Sussex CAMHS Neurodevelopmental Screening Form - Parents and Carers

The Sussex CAMHS Neurodevelopmental Pathway is a neurodivergent positive CAMHS specialist service offering assessment for Autistic Spectrum Condition (ASC) for young people aged 11+ and Attention Deficit Hyperactivity Disorder (ADHD) for young people aged 6 up to 18 years. We also provide medication treatment for young people diagnosed with ADHD. If the young person is outside of these age ranges, please ask to be referred to your local child development centre or adult health service

Please note these are not referral forms. Only screening forms which are linked to an accepted referral will be reviewed. Please do not complete and submit the screening forms unless the young persons referral has been accepted by the local Neurodevelopmental team.

Due to the high demand for our neurodevelopmental assessments, unfortunately, we have long waiting lists.  Consequently, if a young person is referred to us at the age of 17 years, it is unlikely they will be seen by children's services. However, we will ensure that their details are passed on to the local adult teams when they turn 18 years. We sincerely apologise for the extended waiting times for assessments and understand the frustration this may cause. We would like to reassure you that we are working hard to address the increased demand on the neurodevelopmental service.

  • We are very grateful for your help, support and time filling in this screening form properly, with lots of evidence and detail, in order for our Neurodevelopmental Specialist Practitioners to decide if further assessment of the young person for ASC, ADHD or both is indicated.
  • Our Neurodevelopmental Specialist Practitioners are screening only for ASC, ADHD or both. Should you have any concerns about your young person's general mental health and wellbeing please discuss with your GP or school nurse, who can then direct you to the most appropriate service.
  • The form contains around 50 questions: some are multiple choice but most will ask you for evidence and details.
  • For users who are logged in, you can save your progress and are not required to complete the form in a single session. However, for those who do not have an account or are not logged in, it's essential to complete the form in one go. The process may take anywhere between 20 minutes and two hours, so please allocate enough time accordingly.
  • Sometimes, neurodivergent young people expend considerable energy masking their differences, and become very good at trying to look like everything is OK when it isn't. The more evidence and detail you provide, the easier it will be for our Neurodevelopmental Specialist Practitioners to decide if this may be happening.
  • Click on the information button throughout the form to for prompts to help you understand more about the evidence and detail our Neurodevelopmental Specialist Practitioners are looking for.
  • Neurodevelopmental Specialist Practitioners do not need to see evidence and detail for every single question, as some are only relevant for ADHD or Autism on their own. Don't worry too much if you really cannot answer a question. You can put 'not applicable' or 'NA' if the form won't let you go to the next question without putting something.

If further assessment is indicated, the young person will be added to our waiting list by our Neurodevelopmental Specialist Practitioners and you will receive a confirmation letter with further details. If further assessment is not indicated we will send a letter to that effect.

We are experiencing a high demand for this service which is resulting in growing waiting lists. Please be assured that we are working hard to address this. All our local commissioners (the funders of our service) have recognised that the group of young people with neurodevelopmental conditions (including ADHD) is growing.

Neurodivergent positive means acknowledging that:

  • Neurodivergent young people have a different neurology or neurotype that is part of natural human variation, like sexuality, gender or race.
  • Neurodivergent young people are often disabled by barriers put in place by society, not as a consequence of their impairments or differences.
  • Diagnosis can be a gift to the young person, through which many can acknowledge their strengths as well as their differences and vulnerabilities
  • Diagnosis can help a young person find belonging and identity in membership of a worldwide community of neurodivergent people
  • Diagnosis can provide the language for young people to self-advocate
  • Diagnosis can provide the legal foundations for equality of access to education and future work through the Equalities Act (2010) and making reasonable adjustments
  • Diagnosis can validate educators and parents in growing a more effective and compassionate understanding of young people

Sussex CAMHS Neurodevelopmental Screening Form - Parents and Carers

CAMHS Neurodivergent Pathway Logo

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Referral confirmation

Please confirm this young person has had their initial referral accepted for the next stage in the Autism or ADHD assessment process and this screening has been requested by the team?*

Young Person's Details

This service is for patients who are aged over 6 and under 18

Is the child/young person (please select all that apply):
Does the child/young person have a disability?*
Is the child/young person a Young Carer?*
Does the child/ young person or the parent/ carer require an interpreter? e.g. British Sign Language (BSL) or foreign languages*
Does the young person have any siblings?*

Referrer & Parent/Carer Details

Please can the following details be provided about the person with parental rights for the young person who is completing the form.

