health Team (BEH) for an assessment. Before doing so, please follow the graduated response process via your health visitor or the SEND graduated response process prior to making a referral for an assessment. The graduated response is extra special educational needs support that some children may need to make progress.

For the pre-assessment support offer for ADHD, please complete the Nottingham City Council referral form.

You can also find additional support information.

Please note, referrals can only be accepted once the graduated response and pre-assessment support offer has been followed.

A diagnosis is not required for reasonable adjustments to be put in place to support your child’s needs within their education setting.

Step 3: referral to the BEH

Once step 2 above has been followed, a referral can then be made to the team by either your GP, health care professional, Special Educational Needs Co-ordinator (SENCO) lead or you can make a self-referral via the referral form. Confirmation that your referral has been received will be sent to you along with pre-assessment support and advice information.

Step 4: autism and / or ADHD screening assessment

A screening assessment will be undertaken by the BEH Team for indicative behaviours of Autism and/or ADHD. Further interventions may also be recommended at this stage prior to step 4a.

Please follow either step 4a, 5 or 6:

Step 4a: screening assessment identified need for review with community paediatrics service

Your child’s referral will be discussed with the Community Paediatrics Team. If accepted your child will be placed on the Community Paediatric wait list for further assessment and closed to the BEH Team. If not accepted, you/the referrer, will be informed of the outcome and sign posted as at step 6 below.

Step 5: further assessment or information required

Your child’s referral remains open for further assessment and information gathering. This may include discussions with professionals such as CAMHS, speech & language therapy along with observations in school/nursery and/or face-to-face assessments. Where the assessment outcome indicates the need for a review with the Community Paediatrics Service, please see step 4a.

Step 6: insufficient evidence to recommend further assessment for autism and / or ADHD at this time

You will be offered support and advice based on your child’s individual needs; this support is not subject to receiving a diagnosis. You will also be signposted to the appropriate local and national support organisations. Your referral will be closed to the BEH Team once support and advice has been provided.

Step 1: for concerns regarding significant developmental delays, medial conditions or medical reviews

Contact your GP for advice and support. Your GP may refer your child to the Community Paediatrician for an assessment if priority concerns are identified as above.

Step 2: for indications of autism and / or ADHD – graduated response

If you do not have any of the concerns mentioned above at step 1, please follow the graduated response process via your health visitor or the SEND graduated response process prior to making a referral for an assessment. The graduated response is extra special educational needs support that some children may need to make progress.

If you need any help or support relating to the graduated response, please contact the Neurodevelopmental Support Team (NST) at familyservicenst@nottscc.gov.uk or or see the Notts Help Yourself website

Please note – a diagnosis is not required for reasonable adjustments to be put in place to support your child’s needs within their education setting. Here is some information about support programmes available. These can be accessed via the NST self-referral form:

• ADHD workshop: for parents of a child with an ADHD diagnosis and those with ADHD type behaviours without diagnosis.
• Cygnet: for parents and carers of autistic children and young people aged 5-18, and those with autistic behaviours without diagnosis.
• Education transition support workshop: for parents and carers to learn strategies to assist their children and young people with transitions in education.
• Sleep Tight Programme: to support parents and carers to help their children and young people to achieve a better night’s sleep
• Parent workshop: a local model of support and information for parents and carers

Step 3: referral to the NST

Once step 2 has been followed, and if it is considered an assessment need remains following the graduated response process, your child’s education lead or other professional supporting your family will be required to complete a referral form through the MOSAIC portal. Usually, your child’s education lead will complete this with you, however this could occasionally involve the support of a health care professional such as the healthy family team (but excluding your GP).

The referral must be made by a professional such as your child’s educational lead, or healthcare professional. The completed online referral form will be sent to the NST with your child’s referral details to ensure they have as much information as possible regarding your child’s needs.

You will receive confirmation that your referral has been received from the NST along with pre-assessment support information and advice.

For any referral related queries please email referralsnst.familyservice@nottscc.gov.uk phone 0300 500 80 80.

Step 4: NST triage and assessment

Your referral will then be reviewed by the NST for behaviours in common with autism and/or ADHD. Further interventions may also be recommended at this stage or more information may be requested prior to step 5 to support the assessment process.

Step 5: assessment identified need for referral to the community paediatrician

If the NST identify behaviours in common with autism and/or ADHD, your child’s referral will be placed on the community paediatricians wait list for further assessment and closed to the NST.

If your referral is not accepted by the Community Paediatrician, you will be informed of the outcome reasons and sign posted as at step 6 below.

