How to refer

A child can be referred by a member of the child’s local medical team, for instance, a consultant paediatrician, child psychiatrist or other medical specialist.

If the referring professional is not from within the local Child and Adolescent Mental Health (CAMHS) team, we will need to establish which local CAMHS team (or, alternatively, community or other paediatric team) will be responsible for the child’s ongoing care after our assessment.

Until the local team has been identified, they have approved the referral to our team, and they have also accepted responsibility for ongoing treatment after our assessment, then we cannot accept the referral. All referrals require the local CAMHS (or equivalent) team's agreement prior to assessment.

If a family has recently moved to the UK, and they have an existing opinion from an overseas specialist, we may accept the referral provided appropriate local specialist services have agreed to take responsibility for the child’s ongoing treatment after our assessment has been completed .

Families occasionally approach their family doctor (GP) to seek referral for a second opinion regarding their child’s disorder, which has already been diagnosed locally. We do accept referrals from family doctors but only if they are for a second opinion and we have the local CAMHS (or equivalent) team's agreement.

We cannot accept referrals from family doctors if the child has not already been assessed by local services (i. for a first opinion on a suspected case of an autistic spectrum disorder).

It is important, in order to maintain continuity of care, that all referrals for second opinion should come with the agreement of the local service that provided the initial opinion. That service will be responsible for the child’s ongoing treatment. In practice, few local services refuse to give agreement for a second opinion.

Occasionally we are asked to provide opinions for court proceedings. Such opinions are provided when there is reasonable time to prepare the necessary reports (usually, a minimum of 3 months), and this will vary according to the current workload of the NHS clinic.

We only provide opinions on diagnostic issues; that is, whether a particular child has an autistic spectrum disorder or not. We do not provide opinions in cases of dispute between partners concerning custody issues.

We accept legal referrals in connection with both Civil and Criminal legal proceedings, if other criteria are met satisfactorily.

Each referral is considered by the clinical team on an individual basis. The GOSH Department of Child and Adolescent Mental Health has a dedicated Child Care Consultation team. This service is experienced in public law cases where there are complex child protection concerns, requiring a multidisciplinary team's approach.

We sometimes share preparation of a legal case with the Child Care Consultation team, if there are both child protection and diagnostic issues that have to be addressed.

The Social Communication Disorders Clinic was established to assist with clarification of diagnostic difficulties in children who had a tentative diagnosis from their local specialist services.

If there is no doubt about the diagnosis of an autistic spectrum disorder, this Clinic is usually not appropriate.

Advice on providing appropriate treatment to children who have a well-established diagnosis is not within our remit, and so referrals requesting this type of help cannot be accepted at present.

The Clinic does not accept referrals of children who have not yet reached their third birthday, nor those who have already passed their seventeenth birthday, at the date of referral.

Owing to the nature of the assessment procedures used, we cannot provide a firm opinion regarding the presence of an autistic spectrum disorder on any child who has yet to reach their fourth birthday.

Occasionally, we accept three-year-old children, providing their first assessment appointment occurs after their fourth birthday, especially if they have near-fluent speech.

Despite the hospital's policy on accepting only new referrals of children who have yet to reach their 17th birthday, children who are well-known to the clinic may be followed up into late adolescence, working with the local CAMHS before transition to adult services.

Occasionally, older adolescents will be accepted but this has to be negotiated on a case by case basis.

The clinic is a national resource for children with suspected ‘high functioning’ autism or Asperger syndrome. Children with generalised developmental delay will not normally be accepted.

We believe that local services should be best placed to provide adequate assessment and treatment for children with learning difficulties.

If that is not possible, such children may be referred to the Neurodisability team at GOSH

We normally only provide opinions concerning children who are in mainstream school or nursery, and who are regarded as having no generalised learning difficulties. We also see children with specific learning difficulties, such as dyslexia, if the child clearly possesses high or normal intelligence.

Children who are seen by our service may or may not have statements of special educational need. If they are too young to have entered mainstream education and there is doubt about their level of abilities, a decision about accepting the referral would be based upon local information regarding the child's early developmental history.

We welcome non-English speaking patients and families who are eligible for NHS treatment. We will provide interpreters for the assessment appointments, but arranging these may take some time, and the assessment procedure may be longer. Several appointments are often needed to complete assessments where a patient and family does not speak English. Consequently, in these circumstances, waiting lists may be a little longer than average.

We are an NHS service and do not accept private referrals if the child is eligible for NHS treatment. If a private opinion is needed, the referrer should contact the International and Private Patients centre here at Great Ormond Street Hospital for advice on possible options

Children should be between their 4th and 17th birthday, with a previous history of specialist assessment. Either the existing specialist or the parent requests a second opinion.

The local specialist services must be willing to accept the child for implementation of treatment or management decisions following the referral, and should indicate their willingness to do so beforehand.

Legal cases where the questions for the Court concern diagnostic issues are usually accepted, with sufficient notice.

All children seen by this service are in mainstream (public or private) education and most have intellectual abilities that are within the normal range.

If you wish to discuss a case before deciding whether to refer, please contact:

Lynne Vinnicombe
Team Administrator
Telephone number: 020 7829 8679 extension 5855
Email: Lynne.Vinnicombe@gosh.nhs.uk