Our service provides a diagnostic and follow-up service for adults who live in Gloucestershire and do not currently have a diagnosis of ADHD.

If you are diagnosed in our service, you will be offered a follow-up appointment to start medication before we ask your GP to continue treatment.

Our service is not an emergency or crisis service. For help in a crisis, click here.

As well as self-referrals, we accept referrals from GPs and other Gloucestershire Health and Care NHS Foundation Trust colleagues (e.g. the Mental Health Intermediate Care Team (MHICT), Gloucestershire Recovery in Psychosis (GRiP), recovery teams, inpatient wards and eating disorder teams).

Please speak with your GP or the mental health practitioner at your GP surgery. The mental health practitioner can offer a longer appointment and, if necessary, will also be able to advise on strategies and support for any mental health difficulties you may be experiencing.

The referral process includes an informant questionnaire, which we ask you to give to someone who has known you for a long time, ideally since childhood (i.e. a parent, carer, older sibling, aunt, uncle, childhood friend). This is because ADHD is a neurodevelopmental condition, and part of the diagnostic criteria is that the features must be present in early childhood. However, if you do not have anyone who can give a good report on your childhood, we will consider information from a partner, spouse, or friend – although that would not be adequate to have all information necessary for a definitive diagnosis.

Triage process

When we receive a referral, we carry out a triage. We consider the information in keeping with National Institute for Health and Care Excellence (NICE) guidance, as well as reviewing medical notes and looking at any other existing diagnoses.

Following triage, one of the following will happen:

• You will be placed on the waiting list for full assessment and contacted once a date becomes available.
• We may write to you to seek additional information to aid our triage process. We will then triage the referral further.
• We will discharge at this point if the referral form does not contain enough information, has not been filled in correctly, or if the difficulties described in the referral form can be better explained by something other than ADHD.

Waiting list

If your referral meets the criteria for ADHD assessment, you will be placed on the waiting list for an assessment. Please be aware that the waiting time is significant. It is not possible to give exact times, as it does vary.

While waiting for an assessment

While you are waiting for an appointment, it is important that this does not prevent you, or those supporting you, from accessing other services which may help you. This may include mental health or social care support. Please see the resources list at the bottom of the page for some websites/services that you may find helpful.

When you reach the top of the waiting list you will be contacted by our service using your preferred method, to arrange a suitable date for assessment. You will then be sent a letter offering you an ADHD assessment. This letter will contain further information about your appointment.

You will be asked to attend the appointment with someone who knows you well, ideally since childhood. This may be the same person who filled in the informant questionnaire. If you have any questions through this initial process you can contact our service for assistance. Our phone number and email address will be on the letter.

Our service is staffed by a combination of mental health nurses and psychiatrists. We work as a multidisciplinary team to provide the best service we can.

Your assessment can take place virtually or face to face with members of our multidisciplinary team at our clinic in Cheltenham. If you are attending your appointment virtually, this will take place via a video call, using the Attend Anywhere secure platform. To use this, you will need access to the internet, and a laptop or tablet with a camera. We recognise that accessing or using this technology may not be possible for everybody. If this is a concern, our team can discuss with you any adjustments you may need.

Click here to view a step-by-step video guide to using Attend Anywhere.

An ADHD assessment involves gathering a range of different information. Some of this information will be obtained from speaking to you about your experiences, and speaking to your informant. There are no right or wrong answers when answering these. They will help us to gather information about your childhood development.

When possible, this will be through talking to the person that has known you since childhood, who has hopefully accompanied you to your appointment. When someone lives a long way away, we can arrange to speak to them via phone or video call. It may also be helpful for us to speak with someone who knows you well now, for example, a spouse, partner, friend or other relative.

The assessment involves asking questions about a range of experiences in your life. We appreciate that for some people these may be upsetting or difficult to talk about, and we will support you throughout the process. You can let us know if there are some things that you would prefer to talk about when the accompanying person is not present.

The appointment can vary in length, and will take up to 3.5 hours. It will include regular breaks. We will discuss any individual adjustments you might need.

In some instances, we may only need one appointment to reach a diagnostic conclusion. However, we may need a second appointment, depending on circumstances.

If a further appointment is needed, it will involve meeting with at least one of the clinicians from your first appointment, but may also include other members of the team. This appointment may take place via video or in person, and this will be discussed with you.