The person completing this screening form must have parental responsibility for the young person.

In the interests of the environment and costs to the service, we would like to email correspondence and appropriate documentation to you. Do you consent to us using your email address for these purposes?*
Do you wish to submit a second set of parent/ carer details?*
Does either parent have any medical/health conditions or existing diagnosis or are under assessment/investigations for health/medical concerns? Have they noticed similar difficulties to the young person?*

Young Person's Consent

Does the Child/Young Person know about the screening?*
Does the Child/Young Person consent to the screening?*
Does the Child/Young Person/Parent/Carer give consent CAMHS to liaise with external agencies E.g. Children's Services, Education, Voluntary sector? *
Do we have your permission to share information with any other family member not already listed above?*
During the review of the screening forms, the information may indicate either an Autism only, ADHD only or joint Autism and ADHD assessment is needed. Please select an option below to confirm which assessments you consent to (please be aware that we are only commissioned to assess for autism from the age of 11 years. If your child is younger than this please only select for ADHD and seek an alternative referral to the Child Development Clinic for autism assessment):*

Young Person's Contact Details

Does the Child/Young Person consent to be contacted about the screening?*

GP Details

How to find their NHS number

The NHS number is a 10 digit number, like 485 777 3456.

You can use the NHS website to find their NHS number. Vist https://www.nhs.uk/find-nhs-number/what-is-your-name.


Education Details

Is the young person in education e.g full time education, part time education, home schooled, apprenticeship, other education types?*

School Services

Please list below any school services that are involved with the young person

What are school services?

Social services/Voluntary agencies/Charities/Justice system/youth emotional team.


Other Services

Please list below any other services that are involved with the young person

What are other services?

1:1 support, learning support, therapy input, Additional help/support/EHCP or Individual educational plans /professionals who support the young person in the education setting such as physiotherapist, Speech and language therapist, occupational therapist, play therapist etc...

Young person's views

We would like to capture the views of the young person who you are making this referral for. Where possible please detail the young persons perception of the problem in their own words and how you have obtained this information. For example things they really like, or things they find difficult, how they feel about being assessed:

Gaining the young persons views can be completed in a number of ways using mapping tools, drawings and writing. Or through conversation. If you have any attachments to provide please email to NDP.Screening.WestSussex@spft.nhs.uk.


Current Concerns

Why are we asking this?

This is a general, opening question. You can answer this as freely as you want to. Remember, the more evidence and detail you provide, the better for our Neurodevelopmental Specialist Practitioners.

Do you have any current or previous concerns about the young person self-harming or expressing that they would like to seriously harm themselves or others?*

(Please consider: current or historic self-harm, suicidal thinking/intent, thoughts of harm to others, bereavement, substance misuse, criminal justice, exploitation, adverse childhood experiences, trauma, parental MH or substance misuse, domestic abuse)

Why are we asking this?

We ask this so our Neurodevelopmental Specialist Practitioners understand more about the risk that the young person presents to themselves before they ring you for the first time. In particular, we want to try to understand if there are any risks that you are struggling to manage, and understand exactly what the young person has done to themselves (if anything).

Reminder:

We are not a 24 hour emergency service, and our Neurodevelopmental Specialist Practitioners meet to screen referrals at various different times. If you feel the young person needs immediate support and are a danger to themselves, please use one of the links below:

  • Look at https://www.sussexcamhs.nhs.uk.
  • Contact the Sussex Mental Health line 0800 0309 500 (which is open 24/7) or NHS 111.
  • Attend A&E for emergencies and medical treatment. Before you attend A and E if the young person is feeling suicidal, please have a conversation with your young person about the thoughts they are having, and whether they actually intend to harm themselves, and whether they have any concrete plans to harm themselves. It's important that carers are sure that attending A and E is the right thing for the young person, as waiting for assessment there can often take several hours.
  • If the young person absconds, contact the police by dialling 999.
Are there any other factors that have caused you, or others, concern?*

Developmental History and Health

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you can give as much detail about the pregnancy and birth as possible.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any conditions that required frequent or long-term medical treatment in hospital or with a GP.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you are able to detail these to the best of your ability. If you cannot remember, your best guess is okay.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail any sleep difficulties and any other services who might be involved.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail any eating or feeding difficulties and any other services who might be involved.

