Neurodevelopmental conditions - Children’s Specialist Nursing Team

Our aim is to provide a high‑quality, holistic, person‑centred service for children, young people and their families with neurodevelopmental conditions.

The service works in a variety of settings to best support your family.

We work closely with parents, carers and professionals to empower, advocate and help each child or young person maximise their potential.

ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that can affect a person’s attention, hyperactivity and impulsivity (NICE, 2018).

The core symptoms of ADHD include:

inattentive – difficulty concentrating, not finishing tasks, disorganised, often losing things, easily distracted and forgetful, appearing not to listen when spoken to
hyperactivity – fidgety and unable to sit still, restless (children may be running or climbing much of the time), talking constantly, noisy, finding quiet activities difficult
impulsivity – speaking without thinking about consequences, interrupting others, difficulty waiting or taking turns

Following a diagnosis

After your child has received an ADHD diagnosis, the paediatrician will refer them to the specialist nursing team. You will then be offered a place on a post‑diagnostic workshop. If you are unable to attend, a diagnostic pack can be sent to you.

If medication has been started

If medication has been prescribed by the paediatrician, they will telephone you and / or your parents a few weeks later to review how things are going.

You will then be added to our review list to see one of the ADHD nurses in clinic. This appointment is an opportunity for us to meet with you and your parents.

The review follows NICE guidance and includes discussing:

your response to the medication
whether the medication is still effective or needs adjusting
appetite
sleep
behaviour

Because ADHD medications can affect heart rate and blood pressure, these are checked at each appointment, along with height and weight.

Before medication was prescribed, a pre‑medication questionnaire was completed to ensure suitability.

If you have decided against medication

If you have chosen not to start medication at this time, you will not be called for review.

However, telephone consultations can be booked by calling 01925 946773 or emailing bchft.warringtonpaediatricadhd@nhs.net, and we can offer support and advice in this way.

What to expect in your appointment

Medication review clinics are scheduled in line with NICE guidance. During these appointments, height, weight and blood pressure will be taken, so the child or young person will need to be present.

Telephone consultations and home visits are also available when required.

We can also liaise with other professionals involved in your child’s care - including education, social care and other agencies - to ensure support is joined up.

If you need to rearrange your appointment, please contact the ADHD administrator at bchft.warringtonpaediatricadhd@nhs.net.

How to order a prescription

Please order prescriptions with 10 working days’ notice by emailing bchft.warrcompaed-repeatscripts@nhs.net.

When requesting a prescription, please include:

name and date of birth of the child
name of the medication being requested

The prescription will be sent electronically to the nominated pharmacy listed in the child’s record. If you need to change the nominated pharmacy, please contact your GP.

Qb testing

Our team, on behalf of the community paediatricians, provides Qb assessments as part of the ADHD assessment process and to support decisions around medication titration.

A referral from the relevant health professional is required for this assessment. Once the referral is received, you will be sent a letter with your appointment details at the Child Development Centre.

What is a qb test?

A Qb test is a tool that helps to understand a child’s levels in the following areas:

activity - how active your child is while completing the task
concentration - how well your child can maintain attention during the task
impulsivity - how much thought your child puts into their actions during the task

Your child will complete a short computer‑based task (15 or 20 minutes depending on age).

The data is then compared with a control group of children of the same age and sex who do not have a diagnosis of ADHD.

For more information, videos are available on the Qbtech website.

What the appointment will involve

Your child will be invited into the appointment alone to ensure a standardised, controlled environment.

During the appointment:

the practitioner will use visuals and practice tests to help your child feel comfortable
your child will complete a simple task, clicking a button when they see the appropriate image
your child will wear a headband that monitors activity levels
they will sit on a stool or chair positioned correctly for the assessment

Please avoid reflective, sparkly or shiny clothing as this can interfere with the equipment.

If your child is unable to complete the practice test for any reason, the assessment will be discontinued and this information will be shared with the paediatrician. This will not affect the overall diagnostic process, as the Qb test is only one part of the assessment.

In some cases, you may be asked to repeat the Qb test at a later date while your child is on ADHD medication. You will be given a prescription and advised to administer the medication one hour before the appointment.

Outcomes and next steps

The data gathered during the Qb test will be shared with your paediatrician. The practitioner will not be able to give results or timescales for feedback during the appointment.

After the Qb test is completed, your child will be discharged from the specialist nursing team back to the paediatrician for the remainder of the assessment process.

Qb testing for medication titration

If your child has been asked to attend a Qb test to review their existing ADHD medication, you will be given a routine appointment.

It is important that medication is taken exactly as advised before the test.

Autism

What is autism?

Below you will see we use the term autistic, as this is the preferred terminology of much of the autistic community. We recognise that everyone has their own preferences, and we will always use the language you prefer when working with you and your child.

Autism is a neurodevelopmental condition.

It is characterised by differences in an individual’s authentic styles of social interaction and social communication. Autistic people may also experience their senses in a heightened way, show strong passion for favoured interests and often thrive on routine.

These differences will have been present from early childhood and will have influenced everyday life.

Social communication refers to the ability to interpret both verbal and non‑verbal language, including gestures and tone of voice.

This can include having a more literal understanding of language and finding abstract concepts more difficult. Autistic individuals may also find it harder to initiate conversations with people who communicate differently from them.

Social interaction refers to recognising and understanding the feelings and intentions of others, communicating one’s own emotions, and navigating the ‘unwritten’ social rules that many people take for granted.

What happens after a diagnosis of autism?

The professional who gives your child or teen their diagnosis should make a referral to the specialist nursing team for post‑diagnostic support.

Once the team receives this referral, you will be sent an information pack with further details about the diagnosis and our service.

If you need support in relation to your child or teen’s diagnosis, please contact the team on 01925 946773. You will then be offered an appointment with a member of the team to explore how we can support you and your child or young person.

You will not be contacted automatically, so it is important to get in touch if you feel you need our support.

Common areas we help with include:

sleep
behaviour
regulation skills
autism understanding

Where appropriate, we can work with the family, or directly 1‑1 with the child or young person. We can also liaise with other professionals involved in their care - including education, social care and other agencies - to ensure support is joined up.

How do I tell my child they are autistic?

We recommend starting with your child’s strengths and difficulties, and then offering the name for this - autism.

It can help to acknowledge that everyone has strengths and difficulties, and to talk about autism openly and positively.

Learning disabilities

A learning disability is defined by reduced cognitive ability, difficulty understanding new or complex information, learning new skills and coping independently. This affects an individual’s ability to manage everyday activities.

A learning disability is lifelong and must occur while the brain is still developing. This means that accidents or illnesses before, during or soon after birth may result in a learning disability.

A brain injury that occurs before the age of 18 is defined as a learning disability. A brain injury that occurs after the age of 18 is not defined as a learning disability.

Unlike autism, learning disabilities are categorised as mild, moderate or severe.