Some people may not receive a diagnosis of ADHD. This may be because we think there is a different explanation for the difficulties they are experiencing, or that they do not fulfil all the criteria necessary for a diagnosis. If this is the case, we will explain why we have reached our conclusion and signpost or refer to wider services as appropriate.

Unfortunately, on rare occasions, there may not be a clear outcome to a person’s assessment. This might be because there are a range of complicated factors which make the information unclear, or that for various reasons we haven’t been able to gather all the information we need.

Whatever the outcome, we will share our understanding of the information we have gathered during the assessment and you will receive a comprehensive report. We will also discuss the various sources of further support that may be available to you.

Our service is funded and resourced to provide medication treatments only. If you are diagnosed with ADHD we will discuss the current guidance concerning effective and recommended medications for your condition which you may wish to think about. People’s responses to medications will vary, and not everyone responds to treatment in the same way. We will be able to make decisions considering the severity of your symptoms in your life and the eventual benefits that you may obtain from medication and improved self-help techniques.

Once your ADHD assessment is complete, we will discharge you from our service if you have not received a diagnosis. If you are commencing treatment with us, once your treatment is stabilised we will usually transfer prescribing responsibility back to your GP with advice about ongoing care.

Websites

Books

ADHD – feeling low and anxious.

NHS services

In a crisis you can contact

Other sources of support

Drug and alcohol use

Autism is a neurodevelopmental condition, with a set of very specific diagnostic criteria. It is worth noting that most people who come for an autism assessment will not be diagnosed with autism, even though they may be experiencing significant challenges in their lives.

We are aware that it can be distressing when the outcome of the assessment does not align with your view of your difficulties. However, there are many reasons why people might experience difficulties, and we strongly encourage you to remain open-minded to all outcomes prior to assessment.

We are here to provide you with our clinical opinion. We may recommend referral to other services if this is indicated.

As well as self-referrals, we accept referrals from GPs and other Gloucestershire Health and Care NHS Foundation Trust colleagues (e.g. the Mental Health Intermediate Care Team (MHICT), Gloucestershire Recovery in Psychosis (GRiP), recovery teams, inpatient wards and eating disorder teams).

Please speak with your GP or the mental health practitioner at your GP surgery. The mental health practitioner can offer a longer appointment and, if necessary, will also be able to advise on strategies and support for any mental health difficulties you may be experiencing.

As part of the referral process you will be asked to complete two questionnaires. Questionnaire 1 is for you complete and questionnaire 2 is to be given to someone who has known you for a long time, ideally since early childhood (i.e. parent, carer, older sibling, aunt, uncle, childhood friend). This is because autism is a neurodevelopmental condition, and part of the diagnostic criteria is that the features must be present in early childhood.

We realise that finding someone who meets these criteria is not always possible, so a partner, spouse or friend is an acceptable alternative in these cases.
If you need specific advice on filling in questionnaires, please contact our service and we can help.

Triage process

When we receive a referral, we carry out a triage. We consider the information in keeping with National Institute for Health and Care Excellence (NICE) guidance, as well as reviewing medical notes and looking at any other existing diagnoses.

We will discharge at this point if the referral form does not contain enough information, has not been filled in correctly, or if the difficulties described in the referral form can be better explained by something other than autism. We may ask the referrer for more information if some relevant information is provided, but not enough to make an informed triage decision.

Waiting list

While you are waiting for an appointment, it is important that this does not prevent you, or those supporting you, from accessing other services which may help you during this period. This may include mental health or social care support. Please see the resources list at the end of the leaflet for websites / services you may find helpful. You do not need a diagnosis to ask for reasonable adjustments at work, or where you study. For further information see the resources section of this leaflet.

When you reach the top of the waiting list you will be contacted by our service, using your preferred method, to arrange a suitable date for assessment. You will then be sent a letter offering you an autism assessment. This letter will contain further information about your appointment. You will be asked to attend the appointment with someone who knows you well, ideally since childhood.

This may be the same person who filled in the second questionnaire. A video or telephone call can be set up if the person is unable to attend the appointment. If you have any questions through this initial process, you can contact our service for assistance. Our phone number and email address will be on the letter.

Our clinicians come from a number of health professions including:

• mental health nursing
• psychiatry
• occupational therapy
• speech and language therapy.

We work as a multidisciplinary team to provide the best service we can. You will be seen by at least two clinicians from the multidisciplinary team.