Relationships and behaviours

Why are we asking this?

Neurodivergent young people's friendships are incredibly varied and conversational style may be different. It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence the relationships you know they have in their life, and what you have seen happen when those people spend time together.

Why are we asking this?

Many Neurodivergent young people are okay in groups, but many really struggle with the complex demands of that situation. It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence what you have seen when the young person is in a group situation, whether that be a classroom, a family gathering or any form of structured or unstructured group activity. It is especially helpful if you can describe how they behave in conversations in that situation.

Why are we asking this?

Many Neurodivergent young people are okay in groups, but many really struggle with the complex demands of that situation or forming friendships. It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence what you have seen when the young person is in a group situation, whether that be a classroom, a family gathering or any form of structured or unstructured group activity. It is especially helpful if you can describe how they behave in conversations in that situation.

Why are we asking this?

Neurodivergent young people

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence situations in which you have seen the young person respond with compliance, anger or avoidance when an adult has set boundaries or asked them to follow rules, as well as what has happened in the previous few hours that might have led to their response.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence situations in which you have seen the young person repeatedly doing the same thing, or needing to stick to an unusual routine.

Play and Social Skills

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and give examples where the young person has copied everyday activities, mimicking what they have seen.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and can give examples when the young person shared interests with you and how this was done.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence how they young person played when they were younger. Did they need lots of adult direction and support? Did they play for a long time alone and with focus? Did they prefer to have others with them or play alone? How did this look? This will help the Neurodevelopmental Specialist Practitioners to understand early play development and social skills.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence how they young person played when they were younger. Did they need lots of adult direction and support? Did they play for a long time alone and with focus? Did they prefer to have others with them or play alone? How did this look? This will help the Neurodevelopmental Specialist Practitioners to understand early play development, social skills, concentration and impulsivity.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence how they young person played when they were younger and how they responded to other young people.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence how they young person played when they were younger. Did they need lots of adult direction and support? Did they play for a long time alone and with focus? Did they prefer to have others with them or play alone? How did this look? Did they find it challenging to play co-operatively? This will help the Neurodevelopmental Specialist Practitioners to understand early play development and social skills.

Why are we asking this?

Neurodivergent young people may struggle play in the ways that other people expect. They might

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any ways in which you think the young person played or plays in a way that is usual, or doesn't appear the same as their peer group


Language and Communication

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any ways in which you think the young person has had difficulty with their speech and language or is using speech and language in a way that isn't appropriate to a situation or relationship or is using words in a way that appears to indicate their understanding of those words isn't the same as other people's.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any concerns you may have had regarding eye contact when interacting with the young person.

Why are we asking this?

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any ways in which the young person is using speech and language in a way that isn't appropriate to a situation or relationship, or they converse in a way that appears to other people to indicate their understanding of the situation isn't the same as other people's.

Sensory

Why are we asking this?

Neurodivergent young people may experience all kinds of sensory differences. These include differences in how they respond to:

  • Smells
  • Light
  • Sounds
  • Textures
  • Tastes
  • Hot and cold
  • Their internal sense of balance
  • How stretchy or bendy they feel
  • Emotion in their body
  • How they feel in their body generally

Sometimes they may wish to repeat experiences that bring about sensory pleasure connected to these differences, sometimes they may wish to avoid an experience at all costs as it may cause them severe discomfort.

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any ways in which you have noticed that the young person doesn't experience their sense in the way that you or other people might expect them to.

Why are we asking this?

Neurodivergent young people may experience all kinds of sensory differences. These include differences in how they respond to:

  • Smells
  • Light
  • Sounds
  • Textures
  • Tastes
  • Hot and cold
  • Their internal sense of balance
  • How stretchy or bendy they feel
  • Emotion in their body
  • How they feel in their body generally

Sometimes they may wish to repeat experiences that bring about sensory pleasure connected to these differences, sometimes they may wish to avoid an experience at all costs as it may cause them severe discomfort.