Step 6: insufficient evidence at this time to suggest further assessment is required for autism and / or ADHD

You will be offered support and advice based on your child’s individual needs; this support is not subject to receiving a diagnosis. You will also be signposted to the appropriate local and national support organisations. Your referral will be closed to the NST once support and advice has been offered.

Step 1: for concerns regarding significant developmental delays, medial conditions or medical reviews

Please contact your GP for advice and support. Your GP may refer your child to the Community Paediatrician for an assessment if priority concerns are identified as above.

Step 2: for concerns of autism and / or ADHD – support interventions and the graduated response.

If you do not have any of the concerns mentioned above at step 1, please follow the graduated response process prior to making a referral for an assessment. The graduated response is extra special educational needs support that some children may need to make progress.

The graduated response process will be supported by professionals such as your Special Educational Needs Co-ordinator (SENCO) lead, teacher and/or the Healthy Families Team.

Please note, a diagnosis is not required for reasonable adjustments to be put in place to support your child’s needs within their education setting.

Talk with your child’s teacher about options for making reasonable adjustments in school for your child. These adjustments can help meet their individual needs and make school feel more accessible and comfortable. More information and support regarding reasonable adjustments can also be provided by the A Place To Call Our Own in Bassetlaw (APTCOO) Family Support Team. The team will assist you through the graduated response process by providing information, advice, support and access to one-to-one and small group family workshops.

Each workshop is delivered within our SEND Family Hub, a safe, friendly and accessible space. They are facilitated by experienced and trained SEND practitioners who utilise professional evidence-based theories matched to individual family needs including Anna Freud Reflective Parenting; an approach to parenting that aims to develop a better understanding of your child’s emotions and behaviours, wrapped around PACE Principles – how to connect and communicate with your child with a sense of security and attachment.

A referral to APTCOO can be made by either your GP/health care professional/educational lead or you can refer direct by e-mail at enquiries@aptcoo.org or phone 01623 629 902.

Find out more about the graduated response and support interventions:

• Health Families Team
• Emotional Health Support Services
• The Family Service
• Children’s Centre Family Hub
• SEND Local Offer
• Local guide for children and young people with SEND

Step 3: autism and / or ADHD assessment – the general development assessment (GDA) pathway

Once the support interventions and graduated response approach have been followed, and if an assessment need is identified, your child’s education lead or the Healthy Families Team may refer your child to the GDA pathway. This may lead to assessment with a community paediatrician for autism and/or ADHD.

Step 4: insufficient evidence at this time to suggest further assessment is required for autism and / or ADHD

If the need for an Autism and/or ADHD assessment is not identified following referral to the GDA pathway you will be offered support and advice based on your child’s individual needs; this support is not subject to receiving a diagnosis.

You will also be signposted to the appropriate local and national support organisations.

Your referral will be closed to the GDA Pathway once support and advice has been offered.

If your GP refers you, you can choose from NHS or private providers who work with the NHS. Your GP will explain your options so you can decide what’s best for you.

Find out more about your legal right to choose.

Do you need an assessment?

If you think you might be autistic or have ADHD, learning about these conditions can help you decide if an assessment is right for you.

Helpful resources:

• ADHD information
• Autism information

It can also be helpful to think about how your experiences effect everyday life with the characteristics of ADHD or autism. For workplace, education settings or life challenges, consider speaking to your employer or tutor, local mental health services, or support groups. They may offer advice or additional support while you go through the assessment process.

Using your right to choose

Your GP will consider your concerns and overall health before making a referral. They will give you a list of right to choose provider service options for you to choose from. Before deciding on the right one, check their website for details like:

• Location
• Quality of care
• If they follow NHS guidelines NICE Guidelines ADHD Assessment and NICE Guidelines Autism Assessment

Some providers require a referral form, which you may need to fill out for your GP.

Please note that we cannot recommend specific providers and neither can your GP.

When does right to choose apply?

Based on NHS England guidance, you have the legal “Right to Choose” a provider if:

• The GP refers you for a first outpatient appointment.
• The referral is appropriate for your needs i.e. you are showing significant signs of autism and/or ADHD.
• The service is led by a consultant or mental health professional.
• The provider is funded by the NHS.

When does right to choose not apply?

Based on NHS England guidance, you cannot use a right to choose a provider if:

• You have self-referred.
• You are already receiving care for the same condition.
• The service is funded by a local authority or primary care.
• The care is urgent or an emergency.
• You are in the armed forces.
• You are in a secure hospital under the Mental Health Act.

Find out more about your legal right to choose.