In most cases, your assessment will take place face to face with members of our multidisciplinary team at our clinic in Cheltenham. If you are unable to attend the clinic, we would consider whether the assessment may take place via a video call, using the Attend Anywhere secure platform. To use this, you will need internet access and a device with a camera. We recognise that accessing or using this technology may not be possible for everybody. If this is a concern, our team can discuss with you any adjustments you may need.

Click here to view a step-by-step video guide to using Attend Anywhere.

An autism assessment involves gathering a range of different information. Some of this information will be obtained from speaking to you about your experiences, and completing tasks with you. There are no right or wrong answers when completing these tasks. They will help us to understand how you think.

We will also try to gather information about your childhood development. When possible, this will be through talking to the person that has known you since childhood, who has hopefully accompanied you to your appointment. When someone lives a long way away, we can arrange to speak to them via phone or video call. It may also be helpful for us to speak with someone who knows you well now, for example a spouse, partner, friend or other relative.

The assessment involves asking questions about a range of experiences in your life. We appreciate that for some people these may be upsetting or difficult to talk about, and we will support you throughout the process. You can let us know if there are some things that you would prefer to talk about when the accompanying person is not present.

The appointment can vary in length, and will take up to three-and-a-half hours. It will include regular breaks. We will discuss any individual adjustments you might need. During the practical assessment tasks (approximately 1 hour), we ask that the person accompanying you leaves the room. They will be able to wait in the waiting room or leave the clinic for this period. In most instances we only need one appointment to reach a diagnostic conclusion. However, we may need a second appointment, depending on circumstances.

If a further appointment is needed, it will involve meeting with at least one of the clinicians from your first appointment, but also may include other members of the team. This appointment may take place via video or in person, and this will be discussed with you.

What happens if you receive an autism diagnosis?

Some of the people we assess will meet the criteria for autism and will receive a diagnosis. As part of this, an assessment report will be written. This will outline the assessment observations, summarise a person’s individual strengths and include recommendations.

• We offer a short post-diagnostic group called ‘Living Well as an Autistic Person’ to people who have been diagnosed by our service. This lasts for seven sessions (two hours each) and can be done either online or face to face, depending on your preference.
• We also offer two individual appointments with one of our occupational therapists to discuss any challenges with work/education/daily living skills, with a particular focus on managing differences in sensory processing.

What happens if you do not receive an autism diagnosis?

For some people, at the end of an assessment they do not receive a diagnosis of autism. This may be because we think there is a different explanation for the difficulties they are experiencing, or that they do not fulfil all the criteria necessary for a diagnosis. If this is the case, we will explain why we have reached our conclusion and signpost or refer to wider services as appropriate.

Unfortunately, on rare occasions there may not be a clear outcome to a person’s assessment. This might be because there are a range of complicated factors which make the information unclear, or for various reasons we haven’t been able to gather all the information we need. Whatever the outcome, we will share our understanding of the information we have gathered during the assessment and you will receive a comprehensive report. We will also discuss the various sources of further support available to you.

Many people have experienced trauma in their lives. The long-term effects can include difficulties with relationships, social interaction and emotions, as well as sensory sensitivities, a need for sameness and a dislike of change. An autism assessment involves thinking about the origins of a person’s difficulties and whether these could be due to autism. The effects of trauma can be reduced with therapy, whereas autism is a lifelong condition. Autistic people may also experience trauma in their lives and can access treatment for this part of their experience.

If you feel any of the above conditions may be an explanation for some of your difficulties, please see your GP for guidance.

Do not wait until the outcome of this assessment to seek support.

Additional information to consider

Many of the challenges experienced by autistic people are not unique to autism. Below are some other conditions that share a number of characteristics with autism.

Many neurodevelopmental and mental health conditions are characterised by difficulties similar to those seen in autism, such as sensory differences, communication, and relationship difficulties. These Other neurodevelopmental conditions are often more common than autism.

Other neurodevelopmental conditions

Dyslexia – www.bdadyslexia.org.uk
Dyspraxia/ Developmental Coordination Disorder – www.dyspraxiafoundation.org.uk
Language Disorders / Developmental Language disorder – www.radld.org
ADHD – adhduk.co.uk/about-adhd/

Mental health conditions

Anxiety – www.nhs.uk/every-mind-matters/mental-health-issues/anxiety and www.nhs.uk/mental-health/conditions/social-anxiety
Obsessive Compulsive Disorder (OCD) – www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd
Depression – www.nhs.uk/mental-health/conditions/depression

Autism Resources

Books

Autism – feeling low and anxious.

NHS services

In a crisis you can contact

Other sources of support

Drug and alcohol use