ADHD Services and Provision in Hertfordshire by ENH NHS Trust
ADHD, a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, is managed through dedicated clinics in Hertfordshire by the ENH NHS Trust. The services provided include ADHD assessment, ASD diagnostic assessment, and developmental assessment for preschool children. Additionally, the Trust offers a range of specialist clinics and services catering to various developmental and medical needs of children in the region.
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Community Paediatrics - ADHD Dr Carole Anne Colford Consultant Community Paediatrician, Clinical Director for Community Paediatrics. 13.04.2022
What is ADHD? Neurodevelopmental condition. Characterised by Inattention, Hyperactivity and Impulsivity. Incidence 3-5% school age population. Don t diagnose before 5y features can present earlier. Pre-disposing factors familial, prematurity, brain injury, adverse childhood experiences. Multifactorial! Co-morbidities - ASD, LD, ACE s, Mental Health
Community Paediatrics ENH NHS Trust 15 Consultants 2 Admin sites QEII (Howlands) and Danestrete CDC 3 Clinical sites QEII, Lister, Hertford County Our Service provides: ADHD assessment and management; ASD diagnostic assessment; developmental assessment and investigation preschool children; epilepsy clinics; down syndrome clinics; genetic disorder monitoring; motor clinics; feeding clinics; specialist school clinics; safeguarding medical assessments for physical abuse and neglect; SEN reports; designated doctors for Safeguarding, Looked After Children, SEN, CDOP and named doctor for safeguarding ENH NHS trust, Medical advisor for adoption & fostering.
ADHD Services in Hertfordshire There are 3 main services currently: 1. Community Paediatrics - ENH NHS Trust 2. CAMHS East Specialist ADHD clinic (HPFT) 3. CAMHS - West Herts (HV CCG) Specialist ADHD clinic (HPFT) Community paediatricians in West Herts (HV CCG) do not provide a diagnostic service for ADHD.
ADHD provision ENH NHS Trust Dedicated ADHD clinics Children assessed and treated for ADHD in other clinics all consultants assess and treat ADHD 3 ADHD nurses undertake clinics, school observation, QB testing, patient support and liaison with schools.
ENH NHS Trust Referral Pathway NICE guidance March 2018 nice.org.uk/guidance/ng87 Period of watchful waiting for 10 weeks. Parents should be signposted by the GP to Group based ADHD focused support and should not wait for formal diagnosis of ADHD before signposting. Referral pathway and ADHD service information - https://www.enherts- tr.nhs.uk/services/adhd-add/addmore/ We see under 16 years only. Children/young people with identified emerging mental, emotional and attachment issues at time of referral should be discussed and referred to Specialist CAMHS
ENH NHS Trust Referral Pathway Please send: Evidence of ADHD symptoms observed or reported Comprehensive school report detailing concerns and academic levels achieved. Additional reports e.g. Educational Psychology, Social Care, Behaviour support units. Questionnaires e.g. Vanderbilts; SDQs; SNAP IV BUT we wont accept questionnaires alone. Private assessments we do accept private diagnoses but these children will not be prioritised on the waiting list.
Assessment Pathway Initial appointment with Paediatrician 80 mins. Use DSM V (https://www.cdc.gov/ncbddd/adhd/diagnosis.html). Diagnosis made: - clinical decision as to next steps and FU (30 mins). - Signposting/medication information/medication started Diagnosis not made: - request additional info/school observation/QB test. - Referral to other service e.g. CAMHS/ Social Services/Neurology. - Move to different diagnostic pathway e.g. ASD
Support Resources National Organisations: 123 Magic CHADD ADDitude Janssen with me ADHD Foundation www.adhdfoundation.org.uk ADDISS www.addiss.co.uk www.123magic.com www.chadd.org.uk www.additudemag.com www.livingwithadhd.co.uk
Support Resources Local Resources: ADD-Vance SPACE DSPL Families In Focus www.familiesinfocus.co.uk Family Lives www.familylives.org.uk www.add-vance.org www.spaceherts.org.uk www.dspl.co.uk
Challenges What we don t provide: CBT/Counselling/Behavioural Interventions. Mental Health Assessment/Evaluation or Interventions. Prescribing for anxiolytics/ antidepressants/ antipsychotics. Sleep Clinic we do not assess for stand alone sleep difficulties. We do assess and prescribe melatonin for children with underlying neurodevelopmental diagnoses and/or ADHD medication induced sleep difficulties, known to our service. Assessment and management of Tic disorders.
Challenges Volume of referrals. Receive 200+ referrals per week Lack of capacity no increase in consultant numbers. Waiting times for initial assessment > 12 months Backlog for review appointments. Lack of access to mental health services and interventions.
Looking Forward Emotional and Mental Health Wellbeing Board pathway being developed for ADHD and ASD. ICB Mental Health, Learning Disability & ASD Collaborative. Also looking into ADHD pathway/backlog clearance. ANY QUESTIONS?
