Advice and resources : Request for Help process guidance for professionals

• Regular movement breaks and/or ‘brain breaks’ 
• Adjust seating plan, for example sitting near the teacher/away from distractions 
• Use of fidget toys 
• Give regular prompts and reminders 
• Adapt instructions so they are short and specific, written down, and repeated as needed 
• Break work down into small chunks 
• Give regular positive encouragement 
• Allow use of noise-cancelling earplugs or ear defenders, if desired 
• Give opportunities to stand up or walk around classroom in a non-disruptive way, such as giving out books or sharpening pencils 
• If possible, do not remove breaks as a punishment or a way to make up for missed work 
• Use a system such as 'zones of regulation' or the traffic light system 
• Allow extra time to complete work or process information 
• Frequent check-ins or one-to-one mentoring or keyworker  
• Access to a quiet space when needed 
• Regular and effective home-school communication aided by a  communication book or weekly communication sheet 
• Ignore minor behaviour if possible, especially if it seems unintentional (for example, shouting out) or is unlikely to reoccur  
• Offer a break or redirection if they appear dysregulated 

• Regular movement breaks and/or ‘brain breaks’ supported by a time-out card 
• Adjust the seating plan so that they are, for example, sitting near the teacher and/or away from distractions 
• Use of fidget toys 
• Give regular prompts and reminders 
• Adapt instructions so they are short and specific, written down, and repeated as needed 
• Break work down into small chunks 
• Give regular positive encouragement 
• Allow use of noise-cancelling earplugs or ear defenders, if desired 
• If possible, do not remove breaks as a punishment or way to make up for missed work 
• Allow extra time to complete work or process information 
• Frequent check-ins or one-to-one mentoring or keyworker  
• Identify safe person for them to talk to/go to when needed 
• Access to a quiet space when needed 
• Provide spare equipment if forgotten, rather than issuing detentions 
• Regular and effective home-school communication, such as an identified member of staff speaking with a parent on a regular basis 
• Ignore minor behaviour if possible, especially if it seems unintentional (for example, shouting out) or is unlikely to reoccur 
• Provide copies of notes rather than expecting them to copy notes from the board in a limited time 

• Access to a quiet space when needed 
• Use of noise-cancelling earplugs or ear defenders, if desired 
• Adjustments to uniform to meet sensory needs 
• Flexibility to seating plan, for example child may wish to be seated near the door or the teacher, or away from distractions 
• Give advance notice of any changes, where possible 
• Use of visual timetable so they can understand the plan for the day 
• Regular one-to-one time with a keyworker or mentor, or when they appear frustrated or struggling  
• Use of fidget toys for sensory seeking needs 
• Adapt instructions so they are short and specific, written down, and repeated as needed 
• Break work down into small chunks 
• Flexibility around group work  
• Provide a safe, quiet space to for breaks or lunchtime  
• Allow extra time to complete work or process information 
• Flexibility around homework when child struggles with home-school separation 
• Regular and effective home-school communication aided by a communication book or weekly communication sheet 
• Use a system such as 'zones of regulation' or the traffic light system 
• Offer a break or redirection if they appear dysregulated 
• Support for coping with emotions, such as ELSA 
• Use visual aids to support understanding of expectations, boundaries, daily activities, and other issues 
• Identify child’s specific triggers and strategies to limit these, such as adjustments around assemblies, PE, and off-timetable days like sports day 

• Provide a ‘time out’ card to leave classroom when needed 
• Access to a quiet space at break or lunchtimes 
• Use of noise-cancelling earplugs or ear defenders, if desired 
• Adjustments to uniform to meet sensory needs 
• Flexibility to seating plan, for example young person may wish to be seated near the door or the teacher, or away from distractions 
• Give advance notice of any changes where possible 
• Regular one-to-one time with a keyworker or mentor 
• Identify a safe person for them to talk to/go to when needed 
• Use of fidget toys for sensory seeking needs 
• Adapt instruction so they are short and specific, written down,  and repeat as needed 
• Break work down into small chunks 
• Flexibility around group work  
• Allow extra time to complete work or process information 
• Flexibility around homework when child struggles with home-school separation 
• Regular and effective home-school communication, such as conversations between an identified member and parent on a regular basis 
• Offer a break or redirection if they appear dysregulated 
• Support for coping with emotions, such as ELSA or counselling
• Identify young person’s specific triggers and strategies to limit these (for example, adjustments around assemblies, PE, and off-timetable days, such as sports day)

