Adult and child pathways are not the same

Different providers, different age cut-offs, different reported waits and, in at least one area, a restriction that applies to adults only.

The short version

Provider age ranges are set by each provider, not nationally.
Commissioners contract separately for adult and children's services.
The Taskforce reports different wait ranges for children and adults, both in years.
NHS Lancashire and South Cumbria ICB's restriction applied to adult ADHD services specifically.

Advice about this pathway usually gets written once and applied to everyone. In practice the adult route and the children's route diverge at almost every step, and assuming otherwise wastes referrals.

Providers draw the line in different places

ADHD 360 states that its services are available for adults, as well as for children aged 8 plus, under the Right to Choose framework, and specifies that it can only accept referrals for children aged 8 plus and adults 16 years and older.

Psychiatry-UK describes its scheme service as ADHD assessments for adults aged 18 and over.

So a 16-year-old is inside one provider's range and outside another's, and neither is doing anything irregular. There is no national age rule to fall back on.

Commissioning is separate

Because a qualifying contract has to be a commissioning contract for the service required as a result of the referral, a provider can hold one for adults and not for children, or the reverse.

NHS Black Country ICB makes this visible by publishing a table of Right to Choose providers with a separate yes or no column for each of adult ADHD, adult autism, children's ADHD and children's autism. Four columns, because they are four different commissioned services.

Waits and restrictions differ too

The independent ADHD Taskforce reports waiting times increasing to over four years for children and over eight years for adults, and NHS England's programme page states that around 1 in 20 children are estimated to be impacted by ADHD globally.

Restrictions have also landed differently. NHS Lancashire and South Cumbria ICB asked all providers of adult ADHD services, commissioned both locally and nationally, to reduce the number of new adult ADHD assessments they offer from April onwards for patients who have waited less than 52 weeks, while stating it remains committed to ensure residents can continue to access ADHD assessment pathways in respect of Choice legislation and continue to have a choice of provider. That position was about adults.

What this means for a family

If you are seeking assessments for a parent and a child, expect two different provider lists, two different sets of criteria and two different waits. The GP conversation is also two conversations, since the clinical question is different in each case.

For a young person approaching an age boundary, it is worth asking what happens if the boundary is crossed while waiting, because the answer is not standardised.

Questions people ask about this

What age can a child be assessed for ADHD under Right to Choose?

It depends on the provider rather than on a national rule. ADHD 360 states it can only accept Right to Choose referrals for children aged 8 plus and adults 16 years and older, while Psychiatry-UK describes its scheme service as adults aged 18 and over. Your GP will have the list of providers commissioned for children in your area.

Are adult and children's ADHD services commissioned separately?

Yes. A qualifying contract has to cover the service required as a result of the referral, so a provider can hold one for adults and not children. NHS Black Country ICB publishes a provider table with separate columns for adult ADHD, adult autism, children's ADHD and children's autism, which shows the split directly.