What happens in an assessment

Assessments usually include:

• Discussions about your life history, (including childhood, adolescence, birth, and infancy) and current challenges.
• Input from family members or close contacts who can provide insight into your experiences i.e. a partner, parent, or older sibling.
• Family history (including any family history of neurodevelopmental and/or psychiatric disorders).
• Medical and mental health history
• Education & employment history
• Observations and standard tests.

Before the assessment, prepare by gathering information about:

• Your developmental history e.g. how you learnt skills, developed milestones and your behaviours when you were a child.
• Work, relationships, and daily challenges
• Substance misuse history
• Forensic/offending history
• History of trauma
• Previous evaluations or treatments.

If ADHD medication is considered, your medical history will also be reviewed.

The assessment should also include a discussion regarding alternative explanations for potential signs and symptoms of Autism/and or ADHD where other conditions have previously been diagnosed.

If the Right to Choose provider does not do a full and thorough assessment and report, your GP may refuse shared care for medication. The local NHS specialist neurodevelopmental service may also not accept the report as evidence of valid a diagnosis. In these cases, further referrals or re-assessments might be necessary.

Medication and treatment

NHS assessments and treatments are free. If you are prescribed medication, your GP may take over prescribing once you are stable. This is called a “Shared Care Protocol.”

However, if the GP is unhappy with the quality of the assessment, they may decline shared care, and the original provider may continue prescribing medication.

ADHD medications require careful monitoring and should only be given to those who need them, following a full medical history check and a confirmed diagnosis. This is why the GP will ensure the assessment is thorough and meets the necessary quality standards.

If the provider only offers assessments, you might need a referral to another local NHS funded service, for treatment, which could increase waiting times.

Your GP will need to make this referral. They should include the full assessment report from the Right to Choose provider so the local NHS funded service has enough information to support your treatment needs.

The local NHS funded service checks if the assessment meets quality standards before starting or continuing any medication. If it doesn’t, they may refuse to start or continue any medication. In such cases, a re-assessment by the locally funded NHS service may be needed, which could lead to further waiting times.

After your assessment

You should receive a report with findings and recommendations. The provider should discuss next steps with you, such as therapy, medication, or workplace/education adjustments.

Support without a diagnosis: You do not need a diagnosis to request adjustments at work or in education. However, ADHD medication requires a confirmed diagnosis.

NHS locally funded assessment service pathways

While the right to choose pathway may seem appealing, there are benefits to using local NHS services. Using the NHS locally funded pathway service often means smoother coordination of care, and better use of community resources such as:

• Coordinated care: Local services often provide smoother follow-ups and integrated support.
• Access to additional services: Local pathways may signpost to local holistic resources like occupational therapy or counselling.
• Community insight: Local providers are familiar with area-specific resources, such as employment support or adult social care services.

Considerations:

• Waiting times: private providers under the Right to Choose scheme may still have long waiting lists due to high demand.
• Communication gaps: using external providers may result in coordination challenges with local health or support services.

For more information about locally funded service pathways, visit the Nottinghamshire Healthcare Trust website.

If a GP refers a child, the family can choose which hospital or service to use, including private providers that work with the NHS. The GP will discuss available options to help the family make an informed decision.

Find out more about your legal right to choose.

Recognising the need for support

Learning more about autism and ADHD may help you recognise whether your child is showing signs of these conditions.

Helpful resources:

• ADHD information
• Autism information

Talk to your child’s teacher, school Special Educational Needs Coordinator (SENCO), or health visitor first. They will support you by following a “Graduated Response” process before deciding if further assessment is necessary. The graduated response is extra special educational needs support that some children may need to make progress.

You can also find out more about support for special educational needs and disabilities in the SEND Local Offer for Nottinghamshire and for Nottingham.

Using your right to choose

If further assessment need for autism and/or ADHD is identified, schedule an appointment with your GP. The GP will assess whether a referral for the assessment is needed or not based on your child’s health and relevant policies. If your GP suspects autism and/or ADHD, they may decide to make a referral.

The GP will explain the different service options available based on the regularly updated list of approved Right to Choose providers they have, helping you to make an informed choice. You should consider factors like the quality of service, location, and whether it follows guidelines set by the National Institute for Health and Care Excellence (NICE) for ADHD and autism assessments.

You might need to fill out a form from the right to choose provider you select for your child. This form should be given to your GP so they can include it as part of the referral they submit.

However, please note that we cannot recommend any specific provider, neither can your GP.