• Child is aged 2 years 6 months to 4 years 11 months and registered with a Berkshire GP
• Child presents with features highly suggestive of autism
• Social communication differences are clearly out of line with overall developmental level
• Concerns or differences have been present for six months or longer
• Concerns or differences are seen across different settings 
• There is clear and informed consent from parents or carers
• Appropriate developmental checks have been carried out with the Health Visiting Service, a support plan has been put in place, and it has been followed
• Parents or carers have accessed support or training from the relevant autism support service and implemented recommendations at home

If the child is in an early years or educational setting, a SENCO-led support plan needs to have been in place and followed for at least six months or two terms (a minimum of two ‘assess, plan, do, review’ cycles).

If there are concerns regarding the child’s speech and language development (for example, language delay), support and advice from the Speech and Language Therapy Service needs to have been followed. This can be accessed by calling their Early Years enquiries line on 0118 904 3700 between 9am–3.30pm on Tuesdays and Thursdays.

If there are behavioural or emotional concerns, advice needs to have been requested from the Health Visiting Service and support and recommendations in place for at least six months.

If supported by the development officers, early years team, and/or educational psychologist, all support and recommendations must have been followed and evaluated for at least six months.

Vision and hearing checks must have been carried out where these are needed.

• Child or young person is aged 5 years to 17 years 5 months and is registered with a Berkshire GP 
• Child or young person presents with features highly suggestive of autism 
• If child or young person has a learning disability, social communication differences are clearly out of line with overall developmental level 
• Concerns or differences have been present since early childhood 
• Concerns or differences are seen across different settings 
• There is clear and informed consent from parents or carers, or the young person themselves if over 14 years of age (where appropriate)  
• Parents/carers have accessed support and/or training from the relevant autism support service and followed recommendations at home

If the child or young person is in an educational setting, a SENCO-led support plan needs to have been in place, followed, and reviewed for at least six months or two terms (a minimum of two ‘assess, plan, do, review’ cycles).

If there are concerns regarding the child or young person’s cognitive ability, or ability to access the curriculum, advice will be needed from an educational psychologist via the school SENCO (note that this is advice only and may or may not result in direct input).

If seen by an educational psychologist, all support and recommendations must have been followed and evaluated for at least six months.

If there are concerns regarding the child or young person’s speech and language development (for example, language delay), support and advice from the Speech and Language Therapy Service needs to have been followed.

If the child or young person has a moderate or severe learning disability, and there are significant concerns regarding mental health and/or behaviours that challenge/behaviours of distress, a consultation with, or referral to, the Learning Disability Service (often known as CAMHS LD) needs to have taken place.  

Tel: 0118 904 6660 
Email: CAMHSLearningDisabilityTeam@berkshire.nhs.uk 

If there are significant concerns about the child or young person’s mental health, the young person and/or family must have been referred for or accessed support. The best way to support will depend on the type of concerns.

• Child or young person is aged 6-17 and is registered with a Berkshire GP 
• Child or young person presents with symptoms highly suggestive of ADHD 
• If child or young person has a learning disability, concentration, activity levels, and impulsivity are clearly out of line with overall developmental level 
• Symptoms have been present since before the age of 12 and have lasted six months or longer  
• Symptoms are seen across at least two different settings 
• The difficulties have a significant impact on the young person  
• There is clear and informed consent from parents/carers, or the young person themselves if over 14 years of age (where appropriate) 
• The young person does not have current and significant drug issues. Due to the potential risks, we recommend substance misuse is supported and addressed first.
• Parents/carers have accessed support and/or training from the relevant ADHD support service and implemented recommendations at home.