It will help our Neurodevelopmental Specialist Practitioners if you detail and evidence any ways in which you have noticed that the young person doesn't experience their sense in the way that you or other people might expect them to.

Why are we asking this?

Neurodivergent young people may want to have contact/ closeness with objects or toys for comfort and for sensory input.

Academic Profile

Why are we asking this?

The social, sensory and cognitive demands of school can be challenging for some neurodivergent young people. It would be helpful to our Neurodevelopmental Specialist Practitioners if you could provide details of how this may affect your child/young person. Unidentified learning needs can sometimes be wrongly interpreted as ADHD or ASC. It might be important to discuss learning with the school SENDCo if there is a pattern of not meeting academic potential.


Why are we asking this?

The social, sensory and cognitive demands (see above) of school can make going there an incredibly challenging and complicated experience for neurodivergent young people, who sometimes may

  • struggle with the decision-making, planning and focus that it can take to participate in school life.
  • feel highly anxious and overwhelmed by the demands that participating in school life places upon them
  • get into conflict with parents or teachers, perhaps without understanding why or being able to talk about it.

Our Neurodevelopmental Specialist Practitioners need to know what happens rather than why, so please describe what you have seen with as much evidence and detail as you can.


Young Person's Strengths

Why are we asking this?

Consider various areas such as:

  1. Academic Skills: Are there specific subjects where the young person is doing well or enjoys (e.g., mathematics, reading, science)?
  2. Creative Abilities: Does the young person show a particular interest in areas like art, music, writing, or drama?
  3. Problem-Solving Skills: Can they think critically or come up with interesting ideas and solutions to challenges?
  4. Social Skills: Are they good at making friends, showing empathy, or working well in groups?
  5. Emotional Strengths: Do they display resilience, patience, or a positive attitude in difficult situations?
  6. Physical Abilities: Do they enjoy sports, dance, or other physical activities?
  7. Technological Skills: Do they have a knack for working with computers, programming, or other technologies?
  8. Organisational Skills: Are they good at planning, organising tasks, or managing their time effectively?
  9. Passion and Enthusiasm: Do they show a particular interest or dedication in particular hobbies or activities?
  10. Leadership: Do they demonstrate the ability to lead others, take initiative, or inspire their peers?

Please provide specific examples or anecdotes to illustrate these strengths. For example, you might mention a time when the young person did well in a school project, demonstrated leadership in a group activity, or solved a complex problem on their own.

SNAP-IV

Adapted from the SNAP-IV parent and teacher rating scale, originally created by James M Swanson PHD, University of California, Irvine, CA 92715.

  • For each item, select the box that best describes this child / young person
What is this?

This is a validated screening questionnaire. Our Neurodevelopmental Specialist Practitioners want you to rate your young person, selecting the option that best describes the young person, from 0='Not at all', 1='Just a little' 2='Quite a bit' and 3='Very much'.

If you think about the child/young person's behavior, are you completing this screening questionnaire based upon the*

Attention Levels
Question Not at All
(0)
Just a Little
(1)
Quite a Bit
(2)
Very Much
(3)

Activity
Question Not at All
(0)
Just a Little
(1)
Quite a Bit
(2)
Very Much
(3)

Impulsivity
Question Not at All
(0)
Just a Little
(1)
Quite a Bit
(2)
Very Much
(3)

Adapted Social Communication Screening Tool

The following questionnaire is designed to identify patterns of behaviours and abilities in children during their school/college years. This is the age at which unusual patterns of behaviour and abilities are most conspicuous. Some of these questions may have been covered earlier in more detail or seem simlar. Please rate against the scale as indicated below if your young person has displayed any of the following behaviours/patterns.

