Neurodevelopmental Service: Assessment referral form guidance

Before making a referral for a neurodevelopmental assessment, we ask that a child or young person’s needs have been explored and supported. This ensures that early intervention by appropriate services and professionals is in place at the earliest possible opportunity.

It's important to note that a child or young person can access support without a need for a diagnosis.

The special educational needs and disability code of practice: 0 to 25 years (January 2015) provides statutory guidance on duties, policies and procedures and relates to children and young people with special educational needs (SEN) and disabled children and young people.

Consideration should be given to support the parent/carer to access additional intervention through the local offer and together the school can commence the implementation of the graduated response starting with universal provision (cycle 1). The graduated approach aligns the assess, plan, do and review process with the expectations from the SEND Code of Practice.

If the child or young person’s progress following the first cycle of assess, plan, do, review, suggests that further assessment and intervention may be required, then targeted provision should be implemented. This may include working with external specialist SEND practitioners, such as specialist teachers or educational psychologist and mental health services, in liaison with the school Special Educational Needs Coordinator (SENCo). Education settings can use local authority-targeted support services, or private providers. The local authority publishes relevant information for families and education setting staff on their local offer.

Education settings should use the relevant funding streams within their own budgets to access this. If there are queries about the most relevant way to fund targeted provisio,n then the SENCo within the setting should discuss this with the local authority.

It may be that the child or young person​​​​​​​ does not have any additional needs that require further exploration and that their needs are not having a significant impact on their education or within the home. They may still present with key autism traits within more than one setting that they wish to be assessed for. In this case, there may be no need to seek targeted support and the referrer may wish to make a referral directly to the neurodevelopmental team.

• Are the key traits of autism and/or ADHD present across multiple settings, such as home and school?
   
  • If key traits are not evident in multiple settings, it may be beneficial to spend additional time observing the child or young person and then using the ‘Details of Observations’ (sections 5a, b, c) in the referral form to gather this information.
  • Please consider whether there are other settings the child or young person is familiar with which might be helpful in providing information for this referral if required, such as clubs, classes, and any extracurricular activities.
  • Please consider whether the concerns about a child or young person can be better explained by an existing condition or by alternative influencing factors. 
     
• If there are concerns that the child or young person’s difficulties are a response to difficulties within the home or their environment, please seek advice from Early Help or the Integrated Front Door. If you are worried about behavioural difficulties being a result of potential ADHD, an Early Help Assessment should be completed to access interventions for behavioural difficulties. Evidence of this support being accessed, and the impact of the interventions, should be submitted as a part of the referral. Section 5d, the ‘Other Professional’ part of the referral form, can also be given to the Families First practitioner or social worker to provide additional information regarding their own observations.
  • Please be mindful that the Attention Deficit Hyperactivity Disorder assessment for ADHD in children under six is very challenging to assess for. This is due to children's rapid development at this age, and the difficulty in distinguishing between usual levels of hyperactivity, inattention, and impulsiveness and underlying ADHD symptoms. In addition, treatment at this age would be focused on parent support and group-based training to support with behavioural management. Services offering ADHD assessments are understandably cautious about assessment in children of such a young age, with many services nationally not offering assessment below the age of six years. Rather than assessment for this age, it is important to follow a graduated response which ensures that the family and child or young person have had access to the most appropriate support at the appropriate time to meet their needs.
     
• If there are concerns that the child or young person may have significant learning difficulties, please seek advice and/or assessment from educational psychology or other relevant professionals. 
• If there are concerns that the child or young person has Speech and Language needs, please consider referring to the Speech and Language Therapy Service. 
• If the child or young person's primary need is sleep difficulties, please refer to the KIDS Sleep Service. 
• If the child or young person's difficulties are related to emotional wellbeing or mental health issues, please consider seeking advice or support from Compass GO or the Navigo CAMHS team.

Please also consider the below before making a referral for a child aged between 0-4

• Has the graduated response been followed?
   
• If there are concerns around the child’s development, consider a referral to Portage/Health visitor.
   
• If there are concerns that the child has speech and language needs, please consider the early years Wellcomm Programme or a referral to the Speech and Language Therapy Service.
• If the child has significant difficulties with attention and concentration, please refer to the Early Years team.

Any education, health or social care professional can make a referral to the Neurodevelopmental Service — using the Neurodevelopmental Assessment Referral Form — for a child or young person who is registered with a North East Lincolnshire (NEL) GP.

If the child or young person is not registered with a NEL GP, then a referral can be made to the local appropriate service where their GP is registered. 

The referral form is used to make a request for a neurodevelopmental disorder assessment (autism or ADHD). The information from home, school, and other settings is equally important, even if the child or young person shows different behaviours in different places.

The referral form asks about a child or young person’s presentation in areas that are important to consider in assessing for Autism Spectrum Disorder (ASD) or ADHD at home and other settings. The aim is to gather information about other areas of need, such as their learning or significant life events, and the support and strategies that have been tried so far. The purpose of the referral form is to provide information about a child or young person so that the clinician can see whether a specialist assessment for ASD or ADHD is indicated. It is not a tool and does not decide if a child or young person does or does not have a neurodevelopmental disorder. 