If the child or young person is in an educational setting, a SENCO-led support plan needs to have been in place and fully implemented for at least six months or two terms (a minimum of two ‘assess, plan, do, review’ cycles).

If there are concerns regarding the child or young person’s cognitive ability, or ability to access the curriculum, advice will be needed from an educational psychologist via the school SENCO (note that this is advice only and may or may not result in direct input).

If seen by an educational psychologist, all support and recommendations must have been followed and evaluated for at least six months.

If the child or young person has a moderate or severe learning disability and there are significant concerns regarding mental health and/or behaviours that challenge/behaviour of distress: consultation with or referral to the Learning Disability Service (often known as CAMHS LD) needs to have taken place. A consultation will include advice about whether a referral to CAMHS LD should be made.

Tel: 0118 904 6660

Email: CAMHSLearningDisabilityTeam@berkshire.nhs.uk

If there are serious concerns about the child or young person’s mental health, the young person and/or family must have been referred for or accessed support. The best way to support will depend on the type of concerns.

• Child or young person is aged 6 to 17 years old and registered with a Berkshire GP 
• The difficulties have a significant impact on the child or young person  
• There is clear and informed consent from parents/carers, or the young person themselves if over 14 years of age (where appropriate) 
• The young person does not have current and significant drug issues. Due to the potential risks, we recommend substance misuse is supported and addressed first.
• Parents/carers have accessed support and/or training from the relevant ADHD support service and put in place recommendations at home.   

For further information about support:

• Visit the Parenting Special Children website

If the child or young person is in an educational setting, a SENCO-led support plan needs to have been in place and followed for at least six months or two terms (a minimum of two ‘assess, plan, do, review’ cycles).

If there are concerns regarding the child or young person’s cognitive ability, or ability to access the curriculum, advice will be needed from an educational psychologist via the school SENCO (note that this is advice only and may or may not result in direct input). 

If seen by an educational psychologist, all support and recommendations must have been followed and evaluated for at least six months 

If the child or young person has a moderate/severe learning disability and there are significant concerns regarding mental health and/or behaviours that challenge or behaviour of distress, a consultation with, or referral to, the Learning Disability Service (often known as CAMHS LD) needs to have taken place. A consultation will include advice about whether a referral to CAMHS LD should be made. 

Tel: 0118 904 6660

Email: CAMHSLearningDisabilityTeam@berkshire.nhs.uk

If there are significant concerns about the child or young person’s mental health, the young person and/or family must have been referred for or accessed support. The best way to support will depend on the types of concerns. 

Working in partnership with the school (or other involved professional) means that they can support the use of IT systems. Where there is no one available to support the young person, bespoke support can be provided by the service. 

Arrange to meet the parent/carer and explain your concern. Discuss with them how the school can support the child and what support is available to the family. Make sure an effective support plan is in place (this should be based on identified need and does not require referral/assessment/diagnosis). Arrange to meet regularly to evaluate the child's progress.

If you feel the child needs a specific provision or service that can ONLY be accessed with a specific diagnosis, please share this with the family.

This can often happen and it may be for a number of different reasons. A young person may work very hard to manage the school day, although this may not be apparent in the school setting. This may only be seen at home where the young person may, for example, have meltdowns or shutdowns. The effort to manage the school day can leave young people exhausted and with no energy or coping resources left by the time they get home. This can particularly affect young people who mask or camouflage, and work very hard to fit in. 

While the distress may only be seen at home, the underlying triggers or reasons are often things that happen at school. It is very important to understand that, although a child may appear to cope at school, they may be feeling very stressed and distressed, even if they do not show this at school. Talking to the young person and their family will usually provide important information about sources of stress at school and ideas about what support can be put in place to reduce this.  

If there is someone in school that knows the child or young person, we still ask them to work with the family as they will have important information including why the young person is not in the school setting. Where a child or young person is not known to school staff, then generally another professional who has direct knowledge of the young person will partner with the family. 