Social and Emotional Abilities

Has the young person ever lacked of understanding of how to play with other children? For example, unaware of the unwritten rules of social play?*
When free to play with other children, such as at school lunchtime, have they ever avoided social contact with them? For example, finds a secluded place or goes to the library.*
Does the young person appear unaware of social conventions? Or codes of conduct and make inappropriate actions & comments? For example, making a personal comment to someone but the young person seems unaware of how the comment could offend.*
Does the young person lack empathy, i.e. the intuitive understanding of another person's feelings? For example, not realising an apology would help another person feel better.*
Does the young person seem to expect other people to know their thoughts, experiences and opinions? For example: Not realising you could not know about something because you were not with the young person at the time.*
Does the young person need an excessive amount of reassurance, especially if things are changed or go wrong?*
Does the young person lack subtlety in their expression of emotion? For example, the young person shows distress or affection out of proportion to the situation.*
Does the young person's facial expression usually seem inappropriate to the social situation? For example, not expressing pleasure at receiving a gift or not reciprocating smiles appropriately?*

Communication Skills

Does the young person take a literal interpretation of comments? For example, is confused by phrases such as 'pull your socks up', 'looks can kill', or 'hop on the scales'.*
Has the young person ever invented words or replaced words with others such as 'raining eyes' for tears?*
Has the young person ever used an unusual tone of voice? For example, the seems to have a 'foreign' accent or monotone that lacks emphasis on key words.*
When talking to the young person, do they appear uninterested in your side of the conversation? For example, not asking about or commenting on your thoughts or opinions on the topic making it a one-sided conversation? Or do they often try and switch the conversation to a familiar topic.*
Has the young person ever used unusual gestures to get your attention/ask for help as a way to communicate? For example have they ever used your hand instead of their own to pick up something or pointing with your finger, rather than their own?*
Is the young person's speech over-precise or pedantic? For example, talks in a formal manor, uses unusual or repetitive phrases (maybe repeated from TV programmes/scenes/stories or phrases they have heard) or talking like a walking dictionary?*
Does the young person have problems repairing a conversation? For example, when the child is confused, he or she does not ask for clarification but simply switches to a familiar topic, or takes ages to think of a reply.*

Cognitive Skills

Does the young person read books primarily for information, not seeming to be interested in fictional works? For example, being an avid reader of encyclopaedias and science books but not keen on adventure stories.*
Does the young person have an exceptional long-term memory for events and facts? For example, remembering the neighbour's car registration of several years ago, or clearly recalling scenes that happened many years ago.*
Does the young person lack social imaginative play? For example, other children are not included in the young person's imaginary games or the young person is confused by pretend games of other children?*

Specific Interests

Is the young person fascinated by a particular topic and avidly collects information or statistics on that interest? For example, the young person becomes a walking encyclopaedia of knowledge on vehicles, maps or league tables.*
Does the young person become unduly upset by changes in routine or expectation or transitions? For example, is distressed by going to school by a different route or transitions such as changing schools/classroom.*
Does the young person develop elaborate routines or rituals that must be completed? For example, lining up toys before going to bed.*
Has the young person ever seemed fascinated by parts of a toy or object (like spinning wheels) rather than playing with the object/toy? Would they play as expected with the toy or become frustrated easily and break/damage it?*

Movement Skills

Have you ever noticed any difficulties with controlled movements of the body (motor co-ordination)? For example not skilled at catching/throwing a ball or fine motor skills such as handwriting)*
Does the young person have an odd gait when running?*
Have you ever noticed any unusual whole-body movements? e.g. rocking, spinning, jumping.*

The original ASAS was taken from the following book: Attwood, T. PhD. A.S. A Guide for Parents and Professionals. Jessica Kingsley Publishers. ISBN 1 853925777 1

Additional Information

Please also send copies of any reports you may already have for this young person, such as an EHCP or Speech and Language reports to NDP.Screening.WestSussex@spft.nhs.uk.

Terms and Conditions

On receipt of the screening form, we will consider whether or not the neurodevelopmental pathway is the most, or only, appropriate CAMHS service for the young person. Our service is not 24 hours and it may take several weeks for the information to be screened. The information you have provided will be used primarily for the purpose of undertaking a neurodevelopmental assessment, and contacting you, your child's school or the young person directly should we require more information, but there may be instances (particularly around risk) where contacting other Sussex Partnership NHS Foundation Trust services about the young person is deemed appropriate. This information will not be shared with anyone else without your consent. Information will be held as a part of the service user's record in line with the NHS Records Management Code of Practice. For more information on how we use your information, please see our privacy policy.