Attention Deficit Hyperactivity Disorder (ADHD) referral pathway
Please note: the pathway for ADHD and ASD assessment will be changing from March/April 2025 when there will be a singular assessment process for both ASD and ADHD which will be used in all areas of the county. We will update this page once these changes are fully implemented.
ADHD (attention deficit hyperactivity disorder) is a common behavioural disorder in children and young people. It usually starts in early childhood with the core behaviours of ADHD typically present from before the age of 7 years and symptoms sometimes persisting into adulthood The symptoms of ADHD include:
- Inattentiveness- inability to concentrate for a long time or finish tasks, disorganisation, and forgetfulness.
- Hyperactivity- fidgetiness, inability to stay still or restlessness.
- Impulsivity- speaking and doing things without thinking about consequences, interrupting other people, inability to wait or take turns.
You should always discuss your concerns with the child or young person’s parent or carers before considering referring for a diagnosis. A referral can only happen with the parent’s consent. Prior to considering a referral, please ensure all parents/carers are offered support and advised to contact local support groups to access further information and parent training (see ‘Support for families’ section below for more information).
Currently, the referral process for ADHD assessment varies according to where in Hertfordshire the child’s GP is registered. If you are unsure, this information should be found on the GP surgery’s website. It is important that you follow the correct process for the area.
ADHD referrals in South and West Hertfordshire are made through the CAMHS Step 2 service.
Who can refer?
Referrals can be made by school or a health professional, for instance GP, school nurse, health visitor etc. Parents must always give consent, and if the referral is made by the school, then the GP should be informed.
To make a referral for ADHD assessment, the pre-screening forms for home and school will need to be completed. Guidance and forms can be found on the Hertfordshire Community NHS Trust website (hct.nhs.uk)
The completed paperwork then should be sent directly to hct.step2referrals@nhs.net. We require evidence from two settings (usually home and school); if the child is out of education, please book a call with an ADHD specialist who can advise you where best to get the form filled out.
There is currently a wait for the pre-screening. To avoid further delays, make sure that both home and school forms are complete. At the pre-screening, clinicians will review the forms and decide to either signpost to further support or put the child forward for an ADHD assessment by HPFT. (There is currently a long wait for assessments).
Within 4 weeks of the referral being received, a text is sent to the family acknowledging the referral and the outcome of the triage process. The message will indicate if the referral has been added to the ADHD screening waiting list or signposted to other support.
The family are informed of the outcome of the pre-screen process by letter. The letter is sent to the referrer, the family and HPFT single point of access (SPA) that further assessment is needed.
Confirmation is also sent to the family via SMS which includes contact information.
If the pre-screen does not identify the need for an ADHD assessment, they will receive a letter with recommendations for further support.
Referrers/families can also request an ADHD call back if they need additional information.
Currently, referrals for ADHD in East and North Hertfordshire are made to the Community Paediatric service. The team will review referrals for both ASD and ADHD and then refer them to the most appropriate team/service for assessment.
Who can refer?
Referral for an ADHD assessment must be made by a health professional - GP, Health Visitor, School Nursing team. Parents and carers must give consent. If school has concerns, they can talk to the school nurse about making a referral (after an initial conversation and consent from parents). Diagnosis is not made before the age of 7 years as many children are inattentive and restless before this age.
For guidance and information on making a referral in East and North Hertfordshire visit: Referral information (ADHD pathway) – East and North Hertfordshire NHS Trust (enherts-tr.nhs.uk)
School should complete a ‘Strengths and Difficulties questionnaire’ with parents. The information should include the following:
- Concerns and symptoms of suspected ADHD
- How long symptoms have been present
- Interventions and support accessed within the community or specialist service
- Interventions, support, and environmental modifications implemented at school
- Parent support group attended
- Attach relevant medical history and any direct observations of child/young person in multiple settings
- Attach any ADHD rating scales e.g. Strengths and Difficulties Questionnaires (SDQs), SNAP IV.
- Attach any relevant school/Educational Psychologist report/s
- State relevant psychosocial history/social services involvement (if applicable)
- Provide evidence of watchful waiting of at least 10 weeks following initial contact with GP. Parents should be signposted by the GP to Group based ADHD focused support and should not wait for formal diagnosis of ADHD before signposting.
Referrals and accompanying reports and information should be submitted to:
The Contact Centre, Lister Hospital, Corey’s Mill Lane, Stevenage, SG1 4AB
All referrals coming to the ADHD Specialist Service (East/North) will undergo an initial screen to ensure they fulfil criteria. If referrals are accepted, the child/young person will undergo an assessment by the ADHD Specialist. Referrals that do not fulfil criteria will be sent back to the GP/ Referrer/Carer with an accompanying letter stating reasons for non-acceptance or if appropriate, signposted to the right pathways within our service and Referrer/ Carer informed.
As the waiting list is long, schools may be asked to provide more information before the first appointment to reflect any changes in the child’s behaviour or needs.
Some parents will choose to go privately to obtain a diagnosis for their child or young person. The school can use any strategies or recommendations in reports from the private assessment to support the child at school.
If a diagnosis is given privately, parents will then need to contact their GP in order that the child is given an appointment to transfer care to the NHS. There will be a wait for them to be seen by an NHS specialist and they may need to carry on paying privately for prescriptions for any medication until this appointment. At the appointment, the team will confirm the diagnosis and then the management of the medication will be picked up by the GP.
Most ADHD medication will be given to children by parents in the morning, before school. School will not typically need to administer medication for ADHD.
ADHD medication tends to wear off as the day goes on, so children will usually find it easier to focus on tasks in the morning.
For more information on ADHD medication visit: For more information on ADHD medication visit shared/ADHD medication information – East and North Hertfordshire NHS Trust
Information and advice for parents on ADHD can be found on the Local Offer:
- Parents and carers can phone the Neurodiversity Support Hub for advice and support.
- Support Groups and Networks offering information and advice on ADHD for parents.
- Courses and workshops for parent/carers on ASD and ADHD.
ADHD strategies to support – East and North Hertfordshire NHS Trust (enherts-tr.nhs.uk)