Six months will give enough time to implement and evaluate a robust support plan based on the child or young person’s needs. Some children or young people may not need a formal assessment after this, as their needs will now have been met. 

We ask you to work in partnership with the parents and carers. Information needs to be gathered by looking back over a minimum period of two terms or six months. This is so we can fully understand the child/young person’s needs, the strategies put in place and the impact these strategies have had.  This is referred to as a ‘graduated response’ to meet a child/young person’s needs. 

The updates to the process are intended to reflect the graduated response and ordinarily available provision and what is already happening in schools. Our assumption is that where there are concerns that are significant enough to warrant referral for a specialist assessment, these will also be triggering a support plan in school.  

All children and young people will need a fully completed form and supporting evidence before we can accept for assessment as it is the only way to gather the depth of information required. We cannot properly triage the referral and make decisions we have all the information required. 

We would like to reassure you that the additional information forms have been designed to reduce the burden for those completing them when compared to the previous process. For example the combined autism and ADHD form replaces a total of 9 separate questionnaires previously sent out to families and schools. The forms have been designed to streamline the process, reduce duplication and the reliance on referrers providing a great deal of narrative text or description. Very similar additional information forms have been in place in Oxford for over a year and in Buckinghamshire for several months and are working well. 

By making the forms available to download and asking for the form and support plan to be uploaded with the referral form, we are eliminating delays and issues with sending and receiving documentation that has held the process up for many families. We are already seeing that triage under the updated process is taking much less time to complete.

Yes, we will collect feedback from families and schools with every referral to help us evaluate, refine and improve the process. We want to make sure the system adapts to meet the needs of children and young people effectively. 

This is the support in place that is above and beyond what would be typical to support a child/young person at this stage of development. A support plan is expected to include areas of need we would typically associate with possible autism and/or possible ADHD. For example for possible autism this would include needs with communication and social interaction, flexibility of thought and behaviour and sensory needs (three key areas of difference).  

When completing a referral we ask for you to demonstrate that a ‘graduated response’ has been put in place for at least six months or two terms prior to referral. This includes any support that has been offered at home, in school or by other services involved. It can include strategies that parents have introduced at home as well as strategies recommended or put in place by professionals.

When we look at the process overall (in terms of referrals that are not accepted and referrals for children who do not go on to get a diagnosis) it is clear that there are  children and young people whose needs can be met without referral for a specialist assessment. It is also very important that we do not add children to a long waiting list without knowing that they have support in place.  For ADHD we have always asked that support is in place first (previously for 10 weeks) and a copy of the school support plan is provided.  

We are providing detailed guidance on our website and will be available to answer any questions. We encourage families and schools to spend some time on the website reviewing all of the information as this is likely to answer their questions. If not they can contact us for advice. 

CYP Autism and ADHD triage team
CYPADHDandAutismTriage@berkshire.nhs.uk 
0118 9046620

There is a range of resources and free training to help schools with supporting children and young people. This includes:  

• Psychological Perspectives in Education and Primary Care  or PPEPCare Training: Flexible and free training for EYS/schools delivered by Berkshire Healthcare, with a total of 17 modules covering autism, ADHD and a wide range of common concerns and mental health difficulties   

• Our advice pages and workshops

• What does inclusivity in schools look like? 

• NHSE info re Children and Young People including PINS: A national pilot coordinated by the Department for Education, Department of Health and Social Care, NHS England. Currently in primary schools in Reading, Bracknell, Royal Borough of Windsor and Maidenhead. The pilot will focus on early support and intervention for neurodivergent children in the mainstream primary setting. It will achieve this by bringing together health, the local parent carer forum, the local authority, and education staff to help shape whole school SEND provision, provide early interventions at a school level, upskill school staff, and support strengthening of partnerships between schools and parent carers.  

• LEANS Learning about Neurodiversity at Schools 

• Belonging in School  A guide to developing an inclusion policy for schools  

• Person Centred profiling tool from Bracknell Forest