Integrated Therapiesexleas_logo

Integrated Neurodevelopmental Team (INDT) – ADHD Service

Introduction to the Service

The INDT ADHD Service provides diagnostic assessments for young people presenting with significant difficulties in relation to inattention, hyperactivity and impulsivity. We also provide ongoing medication management following a diagnosis.

The team is a multi-disciplinary team that is made up of a Consultant Psychiatrist, a Principal Clinical Psychologist / Team manager, Clinical Nurse Specialists / Prescribers, an Advanced Pharmacist and Healthcare Assistants.

The team is not a CAMHS service. Children and young people presenting with possible ADHD who also have significant mental health concerns should be referred to CAMHS in the first instance.

We work closely with CAMHS, Community Paediatrics and the IND ASD Team. Where a young person is presenting with ASD, in addition to ADHD, then the team can begin the ASD assessment and refer onto the ASD service for further assessment.

What we do offer?

Diagnostic assessments – The team follow the NICE guidelines for ADHD assessments (Overview | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE)

Families and schools are asked to complete questionnaires prior to being seen. These are a key part of the assessment and if they are not returned then a child will be discharged. Once these questionnaires have been received a child is offered an appointment in clinic to complete a QB Test.

The QB Test is a computer based task that takes around 20 minutes to complete. It provides objective information about a child’s levels of inattention, activity and impulsivity which is then compared to a normative sample of children the same age and gender who do not have ADHD.

When the QB Test has been completed the team review the results, alongside the questionnaires, and decide the next steps. Some children with be offered a 45 minute follow up and others will be offered a 90 minute follow up depending on the child’s needs. Follow ups are typically completed remotely but families may be offered a F2F appointment if necessary.

Behavioural support – Following a diagnosis all families are invited to a remote parent information session. In this session families are given information about ADHD and behavioural support for ADHD. Families are sent the slides following the session. Families are also sent Youtubes links to some resources developed by the team. Families receive a telephone following the parent session to answer any questions and to discuss medication.

The team do not provide ongoing behavioural support. If a family decide that they do not want medication then they are discharged.

Medication – When a child is started on medication they will be invited into clinic to complete a physical examination and discuss medication options. A prescription will then be provided if it is agreed to start medication. Families are asked to give feedback to the team about progress 2 weeks after starting medication. A child then has a follow up 4 weeks later. The team will prescribe medication for the first three months and will make any changes to medication that are required. When a child is stable on medication the team set up a shared care agreement with the GP. This means that the GP takes over the prescribing of medication and does some of the physical checks. The team offer medication reviews at least once a year but families can contact the team at any point to request a medication review if they have concerns.

When the team is prescribing medication families need to give 7 days notice for a new prescription as we receive a high number of requests for prescriptions.

Training to schools – The team offer training to schools about ADHD upon request.

Who is the service for?

The team see children and young people from age 5 up to 18.

If families decide that they do not want medication following a diagnosis of ADHD then the team will discharge.

If a family decide that they do want medication then they are offered an appointment with a prescribing nurse or the Consultant Psychiatrist. When a child is on medication they remain open to the team and are reviewed at least once a year; however children will be offered reviews sooner if families contact us asking to discuss medication issues.

When a young person turns 18 they are discharged and the GP will continue to monitor medication.

Referral Criteria

Referrals are accepted from schools, GP’s, social care and other health services for children with a Greenwich GP aged 5-18.

In order for a referral to be accepted there needs to be evidence that a child or young person displays behaviours consistent with possible ADHD in more than one setting and that these difficulties are causing significant impairment.

Following a referral, or diagnosis, families are invited to create an account on Oxcare, an online health record, using their child’s name and NHS number. Families are asked to invite the team to link with their child’s account. This enables families to access reports / letters written by the team, view the appointment diary, message the team and access self help and self management resources.

Living with ADHD

‘Living with ADHD’ is a new video in which children, families and clinicians from Sheppey talk about Attention Deficit Hyperactivity Disorder (ADHD) and the benefits of early diagnosis.

As well as providing first-hand insights about living with ADHD, it also highlights the benefits of using an objective assessment tool to provide accurate diagnosis.

ADHD is a disorder of brain development that impacts behaviour and affects around 5% of school-aged children. ADHD is a treatable disorder, but if it’s undiagnosed – and left untreated – it can have a significant impact on personal development, academic outcomes and family interaction.

Until recently, there has been no simple test to determine whether a child has ADHD and as a result the process for diagnosing or ruling out ADHD is variable across England. It often includes multiple steps and is based on clinical judgement informed by subjective reports from parents, teachers and observation of the patient. As a result, children in the UK often wait 18 months to obtain an accurate diagnosis, far longer than the European average of 11 months. Multiple clinic visits over this period result in significant costs to the NHS, estimated at £23 million each year.

Kent Surrey Sussex Academic Health Science Network (KSS AHSN), is working with mental health trusts and community paediatric services to improve the ADHD assessment offer to children and young people by implementing an objective assessment tool known as QbTest. QbTest measures a child’s attention, impulsivity and motor activity all at the same time. These indicators are core symptoms of ADHD and accurate measurement adds objectivity to support clinicians to make timely diagnosis.

In Kent, Surrey and Sussex, we have supported 16 sites, across 6 NHS Trusts, to use QbTest as part of their ADHD diagnosis. In total 2392 tests have taken place since 2019!

Becca Randell, Implementation Lead, KSS AHSN, said:

“This video provided children and their families’ experiences and views about living with ADHD and the huge difference that early diagnosis can make. We are so excited to be supporting colleagues across the Kent, Surrey and Sussex to improve the ADHD diagnostic process – using QbTest where appropriate – and improve outcomes for children and their parents.”

To find out more about the Focus ADHD programme and how KSS AHSN can support implementation of QbTest, please visit https://improvement.kssahsn.net/our-work/adhd/

Video links:

Useful Links

Use the external website links listed to locate further information that you may find helpful.

Please note: Oxleas NHS Foundation Trust is not responsible for the content of external websites. The above links should not be understood to be an endorsement for those websites, the site owners, or their products/services.