Legal right to choose

Based on NHS England guidance, you have the legal right to choose a provider if:

• The GP refers your child for a first outpatient appointment.
• The referral is appropriate for your child’s needs i.e. child is showing significant signs of autism and/or ADHD.
• The service is led by a consultant or mental health professional.
• The provider works with the NHS.

When the right to choose does not apply

Based on NHS England guidance, you do not have the legal right to choose a provider if:

• You have self-referred.
• You are already receiving care for the same condition.
• The service is funded by a local authority or primary care.
• The care is urgent or an emergency.
• You or your child is in the armed forces or in a secure hospital under the Mental Health Act.

Find out more about your legal right to choose.

The assessment process

The assessment should involve discussions with parents, teachers, and your child, along with observations and standard tests. Before the assessment, gather information about your child’s development, behaviour, and any previous evaluations. The assessment should include a physical examination, as well as a review of medical history, especially if ADHD medication is considered.

It is important to note that if the Right to Choose provider doesn’t follow the correct steps thoroughly, like doing a physical examination, checking medical history etc, the GP might refuse shared cared of medication. Also, the Community Paediatrician or adolescent Psychiatrist could reject the assessment report, as explained in point 7 below.

ADHD medication should be considered only after exploring other types of support, such as ensuring teachers use ADHD-friendly strategies in the classroom. Medication is recommended only for children aged 6 and older and is therefore not recommended for children under the age of 6.

Cost of assessment and treatment

The assessment and treatment through the NHS, after a GP referral, are free through right to choose. If the provider offers ongoing treatment, your child’s GP may take over medication once the child is stable. This is called a “Shared Care Protocol,” where the GP and the specialist share responsibility for ongoing care. However, there are instances when GPs may not agree to shared care, i.e. if the GP is not satisfied with the quality of the Right to Choose assessment, so in those cases, the original provider may continue to prescribe medication.

If the provider only offers assessments, your child might need to be referred to another NHS service for treatment, such as a Community Paediatrician or a child and adolescent Psychiatrist to consider medication, which could lead to longer waiting times.

Your GP will need to make this referral. They should include the full assessment report from the Right to Choose provider so the Community Paediatrician or child and adolescent Psychiatrist has enough information to support your child’s treatment needs.

However, your Paediatrician/Child Psychiatrist will have responsibility to be satisfied with the quality of the assessment to accept the responsibility for starting or continuing any medications. If they are not, they may decline to take this responsibility. In this situation, there may be a need for a re-assessment by another provider, preferably a locally commissioned NHS service.

It should also be noted that another referral may be required to a local NHS funded service if the support/treatment required isn’t provided by the “Right to Choose” provider.

Post-assessment discussion

After the assessment, you should receive a report with the findings and recommendations. You can ask questions and clarify anything in the report. The provider should work with you to create a plan to manage your child’s ADHD or Autism symptoms, which could include therapy, medication, or behaviour management support.

Your child does not need a formal diagnosis to get support and reasonable adjustments at school. However, in cases of suspected ADHD, they do need a confirmed diagnosis to start any specific ADHD medication.

NHS locally funded assessment service pathways

Whilst the option of a right to choose assessment might seem appealing over that of choosing an NHS locally funded pathway, there are a few reasons a family might choose not to use a right to choose provider.

Using the NHS locally funded pathway service often means smoother coordination of care, follow-up, and better use of community resources.

• Local follow-up care: if a family uses the local service, they’re more likely to have consistent follow-up care and ongoing support from the same team. Using the “Right to Choose” for a private provider might mean they’ll have to transfer back to local services later, which could disrupt the flow of support and add to wait times.

• Cost of extra services: the local service often has more resources for additional holistic support (like speech therapy or occupational therapy), which may not be available with an external provider chosen through right to choose. Families may end up having to pay for these services separately if they’re not covered by the private provider.
• Waiting times can still apply: while right to choose might sometimes reduce wait times, it’s not always a guaranteed shortcut. Private clinics might also have long waiting lists due to increased demand, so families could still face delays.
• Less local knowledge: local services are familiar with the community’s support systems, schools, and resources, which helps them make referrals and recommendations that suit the family’s specific area. An external “Right to Choose” provider may not have this local insight.

• Potential gaps in communication: if a family uses a different provider, there can sometimes be a lack of communication between the external “Right to Choose” assessment provider and local health or educational services. This can lead to challenges in coordinating care or ensuring all parts of the system are on the same page about the child’s needs.

Find out more information about the NHS locally funded service pathways for Nottingham, Nottinghamshire and Bassetlaw via the Neurodivergence page.