• Each referral form 'Details of Observations' section can be downloaded separately for ease of sharing these with other professionals, parents or carers, or the young person. If using Section 5d, it may be helpful to share this at the start of the process to ensure that they are returned before submitting the whole referral. Remember to use Section 6 if you would like to use a checklist before submitting.
• Please note that the forms are best to be completed on an electronic device, as they are not designed for printing and completing by hand. 
• Please note that we do not accept parent or young person self referrals.
• It's OK to submit the referral with the different sections and evidence as separate attachments within one email. Naming the different attachments with the contents will be helpful (e.g. Education Psychology Report 01/01/23). It is not a requirement to scan the information in as one document. 
• When the referral is ready to be submitted, the referrer can email this and any additional reports or attachments to navigo.ymmneuro@nhs.net. If sections 1-5a/b are not fully completed or submitted, the referral will not be processed and will be returned back to the referrer.  
• Once the referral has been processed, it will be discussed by the clinical team. If the referral is accepted for an ASD or ADHD assessment, a letter will be sent to the parent or carer (and the young person, where appropriate), the referrer, and the GP. The child or young person will then be placed on the waiting list. 
• If the referral is not taken on for an ASD or ADHD assessment, relevant recommendations and signposting to other appropriate or relevant services will be made. This will be outlined in a letter to the parent or carer (and young person, where appropriate), the referrer, and the GP. A full resubmission will need to be made should the referrer, parent or carer wish to make another request for the child or young person to access a neurodevelopmental assessment in the future. 

As the referrer, it is important to consider what works for the parent, carer and young person when considering how to complete the relevant sections.

It is recommended that the referral is completed jointly with the parent or carer (and young person if appropriate). If the parent or carer wishes to complete their sections of the referral form separately (for example, section 3 and 5a), they can do so and send them back to the referrer to submit. 

It is appreciated that the referrer is only able to share the level of detail that is provided to them. It is OK if the parent or carer does not feel comfortable completing sections of the referral form that may include sensitive information, such as within the Social and Family History and Developmental History sections. Parents or carers (young person if appropriate) are welcome to fill in these parts of the referral form themselves, or if they wish to share information with the Neurodevelopmental Service, they are welcome to contact us via telephone or email. Please arrange to return this information to us or arrange a call with us on the same day that the referral is submitted so that the information can be considered at the same time and to avoid the referral being returned unprocessed.

Reports from other services who have been involved with the child or young person are really helpful in decision making regarding specialist assessments and should be submitted as supporting information alongside the referral form. These may include:

• educational psychology
• specialist teachers
• speech and language therapy
• paediatrics
• mental health services
• early help
• social care

If you don’t have a report yet, but still feel that it is the right time to submit the referral, please tell us details about the service or intervention and relevant outcomes and updates. Supporting information could also include My Plans, Individual Learning Plans and Graduated Approach Cycles. 

This section is to be completed from the perspective of those who live with or care for the child or young person. 

If the child or young person lives in more than one home (such as separated parents), this section can be completed more than once, if preferred. Please see this page for more guidance on providing observations.

For the parent or carer: if you would like to add your child’s voice or views to any of these sections, this is OK to do. For example, if your child has told you something they think or feel about any of the below areas (such as friendships, or sensory difficulties), you can put that in this section. Not all children and young people will want to, or be able to, complete the separate young person perspective section — it is optional.  Please just make it clear to us what you notice as a parent or carer, and what your child may have told you. 

If there is another way you feel your child’s voice or views could be heard, such as drawings for example, these can be submitted as documents with the referral. These are also optional.

Throughout the sections please describe how the child or young person’s difficulties impact on them and others.

It is OK to say which assessment you would like to request and why.

It is OK if home and other settings are observing different things, and this should not affect the referral being submitted.

If key traits are not evident in multiple settings, it may be beneficial to spend additional time observing the child or young person before completing this section. Gathering additional observations from other teachers via a Round Robin may be helpful. 

It is helpful to provide detailed information about what is seen in these areas as the clinician will still be able to consider this. 

The child or young person's voice can be shared throughout this section or attached as a separate document, if appropriate. For information on how to capture the voice of the child, please visit the North East Lincolnshire Council website.

This section is optional and does not need to be completed if the young person does not want to or is not able to.

In this section we would like to hear about the young person’s perspective on their experiences, if they would like to share these. This section is not designed for young children, or older children with significant learning needs; this is because they may not have the same insight into the things that they find difficult or have the ability to explain them fully. A child or young person’s voice can also be expressed via their parents or carers, or other professionals in the respective sections of this referral form. The questions within Section 5 relate to potential traits of ASD/ADHD. 

Section 5c may therefore be suitable for those young people who have insight into their difficulties and are wanting to be more involved within the referral process. 

For the young person: You can complete Section 5c on your own, or you can also ask a person or people who know you well to help you answer the questions, or write your answers for you. 

• Please try to answer each question, but if you cannot answer certain questions that is OK and you can leave them blank.
• Do not worry too much if you stray from the question focus. If you feel something is relevant and you want to write it, feel free to.

For younger children or young people not wishing to complete section 5c, parents and referrers can share the child’s voice throughout the document, where they feel this is appropriate. For information on how to capture the voice of the child, please visit the North East Lincolnshire council website.